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Biomedical subjects

Deborah P Waber

Publications and source records attributed to Deborah P Waber.

12 recordsLinked to original sources
PubMed2006

Everyday cognitive function after craniopharyngioma in childhood.

Despite clinical impressions that cognitive complaints are prominent in patients with a history of craniopharyngioma, formal neuropsychologic documentation is inconsistent. This study assessed everyday cognitive complaints and neuropsychologic test performance to evaluate the prevalence of problems and the relationship of these domains to one another in patients treated for craniopharyngioma in childhood or adolescence. Ten patients treated for craniopharyngioma completed measures of everyday cognitive function (Cognitive Failures Questionnaire, Rivermead Behavioural Memory Test) and a battery of standard neuropsychologic tests. The prevalence of problems was ascertained for each measure. Most patients demonstrated significant deficits in everyday memory (Cognitive Failures Questionnaire, 9/10 patients; Rivermead Behavioural Memory Test, 7/10 patients). Scores were within normal limits, however, for intelligence quotient, achievement, attention, verbal memory, and spatial working memory. Processing speed was slow (5/10 patients). Spatial working memory predicted Cognitive Failures Questionnaire (P < 0.07), as did somatic symptoms from the Beck Depression Inventory (P < 0.01), but these associations appeared independent. Adolescents and young adults with treated craniopharyngioma experience deficits in everyday cognitive functions, many involving memory, that are not easily detected by standard neuropsychologic testing. The extent of self-rated cognitive problems is related to spatial working memory and somatic concerns.

Activities of Daily Living↗
PubMed2006

Executive functions and performance on high-stakes testing in children from urban schools.

High-stakes achievement testing is a centerpiece of education reform. Children from socially disadvantaged backgrounds typically perform more poorly than their more advantaged peers. The authors evaluated 91 fifth-grade children from low-income urban schools using clinical neuropsychological tests and behavioral questionnaires and obtained fourth-grade scores on state mandated standards-based testing. Goals were to determine whether executive functions are selectively diminished in children from poor urban environments and to evaluate to what extent integrity of executive functions is associated with test scores. Neuropsychological variables (particularly executive functions) accounted for 40% of the variance in English scores and 30% in mathematics. Efforts to improve children's academic achievement should consider developmental factors as well as curricular content.

Achievement↗
PubMed2004

Outcomes of a randomized trial of hyperfractionated cranial radiation therapy for treatment of high-risk acute lymphoblastic leukemia: therapeutic efficacy and neurotoxicity.

PURPOSE: We evaluated 8-year survival and late neuropsychologic toxicity in children with acute lymphoblastic leukemia treated in a randomized clinical trial to test whether hyperfractionated (twice daily) cranial radiation therapy (CRT) can reduce incidence and severity of late toxicities associated with 18 Gy of CRT. PATIENTS AND METHODS: Between 1987 and 1995, 369 children treated on two consecutive Dana-Farber Cancer Institute Consortium protocols for high-risk acute lymphoblastic leukemia were randomly assigned to conventionally fractionated CRT (CFX) or hyperfractionated CRT (HFX) to a total dose of 18 Gy. Neuropsychologic testing was completed for 125 of 287 children in continuous complete remission. Event-free and overall survival, as well as neuropsychologic function, were compared for the two arms of the protocol. RESULTS: Eight-year event-free survival (+/- SE) was 80% +/- 3% for children randomly assigned to CFX and 72% +/- 3% for HFX (P =.06). Overall survival was 85% +/- 3% for CFX and 78% +/- 3% for HFX (P =.06). CNS relapses occurred in 2.8% of patients receiving CFX and 2.7% receiving HFX (P =.99). Cognitive function for both groups was solidly in the average range, with no group differences in intelligence, academic achievement, visuospatial reasoning, or verbal learning. Children on the HFX arm exhibited a modest advantage for visual memory (P <.05). CONCLUSION: HFX provides no benefit in terms of cognitive late effects and may compromise antileukemic efficacy. HFX should not be substituted for conventionally dosed CRT in children who require radiation therapy for treatment of acute lymphoblastic leukemia.

Adolescent↗
PubMed2003

Motor sequence learning and reading ability: is poor reading associated with sequencing deficits?

Although it is widely assumed that children with learning disabilities have "sequencing problems," these have not been well specified. A non-verbal serial reaction time (SRT) paradigm was used to evaluate motor sequence learning in 422 children between ages 7 and 11 in relation to reading, cognitive ability level, and attention problems. The children demonstrated the response profile typically associated with motor sequence learning, but the component of the profile indicative of implicit sequence learning was not reliably associated with any of the predictors. Cognitive ability predicted overall response time; cognitive ability, reading, and attention problems each predicted overall accuracy. Explicit learning was predicted by cognitive ability, but not by reading or attention problems. Thus, we found no evidence that poor reading is preferentially associated with a domain general deficit in sequential learning.

Aptitude↗
PubMed2003

A functional magnetic resonance imaging study of paced finger tapping in children.

Fourteen typically developing children from 7.9-11.3 years in age were studied with functional magnetic resonance imaging to identify the cerebral loci involved in performance of paced finger tapping by children. Each child performed two bimanual alternating paced finger-tapping tasks. In the first, paced finger tapping was conducted to external 3-Hz pacing provided by a metronome. In the second, the metronome was turned off and finger tapping continued while each child tried to maintain the 3-Hz rhythm by self pacing. Individual and group data were analyzed with statistical parametric mapping techniques that resulted in activation maps for the two tasks. Metronome tapping produced activation of the posterior regions of both superior temporal gyri, both primary sensorimotor cortices, anterodorsomedial cerebellum and supplementary motor area. Self-tapping resulted in recruitment of pre-supplementary motor area and cerebellum in addition to bilateral supplementary motor area and primary sensorimotor cortical activation. Bimanual alternating paced finger tapping performed by children activates a neural network involving primary motor cortex, supplementary motor area, and cerebellum. Posterior superior temporal gyrus may be important for encoding auditory information, and presupplementary motor area and midline cerebellum play an important role in self-paced finger tapping.

Age Factors↗
PubMed2003

Event-related correlations in learning impaired children during A hybrid go/no-go choice reaction visual-motor task.

One hundred sixty-nine learning impaired (LI) and 71 non-learning impaired (NLI) children underwent a hybrid go/no-go choice reaction time visual-motor task to study the behavioral and physiological fundamentals of learning disorders. A left button was pressed for Left Arrow (LA) stimuli, a right for Right Arrow (RA) stimuli, none (no-go) for a non-directional arrow. Stimulus specific visual evoked potentials were formed and, with PZ as index electrode, were lag-correlated to frontal electrodes to form Event-Related Correlations (ERC). Exploratory t-statistic significance probability maps (t-SPM) were used to define regions of interest (ROI). Behaviorally, there was a right-hand advantage over the left in the NLI group, but less in the LI group. Electrophysiologically, RA and LA conditions increased correlation between visual areas (PZ) and contralateral frontal areas (F3 and F4). A unilateral ROI, at electrode FC1, also preceded both left- and right-handed responses. Neurobehaviorally, increased visual-motor correlation was associated with better performance, especially for the left hemisphere, at F3 and FC1. Surprisingly, visual-motor correlations were not associated with performance for the NLI group in the RA and no-go condition. Our data support previously reported difficulties of learning impaired children in low-level information processing. Furthermore, we hypothesize that LI, in contrast to NLI children, demonstrate difficulty in automatizing routine tasks.

Brain↗
PubMed2003

Neuropsychological functioning after surgery in children treated for brain tumor.

OBJECTIVE: To describe the neuropsychological functioning of children treated with surgery only for localized brain tumors in Dana-Farber Cancer Institute Protocol 92-077. Subsequent reports will describe the neuropsychological functioning of children treated with surgery and stereotactic radiation therapy on Dana-Farber Cancer Institute 92-077. METHODS: The intellectual functioning of 106 patients was evaluated within 3 months after surgery. An in-depth assessment of the neuropsychological functioning, including an impairment index, was conducted for a subset of 77 school-age children (6-16 yr old) across six functional domains. Descriptive statistics were generated; binomial distribution analyses were performed to assess whether the proportion of individuals with impaired performance on each measure exceeded normative expectations. The impairment index assessed whether poor performance was attributable to a few children or reflected the performance of the cohort as a whole. RESULTS: Although the Full Scale IQ was within normative expectations, the Verbal IQ was higher than the Performance IQ with 45% of individuals showing a significant discrepancy (P < 0.01) between these scales. There was an increased prevalence of poor performance for measures of motor output, verbal memory, and visuospatial organization. The distribution of the impairment index indicated moderate impairment across the school-age cohort rather than severe impairment in a few patients. CONCLUSION: The results document a moderate level of neuropsychological morbidity among children with brain tumors before stereotactic radiation therapy, presumably referable to the tumor itself and the surgery. The extent to which stereotactic radiation therapy may increase this burden will be assessed in follow-up studies evaluating the longitudinal neuropsychological data.

Adolescent↗
PubMed1997

Toxicity of CNS prophylaxis for childhood leukemia.

Long-term neurotoxicity associated with central nervous system (CNS) prophylaxis for childhood acute lymphoblastic leukemia (ALL), primarily involving physical growth and cognitive development, is an ongoing concern. Although contemporary treatment protocols are associated with less severe toxicity than was commonly observed with earlier protocols, there continue to be late effects. When treatment includes cranial radiation therapy (CRT), linear growth is likely to be impaired. Female patients are more vulnerable to late cognitive effects than male patients, particularly when treated with CRT and high doses of methotrexate. Young age at treatment is a risk factor as well, particularly for girls. In order to treat medical and psychological problems early, a commitment to long-term follow-up is essential.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

Information processing deficits in children with attention-deficit/hyperactivity disorder, inattentive type, and children with reading disability.

We examined the information processing capabilities of children diagnosed with the inattentive subtype of attention-deficit/hyperactivity disorder (ADHD) who had been characterized as having a sluggish cognitive tempo. Children referred for school-related problems (n = 81) and nonreferred community controls (n = 149) participated. Of the referred children, 24 met criteria for ADHD, 42 met criteria for reading disability (RD), and 9 of these were comorbid for RD and ADHD. Children with ADHD differed from those without ADHD on a visual search task but not on an auditory processing task; the reverse was true for children with RD. Decomposition of the visual search task into component operations demonstrated that children in the ADHD group had a slow processing rate that was not attributable to inattention. The children with ADHD were not globally poor at information processing or inattentive, but they demonstrated diminished speed of visual processing.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

Neurobehavioral factors associated with referral for learning problems in a community sample: evidence for an adaptational model for learning disorders.

We evaluated community general education (CGE; n = 178), community special education (CSE; n = 30) and hospital-referred (HR, n = 145) children (ages 7-6 to 11-11) prospectively over a 2-year period. During this period, 17 CGE children were referred for evaluation (community referred; CR). Prior to referral, CR children performed more poorly than community-nonreferred (CNR) children on cognitive ability, academic achievement, attention problems, and information processing. CR group performance was equivalent to that of CSE and HR groups, but HR children showed poorer academic achievement. Referred children performed more poorly on all measures than nonreferred, whether they met formal diagnostic criteria for a learning disorder or not. Learning disorders may be better conceptualized as a context-dependent problem of functional adaptation than as a disability analogous to physical disabilities, raising questions about the validity of using psychometric test scores as the criterion for identification.

Achievement↗
PubMedDate not supplied

Neurodevelopmental characteristics of children with learning impairments classified according to the double-deficit hypothesis.

The double-deficit model has been examined primarily in relation to reading. We investigated whether children classified according to the double-deficit model would exhibit differences in other neuropsychological domains. Children referred for learning problems (N = 188), ages 7 to 11, were classified by double-deficit subtype. Only three of the four groups predicted by the model could be identified. There were no group differences in IQ or attention problems. The three groups showed different neuropsychological profiles, involving functional domains other than reading and language. Differences also emerged in nonverbal low-level information processing. The double-deficit group was generally most severely affected. The double-deficit groupings identify children with different neuropsychological profiles and variation in the efficiency of basic online information processing, extending beyond the oral and written language domain.

Anomia↗