22q11.2 deletion syndrome (22q11.2DS) is associated with cognitive impairments and an increased risk of psychopathology. Most of the research has been conducted in children and adolescents, although the majority of affected individuals live well into adulthood. Hence, limited data are available on functional outcomes in adults.

To provide more insight in cognitive and adaptive abilities, and daily life functioning (marital status, living situation and work situation) in adults with 22q11.2DS.

This retrospective study included 250 Dutch-speaking adults (16–69 years) with 22q11.2DS from three sites in The Netherlands and Belgium. Data on full-scale IQ (FSIQ) scores (assessed with the Wechsler Adult Intelligence Scale), adaptive functioning (assessed with the Vineland Adaptive Behavior Scale II), and functional outcomes including marital status, living and work situation were systematically collected from clinical files. In addition, we examined predictors of adaptive functioning.

The majority of individuals in our adult sample demonstrated a low level of adaptive functioning (65%). In contrast to previous findings in children and adolescents, the majority functioned at an intellectual disability level (56%). Male sex, lower FSIQ and autism spectrum disorder were predictors of lower adaptive functioning (P = 0.016, P < 0.001 and P = 0.16, respectively).

These results suggest that low levels of cognitive and adaptive functioning are common in adults with 22q11.2DS. Future longitudinal and multicentre studies including older patients (>40 years) are needed to further investigate cognitive and adaptive trajectories and their interactions with physical and psychiatric comorbidities.

Individuals with Spina Bifida (SB) are at increased risk for difficulties with various aspects of adaptive functioning. Poorer adaptive functioning could delay or prevent an individual from successfully living independently and managing their own condition. Despite the importance of understanding adaptive functioning in SB, currently the literature on predictors of and associated neurocognitive skills with adaptive functioning is sparse. Thus, this retrospective chart review study aimed to explore the extent to which intellectual functioning, predicts adaptive functioning in a clinical sample of children with SB.

A retrospective chart review of children with SB was conducted at a Midwestern academic medical center. Children were seen in the context of routine neuropsychological evaluations to identify neuropsychological diagnoses and provide treatment recommendations. All measures were administered based on the age of the child and in accordance with administration guidelines. Only children with complete data were included in analyses. The sample included 42 participants (Mage=10.89, SDage=3.15; 18 male, 24 female). Intellectual functioning was evaluated using either the Wechsler Intelligence Scale for Children - Fifth Edition (WISC-V) or Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV). Adaptive functioning was evaluated using primary caregiver-report scores from the Adaptive Behavior Assessment System - Third Edition (ABAS-3). Hierarchical regressions were conducted to investigate the extent to which intellectual functioning predicts parent-reported adaptive functioning. The unique contribution of each predictor variable was also considered.

Model predictors included participant sex, verbal comprehension, working memory, processing speed, and full scale IQ to predict 4 different indices on the ABAS-3. Results showed a significant contribution of participant sex in all models, with males having been rated as having poorer adaptive skills. Intellectual functioning did not significantly contribute to the models. Semipartial correlations revealed that processing speed and working memory often each accounted for a fair amount of variability when controlling for all of the remaining variables in the models. In particular, when accounting for all of the remaining variables, processing speed accounted for 6.3% of variability in global adaptive functioning, 6.1% in Conceptual Skills, and 10.11% in Social Skills. Furthermore, after controlling for all of the other variables, working memory accounted for 4.5% of the variability in global adaptive functioning.

The present results suggest that males with SB are at increased risk for poorer adaptive functioning, and there may be some preliminary evidence of processing speed and working memory playing contributory roles as well. This may suggest at least in childhood, the verbal and global cognitive capacities of individuals with SB are not as contributory to adaptive functioning as more basic cognitive skills, such as processing speed and working memory. It is recommended that males with SB in particular should be closely monitored with regard to their development of adaptive skills, as they may be at risk of poorer adaptive abilities. Additionally, our findings provide preliminary evidence of processing speed and working memory impacting adaptive functioning. Thus, interventions and accommodations targeting both of these domains may be appropriate to implement to help with poorer adaptive skills in this population.

22q11.2 Deletion Syndrome (22q11DS) is a multi-systemic disorder with great clinical heterogeneity. It is the most common microdeletion syndrome and one of the most common genetic causes of developmental delays (e.g., motor/speech). 22q11DS is estimated to occur between 1/2,000-4,000 live births. However, the diverse clinical presentation of 22q11DS and health inequities that impact ethnically, racially, linguistically, and economically marginalized groups, make early identification, diagnosis, and access to beneficial early interventions (e.g., speech/behavioral therapy) even more challenging. Therefore, 22q11DS’ true prevalence may be larger than documented. Challenges associated with diagnosis, as well as neurocognitive, psychiatric, and medical co-morbidities associated with 22q11DS have been reported to affect the quality of life and well-being of people living with 22q11DS and their families. Yet, there is limited longitudinal data on lifelong functional outcomes of this population and the social factors that may shape them. This study aimed to 1) review the extant literature on adaptive functioning across the lifespan in 22q11DS and 2) report on relevant social and structural variables considered in the literature to contextualize adaptive functioning.

A scoping review was conducted between January-June 2022 across six electronic databases: PubMed, Scopus, PsycINFO, Ovid MEDLINE, EBSCO, and Embase. The 'building block’ method was used to identify and design a comprehensive search strategy used to scan publications’ titles, keywords, and abstracts. Citation mining strategy was utilized to identify additional relevant studies. The following inclusion criteria was met: 1) empirical studies conducted in humans, 2) participants with confirmed diagnosis of 22q11DS, 3) evaluation of adaptive functioning, 4) use of at least one standardized measure of adaptive functioning and 5) written or translated into English or Spanish.

Eighty-four records were initially identified. After deduplication, abstract screening, and full record reviews, a total of twenty-two studies met inclusion criteria for this review. Only eight publications explored adaptive skills as one of their primary outcomes. Clinically significant symptoms of anxiety, withdrawal, anhedonia, and flat affect were associated with worse functional outcomes. Fifteen studies reported between one and three demographic variables (e.g., race/ethnicity, years of education), and only two studies documented mental health treatment status/history. Most studies reported lower adaptive abilities in participants with 22q11DS independent from their cognitive abilities, but the majority of participants scored between the below average range and exceptionally low range on measures of intellectual functioning. Nonetheless, information on contextual variables (e.g., educational/occupational opportunities) that may help to interpret these findings was lacking.

Methodological differences (e.g., definition and measurement of adaptive functioning), recruitment bias (small, clinic-based identified samples) and lack of information regarding contextual level factors, may be limiting our understanding of the neurocognitive and neuropsychiatric trajectories of people with 22q11DS. It is vital to increase representative samples in epidemiological/clinical studies, as well as research examining the social and structural factors (e.g., access to healthcare, socioeconomic position) that impact functional outcomes in this population to promote public health policies that can improve brain health across the lifespan.

Survivors of pediatric brain tumor (BT) experience impaired executive function (EF) and adaptive behavior (i.e. the ability to complete daily living tasks independently). The literature hypothesizes that executive dysfunction contributes to suboptimal adaptive behavior outcomes in BT survivors; however, the aspects of EF that drive this relationship remain unexplored. Task-switching is an EF component that involves switching between concurrently presented tasks. This skill is critical for many day-to-day activities and may therefore contribute to observed adaptive functioning difficulties. This study investigates relationships between performance on two task-switching measures and adaptive behavior outcomes in BT survivors compared to healthy controls.

86 survivors of pediatric BT (Mage(SD)= 23.42(4.24), 44 females) and 86 age- and sex-matched controls (Mage(SD) = 23.09(4.40), 44 females) from the Atlanta area completed the Delis-Kaplan Executive Function System Trail Making Test (TMT) and Verbal Fluency Test (VFT). Respectively, the Letter-Number Sequencing (LNS) and Category Switching (CS) conditions were isolated as measures of task-switching. Baseline conditions, representing the foundational skills needed to perform these timed task-switching measures rapidly (TMT: Letter Sequencing, Number Sequencing; VFT: Category Fluency), were included as covariates in all regressions. Informants familiar with the participants’ daily living were interviewed with the Scales of Independent Behavior-Revised (SIB-R) to measure adaptive behavior in four domains (Motor Skills, Social Communication, Personal Living, Community Living). Linear regressions and t-tests confirmed group differences on task-switching performance and on adaptive functioning outcomes, respectively. Then, linear regressions investigated relationships between performance on each task-switching measure (LNS, CS) and SIB-R scores for survivors. A group by task-switching interaction was added to directly explore group differences in these relationships. α=.0125 was used due to Bonferroni correction for the four SIB-R comparisons within each task-switching measure.

BT survivors were more impaired than controls on LNS, CS, and SIB-R scores (p<.05, except Personal Living p=.058). For TMT, decreased performance on LNS predicted lower SIB-R scores in Social Communication (p=.001, r2semipartial=.14), Personal Living (p=.002, r2semipartial=.13), and Community Living (p=.003, r2semipartial =.11), but not Motor Skills (p=.184) in BT survivors. Strength of significant relationships was greater for survivors than controls (all p<.002). For VFT, decreased performance on CS predicted lower SIB-R scores in Personal Living (p=.036, r2semipartial =.06) and Community Living (p=.04, r2semipartial =.05), but not in Motor Skills (p=.716) or Social Communication (p=.14) in BT survivors. Positive relationships between CS and SIB-R scores for all 4 domains were greater in survivors than controls (p<.0125).

These findings reveal a robust, positive relationship between task-switching performance and independent, daily behaviors that is specific to BT survivors. The relationship between LNS and Motor Skills may have been weakened by covariates involving baseline motor abilities; however, CS results suggest that task-switching is important for motor skills in survivors relative to controls. Community living skills were impaired in survivors and consistently related to task-switching performance. This work may inform interventions to target task-switching abilities and consequently, promote everyday living skills. Interventions aimed at vulnerabilities in adaptive behavior may help increase independence and quality-of-life as survivors transition to adulthood.

Individuals with Down syndrome (DS) experience intellectual disability, such that measures of cognitive and adaptive functioning are near the normative floor upon evaluation. Individuals with DS are also at increased risk for Alzheimer's disease (AD) beginning around age 40; and test performances and adaptive ratings at the normative floor make it difficult to detect change in cognition and functioning. This study first assessed the range of raw intelligence scores and raw adaptive functioning of individuals with DS at the normative floor. Next, we assessed whether those raw intelligence scores were predictive of raw adaptive functioning scores, and by association, whether they may be meaningful when assessing change in individuals with a lower baseline of cognitive functioning.

Participants were selected from a cohort of 117 adults with DS in a longitudinal study examining AD risk. Participants (n=96; M=40.9 years-old, SD=10.67; 57.3% female) were selected if they had both a completed measure of IQ (Kaufmann Brief Intelligence Test; KBIT2) and informant ratings of adaptive functioning (Vineland Adaptive Behavior Scales; VABS-II). Multiple regression was conducted predicting VABS-II total raw score using K-BIT2 total raw score, while controlling for age.

A slight majority (57.3%) of the sample had a standardized IQ score of 40 with the majority (95.7%) having a standardized score at or below 60. Additionally, 85.3% of the sample had a standard VABS-II score at or below 60. Within the normative floor for the KBIT2 (IQ=40), there was a normal distribution and substantial range of both KBIT2 raw scores (M = 31.19, SD = 13.19, range: 2 to 41) and VABS-II raw scores (M = 406.33, SD = 84.91, range: 198 to 569). Using the full sample, age significantly predicted raw VABS-II scores (ß = -.283, p = .008). When KBIT2 raw scores were included in the model, age was no longer an independently significant predictor. KBIT2 raw scores significantly predicted raw VABS-II scores (ß = .689, p < .001). Age alone accounted for 8.0% of variance in VABS-II raw scores and KBIT2 raw scores accounted for 43.8% additional variance in VABS-II raw scores. This relationship was maintained when the sample was reduced to individuals at the normative floor (n = 51) where KBIT2 raw scores accounted for 23.7% of the variance in raw VABS-II scores (ß = .549, p < .001).

The results indicate that meaningful variability exists among raw intelligence test performances that may be masked by scores at the normative floor. Further, the variability in raw intelligence scores is associated with variability in adaptive functioning, such that lower intelligence scores are associated with lower ratings of adaptive functioning. Considering this relationship would be masked by a reduction of range due to norming, these findings indicate that raw test performances and adaptive functioning ratings may have value when monitoring change in adults with DS at risk for AD.

To find how healthy college going participants SRS were affected by a customized Mind Body Intervention (MBI).

We performed a customized online tele-video course based MBI incorporating mindfulness and awareness training over a period of one month in 2021 to MBA students attending the Indian Institute of Management (IIM). Each subject was their own control. We used the World Health Organization Quality of Life Scale (QO-BREF) social relationship sub-scores pre and post intervention to assess participant SRS.

277 MBA students from the IIM with a mean age of 26.89 ± 1.7 were analyzed. Of the 277 students, 90 (32.49%) were female. The MBI decreased the self-perceived Social Relationship score among 277 graduate students. The mean SRS before the intervention was 7.51 ± 1.7 while the mean SRS after was 6.9 ± 1.7. Univariate paired t-test showed a significant mean difference (t = 5.1, p<.001). On a multivariate linear-regression model, the SRS change estimate was 0.46, t-value was 9.3, p < 0.001; 95% confidence interval was 0.37 - 0.56; p-value <0.001.

An online tele-video based customized Mind Body Intervention decreased the self-perceived social relationship score among graduate students at the IIM during the Covid-19 pandemic.

Previous studies have demonstrated a high prevalence of social and emotional problems in young adults with a history of childhood epilepsy, with social skill impairment hypothesized to play a significant role in these outcomes. Few studies have examined social skills within children with epilepsy and very few have examined this within the context of other neuropsychological and neurological variables. This study aims to examine the association between social problems and other relevant neuropsychological variables (IQ, adaptive functioning, social skills) within the pediatric epilepsy population.

Participants were 86 epilepsy patients between the ages 5 and 18 years of age who were referred for neuropsychological assessment as a part of their surgical candidacy work-up. Pearson correlation analysis was conducted to examine the correlations between performance on objective measures of full-scale IQ, and parent ratings on questionnaires assessing parent perception of the patients’ overall adaptive functioning, social skills, and social problems.

As expected, earlier age of onset was associated with lower IQ, which itself was associated with weaker overall daily living skills and social skills. Later age of seizure onset was associated greater social problems. Social skills were not correlated with social problems.

The results of this study suggest that children with later age of onset of seizures, are at increased risk of social problems and that these problems may not related to social skill impairment. Implications for clinical practice and future directions are discussed.

The Texas Functional Living Scale (TFLS) is a measure of adaptive functioning commonly utilized across the geriatric population. Current research suggests that those with Alzheimer’s disease and other dementias perform poorly on the TFLS, compared to those with mild cognitive impairment (MCI) and normal cognition (Cullum et al., 2001). Additional research is needed to examine the influence anxiety and depressive symptoms have on activities of daily living (ADLS) in individuals being evaluated for memory disorders. This study will examine the effects of anxiety and depression on adaptive functioning across all patients, and within samples of those with dementia and MCI. It is hypothesized that higher reported anxiety and depressive symptoms will predict lower scores of ADLS.

Patients at a memory disorder clinic (N = 756; 58.2% female) were screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA). A brief neuropsychological evaluation (BNE) was then conducted in which the TFLS, Geriatric Depression Scale (GDS), and Geriatric Anxiety Inventory (GAI) were administered, among other measures.

A stepwise hierarchical regression was conducted on the entire sample to examine the effects of anxiety and depressive symptoms on TFLS performance, controlling for cognitive impairment using the MoCA. Lower MoCA scores explained a significant amount of variance in TFLS performance (R2 = 0.456, F(1, 754) = 632.78, p < .001). MoCA scores (b = 1.27, p < .001), the GAI (b = 0.14, p = .019), and the GDS (b = 0.10, p = 0.039) were significant predictors of poor TFLS performance across the entire sample. Although the MoCA, GDS, and GAI were each significant predictors of the TFLS, the increased variance explained by the GDS and GAI individually was incremental (AR2 = 0.003, F(1, 752) = 3.90, p = .049). Stepwise hierarchical regressions were also conducted on subsamples diagnosed with MCI (N = 171) and dementia (N = 394). For those with MCI, MoCA scores explained a significant amount of variance in TFLS performance (R2 = 0.044, F(1, 169) = 7.80, p = .006). Neither the GAI nor GDS explained significant additional variance. Only MoCA scores (b = .30, p =.006) predicted TFLS performance. For those with dementia, MoCA scores explained significant variance in TFLS scores (R2 = 0.338, F(1, 392) = 200.47, p < .001). The GAI explained additional significant variance when added (AR2 = 0.009, F(1, 391) = 5.26, p = .022). The GDS did not explain any additional variance. Both the MoCA (b = 1.29, p < .001) and the GAI (b = -0.15, p = .002) significantly predicted TFLS performance.

While results suggest that anxiety and depressive symptoms alone do not explain a significant degree of variance within scores of adaptive functioning across the entire sample, elevated ratings of anxiety and depressive symptoms were significant predictors of lower scores of ADLS, suggesting some support for our hypothesis. Additionally, anxiety symptoms significantly explained increased variance in TFLS scores for those diagnosed with dementia, suggesting a potential relationship between anxiety levels and poor adaptive functioning for dementia patients.

Cognitive flexibility, typically measured using neuropsychological tasks of set-shifting, has been associated with mental and physical health, social relationships, resilience, and overall quality of life (Diamond, 2013; Chen et al., 2014; Davis et al., 2010; de Abreu et al., 2014; Genet et al., 2011). Previous research has found conflicting results regarding the relationship between set-shifting and various measures of functional outcomes in individuals with traumatic brain injury (Allanson et al., 2017). The present study examined the relationship between cognitive flexibility and adaptive functioning in individuals with acquired brain injuries (ABI).

Participants in this research are adults (n = 116) with severe, chronic ABI who completed a neuropsychological evaluation through Bancroft Neurorehab between 2012-2022. Participants ranged in age from 20.4 - 67.8 years (M = 45.8). Individuals included in data analysis completed Trails A and B, Wide Range Achievement Test, Fourth Edition (WRAT-4) Word Reading, and Texas Functional Living Scale (TFLS). Set-shifting ability was measured using Trails B and adaptive functioning was measured using the TFLS. Word reading ability, measured using the WRAT-4, was included as a covariate to account for the impact of word reading difficulties on Trails B performance.

A simple linear regression was conducted to examine if Trails B T-score (M = 24.7) and WRAT-4 Word Reading Standard Score (M = 87.8) predicted TFLS Total T-score (M = 35.8). The overall regression model was statistically significant (R2 = .351, F(2, 113) = 32.0, p < .001). It was found that lower performances on Trails B (ß = .272, p <.001) and WRAT-4 Word Reading (ß = .189, p <.001) both significantly predicted a lower TFLS Total T-score.

Set-shifting and word reading ability significantly predicted the overall adaptive functioning score on the TFLS which adds to a body of literature that suggests that the ability to think and behave flexibly affects functional aspects of everyday living. These findings are consistent with previous literature regarding the association between cognitive flexibility and adaptive functioning in the general population, and these results add to the growing body of research on cognitive flexibility in individuals with brain injury. Clinicians may use an individual’s set-shifting performance to estimate and further assess potential difficulties in completing activities of daily living. This information may assist in subsequent treatment planning and identifying treatment goals of cognitive rehabilitation consistent with rehabilitation psychology’s goals of increasing levels of adaptive functioning and quality of life (Division 22 of the American Psychological Association, n.d.). Future research may examine if certain domains of adaptive functioning are more or less affected by impairments in cognitive flexibility. Future research may also examine patterns of set-shifting performance, such as sequencing errors vs. set-loss errors, associated with specific areas of insult.

Pediatric brain tumor survivors treated with proton radiation therapy (PRT) prior to 4 years of age are at high risk for poor cognitive and developmental outcomes. This cross-sectional study examined developmental outcomes and educational service utilization at follow-up in a cohort of pediatric survivors treated with PRT before the age of 4 years.

A total of 46 patients (58.7% female, 93.5% White) were assessed using age-appropriate measures for executive, behavioral, and adaptive functioning. Mean age at PRT was 2.4 years (SD=0.9, range 1.0-3.9 years); mean age at follow-up was 7.0 years (SD=4.8, range 2.0-18.6 years). Mean follow-up interval was 4.57 years (SD=4.52, range 0.9-16.2 years). Diagnoses included ependymoma (n=26, 54.2%), medulloblastoma (n=7, 14.6%), craniopharyngioma (n=4, 8.3%), and a few other tumor types. Infratentorial tumors were most common (69.6%). Treatment included prior surgical resection (93.5%) and chemotherapy (60.9%). Posterior fossa syndrome was present in 10.9% (n=5). PRT field consisted of focal (n=41, 89.1%) or craniospinal irradiation (CSI) (n=5, 10.9%). The impact of demographic, diagnostic, and treatment-related factors was examined, including age at PRT, gender, time interval since PRT, radiation field, and tumor location, on intelligence quotient (IQ), adaptive skills, and executive functioning. Rates of impairment (T-scores >65) were calculated. The utilization of educational services was determined.

Mean IQ (SS = 97.6, SD=16.3), as well as mean global executive functioning (Mean T=53.4, SD=11.1) and adaptive skills (Mean SS = 92.5, SD=21.4), as assessed by parent rating scales (BRIEF; SIB), were in the average range. Despite mean scores being within the average range, a large proportion of patients demonstrated difficulties with social withdrawal (28.3%) and activities of daily living (28.3%) (BASC), and global executive dysfunction (17.4%) (BRIEF). Younger age at PRT was associated with lower global adaptive skills at follow-up (r=.39, p=.005), better activities of daily living (r=.53, p<.001), lower social skills (r=.43, p=.002), and more hyperactivity (r=-.37, p=.008), but not aggression, anxiety, depression, somatization, atypical behaviors, withdrawal, or attention problems. Longer follow-up interval was correlated with better activities of daily living (r=.46, p<.001), but more anxiety (r=.39, p=.006). Gender, SES, radiation field, history of hydrocephalus, and location of tumor were not significantly related to primary outcome variables. Posterior fossa syndrome was associated with lower adaptive skills (t=2.90, p=.003) and IQ (t=2.02, p=.026). Of those enrolled in school, 59% received special education services and/or accommodations (IEP n=18, Early Intervention n=6; 504 Plan n=3).

Overall, PRT before age 4 years was associated with difficulties with withdrawal, adaptive skills, and executive functioning. Younger age at PRT was associated with lower adaptive functioning, lower social skills, and higher hyperactivity, but not with IQ, attention, mood, or anxiety. While a longer time interval since treatment was associated with improvement in activities of daily living, anxiety was increased, suggesting some late emotional effects. Furthermore, posterior fossa syndrome after surgery was related to lower adaptive skills and IQ. Attention problems were not indicated. Approximately half received school services/accommodations. Young children treated with PRT require proactive support and services to foster their developmental outcomes.

Adaptive functioning, most notably practical skills, are impacted in pediatric brain tumor survivors. This study aimed to examine the individual components of practical adaptive functions that are most impacted in pediatric brain tumor survivors, and to identify specific medical and socio-demographic factors that contribute to weaknesses in this domain.

The sample consisted of 117 pediatric brain tumor patients seen for a clinical neuropsychological evaluation. Inclusion criteria included participants <18 years at time of brain tumor diagnosis, and whose parents were administered the Adaptive Behavior Assessment System, Second (ABAS-II) or Third Edition (ABAS-3) as a measure of adaptive functioning. Medical and socio-demographic variables were gathered from the patient’s medical record. Medical variables examined were age at diagnosis, age at evaluation, time since diagnosis, tumor location (supratentorial or infratentorial), and history of treatment and associated complications as measured by the Neurologic Predictor Scale (NPS). Socio-demographic factors examined included sex, race, insurance type, parental education, and Area Deprivation Index (ADI) as a measure of neighborhood deprivation/access to community resources. One sample t-tests compared the brain tumor sample to population normative means. Correlations examined associations between practical skills and medical and socio-demographic variables. To determine predictors of practical skills, significant correlations were entered into separate linear regressions for each of the four practical subscales (Community Use, Home Living, Health & Safety, Self-Care).

Participants were diagnosed around 7 years and were approximately 5 years from diagnosis at the time of neuropsychological evaluation. Practical skills were clinically and statistically significantly below the normative mean (Standard Score=85.5, p<.001). Additionally, all practical subscales were statistically significantly below the normative mean (p<.001), with both Community Use (Scale Score=7.6, p<.001) and Home Living (Scaled Score=6.9, p<.001) being clinically significant. Community Use was positively correlated with age at diagnosis (r=.27, p=.004) and negatively correlated with Neurologic Predictor Scale (r=-.33, p<.001), time since diagnosis (r=-.24, p=.01), and ADI (r=-.23, p=.02). Health and Safety was positively correlated with age at diagnosis (r=.21, p=.024). Self-Care was positively correlated with age at diagnosis (r=.202, p=.029) and parental education (r=.203, p=.037); Home Living was not correlated with any of the variables examined. Predictors of Community Use included NPS score (p=.002); ADI approached significance (p=.07). Age at diagnosis predicted Health & Safety practical skills (p=.024), and parental education predicted Self-Care skills (p=.004).

Pediatric brain tumor survivors demonstrate clinically significant weakness in practical skills. While specific medical and socio-demographic factors contribute to lower practical adaptive functioning (e.g., younger age at diagnosis, higher NPS score suggestive of greater treatment burden, longer time since diagnosis, lower ADI score suggestive of greater neighborhood deprivation, and lower parental education), medical and socio-demographic factors do not equally impact practical adaptive functions, but rather individual factors predict specific practical skills. While there is appreciation for the contribution of medical factors in pediatric oncology, few studies have examined socio-demographic factors in this population. This study highlights the importance of considering the role of family and environmental factors on neuropsychological functioning in pediatric oncology in addition to medical factors.

Differences in adaptive functioning present early in development for many children with monogenic (Down Syndrome, Fragile X) and neurodevelopmental disorders. At this time, it is unclear whether children with ACC present with early adaptive delays, or if difficulties emerge later as functional tasks become more complex. While potential delays in motor development are frequently reported, other domains such as communication, social and daily living skills are rarely described. We used a prospective, longitudinal design to examine adaptive behavior from 6-24 months in children with ACC and compared their trajectories to those with monogenic and neurodevelopmental conditions.

Our sample included children with primary ACC (n= 27-47 depending on time point) whose caregivers completed the Vineland Adaptive Behavior Scales-Interview 3rd Edition, via phone at 6, 12, 18 and 24 months. Comparison samples (using the Vineland-2) included children with Down Syndrome (DS; n = 15-56), Fragile X (FX; n = 15-20), children at high familial likelihood for autism (HL-; n=192-280), and low likelihood (LL; no family history of autism and no developmental/behavioral diagnosis; n = 111196). A subset of the HL children received an autism diagnosis (HL+; n = 48-74). The DS group did not have an 18-month Vineland.

A series of linear mixed model analyses (using maximum likelihood) for repeated measures was used to compare groups on three Vineland domains at 6, 12, 18 and 24 month timepoints). All fixed factors (diagnostic group, timepoint, and group X timepoint interaction) accounted for significant variance on all Vineland domains (p < .001). Post hoc comparisons with Bonferroni-correction examined ACC Vineland scores compared to the other diagnostic groups at each timepoint. At 6 months, parent-ratings indicated the ACC group had significantly weaker skills than the LL group in Communication and Motor domains. At 12, 18 and 24 months, ratings revealed weaker Communication, Daily Living and Motor skills in the ACC group compared to both the LL and HL- groups. Compared to the other clinical groups, the ACC group had stronger Socialization and Motor skills than Fragile X at 6 months, and at 24 months had stronger Communication and Socialization skills than both the DS and FX groups, as well as stronger Socialization than the HL+ group.

Compared to children with low likelihood of ASD, children with primary ACC reportedly have weaker Communication and Motor skills from 6 to 24 months, with weakness in Daily Living Skills appearing at 12 months and all differences increase with age. Compared to Fragile X, the ACC exhibited relative strengths in socialization and motor skills starting at 6 months. By 24 months, the ACC group was outperforming the monogenic groups on Socialization and Communication. In general, the ACC scores were consistent with the HL+ sample, except the ACC group had stronger Social skills at 18 and 24 months. The results clearly inform the need for early intervention in the domains of motor and language skills. Additionally, as we know that children with ACC are at increased risk for social difficulties, research is needed both using more fine-grained social-communication tools, and following children from infancy through middle childhood.

Wiedemann-Steiner syndrome (WSS) is a rare Mendelian disorder of epigenetic machinery caused by a mutation in KMT2A, with hallmark features that include intellectual disability and developmental delay. Animal models have helped identify the critical roles KMT2A plays in prefrontal neuron maturation and executive function (i.e. working memory) development. However, the neurobehavioral phenotype of individuals with WSS, including executive functioning, remains poorly characterized. Accordingly, this study aimed to 1.) examine the neurobehavioral profile (adaptive, psychosocial, and executive functioning) associated with WSS and 2.) the correlations between executive functioning and these domains.

A total of 25 mothers of individuals with WSS (13 females, Mean age=12.78 years, SD=7.88) completed a combination of parent-informant questionnaires. The caregivers completed the Adaptive Behavior Assessment System 3rd Edition (ABAS-3), the Strengths and Difficulties Questionnaire (SDQ), and a version of the Behavior Rating Inventory of Executive Function (BRIEF). Descriptive analyses were conducted to examine proportion of the sample with clinically significant concerns on the BRIEF and SDQ, and low to very low adaptive skills based on ratings on the ABAS-3. Partial correlations were computed to examine the relationships between overall executive functioning (BRIEF General Executive Composite, GEC) with adaptive domains (ABAS-3 Conceptual, Practical, Social), and psychosocial functioning (SDQ Emotional Problems, Conduct Problems, Hyperactivity, Peer Relations, Prosocial Behaviors) while accounting for age. Associations that survived Benjamin Hochberg correction are reported.

Of our sample, 64% were rated in the very elevated range for executive functioning problems (BRIEF GEC), with a greater proportion endorsing clinically significant concerns with behavior regulation (68%) relative to cognitive regulation (48%). Majority of participants was rated in the low or very low range for ABAS-3 General Adaptive Composite (72%), with a greater proportion showing problems in Practical (64%) and Conceptual Domains (64%) relative to Social Domain (44%). Among those who completed the SDQ, caregiver ratings implicate elevated Total Problems (90%) with greater concerns observed in Emotional Problems (62%), Hyperactivity (81%) and Peer Relationship difficulties (95%). After controlling for age, executive functioning difficulties were associated with weaker skills in the Conceptual (r=-0.56, p=0.003), Social (r=-0.44, p=0.028) and Practical domains (r=-0.51, p=0.009); as well as more Hyperactivity (r=0.49, p=0.025) and Conduct problems (r=0.58, p=0.007). Specifically, day-to-day challenges with executive functions were related to weaker adaptive skills in Self-Care (r=-0.54, p=0.006), Self-Direction (r=-0.53, p=0.007), and Communication (r=-0.49, p=0.01).

Individuals with WSS are at risk for executive functioning deficits, which in turn may impact the development of and/or day-today application of adaptive skills and behavior regulation. Future clinical research should further explore the development and neurophysiology of executive functions among those with WSS with multidisciplinary methods, including behavioral, cognitive and neurobiological metrics. Those working with individuals with WSS may consider executive functioning interventions, which may yield indirect benefits to self-regulation and daily use of life skills.

A non-negligeable proportion of individuals who have sustained a mild traumatic brain injury (TBI) are at risk of developing persistent symptoms. The impact of persistent post-mTBI symptoms can be profound, causing significant disruptions in well-being, functioning and quality of life (Agtarap, et al., 2021). Reduced social participation often extends beyond the acute recovery period and continues to be associated with lower quality of life for many months after mTBI (Voormolen et al., 2019). Coping was found to be essential in order to decrease physical symptoms, have better psychological health, as well as increase social participation (Vos et al., 2019). The variables of perceived stress and depression were also linked directly and indirectly to mild post-TBI adjustment in terms of their return-to-work status (Strom and Kosciulek, 2007). Furthermore, a greater percentage of individuals with mTBI report chronic pain as compared to individuals with more severe TBIs (Weyer Jamora, Schroeder & Ruff, 2013). Given these implications and the growing concern for mTBI as a potentially disabling and chronic medical condition, it is important to focus on identifying the processes that can lead to persistent symptoms and related preventive interventions that can be applied. This present study aimed to investigate the association between coping and social participation according to anxiety, depression, and pain symptomatology, before and after rehabilitation in a mild TBI population benefiting from an outpatient rehabilitation program.

A prospective longitudinal cohort study design was employed, with two-time points for outcome assessment (i.e., start and end of rehabilitation). This study included 70 adults aged between 18 and 78 who experienced a mTBI between February 2016 and January 2020 and received interdisciplinary outpatient rehabilitation services at a major rehabilitation centre in the Greater Montreal region.Measures administered pre and post rehabilitation included the Rehabilitation Survey of Problems and Coping (R-SOPAC), the Mayo-Portland Adaptability Inventory-4 (MPAI-4), the Depression Anxiety Stress Scales 21 (DASS-21), and the Brief Pain Inventory-Short Form (BPI-SF). Mediation analyses were carried out via PROCESS macro for SPSS, model 4 and 6 (Hayes, 2013).

Mediation analyses indicated a partial indirect link between coping, anxiety, and pain on the level of social participation at the pre-rehabilitation time point. Post-rehabilitation, a significant partial mediating relationship regarding the impact of pain on the link between coping and social participation, was found. In addition, a statistically significant mediation relationship was found, where anxiety mediated the relationship of coping and social participation. These relationships suggest that lower levels of coping appear to be linked to a higher self-reported level of psychological distress and pain, resulting in lower social participation.

This observational rehabilitation cohort study demonstrates how anxiety and pain are associated with coping and social participation outcome following mTBI. These results are quite pertinent for clinical purposes in that paying close attention to the level of anxiety and perceived impact of pain during rehabilitation, and applying targeted interventions at these levels, in particular to increase coping, may prove particularly beneficial to improve social participation outcome.

Executive functioning (EF) and socioeconomic status (SES) are associated with functional outcomes (adaptive functioning and academic achievement) in healthy controls and pediatric populations with executive dysfunction. However, these relationships have yet to be investigated in survivors of childhood acute lymphoblastic leukemia (ALL), a population with EF impairment resulting from disease and treatment characteristics. The objective of this study was to examine the associations of functional outcomes with EF and SES (neighborhood-specific variables and academic support) in survivors of childhood ALL.

Forty-four participants (38.6% female, 72.7% non-Hispanic White, ages 6-17) previously diagnosed with low-risk or standard-risk pre-B cell ALL and treated with chemotherapy-only were included. Participants were evaluated on performance-based measures of EF (cognitive flexibility, verbal fluency, working memory, and processing speed) and academic achievement (word reading and math calculation), and parent-ratings of EF and adaptive functioning. All measures were expressed as T-scores with lower scores indicating better performance. Neighborhood-specific variables were based on participants’ zip codes and census block group, and included area deprivation index (ADI) and child opportunity index (COI). Lower ADI and COI indicate lesser deprivation and greater opportunity. Individualized education plan (IEP) status was used as a proxy of academic support, coded dichotomously as with or without IEP. Percentages of participants showing impairments in functional outcomes were calculated using a cutoff of > 1 SD above the normative mean. Partial correlations were conducted while controlling for age at evaluation, age at diagnosis, sex, and verbal IQ, to examine whether participants with poorer performance-based and parent-rated EF would show reduced functional outcomes. Multiple regression analyses were conducted to evaluate whether neighborhood-specific variables and IEP status would predict functional outcomes while controlling for covariates.

Compared to population norms, survivors of childhood ALL showed worse functional outcomes. Within adaptive functioning, 45.5% of participants showed impairment in activities of daily living and leadership. Adaptive functioning was significantly positively correlated with parent-rated, but not performance-based, EF (r=0.694, p<0.001). Compared to female survivors, male survivors were at increased risk for adaptive functioning difficulties (r=-0.401, p<0.05). Impairments for word reading and math calculation were 25% and 41.7%, respectively. Greater math calculation was associated with better verbal fluency (r=0.378, p<0.05) and processing speed (r=0.439, p<0.05). Older participants at evaluation (/3=-0.580, p<0.001) and those without IEP support (ß=0.465, p<0.05) showed better word reading. Lower ADI predicted better verbal fluency (ß=0.282, p=0.041), however, neighborhood-specific variables were not associated with functional outcomes.

Prior findings indicate that performance-based measures and parent-ratings assess different constructs of EF. Thus, adaptive functioning may relate more to the behavioral construct of EF than its cognitive construct. Current findings also suggest that male survivors are at increased risk for reduced adaptive functioning, consistent with recent reports that male survivors of ALL are at greater risk for specific neurocognitive outcomes. Overall, functional outcomes may be more strongly related to EF than neighborhood-specific variables. Long-term goals include early screening of adaptive and academic difficulties, targeted intervention, and neuropsychological monitoring to support pediatric survivors’ neurocognitive and psychosocial development.

Cognitive decline is expected in normative aging (Cabeza et al., 2018; Salthouse, 2019), which can lead to impairments in adaptive functioning (Yam et al., 2014). Several cognitive domains have been associated with adaptive functioning in older adult samples, including processing speed and executive functioning (e.g., Nguyen et al., 2019; Vaughn & Giovanello, 2010). A recent study examining a mixed clinical sample of older adults demonstrated that processing speed was more predictive of functional decline than other cognitive domains, including aspects of executive functioning (Roye et al., 2022). Therefore, this study attempts to build on previous findings by further examining the relationships between processing speed, adaptive functioning, and executive functioning. Specifically, it investigated the extent to which processing speed mediated the associations between executive functioning and adaptive functioning.

Participants (N = 239) were selected from a clinical database of neuropsychological evaluations. Inclusion criteria were age 60+ (M = 74.0, SD = 6.9) and completion of relevant study measures. Participants were majority White (93%) women (53.1%). Three cognitive diagnosis groups were coded: No Diagnosis (N = 82), Mild Neurocognitive Disorder (NCD; N = 78), and Major NCD (N = 79). The Texas Functional Living Scale (TFLS) was used as a performance-based measure of adaptive functioning. Processing speed was measured using the Coding subtest from the Repeatable Battery for the Assessment of Neuropsychological Status. Executive functioning performance was quantified using part B of the Trail Making Test, Controlled Oral Word Association Test, and Similarities and Matrix Reasoning subtests from the WAIS-IV and WASI-II. Mediation models included age and years of education as covariates and indirect effects were assessed with bootstrapped confidence intervals (Hayes, 2020).

Processing speed mediated all measures of executive functioning. The pattern was consistent for all executive functioning measures such that poorer executive functioning was associated with poorer processing speed, which was subsequently associated with poorer adaptive functioning. Direct effects were significant for all models (ps < .03), suggesting that executive functioning maintained unique associations with adaptive functioning. Follow-up analyses indicated no evidence for moderation of the mediation models based on diagnostic group.

These results highlight the importance of processing speed in understanding real-world implications of pathological and non-pathological cognitive aging. Processing speed mediated all relationships between executive functioning and adaptive functioning. There was no evidence for moderation of these effects, supporting generalizability regardless of neurocognitive disorder and etiologic subtype. Further investigation is warranted into the importance of processing speed in explaining associations of other cognitive domains with adaptive functioning.

The presence of cognitive impairment corresponds with declines in adaptive functioning (Cahn-Weiner, Ready, & Malloy, 2003). Although memory loss is often highlighted as a key deficit in neurodegenerative diseases (Arvanitakis et al., 2018), research indicates that processing speed may be equally important when predicting functional outcomes in atypical cognitive decline (Roye et al., 2022). Additionally, the development of performance-based measures of adaptive functioning offers a quantifiable depiction of functional deficits within a clinical setting. This study investigated the degree to which processing speed explains the relationship between immediate/delayed memory and adaptive functioning in patients diagnosed with mild and major neurocognitive disorders using an objective measure of adaptive functioning.

Participants (N = 115) were selected from a clinical database of neuropsychological evaluations. Included participants were ages 65+ (M = 74.7, SD = 5.15), completed all relevant study measures, and were diagnosed with Mild Neurocognitive Disorder (NCD; N = 69) or Major NCD (N = 46). They were majority white (87.8%) women (53.0%). The Texas Functional Living Scale was used as a performance-based measure of adaptive functioning. The Coding subtest from the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS-CD) was used to measure information processing speed. Composite memory measures for Immediate Recall and Delayed Recall were created from subtests of the RBANS (List Learning, Story Memory, and Figure Recall) and the Wechsler Memory Scale-IV (Logical Memory and Visual Reproduction). Multiple regressions were conducted to evaluate the importance of memory and information processing speed in understanding adaptive functioning. Age and years of education were added as covariates in regression analyses.

Significant correlations (p < .001) were found between adaptive functioning and processing speed (PS; r = .52), immediate memory (IM; r = .43), and delayed memory (DM; r = .32). In a regression model with IM and DM predicting daily functioning, only IM significantly explained daily functioning (rsp = .24, p = .009). A multiple regression revealed daily functioning was significantly and uniquely associated with IM (rsp = .28, p < .001) and PS (rsp = .41, p < .001). This was qualified by a significant interaction effect (rsp = -.29, p = .001), revealing that IM was only associated with adaptive functioning at PS scores lower than the RBANS normative 20th percentile.

Results suggest that processing speed may be a more sensitive predictor of functional decline than memory among older adults with cognitive disorders. These findings support further investigation into the clinical utility of processing speed tests for predicting functional decline in older adults.

Few studies have explored associations between adaptive functioning and cognition in adolescents with early-onset schizophrenia spectrum disorders (EOS).

Adaptive functioning, cognition, positive, negative, and general symptoms were characterized in adolescents with EOS and healthy controls. A modified scale of negative, respectively, general symptoms was used. Bivariate analyses identified correlates of adaptive functioning to be included in multivariate analysis.

Adolescents with EOS showed significant impairments of social- and neurocognitive functions (−0.86 < Cohen´s ds < −0.58) and adaptive functioning (Cohen´s d = −2.23). Visual memory, verbal working memory, processing speed, reaction time, social cognition, and modified negative and general symptoms correlated significantly with adaptive functioning. The multiple regression analysis revealed only verbal working memory as uniquely associated with adaptive functioning (explaining 22.7 % of its variance). Verbal working memory also associated significantly with adaptive functioning in the context of the nonsignificant modified negative and the significant modified general symptoms dimension.

Adolescents with first-episode EOS had large impairments in adaptive functioning and moderate to large cognitive deficits. Verbal working memory was an important associate to concurrent adaptive functioning and may be a treatment target for trials to improve cognitive and adaptive functioning in adolescents with EOS.