Cognitive rehabilitation in children with acquired brain injuries

Abstract

Deficits in attention, memory and executive functions are the most common cognitive dysfunctions after acquired brain injuries (ABI) and may have a major negative influence on academic and social adjustment. Neuropsychological measures can assess these dysfunctions and shortcomings in academic and social life, but there is a great need for new efficacious cognitive treatment programmes.

The main aims of this thesis were to evaluate the direct and maintained effects of a specific programme for cognitive training in children, and to evaluate whether the effects of training are transferred to the children s daily life.

In Study I a computerized measure of attention and impulsivity, the Gordon Diagnostic System (GDS) was validated. The GDS was used on a sample (N=71) of Swedish children from the greater Stockholm area fulfilling the criteria for Attention Deficit Hyperactivity Disorder (ADHD) according to the Diagnostic and Statistical Manual for Mental Disorders DSM-IV. The Children with ADHD had significantly lower scores of correct responses on the GDS as compared to controls (N=88). These scores were also strongly associated with age.

In Study II the feasibility of a cognitive training programme, the Amsterdam memory and attention training for children (Amat-c) was tested on children with traumatic brain injuries (TBI).The results on several neuropsychological tests improved. Parents' and teachers' ratings indicated that the children learned strategies enabling them to improve their school achievement and their self-image. The Amat-c method was modified to take into account the experience gained from the preliminary results before launching a randomized controlled study, which formed Study III.

In Study III the immediate effects of training with the Amat-c programme in children with ABI were evaluated. The training group (N=18) as compared to controls (N=20) showed a significant improvement on complex neuropsychological tests of attention and memory. Less effect was observed on more simple tests of reaction time.

In Study IV the persistence of training induced effects was examined 6 months after completion of the intervention, and an investigation whether demographic and clinical variables influenced outcome. The essential finding was that the significant improvement in complex attention and memory tasks reported in Study III persisted 6 months after completion of the training. No significant influence of demographic or clinical variables on outcome could be detected. This result provided support for the robustness of the training programme as well as for its external validity.

In Study V the possible transfer of the previous positive treatment, on the children s daily life was evaluated using behaviour rating scales for the parents, teachers and children. Teachers, in particular observed a significant improvement in school performance as well as on attention and executive functions. Parents and children described a similar trend. Less effect was observed on social behaviour.

Summary: The Gordon Diagnostic System is an objective measure to assess attention problems in children across ages. The Amat-c cognitive training method improved complex attention and memory functions in children with ABI. The gains are maintained for at least 6 months following completion of the programme. Children learn to develop strategies and deal appropriately with a task, but do not improve speed of performance. The training effects seem to transfer to behavioural aspects like school performance, attention and executive functions, but less obviously to social behaviour.