Cognitive Neuropsychology and Developmental Disorders: Uncomfortable Bedfellows

Cognitive neuropsychology provides a theoretical framework and methods that can be of value in the study of developmental disorders, but the "dissociation" logic at the centre of this approach is not well suited to the developmental context. This is illustrated with examples from specific language impairment. Within the developing language system there is ample evidence for interaction between levels of representation, with modularity emerging in the course of development. This means that one typically is seeking to explain a complex pattern of associated impairments, rather than highly selective deficits. For instance, a selective impairment in auditory processing can have repercussions through the language system and may lead to distinctive syntactic deficits that are seen in written as well as spoken language. Changes in the nature of representations and in the relationships between components of a developing system mean that cross-sectional data at a single point in development may be misleading indicators of the primary deficit. Furthermore, traditional cognitive neuropsychology places a disproportionate emphasis on representational (competence) deficits, with processing (performance) deficits being relatively neglected. Methods for distinguishing these two kinds of impairment are discussed, as well as other approaches for elucidating the underlying nature of developmental disorders.     

Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy.

OBJECTIVE: Compare the efficacy of a multicomponent social support intervention to standard-of-care counseling on medication adherence among HIV-infected patients initiating antiretroviral therapy. DESIGN: Randomized controlled trial. Generalized estimating equations tested for differences in the percentage of participants achieving 90% adherence. MAIN OUTCOME MEASURES: Pill-taking, electronically monitored over 6 consecutive months; plasma viral load (VL), assessed at 3 and 6 months following initiation of therapy. RESULTS: Of 226 participants who were randomized and began the trial, 87 (38%) were lost to the study by 6 months. The proportion of adherent participants declined steadily over time, with no time by group interaction. Sustained adherence was associated with increased odds of achieving an undetectable VL (OR=1.78; 95% CI=1.01, 3.13). In intention-to-treat analyses, a larger proportion of the intervention group than the control group was adherent (40.15% vs. 27.59%, p=.02) and achieved an undetectable VL p=.04). However, the majority of participants who remained on study experienced some reduction in VL (>or=1-log drop or undetectable), regardless of experimental condition. CONCLUSION: The multicomponent social support intervention significantly improved medication adherence over standard-of-care counseling; evidence for improved virologic outcomes was inconsistent. Early discontinuation of care and treatment may be a greater threat to the health of HIV patients than imperfect medication-taking.