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Executive Functioning in Children Aged 6–18 Years with Cerebral Palsy

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Abstract

Executive functioning (EF) is necessary for purposeful and goal-directed activity. Deficits in EF have been related to prematurity, low birth weight and early acquired brain lesions. Cerebral palsy (CP) is a condition where all these factors might be present and therefore suited to explore the relative contribution of each. The aim is to investigate factors that may contribute to variability in EF in children with CP. Participants were 68 children with CP, with various degrees of speech and motor impairment. Mean age 10;2 years (range 6;0 to 17;7 years), 38 were girls. EF was investigated with tests, Backward memory from Leiter-R and Wisconsin Card Sorting Test, which were adapted so that the children could respond regardless of their level of motor functioning. The mean standardized scores on tests of EF were within the normal range (89.5–105.9). The considerable individual variation (55–145) is explained by age and cognitive ability. Of the 68 participants, a measure of EF was available for 57 (83.8%). The 11 who did not complete the tests all had an intellectual disability. Variability in EF in children with CP was explained by age and cognitive ability, and not by prematurity, type of brain lesion or epilepsy. There was a developmental trend towards an increase in EF with age. However, the delay in EF may have consequences for overall cognitive and everyday functioning. The large variability in EF suggests that cognition should be assessed in all children with CP.

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References

  • Alvarez, J. A., & Emory, E. (2006). Executive function and the frontal lobes: a meta-analytic review. Neuropsychology Review, 16(1), 17–42. doi:10.1007/s11065-006-9002-x.

    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, V., Anderson, P. J., Jacobs, R., & Smith, M. S. (2008). 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 

  • Baker, S., Hooper, S., Skinner, M., Hatton, D., Schaaf, J., Ornstein, P., & Bailey, D. (2011). Working memory subsystems and task complexity in young boys with fragile X syndrome. Journal of Intellectual Disability Research, 55(1), 19–29. doi:10.1111/j.1365-2788.2010.01343.x.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Bøttcher, L. (2010). Children with spastic cerebral palsy, their cognitive functioning, and social participation: a review. Child Neuropsychology, 16(3), 209–228. doi:10.1080/09297040903559630.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Bøttcher, L., Stadskleiv, K., Berntsen, T., Christensen, K., Korsfelt, Å., Kihlgren, M., & Ödman, P. (2015). Systematic cognitive monitoring of children with cerebral palsy – the development of an assessment and follow-up protocol. Scandinavian Journal of Disability Research, 1–12. doi:10.1080/15017419.2015.1091035.

  • Cheng, C., Burns, T. G., & Wang, M. D. (2013). Mining association rules for neurobehavioral and motor disorders in children diagnosed with cerebral palsy. In Healthcare Informatics (ICHI), 2013 I.E. International Conference on (pp. 258–263). doi:10.1109/ICHI.2013.24.

  • Christ, S. E., White, D., Brunstrom, J. E., & Abrams, R. A. (2003). Inhibitory control following perinatal brain injury. Neuropsychology, 17(1), 171. doi:10.1037/0894-4105.17.1.171.

    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 and Child Neurology, 48, 629–634. doi:10.1017/S0012162206001344.

    Article  PubMed  Google Scholar 

  • Dahlgren, S., Dahlgren Sandberg, A. D., & Larsson, M. (2010). Theory of mind in children with severe speech and physical impairments. Research in Developmental Disabilities, 31, 617–624. doi:10.1016/j.ridd.2009.12.010.

    Article  PubMed  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 functions and the frontal lobes. A lifespan perspective (pp. 23–57). New York: Taylor and Francis.

    Google Scholar 

  • Dunn, L. M., Dunn, L. M., Whetton, C., & Burley, J. (1997). The British Picture vocabulary Scale (Second ed.). London: NFER Nelson.

    Google Scholar 

  • Eliasson, A. C., Krumlinde Sundholm, L., Rösblad, B., Beckung, E., Arner, M., Öhrvall, A. M., & Rosenbaum, P. (2006). The Manual ability classification system (MACS) for children with cerebral palsy: Scale development and evidence of validity and reliability. Developmental Medicine and Child Neurology, 48, 549–554. doi:10.1111/j.1469-8749.2006.tb01313.x.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  • Foy, J. G., & Mann, V. A. (2013). Executive function and early reading skills. Reading and Writing, 26, 453–472. doi:10.1007/s11145-012-9376-5.

    Article  Google Scholar 

  • Ganesalingam, K., Yeates, K. O., Taylor, H. G., Walz, N. C., Stancin, T., & Wade, S. (2011). Executive functions and social competence in young children 6 months following traumatic brain injury. Neuropsychology, 25, 466–476. doi:10.1037/a0022768.

    Article  PubMed  PubMed Central  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 and Child Neurology, 57(3), 294–300. doi:10.1111/dmcn.12619.

    Article  PubMed  Google Scholar 

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

    Google Scholar 

  • Hidecker, M. J. C., Paneth, N., Rosenbaum, P. L., Kent, R. D., Lillie, J., Eulenberg, J. B., et al. (2011). Developing and validating the communication function classification system for individuals with cerebral palsy. Developmental Medicine and Child Neurology, 53, 704–710. doi:10.1111/j.1469-8749.2011.03996.x.

    Article  PubMed  PubMed Central  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 

  • Kolk, A., & Talvik, T. (2000). Cognitive outcome of children with early-onset hemiparesis. Journal of Child Neurology, 15, 581–587. doi:10.1177/088307380001500903.

    Article  PubMed  Google Scholar 

  • Korkman, M., Mikkola, K., Ritari, N., Tommiska, V., Salokorpi, T., Haataja, L., et al. (2008). Neurocognitive test profiles of extremely low birth weight five-year-old children differ according to neuromotor status. Developmental Neuropsychology, 33(5), 637–655. doi:10.1080/87565640802254471.

    Article  PubMed  Google Scholar 

  • Krägeloh-Mann, I., & Horber, V. (2007). The role of magnetic resonance imaging in elucidating the pathogenesis of cerebral palsy: a systematic review. Developmental Medicine and Child Neurology, 49(2), 144–151. doi:10.1111/j.1469-8749.2007.00144.x.

    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., & Sherman, E. M. (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 

  • Majnemer, A., Shevell, M., Hall, N., Poulin, C., & Law, M. (2010). Developmental and functional abilities in children with cerebral palsy as related to pattern and level of motor function. Journal of Child Neurology, 25(10), 1236–1241. doi:10.1177/0883073810363175.

    Article  PubMed  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 

  • Nadeau, L., Routhier, M. E. V., & Tessier, R. (2008). The performance profile on the Wisconsin card sorting test of a group of children with cerebral palsy aged between 9 and 12. Developmental Neurorehabilitation, 11(2), 134–140. doi:10.1080/17518420701688607.

    Article  PubMed  Google Scholar 

  • Olivieri, I., Bova, S. M., Urgesi, C., Ariaudo, G., Perotto, E., Fazzi, E., et al. (2012). Outcome of extremely low birth weight infants: what’s new in the third millennium? Neuropsychological profiles at four years. Early Human Development, 88(4), 241–250. doi:10.1016/j.earlhumdev.2011.08.012.

    Article  PubMed  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 and Child Neurology, 39, 214–223. doi:10.1111/j.1469-8749.1997.tb07414.x.

    Article  PubMed  Google Scholar 

  • Pennington, L., Mjøen, T., da Graça Andrada, M., & Murray, J. (2010). Viking Taleskala. Tønsberg: Sykehuset i Vestfold.

    Google Scholar 

  • Pennington, L., Virella, D., Mjøen, T., da Graça Andrada, M., Murray, J., Colver, A., et al. (2013). Development of the Viking speech scale to classify the speech of children with cerebral palsy. Research in Developmental Disabilities, 34(10), 3202–3210. doi:10.1016/j.ridd.2013.06.035.

    Article  PubMed  Google Scholar 

  • Pirila, S., van der Meere, J., Rantanen, K., Jokiluoma, M., & Eriksson, K. (2011). Executive function in youth with spastic cerebral palsy. Journal of Child Neurology, 26, 817–821. doi:10.1177/0883073810392584.

    Article  PubMed  Google Scholar 

  • Pueyo, R., Junqué, C., & Vendrell, P. (2003). Neuropsychological differences between bilateral dyskinetic and spastic cerebral palsy. Journal of Child Neurology, 18, 845–850. doi:10.1177/088307380301801204.

    Article  PubMed  Google Scholar 

  • da Rocha Dourado, M., Andrade, P. M. O., Ramos-Jorge, M. L., Moreira, R. N., & Oliveira-Ferreira, F. (2013). Association between executive/attentional functions and caries in children with cerebral palsy. Research in Developmental Disabilities, 34(9), 2493–2499. doi:10.1016/j.ridd.2013.05.003.

    Article  Google Scholar 

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

    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 and Child Neurology, 49(Suppl. 109), 8–14. doi:10.1111/j.1469-8749.2007.tb12610.x.

    Google Scholar 

  • Sattler, J. M. (1988). Assessment of children, revised and updated (third ed.). San Diego: Jerome M. Sattler, Publisher.

    Google Scholar 

  • Sherlock, R. L., Anderson, P. J., Doyle, L. W., & Victorian Infant Collaborative Study Group. (2005). Neurodevelopmental sequelae of intraventricular haemorrhage at 8 years of age in a regional cohort of ELBW/very preterm infants. Early Human Development, 81(11), 909–916. doi:10.1016/j.earlhumdev.2005.07.007.

    Article  PubMed  Google Scholar 

  • Sherwell, S., Reid, S. M., Reddihough, D. S., Wrennall, J., Ong, B., & Stargatt, R. (2014). Measuring intellectual ability in children with cerebral palsy: can we do better?. Research in Developmental Disabilities, 35(10), 2558–2567. doi:10.1016/j.ridd.2014.06.019.

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

    Article  PubMed  Google Scholar 

  • Skranes, J., Evensen, K. I., Løhaugen, G. C., Martinussen, M., Kulseng, S., Myhr, G., et al. (2008). Abnormal cerebral MRI findings and neuroimpairments in very low birth weight (VLBW) adolescents. European Journal of Paediatric Neurology, 12(4), 273–283. doi:10.1016/j.ejpn.2007.08.008.

    Article  PubMed  Google Scholar 

  • Smits, D. W., Ketelaar, M., Gorter, J. W., van Schie, P. E., Becher, J. G., Lindeman, E., & Jongmans, M. J. (2011). Development of non-verbal intellectual capacity in school-age children with cerebral palsy. Journal of Intellectual Disability Research, 55(6), 550–562. doi:10.1111/j.1365-2788.2011.01409.x.

    Article  PubMed  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., Vik, T., Andersen, G. L., & Lien, E. (2015). Is cognition assessed appropriately in children with cerebral palsy? Developmental Medicine and Child Neurology, 57(Supplement s4), 23. doi:10.1111/dmcn.12778_52.

    Google Scholar 

  • Stadskleiv, K., Jahnsen, R., & von Tetzchner, S. (2016). Structure of executive functioning in children with cerebral palsy: An investigation of Anderson’s developmental model. Journal of Developmental and Physical Disabilities, 1–20. doi:10.1007/s10882-016-9500-6.

  • Straub, K., & Obrzut, J. E. (2009). Effects of cerebral palsy on neuropsychological function. Journal of Developmental and Physical Disabilities, 21(2), 153–167. doi:10.1007/s10882-009-9130-3.

    Article  Google Scholar 

  • von Tetzchner, S., & Martinsen, H. (2000). Introduction to augmentative and alternative communication (second ed.). London: Whurr/Wiley.

    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 

  • 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 

  • White, D. A., & Christ, S. E. (2005). Executive control of learning and memory in children with bilateral spastic cerebral palsy. Journal of the International Neuropsychological Society, 11, 920–924. doi:10.1017/S1355617705051064.

    Article  PubMed  Google Scholar 

  • World Health Organization. (2004). International statistical classification of diseases and related health problems. Geneve: 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 Clinical Neurosciences for Children, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway

    Kristine Stadskleiv & Reidun Jahnsen

  2. Department of Research, Sunnaas Rehabilitation Hospital, 1450 Nesoddtangen, Nesodden, Norway

    Reidun Jahnsen

  3. The Cerebral Palsy Register of Norway, Vestfold Hospital Trust, P.O. Box 2168, 3103, Tønsberg, Norway

    Guro L. Andersen

  4. Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, 7491, Trondheim, Norway

    Guro L. Andersen

  5. Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317, Oslo, Norway

    Stephen von Tetzchner

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  1. Kristine Stadskleiv
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Correspondence to Kristine Stadskleiv.

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Ethical Approval

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

Informed Consent

Informed consent was obtained from all individual participants included in the study; parents gave consent for the children aged between six and 16 years and 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.

Conflicts of Interest

Authors Kristine Stadskleiv, Reidun Jahnsen, Guro L. Andersen and Stephen von Tetzchner declare that there are no conflicts of interest.

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Stadskleiv, K., Jahnsen, R., Andersen, G.L. et al. Executive Functioning in Children Aged 6–18 Years with Cerebral Palsy. J Dev Phys Disabil 29, 663–681 (2017). https://doi.org/10.1007/s10882-017-9549-x

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