The cooking task: making a meal of executive functions

Current standardized neuropsychological tests may fail to accurately capture real-world executive deficits. We developed a computer-based Cooking Task (CT) assessment of executive functions and trialed the measure with a normative group before use with a head-injured population. Forty-six participants completed the computerized CT and subtests from standardized neuropsychological tasks, including the Tower and Sorting Tests of executive function from the Delis-Kaplan Executive Function System (D-KEFS) and the Cambridge prospective memory test (CAMPROMPT), in order to examine whether standardized executive function tasks, predicted performance on measurement indices from the CT. Findings showed that verbal comprehension, rule detection and prospective memory contributed to measures of prospective planning accuracy and strategy implementation of the CT. Results also showed that functions necessary for cooking efficacy differ as an effect of task demands (difficulty levels). Performance on rule detection, strategy implementation and flexible thinking executive function measures contributed to accuracy on the CT. These findings raise questions about the functions captured by present standardized tasks particularly at varying levels of difficulty and during dual-task performance. Our preliminary findings also indicate that CT measures can effectively distinguish between executive function and Full Scale IQ abilities. Results of the present study indicate that the CT shows promise as an ecologically valid measure of executive function for future use with a head-injured population and indexes selective executive function’s captured by standardized tests

Ecological Assessment of Everyday Executive Functioning at Home and at School using the BRIEF Questionnaire following Childhood Traumatic Brain Injury (TBI)

IntroductionCognitive and behavioural aspects of executive functioning (EF) are frequently impaired following childhood TBI. The Behavior Rating Inventory of Executive Function (BRIEF) questionnaire provides an ecological assessment of EFs in everyday life in home and school environments. The aims of this study were to describe the dysexecutive disorders in children with TBI using the BRIEF; to compare parent- and teacher-ratings and to analyse the demographic and medical variables influencing outcome.MethodsParticipants: Children/adolescents aged 5–17 years 11 months, referred to a paediatric rehabilitation department following TBI. Outcome measures: the parent–and the teacher-report of the BRIEF were collected during neuropsychological assessment (2009–2014), as well as the teacher-report (from 2014). Age at injury and assessment, parental education and TBI severity were collected.Results194 patients (142 boys) participated in the study [mild (n=13), moderate (n=12) or severe (n=169: mean duration of coma 7.2 days; SD=6.5)]. 193 parent-reports and 28 complete teacher reports of the BRIEF were available. Mean age at injury/assessment were 6.9 (SD=4.4), and 11.8 (SD=3.5) years respectively. According to parent-ratings, children had significantly elevated scores in all BRIEF indices [Global Executive Composite (GEC), Behaviour Regulation Index (BRI), Metacognition Index (MI)], and subscales (mean T-scores 61–64; all P<.0001), with 24% to 48.0% scoring in the clinical range. Teachers’ ratings indicated similar deficits in all sub-scales (mean T-scores 63–70; all P<.001), with 39.3–57.2% scoring in the clinical range. For patients with teacher and parent-reports (n=27), no significant difference was found between parent and teacher ratings, which were significantly correlated (r: .44–.72). Regression analyses indicated that GEC was significantly predicted by older age at assessment. The regression model for BRI was not significant. For MI, younger age at injury and older age at assessment were significant predictors.Discussion and conclusionThis study highlights elevated levels of executive dysfunction in everyday life following childhood TBI, evident in home and school environments. Younger age at injury seems to influence the cognitive rather than the behavioural aspects of EFs, whereas older age at assessment is related to higher levels of complaints, probably due to the increasing levels of expectations

Consensus statement on abusive head trauma in infants and young children

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature

Traumatic brain injury among young offenders in France based on the results of the Fleury TBI study

International audienceObjective: This study aimed to estimate the prevalence of traumatic braininjury (TBI) in a French prison population of young offenders and to study variablesknown to be associated with TBI. It also aimed to study whether TBI was associatedwith younger age at entry into prison; longer period of custody and re-offending.Participants: All young offenders (from 13 to 21) consecutively admitted to Fleury-Mérogis prison over a period of 3 months were included. Method: During the ad-mission procedure, young offenders were interviewed by healthcare staff using aself-reported questionnaire. Comparisons between cases (TBI +) and controls (TBI −)were performed. Results: Three hundred thirty two young offenders were included.The prevalence of self-reported TBI was 24.5%. The first cause of TBI was violence-related outcomes (25%). No differences were found regarding the number of timesin custody and the total time spent in prison during the preceding five years. Casesaccumulated multiple health problems including mental health problems (16.3% vs.4.9%; p = .002) and a regular use of cannabis (28.7% vs. 15.9%; p = .02). Conclusions:The results provide further evidence that specific measures need to be developedsuch as, first of all, screening for TBI and related impairments upon arrival in prison