Abstract:
Similarities and Differences of Neuropsychological Profiles in Children and Adolescents with Anorexia Nervosa and Healthy Controls Using Cluster and Discriminant Function Analyses.

OBJECTIVE: This study aimed to identify discrete neuropsychological profiles and their relationship to clinical symptoms in 253 female children and adolescents with anorexia nervosa (AN) and 170 healthy controls (HCs) using a standardised neuropsychological assessment battery. METHOD: Hierarchical cluster analysis was used to identify the optimum number of clusters, and participants were assigned using K-means cluster analysis. Confirmatory discriminant function analysis determined which combination of neuropsychological variables best distinguished the clusters RESULTS: Three distinct clusters in the AN sample emerged- AN cluster 1 (19%) - "neuropsychologically low average to average"; AN cluster 2 (33%) - "verbal/visuo-spatial discrepancy"; and AN cluster 3 (48%) - "verbally strong and neuropsychologically average to high average". Two distinct clusters in HCs were identified. HC cluster 1 (48%) demonstrated poor visuo-spatial memory scores and high verbal fluency scores, whilst HC cluster 2 (52%) scored within the average range on all neuropsychological tasks. Neuropsychological performance was associated with clinical symptoms of body mass index centile, Eating Disorder Examination subscale and global score, anxiety, depression and obsessions, and compulsions between the AN and HC groups. However, niether significant differences emerged between AN clusters only nor HC clusters only at the post-hoc level. DISCUSSION: an underlying neuropsychological heterogeneity may exist in AN. We encourage future studies to investigate whether the identified profiles and their association with clinical characteristics are replicable. We cautiously suggest that neuropsychological profiling may have potential to both inform future research and have possible clinical benefits through individually tailored treatment strategies.

Abstract:
An examination of the ravello profile--a neuropsychological test battery for anorexia nervosa.

The Ravello Profile test battery was developed to ensure a consistent methodology when researching neuropsychological functioning in anorexia nervosa (AN). To date, 157 patients with AN have been assessed with the full Ravello Profile. The present review is the first study to systematically investigate the tests included in the battery. Fifteen experimental studies, comparing AN patients with healthy control participants on at least one of the Ravello Profile tests, were identified, and effect sizes were calculated. Three of the tests, Verbal Fluency Test (VFT), Rey Complex Figure Test (RCFT) and Trail Making Test (TMT), were meta-analysed, and the pooled standardized effect size was significant for all three tests (0.25, -0.68 and 0.49, respectively). Patients with AN performed significantly better than healthy control participants on assessment of verbal fluency (VFT) and worse on tests of visual memory (RCFT) and set-shifting (TMT). The Ravello Profile test battery appears to consist of tests that are appropriate for assessing characteristic neuropsychological profiles specific in AN.

Abstract:
Neurobiological status at initial presentation predicts neuropsychological functioning in early onset anorexia nervosa at four-year follow up.

This study explores whether neurobiological status (indexed by regional cerebral blood flow) at initial presentation predicts neuropsychological status at four-year follow up in a sample of children with early onset anorexia nervosa. Neuropsychological assessment was conducted on 15 females four years after their initial treatment, and matched controls. At follow up there were significant differences between subgroups (based on neurobiological status at initial presentation) and matched controls in long-term visual memory and cognitive inhibition. This study offers preliminary evidence that neurobiological abnormalities at initial presentation predict neuropsychological status at follow up, suggesting a distinct neurodevelopmental subtype of early onset anorexia nervosa.

Abstract:
The neuropsychological profile of children, adolescents, and young adults with anorexia nervosa.

The neuropsychological profile of a sample of 155 patients with a clinical diagnosis of anorexia nervosa was assessed using a test battery specifically developed for such patients. The current findings suggest that the patients display a common neuropsychological profile including both strengths and weaknesses when compared with published norms. The patients displayed good verbal fluency skills, but performed poorly on tests of visuospatial memory, associated with relatively weak central coherence. They were within the average range on the assessment of executive functioning except for one measure of set-shifting. This study provides a valuable point of reference for clinicians when considering treatment options.

Abstract:
'Trails B or not Trails B?' is attention-switching a useful outcome measure?

PRIMARY OBJECTIVE: Difficulties with attention contribute to behavioural and cognitive problems during childhood and may reflect subtle deficits in executive functioning (EF). Attention problems in early childhood have also been found to predict higher levels of anxiety and depression symptoms at 10 years old. It has also been reported that attention problems during childhood may be differentially related to later-emerging distinct EF difficulties. Many of these findings, however, rely on teacher-ratings of attention difficulties. METHODS AND PROCEDURES: This study administered neuropsychological tests of attention-switching and EF to 67 healthy children aged 9-15 years of age. It additionally measured socio-emotional behavioural functioning. MAIN OUTCOMES AND RESULTS: a critical phase of improvement was found at 10 years of age. Correlations were found between attention-switching skills and EF. Attention-switching skills were also correlated with socio-emotional functioning. CONCLUSIONS: Attention-switching skills have some interdependence with EF, but in paediatric assessment such skills are easier to routinely assess than many of the currently available tests of EF. It is suggested that attention-switching ability may prove to be a useful predictor of EF performance in understanding long-term outcome after a neurological event such as traumatic brain injury.

Abstract:
Anorexia nervosa and the insula

Anorexia nervosa is a serious illness with major physical and psychological morbidity. It has largely been understood in terms of cultural and environmental explanations. However these are insufficient to explain the diverse clinical features of the illness, nor its rarity given the universality of sociocultural factors. Over the last 20. years, there has been a steady accumulation of neurobiological evidence requiring a re-formulation of current causal models. We now offer a new empirically-derived hypothesis implicating underlying rate-limiting dysfunction of insula cortex as a crucial risk factor for the development of anorexia nervosa. Supporting evidence for this hypothesis is drawn from anatomical and clinical research of insula cortex damage in humans and neuroscientific studies of relevant clinical features including taste, pain perception and reward processing. This hypothesis, if sustainable, would be the first fully to explain the disorder and predicts promising novel treatment possibilities including Cognitive Remediation and Motivation Enhancement Therapies. The knowledge that the challenging behaviours, so characteristic of AN, are the result of underlying cerebral dysfunction, rather than being purely volitional, could help to reduce the stigma patients experience and improve the therapeutic alliance in this poorly understood and difficult to treat disorder. © 2010 Elsevier Ltd.

Abstract:
Do abnormalities in regional cerebral blood flow in anorexia nervosa resolve after weight restoration?

OBJECTIVE: Previous studies have demonstrated localised abnormalities of cerebral blood flow in anorexia nervosa, suggesting reduction of cerebral activity and function in specific regions. There is debate as to whether such findings are secondary to starvation or indicative of a primary abnormality predating the illness, representing an underlying biological substrate. This small study, the first in early onset anorexia nervosa, reports findings of regional cerebral blood flow (rCBF) at both baseline and follow up. METHOD: Nine participants who had previously undergone rCBF studies at the start of treatment, had a repeat scan at an average of 4.2 years later. RESULTS: Seven out of the nine had persisting reduced cerebral blood flow in one area of the brain, predominantly the medial temporal region. DISCUSSION: These data suggest that in the majority of cases rCBF does not return to normal following weight restoration. The implications for future research are explored.

Abstract:
Resilience and the mediating effects of executive dysfunction after childhood brain injury: a comparison between children aged 9-15 years with brain injury and non-injured controls.

PRIMARY OBJECTIVE: Acquired brain injury (ABI) during childhood can be associated with enduring difficulties related to impairments to executive functioning (EF). EF impairments may detrimentally affect outcome by restricting an individual's ability to access 'resiliency' resources after ABI. RESEARCH DESIGN: the purpose of this study was to explore whether there is deterioration in children's resilience compared with peers after ABI and whether EF is influential in mediating relationships between resilience and behaviour. METHODS AND PROCEDURES: Measures of resilience, depression and anxiety were administered with 21 children with ABI and 70 matched healthy children aged 9-15 years. Parents completed measures of behaviour and EF. MAIN OUTCOMES AND RESULTS: Children with ABI were identified as less resilient and more depressed and anxious than controls. Resiliency measures were correlated with depression and anxiety in both groups. Relationships between resiliency and socio-emotional behaviour were mediated by EF. CONCLUSIONS: Assessment of resilience after ABI may be useful in supporting or defining the delivery of more individualized rehabilitation programmes according to the resources and vulnerabilities a young person has. However, an accurate understanding of the role of EF in the relationship between resilience and behavioural outcome after ABI is essential.

Abstract:
The development of emotion and empathy skills after childhood brain injury.

Lasting socio-emotional behaviour difficulties are common among children who have suffered brain injuries. A proportion of difficulties may be attributed to impaired cognitive and/or executive skills after injury. A recent and rapidly accruing body of literature indicates that deficits in recognizing and responding to the emotions of others are also common. Little is known about the development of these skills after brain injury. In this paper we summarize emotion-processing systems, and review the development of these systems across the span of childhood and adolescence. We describe critical phases in the development of emotion recognition skills and the potential for delayed effects after brain injury in earlier childhood. We argue that it is important to identify the specific nature of deficits in reading and responding to emotions after brain injury, so that assessments and early intervention strategies can be devised.

Abstract:
Beyond parent training: predictors of clinical status and service use two to three years after Scallywags.

The aim of this study is to investigate the predictors of clinical status and service use of a representative sample of children who participated in an innovative multicomponent intervention called Scallywags, a secondary prevention programme for young children at risk of developing conduct disorder. A representative sample of 81 families agreed to contribute to a longitudinal follow-up study two to three years after participation in the intervention. Results showed that participation in the programme was associated with a ;non-clinical' outcome for nearly 50% of children. Predictors of ;clinical' status included family demographics (carer relationship status and family income), child variables (initial problem behaviour level and parent-reported neurodevelopmental disorder) and family factors (parenting stess). Children who participated successfully in the intervention were subsequently significantly less likely to require further specialist children's services. Implications for integrated children's services and future research are explored.

Abstract:
Measuring social cognition in adolescents: implications for students with TBI returning to school.

In everyday adolescent communication, the ability to empathise with the mental state of others, recognise or infer intentions, or make judgements about emotional state, is a non-conscious but vital prerequisite of relating. Execution of these skills in social interactions supports both the exchange of social knowledge and also the development and maintenance of personal relationships. Thus, adolescents with impairments in these skills are at risk for a variety of negative outcomes. In this paper, we present data to illustrate that adolescents with traumatic brain injury (TBI) are likely to have impairments in processes such as emotion recognition and mental state attribution, and that these might not be identified on standardised tests. This is considered from the perspective of clinical assessment and intervention in school contexts.

Abstract:
The fault is not in her parents but in her insula - a neurobiological hypothesis of anorexia nervosa

The reported abnormalities of brain function in anorexia nervosa (AN) include impairment of neural circuits involving cortical (orbito-frontal, somatosensory and parietal) and sub-cortical (amygdala, hippocampus, thalamus, hypothalamus and striatum) structures. The insular cortex serves an integrative function for all the structures relevant to the features of AN and as such may be central to this impairment. We hypothesise that a rate limiting dysfunction of neural circuitry integrated by the insula can account for the clinical phenomena of AN. Such dysfunction could account for the known psychopathology, neuroimaging abnormalities and neuropsychological deficits. Proposals to test this hypothesis are made. Copyright © 2008 John Wiley & Sons, Ltd and Eating Disorders Association.

Abstract:
Reading emotions after child brain injury: a comparison between children with brain injury and non-injured controls.

PRIMARY OBJECTIVE: Child brain injury can have a lasting, detrimental effect upon socio-emotional behaviour, but little is known about underlying impairments that cause behavioural disturbance. This study explored the possibility that a proportion of difficulties result from compromise to systems in the brain which function in reading emotion in others from eyes, face expression or vocal tone. METHODS AND PROCEDURES: Measures of ability in reading emotion from faces, voices and eyes were used in conjunction with a battery of tests of cognitive function, in gathering data from 18 children aged between 9-17 with acquired brain injuries (ABI). Performance levels were compared against the normative data from 67 matched 'healthy' children. Questionnaires were used as a measure of socio-emotional behaviour. MAIN OUTCOMES AND RESULTS: the ABI children in the sample were worse than their same age peers at reading emotions. Regression analyses revealed that emotion recognition skills and cognitive abilities were generally unrelated. Some relationships between emotion reading difficulties and behaviour disturbance were found, however there were limitations associated with this particular finding. CONCLUSIONS: Emotion-recognition skills, which are not routinely assessed following child brain injury, can be adversely affected as a consequence of brain injury in childhood.