Background Only a few small studies have assessed the long-term morbidity that follows the treatment of childhood cancer. We determined the incidence and severity of chronic health conditions in adult survivors. Methods The Childhood Cancer Survivor Study is a retrospective cohort study that tracks the health status of adults who received a diagnosis of childhood cancer between 1970 and 1986 and compares the results with those of siblings. We calculated the frequencies of chronic conditions in 10,397 survivors and 3034 siblings. A severity score (grades 1 through 4, ranging from mild to life-threatening or disabling) was assigned to each condition. Cox proportional-hazards models were used to estimate hazard ratios, reported as relative risks and 95% confidence intervals (CIs), for a chronic condition. Results Survivors and siblings had mean ages of 26.6 years (range, 18.0 to 48.0) and 29.2 years (range, 18.0 to 56.0), respectively, at the time of the study. Among 10,397 survivors, 62.3% had at least one chronic condition; 27.5% had a severe or life-threatening condition (grade 3 or 4). The adjusted relative risk of a chronic condition in a survivor, as compared with siblings, was 3.3 (95% CI, 3.0 to 3.5); for a severe or life-threatening condition, the risk was 8.2 (95% CI, 6.9 to 9.7). Among survivors, the cumulative incidence of a chronic health condition reached 73.4% (95% CI, 69.0 to 77.9) 30 years after the cancer diagnosis, with a cumulative incidence of 42.4% (95% CI, 33.7 to 51.2) for severe, disabling, or life-threatening conditions or death due to a chronic condition. Conclusions Survivors of childhood cancer have a high rate of illness owing to chronic health conditions.

https://www.nejm.org/doi/pdf/10.1056/NEJMsa060185

Chronic Health Conditions in Adult Survivors of Childhood Cancer

(1998). Human cognitive abilities: A survey of factor analytic studies. Gifted and Talented International: Vol. 13, No. 2, pp. 97-98.

Human cognitive abilities: A survey of factor analytic studies

This review paper outlines the issues associated with the assessment of executive function (EF) in children and adolescents, and describes the developmental profile of executive processes across childhood At the outset, EF is defined, and cognitive and behavioral impairments associated with executive dysfunction (EDF) are described A developmental model of EF is proposed incorporating four discrete but inter-related executive domains (attentional control, cognitive flexibility, goal setting, and information processing) which operate in an integrative manner to enable “executive control” Characteristics that constitute traditional EF measures are discussed, as are the problems associated with test interpretation The ecological validity of EF tests and neuropsychological assessment procedures are examined, and adjunct methods of measurement are presented to enable a more comprehensive and valid assessment of EF Based on developmental and normative studies, the maturation of executive domains is mapped

Assessment and development of executive function (EF) during childhood.

This review article examines theoretical and methodological issues in the construction of a developmental perspective on executive function (EF) in childhood and adolescence. Unlike most reviews of EF, which focus on preschoolers, this review focuses on studies that include large age ranges. It outlines the development of the foundational components of EF—inhibition, working memory, and shifting. Cognitive and neurophysiological assessments show that although EF emerges during the first few years of life, it continues to strengthen significantly throughout childhood and adolescence. The components vary somewhat in their developmental trajectories. The article relates the findings to long-standing issues of development (e.g., developmental sequences, trajectories, and processes) and suggests research needed for constructing a developmental framework encompassing early childhood through adolescence.

/pdf/a-developmental-perspective-on-executive-function-383kudscoy.pdf

A Developmental Perspective on Executive Function

Executive functions include abilities of goal formation, planning, carrying out goal-directed plans, and effective performance. This article aims at reviewing some of the current knowledge surrounding executive functioning and presenting the contrasting views regarding this concept. The neural substrates of the executive system are examined as well as the evolution of executive functioning, from development to decline. There is clear evidence of the vulnerability of executive functions to the effects of age over lifespan. The first executive function to emerge in children is the ability to inhibit overlearned behavior and the last to appear is verbal fluency. Inhibition of irrelevant information seems to decline earlier than set shifting and verbal fluency during senescence. The sequential progression and decline of these functions has been paralleled with the anatomical changes of the frontal lobe and its connections with other brain areas. Generalization of the results presented here are limited due to methodological differences across studies. Analysis of these differences is presented and suggestions for future research are offered.

https://www.aecom.yu.edu/uploadedFiles/departments/neurology/Divisions/Child_Neurology/Child_Neurology_References/Executive_Fnc/Jurado.pdf

The Elusive Nature of Executive Functions: A Review of our Current Understanding

Behavior Rating Inventory for Executive Function

Evidence for the validity of the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000) based on internal structure was examined in a sample of children with mixed clinical diagnoses via maximum likelihood confirmatory factor analysis. Four alternative factor models of children's executive function, based on current theories that posit a unidimensional versus fractionated model (Rabbitt, 1997; Shallice & Burgess, 1991), using the revised 9-scale BRIEF configuration that separates two components of the Monitor scale, were examined for model fit. A 3-factor structure best modeled the data when compared directly with 1-, 2-, and 4-factor models. The 3-factor model was defined by a Behavior Regulation factor consisting of the BRIEF Inhibit and Self-Monitor scales, an Emotional Regulation factor consisting of the Emotional Control and Shift scales, and a Metacognition factor composed of the Working Memory, Initiate, Plan/Organize, Organization of Materials, and Task-Mon...

/pdf/confirmatory-factor-analysis-of-the-behavior-rating-32og3koc5f.pdf

Confirmatory Factor Analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a Clinical Sample

Executive function profiles were examined within and between several clinical disorders via the multidomain Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000). Parent ratings of children with Inattentive and Combined types of Attention-Deficit/Hyperactivity Disorder (ADHD-I, ADHD-C), Autistic Spectrum Disorders (ASD), moderate and severe Traumatic Brain Injury (TBI), and Reading Disabilities (RD) were compared with controls. Profile analysis revealed significant (p .10) differences in global elevations and in profile of scale elevations between diagnostic groups. ASD, ADHD-I and ADHD-C groups exhibited greater elevations across the BRIEF scales than did RD and Severe TBI groups, who were in turn more elevated than Moderate TBI and Control groups. The ADHD-C group was unique in its frequency and severity of inhibitory deficits, while the ASD group was distinguishable by its deficits in flexibility. Within diagnostic groups, rela...

Profiles of everyday executive function in acquired and developmental disorders.

Executive dysfunction is a common outcome in children who have sustained traumatic brain injury (TBI). Appropriate assessment of these complex interrelated regulatory functions is critical to plan for the necessary interventions yet present a challenge to our traditional methodologies. Ecological validity has become an increasingly important focus in neuropsychological assessment with particular relevance for the executive functions, which coordinate one's cognitive and behavioral capacities with real-world demand situations. The Behavior Rating Inventory of Executive Function (BRIEF) was developed to capture the real-world behavioral manifestations of executive dysfunction. Its development and various forms of validity, including ecological validity, are described. Application of the BRIEF's methodology to the assessment of executive dysfunction in TBI is provided. We advocate a multilevel approach to understanding executive function outcome in TBI, including traditional test-based measures of executive function, real-world behavioral manifestation of executive dysfunction, and the environmental system factors that impact the child. In this model, ecologically valid assessment of executive dysfunction provides an important bridge toward understanding the impact of component-level (i.e., test-based) deficits on the child's everyday adaptive functioning, which can assist the definition of targets for intervention.

Ecological assessment of executive function in traumatic brain injury.

Clinical assessment of executive function in preschool-age children is challenging given limited availability of standardized tasks and preschoolers' variable ability to participate in lengthy formal evaluation procedures. Given the benefits of ecological validity of measuring behavior by rating scales, the Behavior Rating Inventory of Executive Function (Gioia, Isquith, Guy, & Kenworthy, 2000) was modified for use with children ages 2 through 5 years to assess executive functions in an everyday context. The scale development process, based on samples of 460 parents and 302 teachers, yielded a single 63-item measure with 5 related, but nonoverlapping, scales, with good internal consistency and temporal stability. Exploratory factor analyses identified 3 consistent factors: Emergent Metacognition, Flexibility, and Inhibitory Self-Control across parent and teacher samples. In a second study with a mixed sample of preschool children with various developmental disorders, parents and teachers rated these preschool children as having greater executive difficulties in most domains than matched controls. Such rating-scale methodology may be a useful complementary tool by which to reliably assess executive functions in preschool children via everyday behaviors in the natural environment.

/pdf/executive-function-in-preschool-children-examination-through-4s4yhtgjes.pdf

Peter K. Isquith

Papers

Behavior Rating Inventory for Executive Function

Confirmatory Factor Analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a Clinical Sample

Profiles of everyday executive function in acquired and developmental disorders.

Ecological assessment of executive function in traumatic brain injury.

Executive function in preschool children: examination through everyday behavior.