Tarazi Reem A, Zabel T Andrew, Mahone E Mark
Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA.
Clin Neuropsychol. 2008 Jul;22(4):585-602. doi: 10.1080/13854040701425940. Epub 2007 Aug 18.
Previous research has suggested that adolescents with myelomeningocele and shunted hydrocephalus (MMH) have difficulties with aspects of executive functioning and, in turn, with functional independence. There is little research, however, examining patterns of executive functioning across adolescence in this population. The goal of this cross-sectional study was to examine parent ratings of executive function in children with MMH and in typically developing peers across late childhood and adolescence. Parents of 36 individuals with MMH and 35 typically developing peers, ages 10 to 18 years, completed the Behavior Rating Inventory of Executive Function (BRIEF). The BRIEF is organized into eight scales and two primary indices-Metacognition (MCI) and Behavioral Regulation (BRI). As a whole, the children with MMH had significantly higher BRIEF T-scores, as well as a higher prevalence of clinically significant T-scores across subscales, particularly those representing cognitive control. Effects of group, age, and age-by-group interactions on the mean raw scores of the MCI and BRI were examined using regression analyses. There were significant group effects (p <. 05) for both the BRI and MCI, with the controls having significantly lower mean ratings than the MMH group. There was also a significant contribution of age-by-group interaction on the BRI (p <. 05). Although mean raw scores on the BRI for the MMH group remained stable across ages, mean raw scores in the control group decreased as age increased. Thus, healthy children have age-related improvements in executive control behaviors across adolescence, particularly behavioral control, while children with MMH demonstrate no age-related improvements in parent reported executive behaviors across adolescence. Therefore, children with MMH may continue to require targeted interventions and modifications to address executive dysfunction into young adulthood in order to promote functional independence.
先前的研究表明，患有脊髓脊膜膨出和分流性脑积水（MMH）的青少年在执行功能方面存在困难，进而影响功能独立性。然而，针对这一人群在整个青春期执行功能模式的研究却很少。这项横断面研究的目的是调查患有MMH的儿童以及正常发育的同龄儿童在童年晚期和青春期的执行功能的家长评分。36名患有MMH的个体和35名年龄在10至18岁之间正常发育的同龄人的家长完成了执行功能行为评定量表（BRIEF）。BRIEF分为八个量表和两个主要指标——元认知（MCI）和行为调节（BRI）。总体而言，患有MMH的儿童BRIEF的T分数显著更高，且各分量表中临床显著T分数的患病率也更高，尤其是那些代表认知控制的分量表。使用回归分析研究了组别、年龄以及年龄与组别的交互作用对MCI和BRI平均原始分数的影响。BRI和MCI均存在显著的组别效应（p <.05），对照组的平均评分显著低于MMH组。年龄与组别的交互作用对BRI也有显著贡献（p <.05）。尽管MMH组BRI的平均原始分数在各年龄段保持稳定，但对照组的平均原始分数随着年龄增长而下降。因此，健康儿童在整个青春期的执行控制行为，尤其是行为控制方面，会随着年龄增长而改善，而患有MMH的儿童在家长报告的整个青春期执行行为方面没有与年龄相关的改善。所以，患有MMH的儿童可能需要持续的针对性干预和调整，以解决直至成年早期的执行功能障碍问题，从而促进功能独立。
