Identifying when children with visual impairment share attention: A novel protocol and the impact of visual acuity

BackgroundIn Coordinated Joint Engagement (CJE), children acknowledge that they and their social partners are paying attention to the same object. The achievement of CJE, critical for healthy development, is at risk in infants with visual impairment (VI). Research on CJE in these children is limited because investigators use a child’s gaze switch between social partner and object to index CJE. Research is needed that identifies CJE in children with VI using behaviors that do not require normal vision and that explores the relationship between CJE and visual function. This study aimed to (a) develop a protocol for identifying CJE in children with VI, and (b) explore the relationship between CJE and infants’ visual acuity (VA) and contrast sensitivity (CS), measured with Preferential Looking (PL) techniques and Visual Evoked Potential (VEP).MethodsA protocol that included 9 indices of CJE that did not require normal vision was developed to code videos of 20 infants with VI (mean age =1 year, 6 months, 27 days) and their caregivers. The percentage of CJE episodes in which each index was observed was calculated. Inter-coder reliability was measured using Cohen’s Kappa. Linear regression analysis was used to examine the relationship between the infants’ visual function and CJE.ResultsInter-rater reliability between a first coder and each of two second coders were 0.98 and 0.90 for determining whether the child participated in CJE. The following indices were observed the most (in 43–62 % of CJE): child’s body orientation to caregiver, gaze switch between caregiver and object, and vocalization to caregiver. The only significant model included VA (measured with PL) as a single predictor and explained 26.8 % of the variance in CJE.ConclusionsThe novel protocol can be used to identify CJE in children with VI with good inter-coder reliability. The data suggest that children with lower VA exhibited less CJE.     

Irritability in Children and Adolescents With OCD

Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7–17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed.     

Executive abilities in children with congenital visual impairment in mid-childhood

The role of vision and vision deprivation in the development of executive function (EF) abilities in childhood is little understood; aspects of EF such as initiative, attention orienting, inhibition, planning and performance monitoring are often measured through visual tasks. Studying the development and integrity of EF abilities in children with congenital visual impairment (VI) may provide important insights into the development of EF and also its possible relationship with vision and non-visual senses. The current study investigates non-visual EF abilities in 18 school-age children of average verbal intelligence with VI of differing levels of severity arising from congenital disorders affecting the eye, retina, or anterior optic nerve. Standard auditory neuropsychological assessments of sustained and divided attention, phonemic, semantic and switching verbal fluency, verbal working memory, and ratings of everyday executive abilities by parents were undertaken. Executive skills were compared to age-matched typically-sighted (TS) typically-developing children and across levels of vision (mild to moderate VI [MVI] or severe to profound VI [SPVI]). The results do not indicate significant differences or deficits on direct assessments of verbal and auditory EF between the groups. However, parent ratings suggest difficulties with everyday executive abilities, with the greatest difficulties in those with SPVI. The findings are discussed as possibly reflecting increased demands of behavioral executive skills for children with VI in everyday situations despite auditory and verbal EF abilities in the typical range for their age. These findings have potential implications for clinical and educational practices.     

Vigor predicting health outcomes in a high risk occupational context

Feelings of vigor are associated with positive consequences in the work place but these relationships have not yet been assessed in a high-risk occupational context. The current study assessed the relationships between feelings of vigor on physical health symptoms, functional impairment, and depression symptoms among U.S. service members who recently returned from a combat deployment. U.S. service members were asked to complete questionnaires at 2 time points. Significant positive correlations were found between combat experiences and the 3 outcomes. Significant negative correlations were found for feelings of vigor and each outcome. Regression analyses indicated a significant effect for feelings of vigor such that higher feelings of vigor at Time 1 predicted better physical health and fewer depression symptoms at Time 2. There was no significant effect for functional impairment. Results demonstrate the potential importance of maintaining or improving feelings of vigor throughout the work day, especially for those with high risk occupations.     

Assessment of apathy in neurological patients using the Apathy Motivation Index caregiver version

Apathy is a common, disabling neuropsychiatric syndrome that occurs across many brain disorders and may be associated with diminished motivation in behavioural, cognitive, emotional and social domains. Assessment is complicated by the variability of symptoms across apathy domains and self-report from patients, which can be misleading due to their lack of insight. Independent evaluation by clinicians also has limitations though if it has to be performed with limited time. Caregiver reports are a viable alternative, but current assessments for them either do not distinguish between different apathy domains or are interview-based and take long to administer. In this study, we developed a brief caregiver questionnaire version of the recently developed Apathy Motivation Index (AMI), which is a self-report tool. We confirmed three apathy factors in this new caregiver measure (AMI-CG) that were also present in the AMI: Behavioural Activation, Emotional Sensitivity and Social Motivation. Furthermore, we validated the scores against more extensive caregiver interviews using the established Lillle apathy rating scale as well as patient self-reports of apathy, measures of depression, anhedonia, cognition, activities of daily living and caregiver burden across four different neurological conditions: Parkinson's disease, Alzheimer's disease, subjective cognitive impairment and limbic encephalitis. The AMI-CG showed good internal reliability, external validity and diagnostic accuracy. It also uncovered cases of social apathy overlooked by traditional instruments. Crucially, patients who under-rated their apathy compared to informants were more likely to have difficulties performing everyday activities and to be a greater burden to caregivers. The findings provide evidence for a multidimensional conceptualization of apathy and an instrument for efficient detection of apathy based on caregiver reports for use in clinical practice.     

The role of optimism in patients with tinnitus and in patients with hearing impairment

Abstract

Optimism was investigated in a sample of audiology clinic patients, consisting of one group of tinnitus sufferers (N = 30) and one group of hearing impaired subjects not experiencing tinnitus (N = 44). Optimism was measured by the Life Orientation Test (LOT). In the tinnitus group the LOT correlated significantly with measures of tinnitus related distress and in the hearing impaired group with measures of disability and emotional reactions due to the hearing impairment. Cronbach's alphas for the measures used were generally high. Principal components analysis of the LOT confirmed earlier findings by showing two separate factors; one with the positively worded LOT items reflecting the presence of optimism and one with the negatively worded LOT items reflecting the presence of pessimism. The results indicate that dispositional optimism is an usable concept in research with audiological samples, and that optimism is related with tinnitus distress and experienced disability and emotional reactions due to hearing impairment. Further research should investigate the possible role of personality factors in tinnitus and hearing impairment.     

Follow-up of a cross-national comparison on flashbulb and event memory for the September 11th attacks

Flashbulb memories are defined as vivid and long-lasting memories for the reception context of an important public event (Brown & Kulik, 1977). They are supposed to be triggered by both emotional reactions to the original event and rehearsal processes (Brown & Kulik, 1977; Finkenauer, Luminet, Gisle, El-Ahmadi, van der Linden, & Philippot, 1998; Neisser & Harsch, 1992). A test-retest design (21 vs 524 days after the event on average) was employed to assess flashbulb memory and event memory for the September 11th attacks and the impact of their emotional and rehearsal predictors in a sample of 985 respondents coming from six countries (i.e., Belgium, Italy, the Netherlands, Romania, Japan, and the USA). Results showed that national membership had a significant impact on event memory, and the emotional and rehearsal variables, but flashbulb memories for the September 11th attacks were found to be high and consistent across different countries. The implications of these findings for the debate about the nature and maintenance of flashbulb memories are discussed.     

Spatial Working Memory in Aging and Mild Cognitive Impairment: Effects of Task Load and Contextual Cueing

ABSTRACT

Mild Cognitive Impairment (MCI) is characterized by episodic memory deficits, while aspects of working memory may also be implicated, but studies into this latter domain are scarce and results are inconclusive. Using a computerized search paradigm, this study compares 25 young adults, 25 typically aging older adults and 15 amnestic MCI patients as to their working-memory capacities for object-location information and potential differential effects of memory load and additional context cues. An age-related deficit in visuospatial working-memory maintenance was found that became more pronounced with increasing task demands. The MCI group additionally showed reduced maintenance of bound information, i.e., object-location associations, again especially at elevated memory load. No effects of contextual cueing were found. The current findings indicate that working memory should be considered when screening patients for suspected MCI and monitoring its progression.     

Performance on a measure of category fluency in cognitively impaired elderly

ABSTRACT

Measures of verbal fluency are widely used in the assessment of cognitive functioning of the elderly. However, limited research has evaluated patterns (across specific timed intervals) of performance on tasks of language fluency in different forms of dementia. The current study investigated semantic fluency in 488 elderly individuals (249 with Alzheimer's dementia, 97 Vascular dementia, 97 Mild Cognitive Impairment and 45 cognitively intact) across 15-second intervals in an animal naming task using retrospective chart review. Normal controls produced significantly more exemplars and AD patients produced fewer animal names than the other groups. After the first 15- second time interval, the demented groups produced significantly fewer exemplars than the non-demented. At the end of 30 seconds it was possible to differentiate normal aging from MCI who no longer differed from the VaD group. Overall, it appears that the greatest and most clinically meaningful differences between the diagnostic groups were detected in the first three 15-second intervals. The present findings support the use of time intervals and total scores on tasks of verbal fluency in clinical settings and for research purposes.