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Structure of Executive Functioning in Children with Cerebral Palsy: an Investigation of Anderson’s Developmental Model

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Abstract

To investigate the factor structure of executive functioning (EF) in children with cerebral palsy (CP) and whether this can be described by the four-component model of EF described by Anderson (2002, 2008). Participants were 73 children with CP with various degrees of speech and motor impairment. Mean age was 9;10 years (range 5;1 to 17;7 years) and 39 were girls. EF was investigated with neuropsychological assessment, parent evaluation, and structured tasks. The neuropsychological tests used were Wisconsin Card Sorting Test and Forward and Backward Memory tasks from Leiter-R. Parents evaluated the children’s working memory capacity, attentiveness, ability to plan, impulsivity, and task efficiency. The structured tasks comprise instruction and description, and tap planning ability, monitoring, and impulsivity. In the instruction task, the child instructed the parent to construct a figure similar to a model that was only visible to the child. In the description task, the child described a picture of an object without naming it, and the parent guessed what was depicted. The mean test scores of the group were within the normal range, with considerable individual variation. Measures from different sources – neuropsychological tests, parental evaluations, and structured tasks – correlated significantly. Principal component analysis indicated a one-factor solution. EF has a unitary structure in school-aged children with CP and is not well described by the four-component model of EF.

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Notes

  1. In two cases it was an adult other than the parent who accompanied the child.

References

  • Andersen, G. L., Irgens, L. M., Haagaas, I., Skranes, J. S., Meberg, A. E., & Vik, T. (2008). Cerebral palsy in Norway: prevalence, subtypes and severity. European Journal of Paediatric Neurology, 12, 4–13. doi:10.1016/j.ejpn.2007.05.001.

    Article  PubMed  Google Scholar 

  • Anderson, V. (1998). Assessing executive functions in children: biological, psychological, and developmental considerations. Neuropsychological Rehabilitation, 8(3), 319–349. doi:10.1080/713755568.

    Article  Google Scholar 

  • Anderson, P. J. (2002). Assessment and development of executive function (EF) during childhood. Child Neuropsychology, 8, 72–81. doi:10.1076/chin.8.2.71.8724.

    Google Scholar 

  • Anderson, P. J. (2008). Towards a developmental model of executive function. In V. Anderson, R. Jacobs, & P. J. Anderson (Eds.), Executive functions and the frontal lobes. A lifespan perspective (pp. 3–21). New York: Taylor and Francis.

    Google Scholar 

  • Anderson, V. A., Anderson, P., Northam, E., Jacobs, R., & Mikiewicz, O. (2002). Relationships between cognitive and behavioral measures of executive function in children with brain disease. Child Neuropsychology, 8(4), 231–240. doi:10.1076/chin.8.4.231.13509.

    Article  PubMed  Google Scholar 

  • Anderson, V., Anderson, P. J., Jacobs, R., & Smith, M. S. (2008a). Development and assessment of executive function: from preschool to adolescence. In V. Anderson, R. Jacobs, & P. J. Anderson (Eds.), Executive functions and the frontal lobes. A lifespan perspective (pp. 123–155). New York: Taylor and Francis.

    Google Scholar 

  • Anderson, V., Jacobs, R., & Anderson, P. J. (2008b). Preface. In V. Anderson, R. Jacobs, & P. J. Anderson (Eds.), Executive functions and the frontal lobes. A lifespan perspective (pp. xxvii–xxxiii). New York: Taylor and Francis

  • Batorowicz, B., Stadskleiv, K., von Tetzchner, S., & Missiuna, C. (2016). Children who use communication aids instructing peer and adult partners during play-based activity. Augmentative and Alternative Communication, 1-15. doi:10.3109/07434618.2016.1160150.

  • Bayley, N. (2005). Bayley scales of infant and toddler development (Third ed.). London: Pearson Assessment.

    Google Scholar 

  • Bechara, A., Damasio, A. R., Damasio, H., & Anderson, S. W. (1994). Insensitivity to future consequences following damage to human prefrontal cortex. Cognition, 50, 7–15.

    Article  PubMed  Google Scholar 

  • Best, J. R., & Miller, P. H. (2010). A developmental perspective on executive function. Child Development, 81(6), 1641–1660. doi:10.1111/j.1467-8624.2010.01499.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bishop, D. (2009). Test for reception of Grammar, second edition, Norwegian version. Stockholm: Pearson Assessment.

    Google Scholar 

  • Blair, C. (2016). Developmental science and executive function. Current Directions in Psychological Science, 25(1), 3–7. doi:10.1177/0963721415622634.

    Article  PubMed  Google Scholar 

  • Bodimeade, H. L., Whittingham, K., Lloyd, O., & Boyd, R. N. (2013a). Executive function in children and adolescents with unilateral cerebral palsy. Developmental Medicine & Child Neurology, 55(10), 926–933. doi:10.1111/dmcn.12195.

    Article  Google Scholar 

  • Bodimeade, H. L., Whittingham, K., Lloyd, O., & Boyd, R. N. (2013b). Executive functioning in children with unilateral cerebral palsy: protocol for a cross-sectional study. BMJ open, 3(4), e002500. doi:10.1136/bmjopen-2012-002500.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bøttcher, L., Flachs, E. M., & Uldall, P. (2010). Attentional and executive impairments in children with spastic cerebral palsy. Developmental Medicine & Child Neurology, 52, e42–e47. doi:10.1111/j.1469-8749.2009.03533.x.

    Article  Google Scholar 

  • Brocki, K. G., & Bohlin, G. (2004). Executive functions in children aged 6 to 13: a dimensional and developmental study. Developmental Neuropsychology, 26, 571–593. doi:10.1207/s15326942dn2602_3.

    Article  PubMed  Google Scholar 

  • Carlson, S. M. (2005). Developmentally sensitive measures of executive function in preschool children. Developmental Neuropsychology, 28, 595–616. doi:10.1207/s15326942dn2802_3.

    Article  PubMed  Google Scholar 

  • Clarke, M. T., Loganathan, D., & Swettenham, J. (2012). Assessing true and false belief in young children with cerebral palsy through anticipatory gaze behaviors: a pilot study. Research in Developmental Disabilities, 33, 2058–2066. doi:10.1016/j.ridd.2012.05.009.

    Article  PubMed  Google Scholar 

  • Conti-Ramsden, G., Botting, N., & Faragher, B. (2001). Psycholinguistic markers for specific language impairment (SLI). Journal of Child Psychology and Psychiatry, 42(6), 741–748. doi:10.1111/1469-7610.00770.

    Article  PubMed  Google Scholar 

  • Dahlgren Sandberg, A. (2006). Reading and spelling abilities in children with severe speech impairments and cerebral palsy at 6, 9, and 12 years of age in relation to cognitive development: a longitudinal study. Developmental Medicine & Child Neurology, 48, 629–634. doi:10.1017/S0012162206001344.

    Article  Google Scholar 

  • de Luca, C. R., & Leventer, R. J. (2008). Developmental trajectories of executive functions across the lifespan. In V. Anderson, R. Jacobs, & P. J. Anderson (Eds.), Executive function and the frontal lobes. A lifespan perspective, eds (pp. 23–57). New York: Taylor and Francis.

    Google Scholar 

  • Doebel, S., & Zelazo, P. D. (2013). Bottom-up and top-down dynamics in young children’s executive function: labels aid 3-year-olds’ performance on the dimensional change card sort. Cognitive Development, 28(3), 222–232. doi:10.1016/j.cogdev.2012.12.001.

    Article  PubMed  PubMed Central  Google Scholar 

  • Donders, J., DenBraber, D., & Vos, L. (2010). Construct and criterion validity of the behaviour rating inventory of executive function (BRIEF) in children referred for neuropsychological assessment after paediatric traumatic brain injury. Journal of Neuropsychology, 4(2), 197–209. doi:10.1348/174866409X478970.

    Article  PubMed  Google Scholar 

  • Dunn, L. M., Dunn, L. M., Whetton, C., & Burley, J. (1997). The British picture vocabulary scale (Second ed.). London, UK: NFER Nelson Publishing Company.

    Google Scholar 

  • Eysenck, M. W., & Keane, M. T. (1990). Cognitive psychology. A student’s handbook. Hove, UK: Lawrence Erlbaum.

    Google Scholar 

  • Farran, E. K., & Karmiloff-Smith, A. (Eds.) (2011). Neurodevelopmental disorders across the lifespan: A neuroconstructivist approach. Oxford: Oxford University Press.

    Google Scholar 

  • Geytenbeek, J. J., Vermeulen, R. J., Becher, J. G., & Oostrom, K. J. (2015). Comprehension of spoken language in non-speaking children with severe cerebral palsy: an explorative study on associations with motor type and disabilities. Developmental Medicine & Child Neurology, 57(3), 294–300. doi:10.1111/dmcn.12619.

    Article  Google Scholar 

  • Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2000). Behavior rating inventory of executive function. Stockholm: Hogrefe Psychologiförlaget AB.

    Google Scholar 

  • Gioia, G. A., Isquith, P. K., Retzlaff, P. D., & Espy, K. A. (2002). Confirmatory factor analysis of the behavior rating inventory of executive function (BRIEF) in a clinical sample. Child Neuropsychology, 8(4), 249–257. doi:10.1076/chin.8.4.249.13513.

    Article  PubMed  Google Scholar 

  • Heaton, R. K. (2007). Wisconsin card sorting test (WCST-64: Computer version 2, research edition). Lutz, FL.: Psychological Assessment Resources.

    Google Scholar 

  • Hitch, G. J., & Towse, J. N. (1995). Working memory: what develops? In F. E. Weinert & W. Sneider (Eds.), Memory performance and competencies: Issues in growth and development (pp. 3–22). Hillsdale, N.J.: Lawrence Erlbaum Associates.

    Google Scholar 

  • Hudson, K. D., & Farran, E. K. (2011). Executive function and motor planning. In E. K. Farran & A. Karmiloff-Smith (Eds.), Neurodevelopmental disorders across the lifespan: A neuroconstructivist approach (pp. 165–181). Oxford: Oxford University Press.

    Chapter  Google Scholar 

  • Huizinga, M., Dolan, C. V., & van der Molen, M. W. (2006). Age-related change in executive function: developmental trends and a latent variable analysis. Neuropsychologia, 44(11), 2017–2036. doi:10.1016/j.neuropsychologia.2006.01.010.

    Article  PubMed  Google Scholar 

  • Karmiloff-Smith, A. (2009). Nativism versus neuroconstructivism: rethinking the study of developmental disorders. Developmental Psychology, 45(1), 56–63. doi:10.1037/a0014506.

    Article  PubMed  Google Scholar 

  • Kinsella, G., Storey, E., & Crawford, J. R. (2007). Executive function and its assessment. In A. H. V. Schapira, E. Byrne, S. DiMauro, R. S. J. Frankowiak, R. T. Johnson, Y. Mizuno, et al. (Eds.), Neurology and clinical neuroscience (pp. 83–95). Philadelphia: Mosby Elsevier.

    Google Scholar 

  • Latzman, R. D., & Markon, K. E. (2010). The factor structure and age-related factorial invariance of the delis-Kaplan executive function system (D-KEFS). Assessment, 17(2), 172–184. doi:10.1177/1073191109356254.

    Article  PubMed  Google Scholar 

  • Lawrence, V., Houghton, S., Douglas, G., Durkin, K., Whiting, K., & Tannock, R. (2004). Executive function and ADHD: a comparison of children’s performance during neuropsychological testing and real-world activities. Journal of Attention Disorders, 7(3), 137–149.

    Article  PubMed  Google Scholar 

  • Li, X., Wang, K., Wu, J., Hong, Y., Zhao, J., Feng, X., et al. (2014). The link between impaired theory of mind and executive function in children with cerebral palsy. Research in Developmental Disabilities, 35(7), 1686–1693. doi:10.1016/j.ridd.2014.03.017.

    Article  PubMed  Google Scholar 

  • Lyster, S. A. H., Horn, E., & Rygvold, A. L. (2010). Ordforråd og ordforrådsutvikling hos norske barn og unge. Resultater fra en utprøving av British picture vocabulary scale II, second edition (BPVT II) [vocabulary and vocabulary development of Norwegian children and youth. Results from a try out of British picture vocabulary scale II, second edition (BPVT II)]. Spesialpedagogikk, 74, 35–43.

    Google Scholar 

  • MacAllister, W. S., Bender, H. A., Whitman, L., Welsh, A., Keller, S., Granader, Y., et al. (2012). Assessment of executive functioning in childhood epilepsy: the tower of London and BRIEF. Child Neuropsychology, 18(4), 404–415. doi:10.1080/09297049.2011.613812.

    PubMed  Google Scholar 

  • Mangeot, S., Armstrong, K., Colvin, A. N., Yeates, K. O., & Taylor, H. G. (2002). Long-term executive function deficits in children with traumatic brain injuries: assessment using the behavior rating inventory of executive function (BRIEF). Child Neuropsychology, 8(4), 271–284. doi:10.1076/chin.8.4.271.13503.

    Article  PubMed  Google Scholar 

  • McCoy, D. L. C., Raver, C. C., Lowenstein, A. E., & Tirado-Strayer, N. (2011). Assessing self-regulation in the classroom: validation of the BIS-11 and the BRIEF in low-income, ethnic minority school-age children. Early Education and Development, 22, 883–906. doi:10.1080/10409289.2010.508371.

    Article  Google Scholar 

  • Miyake, A., & Friedman, N. P. (2012). The nature and organization of individual differences in executive functions four general conclusions. Current Directions in Psychological Science, 21(1), 8–14. doi:10.1177/0963721411429458.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cognitive Psychology, 41(1), 49–100. doi:10.1006/cogp.1999.0734.

    Article  PubMed  Google Scholar 

  • Müller, U., Jacques, S., Brocki, K., & Zelazo, P. D. (2009). The executive functions of language in preschool children. In A. Winsler, C. Fernyhough, & I. Montero (Eds.), Private speech, executive functioning, and the development of verbal self-regulation (pp. 53–68). Cambridge: Cambridge University Press.

    Google Scholar 

  • Palisano, R. J., Rosenbaum, P., Walter, S., Russel, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology, 39, 214–223. doi:10.1111/j.1469-8749.1997.tb07414.x.

    Article  Google Scholar 

  • Pallant, J. (2010). SPSS survival manual (4th ed.). Berkshire, England: McGraw-Hill.

    Google Scholar 

  • Piovesana, A. M., Ross, S., Whittingham, K., Ware, R. S., & Boyd, R. N. (2015). Stability of executive functioning measures in 8–17 year-old children with unilateral cerebral palsy. The Clinical Neuropsychologist, 29(1), 133–149. doi:10.1080/13854046.2014.999125.

    Article  PubMed  Google Scholar 

  • Roid, G. H., & Miller, L. J. (1997). Leiter international performance scale-revised. Wood Dale, IL.: Stoelting.

    Google Scholar 

  • Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., et al. (2007). A report: the definition and classification of cerebral palsy April 2006. Developmental Medicine & Child Neurology, 49(Suppl. 109), 8–14. doi:10.1111/j.1469-8749.2007.tb12610.x.

    Google Scholar 

  • Sigurdardottir, S., Eiriksdottir, A., Gunnarsdottir, E., Meintema, M., Arnadottir, U., & Vik, T. (2008). Cognitive profile in young Icelandic children with cerebral palsy. Developmental Medicine & Child Neurology, 50, 357–362. doi:10.1111/j.1469-8749.2008.02046.x.

    Article  Google Scholar 

  • Spillane, M. M., Ross, K. K., & Vasa, S. F. (1996). A comparison of eye-gaze and standard response mode on the PPVT-R. Psychology in the Schools, 33(4), 265–271.

    Article  Google Scholar 

  • Stadskleiv, K., von Tetzchner, S., Batorowicz, B., van Balkom, H., Dahlgren Sandberg, A., & Renner, G. (2014). Investigating executive functions in children with severe speech and movement disorders using structured tasks. Frontiers in Psychology, 5. doi:10.3389/fpsyg.2014.00992.

  • Stadskleiv, K., Jahnsen, R., Andersen, G. L., & von Tetzchner, S. (2016). The relationship between language comprehension, speech, motor functioning and executive functioning. Research in Developmental Disabilities (submitted)

  • Usai, M. C., Viterbori, P., Traverson, L., & De Franchis, V. (2013). Latent structure of executive function in five- and six-year-old children: a longitudinal study. European Journal of Developmental Psychology, 11, 447–462. doi:10.1080/17405629.2013.840578.

    Article  Google Scholar 

  • Visser, L., Ruiter, S. A., Van der Meulen, B. F., Ruijssenaars, W. A., & Timmerman, M. E. (2013). Validity and suitability of the Bayley-III low motor/vision version: a comparative study among young children with and without motor and/or visual impairments. Research in Developmental Disabilities, 34(11), 3736–3745. doi:10.1016/j.ridd.2013.07.027.

    Article  PubMed  Google Scholar 

  • von Tetzchner, S., Almeida, M. A., Balandin, S., Basil, C., Batorowicz, B., Clendon, S., et al. (2012). The development of aided communicative competence – communicative problem solving in aided communicators and naturally speaking children aged 5–15 years. In Presented at the 15th biennial conference of the International Society for Augmentative and Alternative communication, July 28th– august 4th 2012. Pittsburgh: USA.

    Google Scholar 

  • Warschausky, S., Argento, A. G., Hurvitz, E., & Berg, M. (2003). Neuropsychological status and social problem solving in children with congenital or acquired brain dysfunction. Rehabilitation Psychology, 48(4), 250–254. doi:10.1037/0090-5550.48.4.250.

    Article  Google Scholar 

  • Wechsler, D. (2008). Wechsler Preschool and Primary Scale of Intelligence – third edition. Norwegian version. Stockholm: Pearson Assessment.

    Google Scholar 

  • Wechsler, D. (2009). Wechsler Intelligence Scale for Children – fourth edition. Norwegian version. Stockholm: Pearson Assessment.

    Google Scholar 

  • Weierink, L., Vermeulen, R. J., & Boyd, R. N. (2013). Brain structure and executive functions in children with cerebral palsy: a systematic review. Research in Developmental Disabilities, 34(5), 1678–1688. doi:10.1016/j.ridd.2013.01.035.

    Article  PubMed  Google Scholar 

  • Whittingham, K., Bodimeade, H. L., Lloyd, O., & Boyd, R. N. (2014). Everyday psychological functioning in children with unilateral cerebral palsy: does executive functioning play a role? Developmental Medicine & Child Neurology, 56, 572–579. doi:10.1111/dmcn.12374.

    Article  Google Scholar 

  • Wiebe, S. A., Espy, K. A., & Charak, D. (2008). Using confirmatory factor analysis to understand executive control in preschool children: I. Latent structure. Developmental Psychology, 44, 575–587. doi:10.1037/0012-1649.44.2.575.supp.

    Article  PubMed  Google Scholar 

  • Willoughby, M., Holochwost, S. J., Blanton, Z. E., & Blair, C. B. (2014). Executive functions: formative versus reflective measurement. Measurement: Interdisciplinary Research & Perspectives, 12(3), 69–95. doi:10.1080/15366367.2014.929453.

    Google Scholar 

  • World Health Organization (2004). International statistical classification of diseases and related health problems. Geneve, Switzerland: World Health Organization.

    Google Scholar 

  • Yeniceri, N., & Altan-Atalay, A. (2011). Age-related changes in the Wisconsin card sorting test performances of 8- to 11-year-old Turkish children. The Clinical Neuropsychologist, 25(7), 1179–1192. doi:10.1080/13854046.2011.613855.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Child Neurology, Oslo University Hospital, P.O. Box 4956 Nydalen, 0424, Oslo, Norway

    Kristine Stadskleiv & Reidun Jahnsen

  2. Department of Psychology, University of Oslo, Oslo, Norway

    Kristine Stadskleiv & Stephen von Tetzchner

  3. Department of Research, Sunnaas Rehabilitation Hospital, Nesodden, Norway

    Reidun Jahnsen

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  1. Kristine Stadskleiv
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Correspondence to Kristine Stadskleiv.

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All procedures performed were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards and the study was approved by the Norwegian Regional Committees for Medical and Health Research Ethics (#2012/1409).

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Informed consent was obtained from all individual participants included in the study. All parents were given written information about the project and gave consent for the children aged between six and 16 years. Adolescents older than 16 years, who were not intellectually disabled, gave consent themselves. The participants were not compensated economically for participating in the project, but travel expenses were refunded. As the participants were recruited from a hospital clinic, care was made in the written information to emphasize that consent could be withdrawn at any time and that this would not affect the clinical services provided by the hospital.

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Stadskleiv, K., Jahnsen, R. & von Tetzchner, S. Structure of Executive Functioning in Children with Cerebral Palsy: an Investigation of Anderson’s Developmental Model. J Dev Phys Disabil 28, 665–684 (2016). https://doi.org/10.1007/s10882-016-9500-6

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