Cognitive Functioning,Behavior, and Quality of Life After Stroke in Childhood

Rationale: To provide a better understanding of cognitive functioning, motor outcome, behavior and quality of life after childhood stroke and to study the relationship between variables expected to influence rehabilitation and outcome (age at stroke, time elapsed since stroke, lateralization, location and size of lesion).

Methods: Children who suffered from stroke between birth and their eighteenth year of life underwent an assessment consisting of cognitive tests (WISC-III, WAIS-R, K-ABC, TAP, Rey-Figure, German Version of the CVLT) and questionnaires (Conner's Scales, KIDSCREEN).

Results: Twenty-one patients after stroke in childhood (15 males, mean 11;11 years, SD 4;3, range 6;10–21;2) participated in the study. Mean Intelligence Quotients (IQ) were situated within the normal range (mean Full Scale IQ 96.5, range IQ 79–129). However, significantly more patients showed deficits in various cognitive domains than expected from a healthy population (Performance IQ p?=?.000; Digit Span p?=?.000, Arithmetic's p?=?.007, Divided Attention p?=?.028, Alertness p?=?.002). Verbal IQ was significantly better than Performance IQ in 13 of 17 patients, independent of the hemispheric side of lesion. Symptoms of ADHD occurred more often in the patients' sample than in a healthy population (learning difficulties/inattention p?=?.000; impulsivity/hyperactivity p?=?.006; psychosomatics p?=?.006). Certain aspects of quality of life were reduced (autonomy p?=?.003; parents' relation p?=?.003; social acceptance p?=?.037). Three patients had a right-sided hemiparesis, mean values of motor functions of the other patients were slightly impaired (sequential finger movements p?=?.000, hand alternation p?=?.001, foot tapping p?=?.043). In patients without hemiparesis, there was no relation between the lateralization of lesion and motor outcome. Lesion that occurred in the midst of childhood (5–10 years) led to better cognitive outcome than lesion in the very early (0–5 years) or late childhood (10–18 years). Other variables such as presence of seizure, elapsed time since stroke and size of lesion had a small to no impact on prognosis.

Conclusion: Moderate cognitive and motor deficits, behavioral problems, and impairment in some aspects of quality of life frequently remain after stroke in childhood. Visuospatial functions are more often reduced than verbal functions, independent of the hemispheric side of lesion. This indicates a functional superiority of verbal skills compared to visuospatial skills in the process of recovery after brain injury. Compared to the cognitive outcome following stroke in adults, cognitive sequelae after childhood stroke do indicate neither the lateralization nor the location of the lesion focus. Age at stroke seems to be the only determining factor influencing cognitive outcome.     

Neuropsychological Functioning in Children with Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) has been associated with deficits in the areas of verbal memory and learning, executive functioning, working memory, and attention in adults. Findings have been less consistent in the few studies examining neuropsychological functioning in childhood PTSD, which are often limited by comparing children with PTSD to children without trauma histories, making it unclear whether observed neuropsychological deficits are related to trauma exposure or to PTSD symptomatology. In an ethnically diverse sample of 62 children who witnessed intimate partner violence (n = 27 PTSD+ and 35 PTSD?), children with PTSD exhibited slower and less effective learning, heightened sensitivity to interference, and impaired effect of rehearsal on memory acquisition on the California Verbal Learning Test – Children's Version, a word list learning task. Both groups performed in the below average range on measures of executive functioning, attention, and intellectual ability.     

Linkages between childhood executive functioning and adolescent social functioning and psychopathology in girls with ADHD

We followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD (n = 140) and matched comparison girls (n = 88) over a period of 5 years, from middle childhood through early/midadolescence, with the aim of determining whether childhood levels of executive function (EF) would predict adolescent multi-informant outcomes of social functioning and psychopathology, including comorbidity between externalizing and internalizing symptomatology. Predictors were well-established measures of planning, response inhibition, and working memory, along with a control measure of fine motor control. Independent of ADHD versus comparison group status, (a) childhood planning and response inhibition predicted adolescent social functioning and (b) childhood planning predicted comorbid internalizing/externalizing disorders in adolescence. Subgroup status (ADHD-Combined, ADHD-Inattentive, and comparison) moderated the relationship between childhood planning and adolescent internalizing/externalizing comorbidity, with the combined type revealing particularly strong associations between baseline planning and adolescent comorbidity. Mediation analyses indicated that adolescent social functioning mediated the prediction from childhood EF to comorbidity at follow-up; in turn, in the girls with ADHD, adolescent comorbidity mediated the prediction from childhood EF to social functioning at follow-up. We conclude that childhood interventions should target EF impairments in addition to behavioral symptoms.     

Community as Outsider Witness: Utilising Community Members in the Reconstitution of Problem-Saturated Identities

This study explored community members' ability to enlist discourses affirming of psychiatric patients' quest for generative identities. The participants were members of the public who attended an exhibition of psychiatric patients' artwork (n = 7, age range 18–55). A Foucauldian discourse analysis was used to analyse the research interviews. Results revealed that the majority of community members used dominant cultural discourses to speak about psychiatric patient-artists. These discourses conferred a problem-saturated identity on to psychiatric patients. We conclude that community members can be recruited as outsider witnesses to support psychiatric patients' search for generative identities, provided community members resist discourses that produce problem-saturated identity conclusions.     

Community Counselling: Values and Practices

This article focuses on community counselling, specifically in African contexts. A community psychology approach is used as a framework for this discussion. This approach, linked to a critical perspective, highlights the importance of going beyond individualist assessments and interventions towards comprehensive approaches that locate the person in context, and that listen carefully to and engage openly with all voices in a way that highlights dynamics that oppress ourselves and others, for the purposes of building a supportive and health promoting environment for all. Perspectives and values relevant to this approach, and their implications for psychological practice, are discussed. In particular, the implications for psychological assessment and intervention are explored in some detail.     

Addressing Urgent Community Mental Health Needs in Rwanda: Culturally Sensitive Training Interventions

Rwandan leaders in the health and educational sectors have begun to discuss the necessity for establishing culturally appropriate community-based mental health counselling services in Rwanda, especially trauma counselling. The need for a community psychology approach is anchored in the lingering effects of the genocide and the continuing post-traumatic stress symptoms suffered by many in the population. Capacity building in an effort like this would require the design of multi-level counselling curricula that are sensitive to the social structures within Rwandan culture. These curricular endeavours call for the development of a National Counselling Centre to serve as a structural mechanism for organizing community-based counselling initiatives. We consider the community health services needs in Rwanda here, along with associated challenges and strategies for effective mental health services in a country with a recent history of genocide. A community psychology approach to mental health would benefit Rwandan society by making trauma counselling and recovery services available and accessible to citizens throughout the country.     

Childhood Exposure to Community and Domestic Violence: Prevalence,Risk Factors and Posttraumatic Outcomes in a South African Student Sample

The effects of exposure to direct and vicarious community and domestic violence on the posttraumatic adjustment of 323 South African students were examined. Data were collected using self-administered questionnaires, with the relationship between exposure to violence and posttraumatic outcomes being explored using binomial logistic regression analyses. Two hundred and sixty-two participants (81 %) reported that they had been exposed to some form of interpersonal violence during childhood. An analysis of risk factors for exposure to violence indicated that males were more than twice as likely as females to have experienced victimization by a community member. Direct exposure to domestic violence was the only form of violence which was found to be associated with Posttraumatic Stress Disorder (PTSD). Among participants who had experienced direct domestic violence, clinically significant levels of PTSD were significantly predicted by both gender (being female) and by abuse chronicity.     

From state church to faith community: an analysis of worldly and spiritual power in the Church of Sweden

The aim of this article is to discuss the current legislation, and power structures in and between different levels of the Church of Sweden in terms of church–state relations and secularisation, with the help of theories from sociology of religion and ecclesiology drawn from José Casanova, Grace Davie and Avery Dulles. With themes from Lutheran theology, including the two regiments and the common priesthood of all believers, we analyse the current legislation and power structures from the perspective of the so-called ‘dual line of responsibility’. The underlying hypothesis is that the structures of the former state church are still deciding the power structures in the Church of Sweden. This creates obscurity concerning the role of the church in public society and negatively affects the ecclesiastical development of the church now that it has lost its earlier status as a state church.     

Community without memory? In search of an ecclesiology of liberation in the company of people with dementia

The increasing prevalence of dementia among members of the Christian Churches prompts a re-evaluation of Christian ecclesiology. This is particularly true for the ecclesiology born of the theologies of liberation, because of the emphasis it places upon conscious participation in the historical life of the community. The present article draws on stories of people with dementia as recorded by themselves and those close to them; by reflection upon these stories, it seeks to re-think the character of the Church in the face of this challenge, and so to offer a richer interpretation of its identity as a community of liberation.     

Catechists' conceptions of their catechetical learning environments

In ‘A Typology of Catechetical Learning Environments’ (2014), De Kock presented a typology for describing different types of catechetical practices. The typology serves as a theoretical framework for empirically investigating the effects of catechetical practices in church communities. This current article investigates, on the basis of interviews with catechists, whether the types of catechetical learning environments drawn from the typology are reflected in catechists' conceptions of their catechetical practices. It concludes that the stipulated categories are only partially reflected in the conceptions of learning goals at which respondents aim, as well as in the role divisions between catechumens and the catechist. Moreover, the types of learning environments drawn from the typology are not clearly reflected in catechists' own reflections on their catechetical practices. Implications for both the professional practice of catechesis and for further research are suggested.