Social skill and social withdrawal outcomes in children following pediatric stroke.

Pediatric stroke can result in long-term impairments across attention, functional communication and motor domains. The current paper utilized parent reports of the Behavioral Assessment System for Children 2nd Edition and the Pediatric Stroke Outcome Measure to examine children's social skills and withdrawal behavior within a pediatric stroke population. Using the Canadian Pediatric Stroke Registry at The Hospital for Sick Children, data were analyzed for 312 children with ischemic stroke. Children with ischemic stroke demonstrated elevated parent-reported social skills problems (observed = 20.51%, expected = 14.00%) and clinically elevated social withdrawal (observed = 11.21%, expected = 2.00%). Attentional problems significantly contributed to reduced social skills, F (3,164) = 30.68, p < 0.01, while attentional problems and neurological impairments accounted for increased withdrawal behavior, F (2, 164) = 7.47, p < 0.01. The presence of a motor impairment was associated with higher social withdrawal compared to individuals with no motor impairment diagnosis, t(307.73) = 2.25, p < .025, d = 0.25, 95% CI [0.42, 6.21]. The current study demonstrates that children with stroke who experience motor impairments, attentional problems, reduced functional communication skills, and neurological impairments can experience deficits in their social skills and withdrawal behavior.

Evaluating the performance of existing and novel equivalence tests for fit indices in structural equation modelling.

It has been suggested that equivalence testing (otherwise known as negligible effect testing) should be used to evaluate model fit within structural equation modelling (SEM). In this study, we propose novel variations of equivalence tests based on the popular root mean squared error of approximation and comparative fit index fit indices. Using Monte Carlo simulations, we compare the performance of these novel tests to other existing equivalence testing-based fit indices in SEM, as well as to other methods commonly used to evaluate model fit. Results indicate that equivalence tests in SEM have good Type I error control and display considerable power for detecting well-fitting models in medium to large sample sizes. At small sample sizes, relative to traditional fit indices, equivalence tests limit the chance of supporting a poorly fitting model. We also present an illustrative example to demonstrate how equivalence tests may be incorporated in model fit reporting. Equivalence tests in SEM also have unique interpretational advantages compared to other methods of model fit evaluation. We recommend that equivalence tests be utilized in conjunction with descriptive fit indices to provide more evidence when evaluating model fit.

Predictors of neurocognitive outcome in pediatric ischemic and hemorrhagic stroke.

This clinical study examined the impact of eight predictors (age at stroke, stroke type, lesion size, lesion location, time since stroke, neurologic severity, seizures post-stroke, and socioeconomic status) on neurocognitive functioning following pediatric stroke. Youth with a history of pediatric ischemic or hemorrhagic stroke (n = 92, ages six to 25) underwent neuropsychological testing and caregivers completed parent-report questionnaires. Hospital records were accessed for medical history. Spline regressions, likelihood ratios, one-way analysis of variance, Welch's t-tests, and simple linear regressions examined associations between predictors and neuropsychological outcome measures. Large lesions and lower socioeconomic status were associated with worse neurocognitive outcomes across most neurocognitive domains. Ischemic stroke was associated with worse outcome in attention and executive functioning compared to hemorrhagic stroke. Participants with seizures had more severe executive functioning impairments than participants without seizures. Youth with cortical-subcortical lesions scored lower on a few measures than youth with cortical or subcortical lesions. Neurologic severity predicted scores on few measures. No differences were found based on time since stroke, lesion laterality, or supra- versus infratentorial lesion. In conclusion, lesion size and socioeconomic status predict neurocognitive outcome following pediatric stroke. An improved understanding of predictors is valuable to clinicians who have responsibilities related to neuropsychological assessment and treatments for this population. Findings should inform clinical practice through enhanced appraisals of prognosis and the use of a biopsychosocial approach when conceptualizing neurocognitive outcome and setting up support services aimed at fostering optimal development for youth with stroke.

Predictors of externalizing behavior outcomes following pediatric stroke.

Children who experience pediatric stroke are at higher risk for future behavioral problems in childhood. We examined the prevalence of parent reported externalizing behaviors and executive function problems in children following stroke and neurological predictors. This study included 210 children with pediatric ischemic stroke (mean age 9.18 years (SD = 3.95)). The parent form of the Behavioral Assessment System for Children-Second Edition (BASC-2) and Behavior Rating Inventory of Executive Function (BRIEF) were used to evaluate externalizing behavior and executive function. No externalizing behavior or executive function differences were found between perinatal (n = 94) or childhood (n = 116) stoke, except for the shift subscale which had higher T-scores among the perinatal group (M = 55.83) than childhood group (M = 50.40). When examined together, 10% of children had clinically elevated hyperactivity T-scores as opposed to the expected 2%. Parents endorsed higher ratings of concern on the behavior regulation and metacognition indices of the BRIEF. Externalizing behaviors were correlated moderately to strongly with executive functions (r = 0.42 to 0.74). When examining neurological and clinical predictors of externalizing behaviors, only female gender was predictive of increased hyperactivity (p = .004). However, there were no significant gender differences in diagnosis of attention deficit hyperactivity disorder (ADHD). In summary, in this cohort, children with perinatal and childhood stroke did not differ on parent reported externalizing behavior or executive function outcomes. However, compared to normative data, children with perinatal or childhood stroke are significantly more likely to experience clinically elevated levels of hyperactivity.

Denouncing the use of field-specific effect size distributions to inform magnitude.

An effect size (ES) provides valuable information regarding the magnitude of effects, with the interpretation of magnitude being the most important. Interpreting ES magnitude requires combining information from the numerical ES value and the context of the research. However, many researchers adopt popular benchmarks such as those proposed by Cohen. More recently, researchers have proposed interpreting ES magnitude relative to the distribution of observed ESs in a specific field, creating unique benchmarks for declaring effects small, medium or large. However, there is no valid rationale whatsoever for this approach. This study was carried out in two parts: (1) We identified articles that proposed the use of field-specific ES distributions to interpret magnitude (primary articles); and (2) We identified articles that cited the primary articles and classified them by year and publication type. The first type consisted of methodological papers. The second type included articles that interpreted ES magnitude using the approach proposed in the primary articles. There has been a steady increase in the number of methodological and substantial articles discussing or adopting the approach of interpreting ES magnitude by considering the distribution of observed ES in that field, even though the approach is devoid of a theoretical framework. It is hoped that this research will restrict the practice of interpreting ES magnitude relative to the distribution of ES values in a field and instead encourage researchers to interpret such by considering the specific context of the study.

Exploring perceptions of meaningfulness in visual representations of bivariate relationships.

Researchers often need to consider the practical significance of a relationship. For example, interpreting the magnitude of an effect size or establishing bounds in equivalence testing requires knowledge of the meaningfulness of a relationship. However, there has been little research exploring the degree of relationship among variables (e.g., correlation, mean difference) necessary for an association to be interpreted as meaningful or practically significant. In this study, we presented statistically trained and untrained participants with a collection of figures that displayed varying degrees of mean difference between groups or correlations among variables and participants indicated whether or not each relationship was meaningful. The results suggest that statistically trained and untrained participants differ in their qualification of a meaningful relationship, and that there is significant variability in how large a relationship must be before it is labeled meaningful. The results also shed some light on what degree of relationship is considered meaningful by individuals in a context-free setting.