Maternal Depression in Families of Children with ADHD: A Meta-Analysis

Although research has demonstrated a relationship between maternal depression and child attention deficit/hyperactivity disorder (ADHD); the strength of the relationship is currently unclear. The results of some studies have found a strong association between maternal depression and child ADHD, while other studies have found little or no association. A meta-analysis was conducted to clarify the strength of the association between maternal depression and child ADHD. The current study included 51 published and unpublished studies that included a quantitative comparison between maternal depression and child ADHD. Mothers of children with ADHD had significantly higher levels of depressive symptoms than mothers of children without ADHD (d?=?0.58; 95% CI [0.43, 0.74]; p?<?.001; k?=?18). The relationship between maternal depressive symptoms and child ADHD symptoms was moderate (r?=?.22; 95% CI [.17, .28]; p?<?.001; k?=?21). 17.11% of mothers of children with ADHD currently met criteria for a depressive disorder (95% CI [11.95, 23.89], p?<?.001, k?=?19). The DSM version used to evaluate child ADHD status was the only moderator that was statistically significant (p?=?.021, k?=?15). Specifically, studies that used the DSM-III or DSM-III-R were associated with larger effect sizes than studies that used the DSM-IV or DSM-IV-TR. The results suggest that clinicians should screen for the possible co-occurrence of maternal depression when working with families of children with ADHD.     

Relationship between Disabilities and Adoption Outcomes in African American Children

Although many children adopted from the public child welfare system have special needs, little is known about the experiences of African American adopted children with disabilities and their families. The purpose of this study is to explore different categories of disabilities, including chronic health issues; emotional, mental, or behavioral (EMB) disorders; and intellectual or developmental disabilities (IDDs) on adoption outcomes in a sample of African American children. Data were from the Post-Permanency Round II Survey collected in 2008. A random sample of 412 adoptive parents or legal guardians self-reported their children’s disability diagnoses and family caregiving experiences. Hierarchical regression modelling was used to investigate the relationship between child disability and child and parental outcomes. Results indicated that chronic health issues (β?=?.10, p?<?.05), EMB disorders (β?=?.16, p?<?.01), and IDDs (β?=?.12, p?<?.05) were positively associated with parental burden. In addition, asthma (β?=?.10, p?<?.05), from the larger physical health issue category, was also associated with parental burden. However, none of the disability categories was significantly related with caregiver commitment or adoption dissolution. Future research should disentangle the definitions of special needs or disabilities.     

Emotion Regulation in Families of Children with Behavior Problems and Nonclinical Comparisons

The current study compared parents’ emotion regulation (ER) in clinical (those with a child with externalizing behavioral problems) and low-risk comparison families. Additionally, mediation models were explored with parent ER predicting child behavior problems through child ER. Participants were 60 families with children (71.7% boys; 73% Caucasian) ages 2 through 8 years (M?=?4.62; SD?=?1.69) from a rural population in the United States: 34 clinical families referred for parent training and 26 nonclinical families. A blocking design was used to balance the two groups on key demographic characteristics. Parents’ and children’s ER was assessed using parent-report surveys and structured behavioral observations. Analyses indicated higher rates of parental emotion dysregulation (specifically, more difficulty when upset with achieving goal-directed behaviors, p?=?.01, d?=?0.67; controlling impulses, p?=?.01, d?=?0.64; limited use of ER strategies, p?=?.02, d?=?0.62; and more negative verbalizations to their child during the observed task, p?<?.01, d?=?0.73) and child emotion dysregulation (specifically, more difficulty as reported by parents, p?<?.01, d?=??2.42) in the clinical group. Mediational analyses indicated there were indirect paths from parental ER to children’s behavioral problems through child ER. Findings from this research suggest a need to measure and target ER in both parents and their children when working with families who are referred for treatment of child behavior problems.     

Early Feeding,Child Behaviour and Parenting as Correlates of Problem Eating

Mealtimes are a common source of stress for families. Examining factors related to problem eating may provide markers by which to identify families requiring assistance and salient targets for treatment. The current study investigated parenting practices and cognitions, generalisation of child behavioural issues, and early feeding history as they relate to problem eating in typically developing young children. We compared a community sample of 105 parents of 1.5–6-year-old children via survey and observation with 96 parents seeking treatment for their child’s problem eating. History of problems with breastfeeding, χ²(1)?=?3.88, p?=?.049, and the transition to solids, χ²(1)?=?7.27, p?=?.007, were more common among problem eaters than comparisons. Problem eaters had a greater number of problem behaviours outside of mealtimes, F(1181)?=?10.88, p?=?.001, though not more frequently than comparisons and not to clinical levels, F(1181)?=?1.81, p?=?.181. Parents of problem eaters reported more unhelpful mealtime parenting strategies, F(1155)?=?22.59, p?<?.001, yet general parenting style was similar by group, F(1187)?=?0.42, p?=?.527. Parents’ cognitions about mealtimes, F(1155)?=?119.81, p?<?.001, including mealtime-specific self-efficacy, F(1155)?=?171.30, p?<?.001, were poorer amongst problem eaters, and were the only factors to predict problem eating in the total sample. General parenting self-efficacy was poorer in parents of problem eaters (Behaviour: F(1187)?=?42.36, p?<?.001; Setting: F(1187)?=?10.64, p?=?.001). Evidence of feeding issues in infancy may support early detection of and intervention for later problem eating. The significance of broader child behaviour is less clear. Parent factors, particularly those specific to mealtimes, and cognitive in nature (including mealtime parenting self-efficacy) clearly differentiated the groups, and represent important targets for intervention.     

Effects of Individual,Peer, and Family Factors on Child Alcohol Abuse in Ukraine

The present study aims to estimate the relationship between child alcohol problems, sociodemographic characteristics, externalizing behavior, parental and peer alcohol use, and family violence by using a cross-sectional community sample of 320 Ukrainian children (9–16 years of age, 50% boys) and their parents. Participants answered questions from the Drinking and Drug History and Current Use Patterns Questionnaire, the Revised Conflict Tactics Scales, the Alabama Parenting Questionnaire, and the Child Behavior Checklist. Fifty-two percent of children reported alcohol use within the past year and 32% experienced alcohol-related problems. The average number of reported alcohol problems was 11.19 (SD?=?63.65). Five robust regression models examined correlates of early problem drinking in Ukraine. The final model indicated older child age (β?=?0.21, p?<?0.001), more symptoms of externalizing behavior (β?=?0.17, p?<?0.01), and higher peer alcohol use (β?=?0.23, p?<?0.001) were significantly and positively associated with child alcohol problems. Results of the final model explained 32% of the variance in child alcohol problems, F(8, 311)?=?10.76, p?<?0.001. In conclusion, the findings suggest that older age, exposure to high-risk alcohol permeated peer environments, impulsivity, and rule-breaking behaviors are linked with the trajectory of early alcohol abuse among Ukrainian children. Mechanisms that reduce the harmful influence of these risk factors on alcohol consumption need to be in place.     

Differential Effects of Mother’s and Father’s Parenting on Prosocial and Antisocial Behavior: Child Sex Moderating

The current study examined the differential effects of maternal and paternal parenting on prosocial and antisocial behavior during middle childhood, and the moderating role of child sex. Parents of 96 boys and 107 girls (mean age?=?92.42?months, SD?=?3.52) completed different questionnaires to assess parenting and child behavior. All participants were Caucasian from south of Spain. Multiple hierarchical regressions (enter method) were performed to determine significant predictors of prosocial and antisocial behavior. The results showed that maternal and paternal hostility predicted an increase of externalizing problems in boys and girls (p?<?.001 in both sex groups). As well, Warmth/Induction of both parents predicted an increase in adaptive skills in boys and girls (p?<?.001 in both sex groups). On the other hand, differential effects of fathers’ and mothers’ parenting were found: both for boys and girls, maternal inconsistency positively predicted externalizing problems and negatively adaptive skills (p?<?.001 in both sex groups) and paternal overprotection positively predicted externalizing problems and negatively adaptive skills (p?<?.05 in both sex groups). Finally, maternal coercion negatively predicted adaptive skills in boys and girls (p?<?.05 in both sex groups); however, it increased externalizing problems only in girls (p?<?.05), whereas maternal permissiveness only increased these problems in boys (p?<?.01 in both cases). The discussion highlighted the importance of considering both parents’ and children’s sex to further knowledge of parenting styles affecting children’s behaviors.     

Family Exploration: The Contribution of Stability and Change Processes

Building upon the redefinition of exploration as a family process, this study analyses how the processes of family stability and change may favour exploration by members of multiple family relational contexts. Sixty non-clinical family triads (mother, father, child) participated in an experimental observational study and were video-recorded while playing in different interactive configurations. The children (37 females and 23 males) were 4–5 years old (M?=?55 months). The mothers’ ages ranged from 29 to 45 (M?=?38) and the fathers’ ages ranged from 29 to 46 (M?=?39). All the parents were employed and were living together. All participants were Caucasians of Italian nationality. Using the Triadic Interactions Analytical Procedure (TIAP), the family morphostatic processes and the family morphogenetic processes were analysed in relation to the family members’ exploration. Data analyses showed that family stability continual construction (morphostasis) and family change (morphogenesis) involve different interactive and relational dynamics (χ²(8)?=?13.84, p?>?.05; CFI?=?.97, TLI?=?.94, SRMR?=?.06), even if they are intertwined processes (p?<?.001). Both morphostatic and morphogenetic processes were correlated to the level of exploration showed by family members (respectively r?=?.32, p?<?.05, and r?=?.59, p?<?.001), even if the morphogenetic processes had a stronger relation with family exploration (z?=?1.85, p _one-tailed ?<?.05).     

Physiological Emotion Regulation in Children with ADHD with and without Comorbid Internalizing Disorders: a Preliminary Study

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) experience deficits in emotion regulation that can be measured physiologically under environmental stress conditions by examining respiratory sinus arrhythmia (RSA), a marker of parasympathetic nervous system (PNS) withdrawal. The current pilot study examined the impact of comorbid internalizing disorders and comorbid Oppositional Defiant Disorder (ODD) on emotion regulation in children with ADHD by measuring RSA as an indicator of dysregulated emotional reactivity. Twenty-four 7–10 year old children with ADHD participated in the current study. Children completed a 5-min resting attending baseline while electrocardiogram data (ECG) were recorded to examine baseline RSA. Children then completed a stress inducing, blocked goal, Card Sorting Task to measure RSA reactivity to stress. Results revealed a significant effect of internalizing disorder status on RSA difference score, F (1, 18)?=?5.83, p?=?.03, η² = .25. Children in the comorbid internalizing disorder group had a significantly greater decrease in RSA from the baseline time period to the card sorting task. There was no significant effect of ODD diagnostic status on RSA difference score, p?>?.05. The results of this preliminary study suggest that among children with ADHD, the presence of a comorbid internalizing disorder predicts greater withdrawal of the PNS. These findings represent an important step in understanding autonomic functioning of children with ADHD and comorbid disorders.     

A Psychometric Evaluation of the Behavioral Inhibition Questionnaire in a Non-Clinical Sample of Israeli Children and Adolescents

This study examined the psychometric properties of a Hebrew version of the Behavioral Inhibition Questionnaire (BIQ) in a non-clinical sample of Israeli children and adolescents. We produced a Hebrew translation of the BIQ and collected 227 responses to it from parents of children aged 4–15. Some respondents in the larger sample also completed the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire (n?=?91) and the Conners’ Abbreviated Parent-Teacher (CONNERS) questionnaire (n?=?39), in addition to the BIQ. Lastly, 21 children of BIQ respondents (aged 8–14) completed a self-report version of the questionnaire. Confirmatory factor analysis (CFA) was performed to assess how well the established six correlated factor model of the BIQ applied to the sample data. The Hebrew BIQ demonstrated good internal consistency (Chronbach’s α?=?.94, n?=?227) and 3 month test–retest reliability, (r?=?.95, p?<?.001, n?=?21). It also showed both convergent validity, as scores on the BIQ were correlated with the SCARED (r?=?.66, p?<?.01. n?=?91), and discriminant validity, as BIQ scores were not correlated with the CONNERS (r?=?.24, n?=?39). Finally, mother reports of BI were significantly correlated to child reports of BI via the BIQ (r?=?.60, p?<?.01, n?=?21). Thus, through this preliminary study we demonstrated that the Hebrew version of the BIQ is an effective tool for screening for BI among Israeli children, making it a useful instrument for future research.     

The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes

The Children’s Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model. Here, we present caregiver outcomes. 88 primary care providers (PCPs) in seven geographically underserved communities referred 223 children (ages 5.5 ? 12.9 years) to the randomized controlled trial. Over 22 weeks, children randomized to the CATTS service delivery model received six sessions of telepsychiatry and six sessions of caregiver behavior management training provided in person by community therapists who were trained and supervised remotely. Children randomized to the comparison Augmented Primary Care (APC) service model received management in primary care augmented by a single telepsychiatry consultation. Caregiver outcomes included changes in distress, as measured by the Patient Health Questionnaire (PHQ-9), Parenting Stress Index (PSI), Caregiver Strain Questionnaire (CSQ) and Family Empowerment Scale (FES). Caregivers completed five assessments. Multilevel mixed effects regression modeling tested for differences between the two service delivery models in caregiver outcomes from baseline to 25 weeks. Compared to caregivers of children in the APC model, caregivers of children in the CATTS service model showed statistically significantly greater improvements on the PHQ-9 (β?=?-1.41, 95 % CI?=?[?2.74, ?0.08], p?<?.05), PSI (β?=??4.59, 95 % CI?=?[?7.87, ? 1.31], p?<?.001), CSQ (β?=??5.41, 95 % CI?=?[? 8.58, ?2.24], p?<?.001) and FES (β?=?6.69, 95 % CI?=?[2.32, 11.06], p?<?.01). Improvement in child ADHD symptoms mediated improved caregiver scores on the PSI and CSQ. Improvement in child ODD behaviors mediated caregiver CSQ scores. The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.     

Mother-Child Interactions and Preschoolers’ Emotion Regulation Outcomes: Nurturing Autonomous Emotion Regulation

Emotion regulation is a complex process that begins in infancy and continues through childhood with parents’ support. Early parent-child interactions shape the way children learn emotion management. We took a sociocultural and social learning approach to exploring the specific components of mother-child interactions that are related to mothers’ perceptions of her child’s regulatory ability and the child’s observed emotion regulation. Thirty mothers and their preschool children were recruited from two New England urban areas: one community sample and one head start sample. Dyads engaged in a free play session, children completed an observed compliance task, and mothers completed a set of questionnaires assessing their perceptions of their child’s regulation. Regression analyses revealed that maternal behaviors during free play predicted child’s observed hostility (F _(2,29)?=?3.137, p?<?.05) and mothers’ perceptions of her child’s regulatory ability predicted observed child compliance (F _{(2, 17)}?=?4.990, p?<?.05). Child behaviors during play significantly predicted child’s compliance (F _(3,20)?=?4.722, p?<?.05) and child’s hostility (F _{(1, 26)}?=?9.220, p?<?.001). Maternal modeling and intentional scaffolding as well as perceptions of her child’s regulatory capacity have a powerful impact on her child’s observed regulation. Results indicate that it is particularly important for mothers of preschoolers to support autonomy while guiding socially appropriate behavior. Interventions that target improving mothers’ negative perceptions of their children, educating on appropriate preschool expectations, and facilitating preschoolers’ mature play may help mothers interact with their children in the ways that foster children’s autonomous emotion regulation.     

Prioritizing Parental Worry Associated with Duchenne Muscular Dystrophy Using Best-Worst Scaling

Duchenne muscular dystrophy (DMD) is a progressive, fatal pediatric disorder with significant burden on parents. Assessing disease impact can inform clinical interventions. Best-worst scaling (BWS) was used to elicit parental priorities among 16 short-term, DMD-related worries identified through community engagement. Respondents viewed 16 subsets of worries, identified using a balanced, incomplete block design, and identified the most and least worrying items. Priorities were assessed using best-worst scores (spanning +1 to ?1) representing the relative number of times items were endorsed as most and least worrying. Independent-sample t-tests compared prioritization of parents with ambulatory and non-ambulatory children. Participants (n?=?119) most prioritized worries about weakness progression (BW score?=?0.64) and getting the right care over time (BW?=?0.25). Compared to parents of non-ambulatory children, parents of ambulatory children more highly prioritized missing treatments (BW?=?0.31 vs. 0.13, p?<?0.001) and being a good enough parent (BW?=?0.06 vs. ?0.08, p?=?0.010), and less prioritized child feeling like a burden (BW?=??0.24 vs. ?0.07, p?<?0.001). Regardless of child’s disease stage, caregiver interventions should address the emotional impact of caring for a child with a progressive, fatal disease. We demonstrate an accessible, clinically-relevant approach to prioritize disease impact using BWS, which offers an alternative to the use of traditional rating/ranking scales.     

Is the Association of ADHD with Socio-Economic Disadvantage Explained by Child Comorbid Externalizing Problems or Parent ADHD?

It has been unclear whether an associations of child ADHD with socio-economic disadvantage (SES) could be accounted for by (a) parental ADHD explaining both low SES and child ADHD, and/or (b) the joint overlap of ODD or CD with low SES and ADHD. Study 1 used a community-recruited case-control sample with detailed evaluation of SES indicators, child ADHD, child externalizing, and parent ADHD symptoms (n = 931 children, 521 ADHD, 577 boys, 354 girls) in a path modeling analysis with latent variables. Study 2 evaluated ADHD and externalizing behavior in a regression model using a poverty index for SES, in 70,927 children (48.2% female) aged 5–17 years from the US 2011–2012 National Survey of Children’s Health (NSCH). In Study 1, lower SES was related to the ADHD latent variable, β = ?.18, p < .001; 95%CI [?.25,-.12]. This effect held when parent ADHD and child ODD and CD were in the model, β = ?.11, p < .01, 95% CI [?.09,-.03], equivalent to OR = 1.50, 95% CI[1.12–2.04]). In Study 2, these results replicated. Adjusting only for age and sex, children from families who were below 200% of the federal poverty line were more likely to have moderate or severe ADHD than no ADHD, versus children above that line, OR = 2.13, 95% CI[1.79,2.54], p < .001. The effect held after adjusting for disruptive/externalizing problems, OR = 1.61, p < .01, 95%CI [1.32,1.96]. The effect size for comparable models was similar across both studies, lending higher confidence to the results. It is concluded that the SES association with child ADHD is not explained by artifact and requires a mechanistic explanation.     

Subtypes of Adaptive and Maladaptive Perfectionism in Anorexia Nervosa: Associations with Eating Disorder and Affective Symptoms

Perfectionism is hypothesized to contribute to the etiology of anorexia nervosa (AN). However, there is little research regarding whether individuals with AN can be classified according to maladaptive (e.g., evaluative concerns) and adaptive (e.g., high personal standards) facets of perfectionism that predict distinct outcomes and might warrant different intervention approaches. In this study, a latent profile analysis was conducted using data from adults with AN (n?=?118). Frost Multidimensional Perfectionism Scale (Frost et al. Cognitive Therapy and Research, 14(5), 449–46, 1990) subscales were used to identify subgroups differing according to endorsed perfectionism features (e.g., adaptive and maladaptive perfectionism). Generalized linear models were used to compare subgroups on eating disorder and affective symptoms measured through questionnaire and ecological momentary assessment. Four subgroups were identified: (a) Low Perfectionism; (b) High Adaptive and Maladaptive Perfectionism; (c) Moderate Maladaptive Perfectionism; and (d) High Maladaptive Perfectionism. Subgroups differed on overall eating disorder symptoms (p?<?.001), purging (p?=?.005), restrictive eating (p?<?.001), and body checking (p?<?.001) frequency, depressive (p?<?.001) and anxiety (p?<?.001) symptoms, and negative (p?=?.001) and positive (p?<?.001) affect. The Low Perfectionism group displayed the most adaptive scores and the Moderate and High Maladaptive Perfectionism groups demonstrated the most elevated clinical symptoms. The High Adaptive and Maladaptive Perfectionism group demonstrated low affective disturbances, but elevated eating disorder symptoms. Results support the clinical significance of subtyping according to perfectionism dimensions in AN. Research is needed to determine if perfectionism subtyping can enhance individualized treatment targeting in AN.     

Mindfulness Among Genetic Counselors Is Associated with Increased Empathy and Work Engagement and Decreased Burnout and Compassion Fatigue

Genetic counselors experience high rates of compassion fatigue and an elevated risk for burnout, both of which can negatively impact patient care and retention in the profession. In other healthcare professions, mindfulness training has been successfully used to address similar negative psychological sequelae and to bolster empathy, which is the foundation of our counseling work. We aimed to assess associations between mindfulness and key professional variables, including burnout, compassion fatigue, work engagement, and empathy. Data were collected via an anonymous, online survey that included validated measures of mindfulness and these key professional variables. The survey was completed by 441 genetic counselors involved in direct patient care. Half of the respondents (50.1%) reported engaging in yoga, meditation, and/or breathing exercises. Mindfulness was positively correlated with work engagement (r?=?0.24, p?<?0.001) and empathy (as measured through four subscales: perspective taking (r?=?0.15, p?=?0.002), empathic concern (r?=?0.11, p?=?0.03), fantasy (r?=???0.11, p?=?0.03) and personal distress (r?=???0.15, p?=?0.001)). Mindfulness was negatively correlated with compassion fatigue (r?=???0.48, p?<?0.001) and burnout (r?=???0.50, p?<?0.001). Given these findings, mindfulness training may be a valuable addition to graduate and continuing education for genetic counselors. The integration of mindfulness into the genetic counseling field will likely improve professional morale and well-being, while promoting workforce retention and bolstering the relational and counseling aspects of our clinical work.     

Psychometric Properties of the Parenting Sense of Competence Scale in Treatment-Seeking Post-9/11 Veterans

Although evidence suggests deployment-related stress impacts parenting, few measures of parenting competency have been validated in returning post-9/11 veterans. As part of clinical care in a multidisciplinary clinic serving veterans and military families, 178 treatment-seeking OEF/OIF/OND veterans completed measures including the 16-item Parenting Sense of Competence Scale (PSOC), a widely-used measure of parental efficacy and satisfaction; the Family Assessment Device—general functioning subscale; and the depression, anxiety, and stress scale. Utilizing data from an IRB-approved de-identified data repository, we examined the psychometrics and factor structure of the PSOC. According to a proposed clinical cut-off, 10?% of our clinical sample of veterans exhibited low self-confidence in parenting. A confirmatory factor analysis of the 2-factor structure introducing correlated error terms between items 3 and 9, and between items 10 and 11, revealed to be a satisfactory fit to the data (Χ ² /df?=?1.57, RMSEA?=?0.056 [90?% CI 0.039–0.073]; CFI?=?0.928; TLI?=?0.914; SRMR?=?0.055). In addition, the PSOC exhibited good convergent validity with measures of parental distress (r?=??.22, p?<?0.01 with anxiety symptoms, and r?=??.33, p?<?.001 with depressive symptoms) and family functioning (r?=??.53, p?<?.0001), very good temporal stability (r?=?.81, p?<?.0.0001), and excellent internal consistency (α?=?.85). The PSOC exhibited satisfactory psychometric properties in treatment-seeking veterans and may be used by clinicians and researchers to assess parenting sense of competence, including satisfaction and sense of efficacy, in this population.     

In the Same Ballpark or a Whole New Ball Game? Staff as Raters of Youth Behavior

There is a lack of psychometrically sound tools for measuring youth outcomes in out-of-school time (OST) settings. Consequently, behavior ratings completed by OST staff are being scored as though the raters were teachers, even though cross-informant correlations are notoriously low (meta-analysis r?=?.27). Across 26 schools, 227 students were assessed by both teachers and OST staff using the Devereux Student Strengths Assessment (DESSA) to measure Social Emotional Competence. These 4th and 5th grade students were 50% male; 53% 5th graders; and 51% Latino, 20% Mixed/Other, 11% Black, 11% Asian, and 7% White. In the full sample, OST staff rated children’s behavior more harshly than teachers (p?<?.001; d?=?.32), although the scores were associated (r?=?.31, p?<?.001). Among the ratings completed within the same week, teacher and staff distributions were not statistically different. Teacher and staff ratings had a “medium” correlation (r?=?.42; p?=?.01) and a classification consistency (88%) that exceeded chance by a “moderate” amount (κ?=?.43). Few, if any, studies have previously compared the ratings of the same children by teachers and OST providers. Cross-informant inter-rater reliability between teachers and OST staff was higher than expected on the DESSA.     

General and Domain-Specific Effectiveness of Cognitive Remediation after Stroke: Systematic Literature Review and Meta-Analysis

Cognitive remediation (CR) has been shown to improve cognitive abilities following a stroke. However, an updated quantitative literature review is needed to synthesize recent research and build understanding of factors that may optimize training parameters and treatment effects. Randomized controlled trials of CR were retrieved from seven electronic databases. Studies specific to adult stroke populations were included. Treatment effects were estimated using a random effects model, with immediate and longer-term follow-up outcomes, and moderator effects, examined for both overall and domain-specific functioning. Twenty-two studies were identified yielding 1098 patients (583 in CR groups). CR produced a small overall effect (g?=?0.48, 95% CI 0.35–0.60, p?<?0.01) compared with control conditions. This effect was moderated by recovery stage (p?<?0.01), study quality (p?=?0.04), and dose (p?=?0.04), but not CR approach (p?=?0.63). Significant small to medium (g?=?0.25–0.75) post-intervention gains were evident within each individual outcome domain examined. A small overall effect (g?=?0.27, 95% CI 0.04–0.51, p?=?0.02) of CR persisted at follow-up (range 2–52 weeks). CR is effective and efficient at improving cognitive performance after stroke. The degree of efficacy varies across cognitive domains, and further high-quality research is required to enhance and sustain the immediate effects. Increased emphasis on early intervention approaches, brain-behavior relationships, and evaluation of activity and participation outcomes is also recommended.