Visual‐motor and executive functions in children born preterm: The Bender Visual Motor Gestalt Test revisited

Böhm, B., Lundequist, A. & Smedler, A.‐C. (2010). Visual‐motor and executive functions in children born preterm: The Bender Visual Motor Gestalt Test revisited. Scandinavian Journal of Psychology, 51, 376–384. Visual‐motor development and executive functions were investigated with the Bender Test at age 5½ years in 175 children born preterm and 125 full‐term controls, within the longitudinal Stockholm Neonatal Project. Assessment also included WPPSI‐R and NEPSY neuropsychological battery for ages 4–7 ( Korkman, 1990 ). Bender protocols were scored according to Brannigan & Decker (2003) , Koppitz (1963) and a complementary neuropsychological scoring system (ABC), aimed at executive functions and developed for this study. Bender results by all three scoring systems were strongly related to overall cognitive level (Performance IQ), in both groups. The preterm group displayed inferior visual‐motor skills compared to controls also when controlling for IQ. The largest group differences were found on the ABC scoring, which shared unique variance with NEPSY tests of executive function. Multiple regression analyses showed that hyperactive behavior and inattention increased the risk for visual‐motor deficits in children born preterm, whereas no added risk was seen among hyperactive term children. Gender differences favoring girls were strongest within the preterm group, presumably reflecting the specific vulnerability of preterm boys. The results indicate that preterm children develop a different neurobehavioral organization from children born at term, and that the Bender test with a neuropsychological scoring is a useful tool in developmental screening around school start.     

Neurocognitive development in 5- to 16-year-old North American children: A cross-sectional study

Executive functions are thought to be the latest functions to mature. However, this view has not been tested by assessing simultaneously memory, perception of emotions, visuospatial perception, and visuoconstructional skills. NEPSY II norm data from 1000 5- to 16-year-old U.S. children were obtained. Fifteen NEPSY II subtests with no floor or ceiling effects in any age group and no major changes in task type were selected. The 16-year level was attained at age 12 to 13 in all subtests with two exceptions: social perception (age 10 to 11) and narrative memory (age 14). Trend analyses showed that development was rapid in the age range 5 to 9 years followed by a deceleration in the rate of development. Peak performances were reached at 14 to 16 years but later in some subtests representing executive functions, verbal memory, and visuospatial performance. Thus, the study specified developmental time tables of neurocognitive functions. It demonstrated that not only executive functions but also verbal memory and visuospatial performance continue to develop beyond age 16.     

Relation of infant motor development with nonverbal intelligence,language comprehension and neuropsychological functioning in childhood: a population‐based study

Within a population‐based study of 3356 children, we investigated whether infant neuromotor development was associated with cognition in early childhood. Neuromotor development was examined with an adapted version of Touwen's Neurodevelopmental Examination between 9 and 20 weeks. Parents rated their children's executive functioning at 4 years. At age 6 years, children performed intelligence and language comprehension tests, using Dutch test batteries. At age 6–9 years, neuropsychological functioning was assessed in 486 children using the validated NEPSY‐II–NL test battery. We showed that less optimal neurodevelopment in infancy may predict poor mental rotation, immediate memory, shifting, and planning; but not nonverbal intelligence or language comprehension.     

Confirmatory factor analysis of the NEPSY for younger and older school-age children

Using the standardization sample from the NEPSY, confirmatory factor analysis was conducted to examine the factor structure for ages 5 through 12 of the NEPSY sample, as well as for the younger (5 to 8 years, n=400) and older (9 to 12 years, n=400) age bands, to explore possible differences in test structure at different developmental epochs. Using four standard fit indices, results indicated that a 5-factor model was less than adequate for the entire sample and produced negative error variance for the younger and older age groups, making any solutions for the two subgroups inadmissible. A 4-factor model without the Attention/Executive Function subtests produced satisfactory fit statistics for the entire sample and the younger group, but did not fit the data as well for the older group. A 1-factor model did not fit well for the full sample. These results indicated that the structure for the NEPSY is not invariant across development, with the 4-factor model best fitting the data for the younger age group and for the entire school-age sample.     

Neuropsychological Abilities of Preschool-Aged Children Who Display Hyperactivity and/or Oppositional-Defiant Behavior Problems

This study focused on gaining a better understanding of the neuropsychological abilities of preschool-aged children who show elevated levels of hyperactivity and oppositional-defiance. It examined the performance of children aged 48 to 67 months on tests of attention/executive function, language, memory, and sensorimotor abilities, as measured by the NEPSY and Conners' K-CPT. Two hundred thirty-seven children were divided into four subgroups based on mothers' report of behavior using rating scales and a diagnostic interview: hyperactive only (HYP), oppositional-defiant only (OD), hyperactive and oppositional-defiant (HYP/OD), and nonproblem. Children in the HYP/OD group scored significantly worse than nonproblem children on four of nine subtests on the NEPSY, including one test of executive function, one test of language comprehension, and both tests of short-term verbal memory. However, only the test of executive function (Statue) showed significant predictive power, and, while specificity of this subtest was good, sensitivity was poor. On the K-CPT, a continuous performance test, children in both the HYP and HYP/OD groups performed worse than children in the OD and nonproblem groups. When the NEPSY Statue subtest and the K-CPT were used together, overall predictive power was .74. Results suggest that neuropsychological deficits can be observed among preschool children with hyperactivity, particularly when comorbid oppositional-defiance is present; however, moderate predictive power suggests that these tests should be used in conjunction with other methods of assessment.     

Neuropsychological abilities of preschool-aged children who display hyperactivity and/or oppositional-defiant behavior problems.

This study focused on gaining a better understanding of the neuropsychological abilities of preschool-aged children who show elevated levels of hyperactivity and oppositional-defiance. It examined the performance of children aged 48 to 67 months on tests of attention/executive function, language, memory, and sensorimotor abilities, as measured by the NEPSY and Conners' K-CPT. Two hundred thirty-seven children were divided into four subgroups based on mothers' report of behavior using rating scales and a diagnostic interview: hyperactive only (HYP), oppositional-defiant only (OD), hyperactive and oppositional-defiant (HYP/OD), and nonproblem. Children in the HYP/OD group scored significantly worse than nonproblem children on four of nine subtests on the NEPSY, including one test of executive function, one test of language comprehension, and both tests of short-term verbal memory. However, only the test of executive function (Statue) showed significant predictive power, and, while specificity of this subtest was good, sensitivity was poor. On the K-CPT, a continuous performance test, children in both the HYP and HYP/OD groups performed worse than children in the OD and nonproblem groups. When the NEPSY Statue subtest and the K-CPT were used together, overall predictive power was .74. Results suggest that neuropsychological deficits can be observed among preschool children with hyperactivity, particularly when comorbid oppositional-defiance is present; however, moderate predictive power suggests that these tests should be used in conjunction with other methods of assessment.     

Use of the everyday memory questionnaire with children.

The Everyday Memory Questionnaire (EMQ; Sunderland, Harris, & Baddeley, 1983) was examined for its suitability to assess children's memory. The parents of 226 school children (6-12 years) completed the EMQ in relation to their own children. A subset of these children (N = 101), in 6, 8 and 10 years age groups, completed subtests of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990). Comparison of EMQ and WRAML data found aspects of verbal memory correlated moderately with the EMQ in the 10 years age group. There were no meaningful correlations in the 8 years age group. In the 6 years age group aspects of visual memory correlated moderately with the EMQ. The diagnostic utility of the EMQ for children was assessed by comparing the school group to children diagnosed with ADHD and/or learning disorders. Diagnostic indicators revealed the EMQ to have high sensitivity (89%) but poor positive predictive power, identifying 40% of the school group as having memory deficits. Negative predictive power (confirming a negative diagnosis) was high. Validity data suggested that the EMQ could be useful with children at least as young as 10 years and further research needs to be conducted to establish the utility of the EMQ in clinical groups with primary memory deficits.     

The development of executive functions and early mathematics: A dynamic relationship

Background. The relationship between executive functions and mathematical skills has been studied extensively, but results are inconclusive, and how this relationship evolves longitudinally is largely unknown. Aim. The aim was to investigate the factor structure of executive functions in inhibition, shifting, and updating; the longitudinal development of executive functions and mathematics; and the relation between them. Sample. A total of 211 children in grade 2 (7–8 years old) from 10 schools in the Netherlands. Method. Children were followed in grade 1 and 2 of primary education. Executive functions and mathematics were measured four times. The test battery contained multiple tasks for each executive function: Animal stroop, local global, and Simon task for inhibition; Animal Shifting, Trail Making Test in Colours, and Sorting Task for shifting; and Digit Span Backwards, Odd One Out, and Keep Track for updating. The factor structure of executive functions was assessed and relations with mathematics were investigated using growth modelling. Results. Confirmatory factor analysis (CFA) showed that inhibition and shifting could not be distinguished from each other. Updating was a separate factor, and its development was strongly related to mathematical development while inhibition and shifting did not predict mathematics in the presence of the updating factor. Conclusions. The strong relationship between updating and mathematics suggest that updating skills play a key role in the maths learning process. This makes updating a promising target for future intervention studies.     

Teacher rated problems and school ability tests in relation to preschool problems and parents'' health information at school start. A study of first-graders

The reliability of assessments at four and six years of age in identifying teacher rated problems in behaviour, concentration, motor skill and school achievement was investigated in a study of first-graders. Relationships between preschool data and school ability tests, and between parents' information at school start and teacher ratings were also studied. Problems noted in preschool and school were often present in more than one area. Multiple problems at four and six years were strong predictors of later school problems, but preschool assessments of separate areas could not in general predict problems in corresponding areas in school. However, cross situational concentration deficits at the age of six did reliably identify concentration problems in the first grade, at the age of seven.     

Use of the Everyday Memory Questionnaire With Children

The Everyday Memory Questionnaire (EMQ; Sunderland, Harris, & Baddeley, 1983) was examined for its suitability to assess children's memory. The parents of 226 school children (6-12 years) completed the EMQ in relation to their own children. A subset of these children (N=101), in 6, 8 and 10 years age groups, completed subtests of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990). Comparison of EMQ and WRAML data found aspects of verbal memory correlated moderately with the EMQ in the 10 years age group. There were no meaningful correlations in the 8 years age group. In the 6 years age group aspects of visual memory correlated moderately with the EMQ. The diagnostic utility of the EMQ for children was assessed by comparing the school group to children diagnosed with ADHD and/or learning disorders. Diagnostic indicators revealed the EMQ to have high sensitivity (89%) but poor positive predictive power, identifying 40% of the school group as having memory deficits. Negative predictive power (confirming a negative diagnosis) was high. Validity data suggested that the EMQ could be useful with children at least as young as 10 years and further research needs to be conducted to establish the utility of the EMQ in clinical groups with primary memory deficits.     

Modeling a cascade of effects: the role of speed and executive functioning in preterm/full-term differences in academic achievement

This study identified deficits in executive functioning in pre-adolescent preterms and modeled their role, along with processing speed, in explaining preterm/full-term differences in reading and mathematics. Preterms (< 1750 g) showed deficits at 11 years on a battery of tasks tapping the three basic executive functions identified by Miyake - updating/working memory, inhibition, and shifting. Confirmatory factor analysis showed that these executive functions, though correlated, were distinct from one another and from processing speed, which later proved to account for much of the intercorrelation among executive functions. In the best-fitting structural equation model, the negative effects of prematurity on achievement were completely mediated by the three executive functions and speed in a cascade of effects: prematurity → slower processing speed → poorer executive functioning (working memory) → lower achievement in math and reading.     

The structure of executive functions in children: A closer examination of inhibition,shifting, and updating

An increasing number of studies has investigated the latent factor structure of executive functions. Some studies found a three‐factor structure of inhibition, shifting, and updating, but others could not replicate this finding. We assumed that the task choices and scoring methods might be responsible for these contradictory findings. Therefore, we selected tasks in which input modality was varied, controlled for baseline speed, and used both speed and accuracy scores, in order to investigate whether a three factor model with inhibition, shifting, and updating could still be replicated. In a group of 211 children, who were tested at the beginning of grade 1, at approximately 6 years of age, and again after 18 months, the best fitting model was not the three‐factor model, but instead consisted of an updating factor and a combined inhibition and shifting factor, besides two baseline speed factors (verbal and motor). We argue that these results might indicate that the structural organization of executive functions might be different in children than in adults, but that there might also be an alternative explanation: the distinction in executive functions might not accurately represent cognitive structures but instead be a methodological artefact.     

Applying Luria's Diagnostic Principles in the Neuropsychological Assessment of Children

The first part of this article examines the theoretical justification for applying Luria's approach in the assessment of children. It is concluded that Luria's concepts of functional systems and the principle of specifying primary and secondary deficits may be applied to children. However, the selection of functional components to assess should be based on traditions of child neuropsychology rather than on Luria's assessment of adults. In addition, the tendency for comorbid disorders, mechanisms of neural adaptation to damage, and the prevalent types of brain abnormality in children render brain–behavior relationships more complex in children than in adults. The second part of the article describes how Luria's methods were adapted for use with children. An assessment, NEPSY, was developed by integrating Luria's views with contemporary child neuropsychological traditions. The NEPSY includes 27 homogeneous and psychometrically developed subtests, standardized in the United States and Finland for the age range of 3 to 12 years. The rationale of analyzing disorders of cognitive processes through a comprehensive and systematic assessment of their components, characteristic of Luria's approach, was preserved, but more specific principles of diagnosis were modified. Research findings obtained with a previously published, Finnish NEPSY version are presented.     

Dimensions of executive functioning: Evidence from children

This study investigated dimensions of executive functioning in 8‐ to 13‐year‐old children. Three tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB), two tasks from the NEPSY battery and some additional executive function (EF) tests were administered to 108 children. In line with earlier work, modest correlations among EF measures were obtained (r < .4). Both exploratory and confirmatory factor analyses yielded three interrelated factors, which resembled those obtained by Miyake et al. (2000) and which were—with some reservations—labelled Working Memory (WM), Inhibition and Shifting. Age correlated with performance on most individual EF measures as well as Shifting and WM. The present findings are in agreement with contemporary views as to the simultaneous unity and diversity of EFs.     

Refining the Preschool Self‐regulation Assessment for Use in Preschool Classrooms

To aid in understanding preschoolers' self‐regulation and refinement of measurement, we examined properties of a field‐based assessment battery of preschooler's self‐regulation, the Preschool Self‐regulation Assessment (PSRA). The PSRA, which includes seven age‐appropriate tasks that tap children's executive control, was administered to 313 preschoolers and then to 261 of these children approximately 3 months later. Teachers reported on children's school readiness (social competence and classroom adjustment) at the end of preschool and kindergarten years, and on academic success in kindergarten. PSRA tasks were examined for ceiling effects at 35–65 months; Pencil Tap, Balance Beam, Toy Wrap and Snack Delay were retained for lack of such effects. Confirmatory factor analyses showed two components at each time point – hot and cool executive control – and cross‐time correlations showed significant stability of individual differences. Four‐year‐old girls and children of higher socioeconomic status outperformed 3‐year‐old boys and those at socioeconomic risk. Children, especially girls, scored higher on hot executive control. Finally, aspects of executive control differentially predicted teacher‐reports of school readiness at both times of assessment, with age, gender and risk status controlled. These selected PSRA tasks, as a shortened battery, have potential for research and applied usage, and findings speak to theoretical understanding of preschoolers' self‐regulation. Copyright © 2012 John Wiley & Sons, Ltd.     

Early executive control and risk for overweight and obesity in elementary school

An emerging literature suggests that poor executive control (EC) may be associated with clinical weight problems, e.g., body mass index (BMI) for age percentile ≥85 in children. However, our understanding of the impact of EC on overweight and obesity in childhood is limited by the lack of longitudinal studies spanning critical developmental periods and assessing EC using comprehensive performance-based batteries. The current study addresses these limitations in a longitudinal examination of 212 children who completed an extensive laboratory-based EC task battery in preschool (age 4 years and 6 months) and were followed through elementary school (Grades 1 through 4) with objective measures of weight status. The logistic regression results indicate that poorer EC in preschool is associated with significantly greater risk for clinical weight problems (either overweight or obese status, as defined by BMI-for-age percentile ≥ 85) in elementary school, controlling for maternal education. EC in preschool was not significantly associated with risk for obese status, specifically (defined by BMI-for-age percentile ≥ 95), but the trend was in the expected direction. The results suggest that early executive abilities are relevant for children’s subsequent health status, with deficits in EC in the critical period of preschool conferring risk for later problems with weight. Based on these findings, early interventions to promote stronger EC may be a promising, yet currently overlooked, component in pediatric obesity prevention efforts.     

Motivational‐emotional vulnerability and difficulties in learning to read and spell

Background: Although the relationship between motivation and learning problems has been studied in older children, little is known about how these factors interact during the first years of schooling or even earlier. Aims: To compare the development of motivational‐emotional profiles from preschool to grade 2 between groups classified as poor readers, good decoders and good readers in grade 2. To study the possibility that diverging motivational‐emotional paths occur concomitantly with school experience. Sample: A total of 127 children were followed longitudinally from preschool up to the second grade. In preschool, their mean age was 6 years 8 months. Method: Two different methods tapping motivational‐emotional vulnerability were used. Firstly, researchers at preschool age and classroom teachers in grades 1 and 2 rated children's task, ego‐defensive and social dependence orientations. Secondly, an experimental situation was arranged each year where children's play behaviour with LEGO® bricks was observed in free play vs. in induced pressure situations, and their motivational orientations were scored. Results: In preschool, the motivational‐emotional profiles were almost the same among the three prospective reading‐level groups, but in grades 1 and 2, classroom teachers rated poor readers as less task‐oriented and more ego‐defensive and socially dependent compared to good decoders and good readers. The ratings were corroborated by observational data on play behaviour in induced pressure situations. Conclusions: Early problems in learning to read and spell are related to motivational‐emotional vulnerability in learning situations in the school context.     

The end of the reading age: grade and age effects in early schooling

During the school years, psychological test norms may be indexed by age or by grade. A number of studies have shown that using age-based norms appears to produce biases associated with grade assignment. Cahan and Cohen [Child Dev. 60 (1989) 1239-1249] showed that the effect of one grade was over twice the effect of 1 year of age for most verbal cognitive ability subtests in Grades 4-6. A higher ratio might be expected for more curriculum-related areas such as reading tests. Analysis of a representative sample of 4257 Grade 1 and 2 children in Tasmanian government schools (which use relatively strict age assignment to grades) for three subtests of the Woodcock Reading Mastery Test—Revised (WRMTR): Word Identification, Word Attack, and Passage Comprehension, showed that the grade effect is about twice the age effect. This data shows that using age-based norms instead of grade-based norms for reading and other verbal ability tests may produce bias in the early school years. Psychologists should thus be primarily concerned with children's educational history, as once children have entered school other developmental factors indexed by age have less influence on children's verbal performance.     

The Role of Executive Function in Arithmetic Problem-Solving Processes: A Study of Third Graders

This study investigated the roles of different executive function (EF) components (inhibition, shifting, and working memory) in 2-step arithmetic word problem solving. A sample of 139 children aged 8 years old and regularly attending the 3rd grade of primary school were tested on 6 EF tasks measuring different EF components, a reading task and a reading comprehension task, an arithmetic facts task evaluating basic knowledge of calculation, and three 2-step arithmetic word problems. Multiple hierarchical regression analyses were conducted to investigate the roles of the different EF components in the various phases of the problem-solving process. The results showed that EF affects the various phases of problem solving differently over and above calculation knowledge and reading abilities. The implications of these findings are discussed in relation to further understanding the role of cognitive skills in mathematical problem solving and in relation to instructional approaches that may increase children’s performance on 2-step arithmetic word problems.