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Predictors of psychosocial adaptation in children with CHD
- Jessica L. Metelski, Kiona Y. Allen, L. Barrera, M. Heffernan, Clayton D. Hinkle, Pooja Parikh, Carolyn C. Foster
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- Journal:
- Cardiology in the Young , First View
- Published online by Cambridge University Press:
- 18 April 2024, pp. 1-5
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Survival of CHD has significantly improved, but children with CHD remain susceptible to neurodevelopmental and psychosocial impairments. Our goal was to investigate the association between socio-demographic factors and psychosocial adaptation for future intervention. A retrospective cross-sectional study of an independent children’s hospital’s records was conducted. Psychosocial adaptation was measured by the Pediatric Cardiac Quality of Life Inventory Psychosocial Impact score (range 0–50, higher score indicates greater psychosocial adaptation). Bivariate and regression analyses were performed to estimate relationships between Psychosocial Impact score and socio-demographic variables including Child Opportunity Index, family support, financial support, academic support, and extracurricular activities. A total of 159 patients were included. Compared to patients in high opportunity neighbourhoods, patients in low opportunity neighbourhoods had a 9.27 (95% confidence interval [−17.15, −1.40], p = 0.021) point lower Psychosocial Impact score, whereas patients in moderate opportunity neighbourhoods had a 15.30 (95% confidence interval [−25.38, −5.22], p = 0.003) point lower Psychosocial Impact score. Compared to patients with adequate family support, those with limited support had a 6.23 point (95% confidence interval [−11.82, −0.643], p = 0.029) lower Psychosocial Impact score. Patients in moderate opportunity neighbourhoods had a higher Psychosocial Impact score by 11.80 (95% confidence interval [1.68, 21.91], p = 0.022) when they also had adequate family support compared to those with limited family support. Our findings indicate that among children with CHD, psychosocial adaptation is significantly impacted by neighbourhood resources and family support structures. These findings identify possible modifiable and protective factors to improve psychosocial adaptation in this vulnerable population.
Chapter 3 - The neurobiology of executive functions
- from Section I - Foundations of Executive Function/Dysfunction
- Edited by Scott J. Hunter, University of Chicago, Elizabeth P. Sparrow
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- Book:
- Executive Function and Dysfunction
- Published online:
- 05 October 2012
- Print publication:
- 04 October 2012, pp 37-64
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Summary
Executive functions are a set of interdependent, progressively acquired, higher-order cognitive skills that emerge in tandem with the expansion and integration of cerebellar, subcortical, corticocortical, and prefrontal neural networks across early childhood, through adolescence, and into early adulthood. Because the development of neural systems that support EF is so protracted, it is vulnerable across time to alterations in its unfolding trajectory, resulting in multiple possible routes to EdF. This chapter provides a summary of the underlying neuroanatomical and neurochemical substrates of EF development that support the behavioral and cognitive capacities discussed in Chapter 2. Although a primary emphasis of this chapter is typical EF development, discussion of abnormalities in and insults to the developing circuits that support EF are also considered.
Neurodevelopment
In contrast to models that describe the neural underpinnings of EF in adults, which emphasize modularity and take a reductionist approach to characterizing the “how and where” of executive capabilities, given their focus on the frontal lobes, models of early brain development and its role in the establishment of EF are much less “tidy” and “bounded”. Instead, the boundaries of what constitutes EF in childhood and the description of specific structures supporting its elicitation are less distinct and are more broadly situated anatomically. As a result, the classical emphasis on frontal cortical networks that characterizes adult neuropsychology is inadequate when thinking about EF developmentally. Instead, when considering the developmental neurobiology of EF, it is important to think about how the whole brain organizes and establishes its connections over time and across neural space, in order to best understand and make sense of the increasingly automatic and controlled responses that emerge neuropsychologically.
Chapter 2 - The developmental neuropsychology of executive functions
- from Section I - Foundations of Executive Function/Dysfunction
- Edited by Scott J. Hunter, University of Chicago, Elizabeth P. Sparrow
-
- Book:
- Executive Function and Dysfunction
- Published online:
- 05 October 2012
- Print publication:
- 04 October 2012, pp 17-36
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Summary
The predominant view regarding EF among clinical and research neuropsychologists has historically been one of modularity. As a result, EF skills have been most commonly equated with frontally-focused neural systems that are presumed to drive and regulate their performance. Consequently, it is a still popular belief within the field of neuropsychology that EF skills are best characterized as a set of control capabilities that only fully emerge as an individual achieves adult maturity. This belief holds despite the exponential growth of developmental neuropsychology and the empirical literature addressing developmental evidence of EF. Although the research has shown that it is risky to extrapolate from adult models of brain function to patterns of neural development and consequent behavior in children, there remains a tendency to do so, particularly with regard to EF.
A corollary belief is that effective EF is achieved by late adolescence or early adulthood when neural systems directed by the frontal lobes are reaching their final period of myelination and adult patterning. While this belief is increasingly understood as developmentally erroneous, given that some EF skills reach adult levels of performance at younger ages, it serves as a reminder that much in neuropsychology remains adult “privileged” in theories and models. This impacts how we can guide “real” thinking about EF skills and their expression at varying points in development.