Subjective and Objective Assessments of Executive Functioning among Persons 10 years after Stroke Onset

Aim: This study aimed to investigate executive functioning (EF) among patients 10 years after stroke onset through comparing subjective patients’ and informants’ perceptions as well as objective neuropsychological assessments (NPAs). Materials and Method: One month prior to the neuropsychological assessment, 36 patients and their informants completed the Behaviour Rating Inventory of Executive Function - Adult Version (Brief-A) around 10 years after stroke onset. The patients’ EF was assessed with verbal fluency (FAS), backward Digit span backward and Trail making test (TMT)-B. Results: We found no significant differences between patient and informant ratings on EF on a group level, but more patients reported clinically significant executive dysfunctions (T > 65) than their informants. Only poor to slight agreements were observed between the patient and informant ratings of the BRIEF-A. Digit span backward was the only executive test that demonstrated significant improvement of EF 10 years post-stroke in the cohort. Neither patient nor informant ratings on EF showed any significant association with objective EF test performance. Conclusions: Mismatch patient-informant agreement on perceived executive dysfunction showed no clear association with EF test performance in this study. This may indicate the complexity of EF among persons with stroke at chronic phase.

P.124 Baseline Assessment of Attention and Executive Function Deficits in Children with Neurodevelopmental Disorders: Data from a Speciality Attention Clinic

Background: Attention and executive function (EF) deficits in children negatively impact academics, social interactions, and overall quality of life. Children with other brain-based disorders are at high risk for attention and EF concerns, but the effects of these impairments are not well studied in the literature. The Complex Attention and Executive Function Clinic at the Alberta Children’s Hospital collected baseline data on patients referred for concerns of attention deficits co-occurring with diagnosed neurologic illness/injury, or neurodevelopmental disorder (NDD). Methods: The Behaviour Rating Inventory of Executive Function (BRIEF-2), Behaviour Assessment System for Children (BASC-3), Parenting Stress Index (PSI-4) and medical and past treatment information were collected on initial clinic visit for patients aged 5-15 years. Results: BRIEF-2 Global Executive Composite demonstrated 88.9% of children had clinically elevated scores. Clinically significant scores were observed in 55.5% for BASC-3 Adaptive Skills index and 40% of parents in PSI-4 Total Stress scores. Conclusions: Children with neurologic illness/NDDs are at high risk of clinical impairments in attention and EF. In children referred for attention and behavioural regulation, there is clinically significant increased reporting of executive function impairment out of proportion to other behavioural difficulties. The clinic aims to improve overall functioning through treatment of unmanaged attention and EF deficits.

Exploring the Effect on 5 Senses in Children under Nitrous Oxide Sedation

BACKGROUND Sensation and perception are two separate processes that are very closely related. Sensation is the input about the outside world obtained by our sensory receptors while perception is the difficult system by which the brain selects, organizes and interprets these sensations. Effects of nitrous oxide on the sensation and perception has not been unturned although role in physiological, anxiolytic, behavioural, psychomotor and analgesic parameters have been examined in both children and adults. The human senses have long been unnoticed, despite their responsiveness being of great importance. The purpose of this study was to evaluate the effectiveness of nitrous oxide inhalation sedation on 5 senses i.e. sight, hearing, touch, smell and taste at different titrations of nitrous oxide and oxygen. METHODS 7 to 12 years old children with Frankl’s behaviour rating score of 2, 3 and 4 with no prior dental experience and requiring dental treatment under nitrous oxide sedation who were systemically healthy were included in the study. The 5 senses (i.e. hearing, touch, smell, taste and vision) were evaluated with different materials at 4 different titration levels to evaluate the effect of nitrous oxide on the 5 senses T0: 100 % oxygen, T1: 30 % nitrous oxide, T2: 50 % nitrous oxide, T3: 100 % oxygen. RESULTS The results of the present study depicted that there is significant difference in the perception of various senses at different concentrations of nitrous oxide and also when compared to baseline values. It was observed that the patient regained the normal perception in 5 minutes after 100 % oxygen post-operatively. CONCLUSIONS Nitrous oxide is found to depress/relax one’s senses too. KEY WORDS Vision, Smell, Taste, Touch, Sound, Perception, Consciousness, Nitrous Oxide Sedation, Oxygen, Behaviour

Nightmares in Children with Foetal Alcohol Spectrum Disorders, Autism Spectrum Disorders, and Their Typically Developing Peers

Children with Foetal Alcohol Spectrum Disorders (FASD) and Autism Spectrum Disorders (ASD) experience significantly higher rates of sleep disturbances than their typically developing (TD) peers. Pre-sleep anxiety and waking emotional content is known to affect the content and frequency of nightmares, which can be distressing to children and caregivers. This is the first study to analyse nightmare frequency and content in FASD, and to assess its association with psychometric outcomes. Using online caregiver questionnaires, we assessed reports from 277 caregivers of children with ASD (n = 61), FASD (n = 112), and TD children (n = 104) using the Children’s Sleep Habits Questionnaire (CSHQ), the Child Behaviour Checklist (CBCL), the Spence Children’s Anxiety Scale (SCAS), and the Behaviour Rating Inventory for Executive Functioning (BRIEF). Within the ASD group, 40.3% of caregivers reported their children had nightmares. Within the FASD group, 73.62% of caregivers reported their children had nightmares, and within the TD group, 21.36% of caregivers reported their children had nightmares. Correlation analysis revealed significant associations between anxiety and nightmares, maladaptive behaviour and nightmares, and executive functioning and nightmares in the TD and FASD groups, but not ASD group. This paper adds to the emerging body of work supporting the need for sleep interventions as part of clinical practice with regard to children with ASD and FASD. As a relatively niche but important area of study, this warrants much needed further research.

Neurocognitive functioning in young adults with congenital heart disease: insights from a case-control study

Background: While there is evidence that cognitive impairment of children with congenital heart disease (CHD) may persist into adolescence, little is known about the spectrum of neurocognitive functioning of young adults with this disorder. The aim of this study was to assess neurocognitive functioning in a population of young adults with different types of CHD. Methods: Cross-sectional cohort study in young adults with CHD and a group-matched healthy control group. We assessed neurocognitive and general intellectual functioning with a comprehensive battery of standardised neuropsychological tests. In addition to task-based assessments, questionnaire data of executive dysfunctions in everyday life were measured with the Behaviour Rating Inventory of Executive Function – Adult Version. Results: A total of 67 patients (55% men) with CHD and 55 healthy controls (51% men) were included for analysis. Mean age at assessment was 26.9 (3.68) and 26.0 (3.32) years, respectively. The CHD group performed poorer in the domains of Executive Functions, Memory, Attention & Speed, and general intellectual functioning. Patients with a CHD of severe complexity were more affected than patients with simple or moderate complexity. Behaviour Rating Inventory of Executive Function – Adult Version scores indicated that patients’ self-rated deficits in behaviour regulation in everyday life was higher compared with healthy controls. Conclusion: Our findings indicate lower neurocognitive functioning in young adults with a CHD, particularly in those with severe defect complexity. In view of the potentially enhanced risk for cerebrovascular and neurodegenerative disease in this patient group as reported in the literature, systematic longitudinal monitoring of cognitive functioning is recommended.

Video modelling technique used to manage the behaviour of uncooperative children in a dental set up

Objective: To investigate if video modelling is an effective technique in behaviour modelling of a child in a dental set up. Material and Methods: Fifty children aged 4-6 years indicated for pulpectomy were enrolled in this study. They were selected based on their behaviour using Frankl behaviour rating scale. Children with Frankl behaviour rating 1 and 2 were selected for this study. The video of a child who was cooperative while undergoing pulpectomy was shown to these children. The behaviour was assessed using Frankl behaviour rating scale after the video was shown to the children included in the study. Results: There was a statistically significant difference in the behaviour rating score of the children before after the video of the cooperative child was shown to them. Conclusion: It was observed that video modelling is an effective technique in managing the behaviour of an uncooperative child in a dental set up. Keywords Video modelling; Behaviour management; Fear; Anxiety; Pediatric dentistry.

Emotional problems and intellectual disability: comparing groups with and without forensic involvement

Purpose Individuals with intellectual disability (ID) are known to experience increased emotional and behavioural concerns. The study aims to assess whether detained ID patients with a forensic history (IDPF) have increased difficulty managing their impulse control in comparison to detained ID patients without a forensic history (IDP). Using the externalising behaviour problems (EBP) subscale of the EPS, the study aims to compare the differences between the IDFP and IDP groups. Design/methodology/approach A total of 60 patients with ID detained under the Mental Health Act 1983 (Revised 2007) were assessed using the behaviour rating scale of the EPS. The outcome scores of the EBP were used to examine any observed differences between the scores of forensically involved patients [n = 34] and those without a forensic history [n = 26]. It was hypothesised that patients with a forensic history would display higher scoring on externalised behavioural problems (EBP) than patients without such a history. Findings Non-parametric testing revealed that there were no significant differences in EBP scoring between the two sample groups. These findings indicate that, for patients in the present study, no differences were detected in the presentation of these two distinct groups. In fact, with the exception of the verbal aggression subscale of the EBP, the other three subscales (physical aggression, non-compliance and hyperactivity) show that actually the IDP group displayed the higher ranked means in these subscales when compared with the forensically involved group. Originality/value These results indicate possible increased treatment needs within the IDP group and question whether offending history is necessarily a reliable predictor of ongoing hostility and behavioural concerns within similar inpatient services.

An Investigation on the Relationship between Facial Emotional Recognition and Tendency to Commit Crime; Moderating the Effects of Socio-Economic Well- Being

The growth of crime rates are on the increase all over the world and Nigeria is not an exception. Crime the intentional illegal action committed by any person for which such a person can punish by law does not have a definite cause but rather combination of causes which may include: economic situation, social environment, personality traits, and family structures. This study investigates if socioeconomic wellbeing has a mediating effect on relationship between facial emotional recognition and the tendency to commit crime among hospital workers in Imo state. A total of 150 (75 males and 75 females) workers, were randomly selected to participate in this study. Three instruments were used in this study which includes: Criminal Behaviour Rating Scale (CBRS) developed by Animasahun (2011), Socio-economic wellbeing scale developed by Obi-Nwosu (2018) and Facial emotion scale developed by Paul Ekman.

Development of Executive Functions as Reflected in Daily Life Behaviors in Young Adults at Ultra-High Risk for Psychosis: Associations With Symptoms and Functioning

There is a paucity of evidence on executive functions (EF) as reflected in daily life behaviors in individuals at ultra-high risk (UHR) for psychosis. This prospective follow-up study investigated the 1-year development in EF in UHR compared to healthy controls (HC) and how this change may relate to change in severity of clinical symptoms, social communication, and functioning. UHR (N = 132) and HC (N = 66) were assessed with the Behaviour Rating Inventory of Executive Function–Adult version (BRIEF-A) self and informant report at baseline and 12 months follow-up comprising the Behavioral Regulation Index (BRI) and the Metacognition Index (MI). Additionally, data on depressive-, negative-, and attenuated psychotic symptoms and everyday social functioning were collected. The study found UHR to display large baseline impairments in EF in real life on both self- and informant reports. UHR and HC showed a significantly different development of EF over time, with UHR displaying greater improvements in EF compared to HC. Change in clinical symptoms did not relate to improvements in EF, except for depressive symptoms negatively associating with the development of the MI. Improvements on the BRI and MI were significantly associated with improvements in social functioning. Findings suggest the potential of UHR individuals displaying a larger ongoing maturational development of daily life EF than HC that seems predominantly independent of development of clinical symptoms. If replicated, this supports a maturational trajectory of daily life EF in UHR that approaches, but do not reach, the level of HC and may indicate a window of opportunity for targeted remediation approaches.