Planning and problem solving skills following focal frontal brain lesions in childhood: analysis using the Tower of London.

Problem solving skills were investigated in children with focal lesions using the Tower of London test (TOL; Shallice, 1982). The scoring procedure was elaborated from previous studies to delineate separate processes contributing to overall performance in children. Thirty-one children with focal frontal pathology, 18 children with focal pathology in other brain regions (extra-frontal), 17 children with generalized pathology and 38 healthy children participated in the study. Results suggest a distributed network for problem solving skills, particularly cognitive flexibility and goal setting skills. Within the frontal group, children with lesions involving the right pre-frontal cortex had greatest problems with self-regulation, with rule breaks most common among this group. As these skills develop relatively early in comparison to other aspects of executive function, right pre-frontal regions may play a particularly important role in the development of executive skills in childhood, with damage to these regions rendering children vulnerable to a range of cognitive and social deficits.     

Relationships between cognitive and behavioral measures of executive function in children with brain disease.

This study addressed the clinical and construct validity of the Behavior Rating Inventory of Executive Function. (BRIEF: Gioia, Isquith, Guy, & Kenworthy, 2000), a questionnaire designed to tap behavioral aspects of executive functions in children. BRIEF profiles in early treated phenylketonuria (PKU; n=44), early treated hydrocephalus (n=45), frontal focal lesions (n=20) and controls (n=80) were examined. Clinical validity was supported through significant between-group comparisons, especially between the frontal focal lesion group and other groups. To examine construct validity, raw scores on cognitive executive function measures including the Contingency Naming Test (CNT), Rey Complex Figure (RCF), Tower of London (TOL), and Controlled Oral Word Association Test (COWAT), were correlated with BRIEF scale scores. Few significant correlations were found, indicating cognitive and behavioral measures appear to tap different constructs within the executive function domain. A dissociation was found between behavioral and cognitive impairments in the frontal as opposed to PKU and hydrocephalus groups. This is discussed in relation to underlying pathology, the cognitive measures used, and possible limitations in the BRIEF's usefulness for measuring behavioral executive dysfunction in groups only mildly affected by neurological compromise.     

Relationships Between Cognitive and Behavioral Measures of Executive Function in Children With Brain Disease

This study addressed the clinical and construct validity of the Behavior Rating Inventory of Executive Function. (BRIEF: Gioia, Isquith, Guy, & Kenworthy, 2000), a questionnaire designed to tap behavioral aspects of executive functions in children. BRIEF profiles in early treated phenylketonuria (PKU; n = 44), early treated hydrocephalus (n = 45), frontal focal lesions (n = 20) and controls (n = 80) were examined. Clinical validity was supported through significant between-group comparisons, especially between the frontal focal lesion group and other groups. To examine construct validity, raw scores on cognitive executive function measures including the Contingency Naming Test (CNT), Rey Complex Figure (RCF), Tower of London (TOL), and Controlled Oral Word Association Test (COWAT), were correlated with BRIEF scale scores. Few significant correlations were found, indicating cognitive and behavioral measures appear to tap different constructs within the executive function domain. A dissociation was found between behavioral and cognitive impairments in the frontal as opposed to PKU and hydrocephalus groups. This is discussed in relation to underlying pathology, the cognitive measures used, and possible limitations in the BRIEF's usefulness for measuring behavioral executive dysfunction in groups only mildly affected by neurological compromise.     

Mapping numerical processing, reading, and executive functions in the developing brain: an fMRI meta-analysis of 52 studies including 842 children

Tracing the connections from brain functions to children's cognitive development and education is a major goal of modern neuroscience. We performed the first meta-analysis of functional magnetic resonance imaging (fMRI) data obtained over the past decade (1999-2008) on more than 800 children and adolescents in three core systems of cognitive development and school learning: numerical abilities, reading, and executive functions (i.e. cognitive control). We ran Activation Likelihood Estimation (ALE) meta-analyses to obtain regions of reliable activity across all the studies. The results indicate that, unlike results usually reported for adults, children primarily engage the frontal cortex when solving numerical tasks. With age, there may be a shift from reliance on the frontal cortex to reliance on the parietal cortex. In contrast, the frontal, temporo-parietal and occipito-temporal regions at work during reading in children are very similar to those reported in adults. The executive frontal regions are also consistent with the imaging literature on cognitive control in adults, but the developmental comparison between children and adolescents demonstrates a key role of the anterior insular cortex (AIC) with an additional right AIC involvement in adolescents.     

Grammaticality sensitivity in children with early focal brain injury and children with specific language impairment

Grammaticality judgments and processing times associated with violation detection were examined in typically developing children, children with focal brain lesions (FL) acquired early in life, and children with specific language impairment (SLI). Grammatical sensitivity in the FL group, while below typically developing children, was above levels seen in children with SLI. Age effects were noted with developmental changes in sensitivity extending into adolescence. Developmental delays in grammatical processing were particularly pronounced for children with SLI, who showed sensitivity levels below those of younger typically developing children. Sensitivity to agreement violations was also protracted in the SLI group providing further evidence of the vulnerability of morphology, a pattern not unlike that seen in adult aphasics. Findings for the FL group provide compelling evidence of neural and behavioral plasticity in children with early unilateral brain injury. Moreover, results from these children underscore how very different compensatory organization may be compared to profiles seen in adult aphasics who have comparable lesions. In contrast, although it was expected that the SLI children would perform below the typically developing children, the disadvantage seen with respect to the FL group suggests that the underlying pathology responsible for SLI may be more pervasive and less plastic than the focal pathology of children with early brain damage.     

Applied Problem Solving in Children with ADHD: The Mediating Roles of Working Memory and Mathematical Calculation

The difficulties children with ADHD experience solving applied math problems are well documented; however, the independent and/or interactive contributions of cognitive processes underlying these difficulties are not fully understood and warrant scrutiny. The current study examines two primary cognitive processes integral to children’s ability to solve applied math problems: working memory (WM) and math calculation skills (i.e., the ability to utilize specific facts, skills, or processes related to basic math operations stored in long-term memory). Thirty-six boys with ADHD-combined presentation and 33 typically developing (TD) boys aged 8–12 years old were administered multiple counterbalanced tasks to assess upper (central executive [CE]) and lower level (phonological [PH STM] and visuospatial [VS STM] short-term memory) WM processes, and standardized measures of mathematical abilities. Bias-corrected, bootstrapped mediation analyses revealed that CE ability fully mediated between-group differences in applied problem solving whereas math calculation ability partially mediated the relation. Neither PH STM nor VS STM was a significant mediator. When modeled together via serial mediation analysis, CE in tandem with math calculation ability fully mediated the relation, explained 79% of the variance, and provided a more parsimonious explication of applied mathematical problem solving differences among children with ADHD. Results suggest that interventions designed to address applied math difficulties in children with ADHD will likely benefit from targeting basic knowledge of math facts and skills while simultaneously promoting the active interplay of these skills with CE processes.     

Online measures of basic language skills in children with early focal brain lesions

Twenty children with early focal lesions were compared with 150 age-matched control subjects on 11 online measures of the basic skills underlying language processing, a digit span task, and 6 standardized measures. Although most of the children with brain injury scored within the normal range on the majority of the tasks, they also had a disproportionately high number of outlier scores on the reaction time tests. This evidence for a moderate impairment of the basic skills underlying language processing contrasts with other evidence suggesting that these children acquire normal control of the functional use of language. Furthermore, these children scored within the normal range on a measure of general cognitive ability, suggesting that there is no particular sparing of linguistic functions at the expense of general cognitive functions. Using the MPD procedure (Valdés-Pérez & Pericliev, 1997), we found that the controls and the five clinical groups could be best distinguished with two measures of online processing (word repetition and visual number naming) and one standardized test subcomponent (the CELF Oral Directions subtest). The 12 children with left hemisphere lesions scored significantly lower than the 8 other children on the CELF-RS measure. Within the group of children with cerebral infarct, the nature of the processing disability could be linked fairly well to site of lesion. Otherwise, there was little relation between site or size of lesion and the pattern of deficit. These results support a model in which damage to the complex functional circuits subserving language leads to only minor deficits in process efficiency, because of the plasticity of developmental processes.     

Cognitive procedural learning in patients with fronto-striatal lesions

Previous studies on the role of prefronto-striatal loop systems for cognitive procedural learning (PL) brought inconsistent results. To examine whether the integrity of the dorsolateral prefrontal loop is indispensable for normal cognitive PL, we examined the acquisition of cognitive skills in 35 patients with focal prefrontal lesions, focal caudate lesions, and Huntington's Disease (HD), and compared it with a control group. To examine the potential role of the processing demands made by the cognitive tasks, a set of tasks was applied whose acquisition places demand either on reasoning and problem solving, or on the establishment of fast and repetitive processing routines. The Pursuit Rotor task was also studied with the aim to re-examine earlier findings of a functional segregation of motor and complex prefronto-striatal loops. Deficits of cognitive and motor PL were found to be limited to certain tasks and groups. PL of one task, which demanded rapid, repetitive processing of visuo-spatial stimuli, was impaired in all patient groups. PL of two problem-solving tasks was impaired in patients with focal and degenerative caudate lesions only. None of the groups was impaired at PL of Mirror Reading, another task demanding rapid and repetitive visuo-spatial processing, and none was impaired in a fifth task of language skill. Deficits of motor learning were only observed in patients in whom the motor loop was affected. These results suggest that the dorsolateral prefronto-striatal loop is involved in the establishment of cognitive processing routines. The comparison of patients with and without caudate lesions suggests that disconnection of this circuit is critical. However, the normal acquisition of two cognitive tasks even in this group indicates that the integrity of the dorsolateral prefrontal loop is not mandatory for normal cognitive PL. We discuss these dissociations with regard to the demand profiles of the applied tasks and the locations of the lesions.     

The roles of different executive functioning skills in young children’s mental computation and applied mathematical problem-solving

This study investigated the relationships of four executive functioning skills (including verbal working memory, spatial working memory, inhibitory control, and cognitive flexibility) with young children’s mental computation and applied mathematical problem-solving. Two hundred and twenty-five Chinese kindergarteners were tested with a battery of general cognitive, executive functioning and mathematics skills. Results showed that when children’s age, gender, non-verbal intelligence, and listening comprehension skills were controlled, verbal working memory and cognitive flexibility were significant correlates of mental computation, whereas verbal working memory, spatial working memory, and cognitive flexibility were significant correlates of applied mathematical problem-solving. Inhibitory control was not significantly associated with the two domains of mathematics under investigation. The findings highlight the differential roles of different executive functioning skills in early mathematical skills and offer practical implication for helping young children in learning complex mathematical skills.     

Parent-reported executive functioning in young children treated for cancer

It is well known that children treated for cancer are at risk for cognitive and functional impairments. Such research is largely based on studies of late effects in school-aged or older children. However, far less is known about executive function weaknesses in preschool-aged children treated for cancer. Thus, the aim of this study was to examine executive functioning in a clinically referred sample of young oncology patients, and its association with broader domains of functioning. Data from 61 young children with cancer, who were referred for clinical cognitive evaluations, were abstracted and included in this study. Patients were 5.00 years of age (SD = 0.72) at assessment, 54.1% male, and two-thirds (63.9%) had been treated for brain tumors. Most executive functions were significantly discrepant from the mean, with 47.5% of preschoolers having parent-reported working memory concerns within the clinically significant range. There were no differences in executive functioning based on diagnosis or treatment status. Parent-reported executive functioning was strongly correlated with global intelligence and adaptive functioning, with some indices also associated with nonverbal problem solving and pre-academic skills. Ultimately, results indicate the presence of emerging weaknesses in executive functioning in young children with cancer, and add to a growing body of literature highlighting the potential cognitive and behavioral risks associated with a cancer diagnosis in early childhood.     

Neuropsychologic Deficits in Children with Sickle Cell Disease and Cerebral Infarction: Role of Lesion Site and Volume

Little is known about the correlation between the location and size of cerebral infarction in children and neuropsychologic deficits. We related lesion location and volume on magnetic resonance exams to neuropsychologic performance in 28 children with cerebral infarcts due to sickle cell disease. Seventeen healthy siblings served as a comparison group. Children with anterior cerebral infarcts (n = 7) showed deficits in attention and executive skills, whereas children with more widespread cerebral infarcts (n = 18) showed additional deficits in spatial skills. The volume of cerebral infarction was associated with spatial and language performance, but minimally related to performance in other cognitive domains. The location and volume of cerebral infarction are both important for defining the type and magnitude of cognitive sequelae in childhood stroke.     

Improving executive functions in 5‐ and 6‐year‐olds: Evaluation of a small group intervention in prekindergarten and kindergarten children

Research suggests a central role of executive functions for children's cognitive and social development during preschool years, especially in promoting school readiness. Interventions aiming to improve executive functions are therefore being called for. The present study examined the effect of a small group intervention implemented in kindergarten settings focusing on basic components of executive functions, i.e., working memory, interference control and cognitive flexibility. A total of 135 children enrolled in Swiss prekindergarten (5‐year‐olds) and kindergarten (6‐year‐olds) were involved. Results revealed that the small group intervention promoted gains in all three included components of executive functions: prekindergarten children substantially improved their working memory and cognitive flexibility processes, whereas significant training effects were found for the kindergarten children in interference control. Implications of these findings for early intervention programs and for tailoring preschool curricula are discussed, particularly with respect to children's school readiness. Copyright © 2011 John Wiley & Sons, Ltd.     

Executive functions and social skills in survivors of pediatric brain tumor

Medical advances have resulted in increased survival rates for children with brain tumors. Consequently, issues related to survivorship have become more critical. The use of multimodal treatment, in particular cranial radiation therapy, has been associated with subsequent cognitive decline. Specifically, deficits in executive functions have been reported in survivors of various types of pediatric brain tumor. Survivors are left with difficulties, particularly in self-monitoring, initiation, inhibition, and planning, to name a few. Another domain in which survivors of pediatric brain tumor have been reported to show difficulty is that of social skills. Parents, teachers, and survivors themselves have reported decreased social functioning following treatment. Deficits in executive functions and social skills are likely interrelated in this population, as executive skills are needed to navigate various aspects of social interaction; however, this has yet to be studied empirically. Twenty-four survivors of pediatric brain tumor were assessed using a computerized task of executive functions, as well as paper-and-pencil measures of social skills and real-world executive skills. Social functioning was related to a specific aspect of executive functions, that is, the survivors' variability in response time, such that inconsistent responding was associated with better parent-reported and survivor-reported social skills, independent of intellectual abilities. Additionally, parent-reported real-world global executive abilities predicted parent-reported social skills. The implications of these findings for social skills interventions and future research are discussed.     

Differential effect of lesion side on intra-individual variability in children with focal lateralized epilepsy

A differential impact of hemispheric side (left vs right) on cognitive measures, specifically Verbal and Performance IQ, has been described previously for both focal onset seizures and lateralized brain lesions. This study revealed a differential effect on intra-individual variability, measured as subtest scaled-score range, on the Dutch WISC-R and WISC-III, in children with epilepsy. The presence of documented brain lesion was associated with elevated variability on the Verbal Scale for the left hemisphere seizure group and with decreased variability on the Verbal and Full Scales for the right hemisphere seizure group.     

Social problem‐solving skills as a mediator between executive function and long‐term social outcome following paediatric traumatic brain injury

There is debate regarding the relationship between executive function and social outcome following paediatric traumatic brain injury (TBI), due to inconsistent findings in the literature. It has been suggested that these contradictory results may reflect the absence of an established mechanism to explain this relationship. Yeates and colleagues (2004) proposed a possible model in which the maturity of social problem‐solving skills mediates the relationship between executive function and social outcome. The current study aimed to explore this model and determine whether social problem solving mediates the relationship between executive function and social outcome in a TBI population. The sample consisted of 36 adolescents and young adults who sustained a TBI between 8 and 12 years of age. They ranged between 16 and 22 years of age and were 7–10 years post‐injury. Findings indicated that a higher level of executive dysfunction was associated with less sophisticated social problem‐solving skills and poorer social outcome. Further, the maturity of social problem‐solving skills was found to mediate the relationship between executive function and social outcome in this group.     

Metacognitive scaffolding boosts cognitive and neural benefits following executive attention training in children

Interventions including social scaffolding and metacognitive strategies have been used in educational settings to promote cognition. In addition, increasing evidence shows that computerized process‐based training enhances cognitive skills. However, no prior studies have examined the effect of combining these two training strategies. The goal of this study was to test the combined effect of metacognitive scaffolding and computer‐based training of executive attention in a sample of typically developing preschoolers at the cognitive and brain levels. Compared to children in the regular training protocol and an untrained active control group, children in the metacognitive group showed larger gains on intelligence and significant increases on an electrophysiological index associated with conflict processing. Moreover, changes in the conflict‐related brain activity predicted gains in intelligence in the metacognitive scaffolding group. These results suggest that metacognitive scaffolding boosts the influence of process‐based training on cognitive efficiency and brain plasticity related to executive attention.     

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.     

The impact of frontal and non-frontal brain tumor lesions on Wisconsin Card Sorting Test performance

Several lesion and imaging studies have suggested that the Wisconsin Card Sorting Test (WCST) is a measure of executive dysfunction. However, some studies have reported that this measure has poor anatomical specificity because patients with either frontal or non-frontal focal lesions exhibit similar performance. This study examined 25 frontal, 20 non-frontal low-grade brain tumor patients, and 63 normal controls (NC) on the WCST. The frontal patients were also assigned to either a left frontal (n=10) group or a right frontal group (n=15) and compared with the non-frontal group and NC. It was hypothesized that the frontal brain tumor patients would display greater deficits on categories achieved and a higher number of perseverative errors than non-frontal brain tumor patients on the WCST. Finally, it was predicted that right frontal brain tumors would result in greater executive functioning deficits than left frontal or non-frontal brain tumors. Results indicated that the left frontal group achieved the fewest categories and committed the most perseverative errors compared to the other patient and normal control groups. In addition, the left frontal group committed significantly more perseverative errors than the right frontal group. These results suggest that the WCST is sensitive to the effects of low-grade brain tumors on executive functioning.     

Interpersonal problem solving: An intervention program for preschool children

The purpose of the present study was to evaluate the effectiveness of an intervention program designed to train preschool children in interpersonal problem solving skills. Forty preschool age children were randomly assigned to an experimental or control group. Experimental subjects were trained in interpersonal problem solving skills for ten weeks, four days per week, for a total of 10–13 hours. Problem-solving skills were assessed at pretest, posttest, and three months after training was completed. Seventy-eight percent of the children who participated in pretest and posttest were tested at follow-up. Results indicated that the experimental group, compared to the control group, showed a significant increase in both cognitive—verbal and behavioral interpersonal problem-solving skills from pretest to posttest and that these changes were maintained at follow-up testing. Discussion focuses on suggestions for future research and implications for applied settings.     

Cognitive skills in mathematical problem solving in Grade 3

Background. Research on the relationship between cognitive skills and mathematical problem solving is usually conducted on adults or on participants with acquired deficits associated with brain injury (e.g. Cipolotti, 1995 ; Cohen, Dehaene, & Verstichel, 1994 ; McCloskey, 1992 ). Aims. In these studies we wanted to make a contribution to the field of children's mathematical problem solving. The first aim of this study was to investigate whether mathematical problem solving in children is merely determined by semantic elaboration, as hypothesized in some of the models of adult processing (semantic hypothesis). In addition, we aimed to investigate whether there is a continuum from very good to very poor mathematical problem solving among children with mathematical learning disabilities showing immature cognitive skills (maturational lag hypothesis). Sample. The participants were 376 third graders and 107 second graders. Method. The internal structure of the data was analysed with a principal components analysis. In addition, two MANOVA were conducted to compare children with learning disabilities or problems with age‐matched and performance‐matched subjects. Results. Two components, a semantic and a non‐semantic one, were needed to account for an adequate fit of the dataset. In addition, children with mathematical learning disabilities had less‐developed cognitive skills compared with peers without learning disabilities, but they did not differ from younger children on seven of the nine cognitive skills. Conclusions. This study highlighted that children's mathematical problem solving is not determined by one general component. The picture is more complex, since two mathematics components were found. In addition, although our findings point in the direction of the maturational lag hypothesis it may be important to assess the different cognitive skills and especially assess the number system knowledge, since it seems below average in children with mathematical learning disabilities, compared with the knowledge of younger children with comparable skills in mathematics.