Ability of early neurological assessment and continuous EEG to predict long term neurodevelopmental outcome at 5 years in infants following hypoxic-ischaemic encephalopathy

Hypoxic-ischaemic encephalopathy (HIE) symptoms evolve during the first days of life and their monitoring is critical for treatment decisions and long-term outcome predictions. This thesis aims to report the five-year outcome of a HIE cohort born in the pre-therapeutic hypothermia era and to evaluate the predictive value of (a) neonatal neurological and EEG markers and (b) development in the first 24 months, for outcome. Methods: Participants were recruited at age five from two birth cohorts; HIE and Comparison. Repeated neonatal neurological assessments using the Amiel-TisonNeurological-Assessment-at-Term, continuous video EEG monitoring in the first 72 hours, and Sarnat grading at 24 hours were recorded. EEG severity grades were assigned at 6, 12 and 24 hours. Development was assessed in the HIE cohort at 6, 12 and 24 months using the Griffiths Mental Development (0-2) Revised Scales. At age five, intellectual (WPPSI-IIIUK scale), neuropsychological (NEPSY-II scales), neurological and ophthalmic testing was completed. Results: 5-year outcomes were available for 81.5% (n=53) of HIE and 71.4% (n=30) of Comparison cohorts. In HIE, 47.2% (27% mild, 47% moderate, 83% severe Sarnat), had non-intact outcome vs. 3.3% of the Comparison cohort. Non-intact outcome rates by 6-hour EEG-grade were: grade0=3%, grade1=25%, grade2=54%, grade3/4=79%. In HIE, processing speed (p=0.01) and verbal short-term memory (p=0.005) were below test norms. No significant differences were found in IQ, NEPSY-II or ocular biometry scores between children following mild and moderate HIE. Median IQ scores for mild (99(94-112),p=grade 2) at 24hours had superior positive predictive value (74%; AUROC(95%CI)=0.70(0.55-0.85) for non-intact 5-year outcome than abnormal EEG at 6 hours (68%; AUROC(95%CI)=0.71(0.56-0.87). Within-child development scores were inconsistent across the first 24 months. Although all children with intact 24-month Griffiths quotient (n=30) had intact 5-year IQ, 8/30 had non-intact overall outcome. Conclusion: Predictive value of neonatal neurological assessments and an EEG grading system for outcome was confirmed. Intact early childhood outcomes post-HIE may mask subtle adverse neuropsychological sequelae into the school years. This thesis supports emerging evidence that mild-grade HIE is not a benign condition and its inclusion in studies of neuroprotective treatments for HIE is warranted

Do informal caregivers of people with dementia mirror the cognitive deficits of their demented patients?:A pilot study

Recent research suggests that informal caregivers of people with dementia (ICs) experience more cognitive deficits than noncaregivers. The reason for this is not yet clear. Objective: to test the hypothesis that ICs ‘mirror' the cognitive deficits of the demented people they care for. Participants and methods: 105 adult ICs were asked to complete three neuropsychological tests: letter fluency, category fluency, and the logical memory test from the WMS-III. The ICs were grouped according to the diagnosis of their demented patients. One-sample ttests were conducted to investigate if the standardized mean scores (t-scores) of the ICs were different from normative data. A Bonferroni correction was used to correct for multiple comparisons. Results: 82 ICs cared for people with Alzheimer's dementia and 23 ICs cared for people with vascular dementia. Mean letter fluency score of the ICs of people with Alzheimer's dementia was significantly lower than the normative mean letter fluency score, p = .002. The other tests yielded no significant results. Conclusion: our data shows that ICs of Alzheimer patients have cognitive deficits on the letter fluency test. This test primarily measures executive functioning and it has been found to be sensitive to mild cognitive impairment in recent research. Our data tentatively suggests that ICs who care for Alzheimer patients also show signs of cognitive impairment but that it is too early to tell if this is cause for concern or not

Understanding children's thinking about alcohol advertisements on television : a cognitive developmental approach

A theoretical understanding of the nature of knowledge and its development in children was applied to an under-researched area: children's thinking about television alcohol advertisements. Methodologies were developed which recognise that children have multiple ways of thinking about things, that learning is a dynamic process and that knowledge is not always available for verbal report. Research took two complementary routes. Firstly, cross-sectional studies with children aged 7 to 10 tapped into children's implicit, pre-explicit and explicit knowledge, by means of a categorisation study, a story style paradigm and interviews. Children of all ages found television alcohol advertisements attractive and particular styles of advertising, e. g. humour, cartoon format or the inclusion of an animal, increased the popularity of an advertisement. Children's pre-explicit and explicit responses appeared to be biased by the development of alcohol knowledge. Secondly, a longitudinal study followed a group of over 100 children aged 9 for three years, collecting data every six months and investigating the potential influence of a number of factors on positive alcohol expectancies, a predictor of alcohol behaviour. New measures provided data on children's alcohol expectancies (Alcohol Beliefs and Expectancies in Childhood questionnaire), family and peer influences (The Children's Alcohol Inventory), self-esteem (IAM questionnaire), television viewing habits (TV Viewing Habits Questionnaire), and exposure to television alcohol advertisements (Television Advertising Awareness Questionnaire). The findings suggest a possible long term influence of alcohol advertising around the age of II on later alcohol expectancies, but that this influence is less than that of peer behaviour and parental attitudes. It is also suggested that children as young as seven be included in future research,t hat the style of alcohol advertisements is monitored closely to minimise their appeal to children and, finally, that applied research should include methodologies which reflect the state and complexity of children's developing knowledge

Working memory and reading : a developmental study

Models of reading comprehension using the working memory paradigm have been formulated from studies using adult readers. Although there appear to be differences in working memory skills between beginner and mature readers, and normal and reading disabled children, the exact role of working memory in reading is still unclear. This study examined the role of working memory in the development of reading in children. A study ~v Baddeley, Logie, Nimmo-Smith, and Brereton (1985) was modified for this purpose to accommodate factors relevant to reading development in childre

Listening to the inner child in social cognition: the ontogeny of the dual architecture of social information processing

Studies conducted with children may be highly valuable for the advancement of social cognitive theory testing and building, beyond a strictly developmental scope, and particularly under the framework of the dual-architecture of social information processing. The arguments favouring this thesis are presented through the implementation of 7 studies, grouped in 2 sets. The first set of studies illustrates how research with differently-aged participants (preschoolers to ninth-graders) is useful for testing and informing dual-process theories, such as the three-stage model of person perception (Gilbert, Pelham, & Krull, 1988). Studies 1 and 2 tested, and corroborated, the ontogenetic prediction derived from the model that the situational correction process has a later ontogenetic onset than the dispositional characterization process. Study 3 examined the impact of prior expectancies on the dispositional characterization process, and the ways the obtained results inform the threestage model were discussed. The second set of studies illustrates how research with children is valuable for gathering knowledge about the operation of the more automatic processes, such as the ones involved in incongruency processing in impression formation settings. Studies 4 and 5 investigated participants’ willingness to know more about either a congruently or an incongruently described target-person. Study 6 examined whether participants conceived of a target-person described in incongruent terms as a real person. Finally, Study 7 tested differential recall of expectancy-congruent and incongruent information in 4- to 10-years-old children. Based on these results, hypotheses were generated about the more automatic processing of incongruent information, namely of incongruencyneglect and avoidance.Estudos com crianças podem ser valiosos para o teste e construção de teorias sóciocognitivas, para além dum âmbito estritamente desenvolvimentista, particularmente sob o enquadramento da arquitectura dualista do processamento de informação social. Sete estudos, agrupados em 2 conjuntos, servem a apresentação de argumentos a favor desta tese. O primeiro conjunto ilustra a utilidade de investigação com participantes de diferentes idades (pré-escolar até 9º ano) para testar e informar teorias de processamento dualista, como o modelo das três-etapas da percepção social (Gilbert, Pelham, & Krull, 1988). Os Estudos 1 e 2 testaram, e corroboraram, a predição ontogenética derivada do modelo de que a correcção situacional é um processo ontogeneticamente mais tardio do que a caracterização disposicional. O Estudo 3 examinou o impacto das expectativas prévias na caracterização disposicional e discutiu-se o modo como os resultados informam o modelo. O segundo conjunto de estudos ilustra o valor de investigação com crianças na acumulação de conhecimento sobre processos mais automáticos, tais como os envolvidos no processamento de incongruência em contextos de formação de impressões. Os Estudos 4 e 5 investigaram a preferência dos participantes por saber mais sobre uma pessoa-alvo congruente ou incongruentemente descrita. O Estudo 6 examinou se os participantes concebiam como real uma pessoa-alvo descrita de forma incongruente. Finalmente, o Estudo 7 testou a recordação diferencial de informação congruente e incongruente com expectativas em crianças de 4 a 10 anos. Com base nestes resultados geraram-se hipóteses sobre o processamento mais automático de informação incongruente, nomeadamente sobre negligência e evitação de incongruência

ImpacT2 project: preliminary study 1: establishing the relationship between networked technology and attainment

This report explored teaching practices, beliefs and teaching styles and their influences on ICT use and implementation by pupils. Additional factors explored included the value of school and LEA policies and teacher competence in the use of ICT in classroom settings. ImpaCT2 was a major longitudinal study (1999-2002) involving 60 schools in England, its aims were to: identify the impact of networked technologies on the school and out-of-school environment; determine whether or not this impact affected the educational attainment of pupils aged 816 years (at Key Stages 2, 3, and 4); and provide information that would assist in the formation of national, local and school policies on the deployment of IC

Classification of Motivational Dispositions: A Psychological Systems Perspective of Academic Behavior

Academic motivation is a complex psychological construct. It is multifaceted, hierarchical, dynamic, and developmental in nature. Students exhibit substantial heterogeneity in the ways in which academic motivation develops and manifests in short and long-term behavior. Much of the prior literature has considered motivated behavior in an academic subject like math to be the result of math motivation alone. This dissertation draws from the Eccles’ expectancy-value theory of achievement motivation, which posits that academic behavior is the result of subjective psychological perceptions of competence and task-value, in order to investigate the hierarchical and dynamic nature of motivational dispositions and their associations with academic behavior. In Chapter 2, I use variable and person-centered approaches to investigate the development of math and English self-concept of ability throughout adolescence and their dual role in the process of selecting a college major. I demonstrate that the relationship between math and English self-concept changes over time, from being positively correlated to uncorrelated to negatively correlated between sixth and twelfth grade. Cluster analyses uncover heterogeneity in the patterns of math and English self-concept that students hold, and these clusters are predictive of the college major that students eventually select. The cluster also reveal gender differences in self-concept hierarchies that ultimately relate to college major choice. In Chapter 3, I use longitudinal structural equation modeling to study the development of academic task-values in high school. I focus on the role of dimensional comparisons, which refer to cross-domain influences, across the domains of math, English, biology, and physical science. Results indicate that achievement relates to cross domain subjective task values (STV), and STV in 10th grade relates to cross domain STV in 12th grade. STVs in 12th grade relate to college major choice. In Chapter 4, I use cluster analysis and hierarchical logistic regression to investigate daily academic behavior in an undergraduate online course. I synthesize theories of motivated behavior and demonstrate that unique profiles of subjective task values and emotions relate to both expectations of task attainment and actual task attainment. In Chapter 5, I conclude with some critiques regarding the scientific study of motivation, such as problems with modeling latent constructs using linear models. I then present a dynamic systems approach from the physics to modeling human motivation

An evaluation of full-time remedial provision for boys with specific reading retardation

This study examined full-time remedial provision for 9-year-old\ud reading retarded boys. An operational definition of Specific\ud Reading Retardation (SRR) based on chronological age, IQ and\ud expected reading age was used, identifying groups of boys with\ud similar degrees of reading disability. Effects of remedial\ud provision for different IQ levels, perceptual motor maturation,\ud motor impairment and emotional behaviour were examined.\ud Comparisons were made between screening and retest reading\ud scores, (taken after 4 terms) using the boys as their own\ud controls. Remedial Class SRR boys were compared with SRR boys\ud remaining in mainstream classes. A chronological age control\ud group of 9-year-olds where CA=RA, and a reading age control group\ud of 7-year-olds where CA=RA were also used.\ud Control SRR boys made greater gains in reading than remedial\ud class boys. Reading age controls made greater gains than either\ud SRR group. Adjusted gain scores indicated a mean loss for\ud accuracy and comprehension in the remedial class and a loss for\ud comprehension for SRR controls. Rate of reading gain (one year)\ud was the same for all 9-year-old groups. Seven year olds advanced\ud 15 to 18 months.\ud Perceptual motor skills, motor impairment, and emotional\ud indicators were not related to reading gains. Higher Verbal IQ\ud scores were related to gains in reading comprehension, but not in\ud conjunction with a higher degree of emotional disturbance.\ud Nine year old SRR boys were developmentally similar to CA\ud controls in perceptual motor development, and similar to RA\ud controls in patterns of reading errors. They were behaviourally\ud different from either CA or RA controls at the beginning of the\ud study, but not significantly different at the end. SRR boys\ud were significantly poorer than either CA or RA controls in\ud control and coordination of upper limbs.\ud In spite of intensive remediation, SRR children remained behind\ud in reading and may always need a special curriculum