Puolustusvoimien tulevaisuuden haasteita

Artikkeli on puolustusvoimain komentajan Suomen Sotatieteellisen Seuran vuosikokouksessa huhtikuussa 1993 pitämä esitelmä. Komentaja totesi puheensa alussa, että "Kuluva vuosi on puolustusvoimille paitsi juhlavuosi myös poikkeuksellisen monien ja suurien haasteiden vuosi. Euroopan murroksesta ja taloudellisesta lamastamme johtuvien haasteiden moninaisuus ja ristiriitaisuus ovat ongelma sinänsä. Vielä vaikeampaa on ratkaisujen tarjoaminen niihin, sillä tulevaisuuden ennustaminen on tunnetusti vaikeaa ja viime vuosien nopeatempoisten muutosten perusteella huominen näyttää olevan tulvillaan epävarmuustekijöitä. On syytä muistaa, että maailman ja maanosamme turvallisuus on yleensä joutunut koetukselle tilanteissa, joita ja joiden laatua ei ole kyetty näkemään etukäteen. Lähden esityksessäni liikkeelle kylmän sodan aikana vallinneesta turvallisuusympäristöstä ja Suomen ratkaisuista sen aikana ja jatkan hahmottelemalla suuren muutoksen aiheuttamia haasteita ja puolustuksen kehitysnäkymiä." Puheensa loppuosassa komentaja toteaa, että " Olen esityksessäni käsitellyt puolustusvoimien kohtaamia haasteita tärkeinä näkemistäni lähtökohdista käsin. Haluan lopuksi uudelleen korostaa varsinaisen puolustuskyvyn vaalimisen tärkeyttä ja vähäisten voimavarojen kohdistamista sen hyväksi.

Assessment and development of executive functions in school-age children

Executive functions (EFs) are essential for coordination and controlling of other cognitive functions and behavior. EFs are involved in all purposeful activity, and for children, they are important for learning and functioning in school environments. Difficulties in EFs are common in school-age children with developmental disabilities, such as attention deficit disorder (ADHD). This thesis consists of three studies addressing EFs in school-age children. The first study employed neuropsychological tests from the Developmental Neuropsychological Assessment NEPSY to examine age-related differences in EFs in a sample of 400 children. The second study investigated the methodological factors related to EF measures in a sample of 340 children using response inhibition tasks from the NEPSY-II, the second edition of the Developmental Neuropsychological Assessment. The third study aimed at constructing a new instrument, the Attention and Executive Function Rating Inventory ATTEX, for the clinical assessment of EFs and verifying the psychometric properties of the rating scale in a sample of 916 children. Age-related improvement in EF task performance continued throughout the school-age period, proceeding from inhibition to attention control, and further to fluency of actions. A closer examination of response inhibition showed developmental variation even within this EF domain. The developmental change was apparent at school age, but different outcome measures and the cognitive requirements of tasks had an effect on how the development of response inhibition was depicted. In the assessment of everyday EF behaviors, the ATTEX rating scale demonstrated high internal consistency reliability and good criterion and discriminant validity for ADHD. The EF profiles were different for the ADHD subtypes, and children with predominantly inattentive symptoms showed more wide-ranging difficulties in EFs than children with combined symptoms of inattention and hyperactivity-impulsivity. Carefully examined, reliable, and valid measures are essential for both the scientific research and clinical assessment of EFs. Factors related to the measures, e.g., materials, stimuli, and the selected outcome measure, and the cognitive processes involved in tasks have effect on how development of EFs is depicted. Close examination of these factors can help to attain a more consisted account on EF development. In the clinical assessment of EF difficulties, the measures need to be sensitive to the actual difficulties that arise in every-day situations. These are best assessed with standardized rating scales. The new rating scale presented in this thesis proved to be a suitable measure both for screening and examining the detailed EF profiles of children in school situations.Toiminnanohjaus koordinoi ja kontrolloi muita kognitiivisia toimintoja ja käyttäytymistä. Se osallistuu kaikkeen tavoitteelliseen toimintaan ja, etenkin lapsilla, se vaikuttaa oppimiseen sekä käyttäytymiseen kouluympäristössä. Toiminnanohjauksen vaikeuksia esiintyy yleisesti lapsilla, joilla on kehitykseen liittyviä häiriöitä kuten tarkkaavuushäiriöitä. Väitöstutkimuksen ensimmäisessä osassa toiminnanohjauksen kehitystä arvioitiin 400 lapsen aineistossa Lasten neuropsykologinen tutkimus NEPSY:n osatesteillä. Toisessa tutkimuksessa selvitettiin testien metodologisten ominaisuuksien vaikutuksia käyttäen NEPSY-II:n inhibitiotehtäviä 340 lapsen kehityksen arvioinnissa. Kolmannen tutkimuksen tavoitteena oli kehittää uusi kyselymenetelmä, Keskittymiskysely, lasten toiminnanohjauksen vaikeuksien kliinistä arviointia varten sekä arvioida menetelmän toimivuutta 916 lapsen aineistossa. Toiminnanohjauksessa havaittiin kehitystä koko kouluiän ajan. Ensimmäisinä vahvistuivat reaktioiden kontrollointi, sitten tarkkaavuuden säätely ja lopulta sujuva toimintojen tuottaminen. Lähemmin tarkasteltuna nämä muutokset näyttivät kuitenkin heijastavan käytettyjen mittareiden ominaisuuksia. Esimerkiksi reaktiokontrolli kehittyi kouluiässä edelleen, mutta kehityksen eteneminen oli eri tulosmuuttujilla mitattuna erilaista. Myös tehtävien kognitiiviset vaatimukset ja käytetyt ärsykkeet vaikuttivat kehityskulkua kuvaaviin tuloksiin. Keskittymiskyselyn luotettavuus ja erottelukyky tarkkaavuushäiriön arvioinnissa osoittautuivat vahvoiksi. Kyselyn perusteella tarkkaavuushäiriön alatyyppien toiminnanohjauksen profiilit erosivat toisistaan. Pääsääntöisesti tarkkaamattomilla lapsilla oli laaja-alaisempia toiminnanohjauksen vaikeuksia kuin lapsilla, joilla oli sekä ylivilkkauteen ja impulsiivisuuteen että tarkkaamattomuuteen liittyviä oireita. Huolellisesti tutkitut ja luotettavat neuropsykologiset arviointimenetelmät ovat välttämättömiä niin tieteellisessä tutkimuksessa kuin kliinisessä työssäkin. Menetelmiin liittyvät tekijät, kuten tehtävämateriaalit, ärsykkeet ja tulosmuuttujat sekä suoritukseen osallistuvat muut kognitiiviset toiminnot vaikuttavat toiminnanohjauksen kehitystä koskeviin tuloksiin. Näitä tekijöitä huolellisesti tarkastelemalla voidaan tulevaisuudessa saada tarkempaa tietoa kehityksen etenemisestä. Toiminnanohjauksen vaikeuksien kliinisessä arvioinnissa tarvitaan menetelmiä, jotka kuvaavat luotettavasti arjen taitoja ja ongelmia. Kyselymenetelmien käyttäminen onkin kliinisessä arvioinnissa tarpeellista. Tässä väitöstutkimuksessa käytetty uusi kyselymenetelmä osoittautui toimivaksi välineeksi tarkkaavuusvaikeuksien seulonnassa sekä koulussa esiin tulevien toiminnanohjauksen ongelmien tarkemmassa arvioinnissa

Teacher Ratings of Executive Function Difficulties in Finnish Children with Combined and Predominantly Inattentive Symptoms of ADHD

School-age children with difficulties in executive functions (EFs) are at risk for substantial academic impairment and poorer developmental outcome. Although Attention Deficit Hyperactivity Disorder (ADHD) is generally associated with weaknesses in EFs, a relatively minimal amount is known about school-related EF difficulties and differences between ADHD subtypes. The present study examined teacher ratings of EF behaviors in 7- to 15-year-old Finnish children with combined symptoms of ADHD (ADHD-C; n =189), predominantly inattentive symptoms (ADHD-I; n = 25), and no ADHD (n = 691). The teacher ratings showed that both ADHD groups had more EF difficulties than controls. Ratings also indicated specific EF profiles for the ADHD subtypes, students with ADHD-I having more wide-ranging EF difficulties in attention as well as initiation, planning, and execution of actions than children with ADHD-C. According to the present findings, the school-related EF difficulties of children with ADHD-I need to be specifically acknowledged. Teacher ratings seem to be sensitive indicators of EF difficulties and distinguish between different kinds of EF profiles. In clinical practice, rating scales with reliable psychometric properties and normative data relevant to the specific cultural environment should be employed.Peer reviewe

Impairments of executive functionin young children referred to child psychiatric outpatient clinic

Few studies have reported on the quantity and quality of executive function (EF) deficits in young children referred to child psychiatric outpatient clinic with multiple psychiatric symptoms. We evaluated the EF deficits with the Attention and Executive Function Rating Inventory-Preschool (ATTEX-P) filled out by day care teachers for 4- to 7-year-old clinical group (n = 171) and reference group (n = 709). Family background information was collected from all families by parent questionnaire. Diagnoses of the referred children were collected from medical records. Clinical group exhibited higher mean ranks across the ATTEX-P Total score and all nine subscales than reference group (p <.001). Most of the children in the clinical group (58.5%) showed a significant amount of EF deficits (ATTEX-P Total score over clinical cut-off) including distractibility (55.6%) and impulsivity (53.8%) regardless of their diagnoses. In a multiple logistic regression model (controlling for age, gender and parental education), children in the clinical group had increased risk (odds ratio (OR)) = 10.6, 95% confidence interval (CI) = [6.88, 16.2], p <.001) for scoring over the clinical cut-off point on the ATTEX-P Total score. Assessment of EFs should be a routine part of the treatment plan in young children referred to child psychiatric outpatient clinic as it may guide the treatment choices.Peer reviewe

Heterogeneity of executive functions among preschool children with psychiatric symptoms

The aim of the present study was to investigate associations between internalizing and externalizing symptoms and deficits in executive functions (EF) as well as to examine the overall heterogeneity of EFs in a sample of preschool children attending a psychiatric clinic (n = 171). First, based on cut-off points signifying clinical levels of impairment on the parent-completed Child Behavior Checklist (CBCL), children were assigned into groups of internalizing, externalizing, combined or mild symptoms and compared to a reference group (n = 667) with regard to day care teacher ratings of EFs on the Attention and Executive Function Rating Inventory-Preschool (ATTEX-P). Second, latent profile analysis (LPA) was employed to identify distinct subgroups of children representing different EF profiles with unique strengths and weaknesses in EFs. The first set of analyses indicated that all symptom groups had more difficulties in EFs than the reference group did, and the internalizing group had less inhibition-related problems than the other symptom groups did. Using LPA, five EF profiles were identified: average, weak average, attentional problems, inhibitory problems, and overall problems. The EF profiles were significantly associated with gender, maternal education level, and psychiatric symptom type. Overall, the findings suggest that the comparison of means of internalizing and externalizing groups mainly captures the fairly obvious differences in inhibition-related domains among young psychiatric outpatient children, whereas the person-oriented approach, based on individual differences, identifies heterogeneity related to attentional functions, planning, and initiating one's action. The variability in EF difficulties suggests that a comprehensive evaluation of a child's EF profile is important regardless of the type of psychiatric symptoms the child presents with.Peer reviewe

Phonologic Rehabilitation of Anomia in Aphasia

The single most common feature of aphasia is impairment in ability to name, whether it involves naming seen objects, or producing nouns, verbs and other words conveying meaning in spontaneous language. The traditional treatment approach to this problem is to explicitly train aphasic patients in naming. Controlled studies have shown that this approach may be quite effective. However, typically generalization is very limited, that is, the knowledge gained by the patient tends to be limited to the words actually trained, and there is at best very modest improvement in performance with untrained words (limited mainly to those that are semantically related to the trained words). Because generalization is can be limited with this approach, there currently exists no viable means of training patients on the full corpus of words (perhaps several thousand) they are likely to need in daily life. Two approaches might be taken to solving this problem: 1) develop cost effective means for providing training on several thousand words; and 2) develop alternative training methods, e.g., phonological therapy, that potentially could intrinsically generalize widely. The focus of this proposal is the second of these two approaches. Thus, the primary purpose of this Phase II clinical rehabilitation study was to examine the effect of a phonologic based treatment on confrontation naming by individuals with anomic aphasia. We used a single-subject ABA design replicated across ten participants. The primary research question asked if phonologic treatment would improve confrontation naming. Secondary research questions addressed the impact of treatment on 1) generalization to untrained behaviors such as discourse production; 2) retention effects at 3-months; 3) phonologic production and 4) nonword repetition (potential evidence of phoneme sequence knowledge acquisition)

Postnatal N‑acetylcysteine does not provide neuroprotection in extremely low birth weight infants : A follow-up of a randomized controlled trial

Corrigendum, DOI: 10.1016/j.earlhumdev.2019.05.004.Peer reviewe

Latent class growth analysis identified different trajectories in cognitive development of extremely low birthweight children

Background Recent longitudinal studies suggest stable cognitive development in preterm children, although with great individual variation. This prospective neurocognitive follow-up study of extremely low birthweight (ELBW, 115) showed stable development (-3.2 points, p=0.250). Multiple linear regression showed that neonatal complications (intraventricular haemorrhage grade 3-4 and blood culture positive sepsis) and maternal education significantly predicted lower intelligence at the second assessment (F(3,106)=7.27, pPeer reviewe

Uudistunut neuropsykologian erikoispsykologikoulutus

Non peer reviewe