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.

Social determinants of health (SDOH) are social conditions (e.g., employment, access to healthcare, quality schools) which are shown by a growing body of literature to impact many health outcomes, including cognition. The development of community-level measures including the Child Opportunity Index (COI) have allowed for increased understanding of the resources and conditions in neighborhoods and their impact on children’s health. Given the limited existing research on how neighborhood factors impact cognitive development, this study aimed to examine associations between neighborhood context (COI) and cognitive outcomes in children and adolescents who presented for neuropsychological evaluations.

Participants included 4,633 youth (ages 2-22; M = 10.8 years; SD = 4.1 years; 63% Male; 33% with a medical condition involving the central nervous system [CNS]) living in the DC-VA-MD-WV Metro Area who presented to an outpatient clinic for evaluation and completed an intellectual functioning (IQ) measure (88% Weschler, 11% DAS, <1% Leiter, <1% RIAS). COI values were extracted from electronic medical records based on home address. COI values include an overall index and three domain scores in educational (educational access, quality, and outcomes), health/environment (access to healthy food, healthcare, and greenspace) and social/economic (income, employment, poverty); higher scores indicate higher opportunity. Using metro-based norms, children from all opportunity levels were represented (14% Very Low, 13% Low, 18% Moderate, 21% High, 34% Very High). Multiple regression analyses were conducted to examine main effect associations between COI and Full-Scale IQ (FSIQ), Verbal IQ (VIQ), and Non-Verbal IQ (NVIQ) and explore moderation of age, gender, and medical condition on these associations. Additional regression analyses examined these relationships for the three COI domains.

Controlling for age, gender, and medical condition, neighborhood opportunity was positively associated with cognitive function (FSIQ: ß=0.198; VIQ: ß=0.202; NVIQ: ß=0.148, p’s <0.01). Models accounted for approximately 10-14% percent of the variance in cognitive outcomes (FSIQ: F[6,4476]=180.331), Adj.R2=0.138; VIQ: F[6,4556]=161.931), Adj.R2=0.124; NVIQ: F[6,4548]=123.893), Adj.R2=0.098). Age moderated the association between overall COI and cognitive outcomes (FSIQ: ß=0.005, p=0.018; VIQ: ß=0.005, p=0.043; NVIQ: ß=0.005, p<0.01) such that the association between neighborhood opportunity and cognitive outcomes was stronger at older ages, though this was a small effect. When examining subdomains of COI, cognitive outcomes were associated with educational (FSIQ: ß=0.094; VIQ: ß=0.099; NVIQ: ß=0.078, p’s <0.01) and social/economic opportunity (FSIQ: ß=0.115; VIQ: B=0.121; NVIQ: ß=0.084, p’s <0.01) but not health/environmental opportunity (FSIQ: ß=-0.001, p=0.991; VIQ: ß=-0.008, p=0.581; NVIQ: ß=-0.008, p=0.553). Medical diagnosis moderated the association between social/economic opportunity and FSIQ; there was a stronger association between IQ and COI in youth with a medical diagnosis (ß=-0.071, p<0.05).

These findings demonstrate the importance of neighborhood factors, especially education and social/economic opportunities, on cognitive development. Children living in higher opportunity neighborhoods showed higher cognitive functioning. Older age and CNS-involved medical conditions were associated with higher risk in the context of reduced neighborhood opportunities. These findings emphasize the need for advocacy and other efforts to improve community resources (e.g., access to early childhood education) to address inequities in cognitive development.

Deficits in visual-motor coordination and/or fine motor dexterity are often present in pediatric neurological and neurodevelopmental conditions and may adversely affect performance on tests with motor demands. This consideration is relevant when interpreting discrepant scores across Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) Processing Speed Index (PSI) subtests, specifically Symbol Search and the more motorically demanding Coding. Although test developers maintain that motor ability is unlikely to significantly impact Coding performances, clinicians often consider whether uneven WISC-V PSI subtest scores (Coding<Symbol Search) may in part be attributed to motor-related difficulties, when indicated. This has important clinical implications, as WISC-V Coding may then be omitted or substituted when calculating FSIQ. Thus, the present study aims to evaluate the role of motor task deficits in uneven PSI subtest scores in a sample of clinic-referred youth.

Participants were 238 children and adolescents (MAge=10.62 years; 65.5% male; 60.5% white) referred for neuropsychological assessment. All participants completed the Coding and Symbol Search subtests of the WISC-V and at least one of two motor tasks: the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) and the Grooved Pegboard (GP). To evaluate patterns of functioning, we determined the frequencies of patients who demonstrated uneven PSI subtest performances (defined in this study as a Coding scaled score [ss] at least 3-points lower than that of Symbol Search) and/or normative weaknesses (i.e., Standard Score [SS] below 80, per recommendations from the American Academy of Clinical Neuropsychology) on motor tasks. A chi-square test of independence was used to evaluate associations between uneven PSI performance and the presence/absence of motor weaknesses. Among those with uneven PSI performance, a one-way ANOVA was used to examine whether PSI subtest difference scores varied as a function of motor performance group (No Weakness=0, VMI Weakness Only=1, GP Weakness Only=2, Weaknesses on Both=3).

Of the 238 participants, 28 (11.0%) displayed normative weaknesses on the VMI only, 43 (16.9%) displayed weaknesses on the dominant-GP only, and 18 (7.1%) displayed weaknesses on both tasks. On the WISC-V, 56 participants (23.5%) exhibited uneven PSI subtest performance (Coding<Symbol Search), with 21 (37.5%) of those participants displaying at least one normative motor weakness. Chi-square analyses indicated no significant association between the presence/absence of motor skill weakness and uneven PSI subtest performance, (X2 (3) = 5.79, p = .122). Among those with uneven PSI performance, Coding/Symbol Search difference scores were not significantly associated with motor performance group (F(3,55) = 1.26, p = .297).

These findings suggest that while patients with uneven WISC-V Coding and Symbol Search scores may also display motor task deficits, these deficits are not significantly associated with uneven performances overall. Additionally, of the participants with uneven PSI subtest scores, the majority did not exhibit normative weaknesses on motor tasks. Therefore, clinicians may be overcorrecting for a motoric cause of uneven performance and underappreciating the potential unevenness a child demonstrates in processing speed. Future studies should evaluate the role of other neurocognitive factors, such as working memory, in this score discrepancy pattern.

Motor impairments are one of the most common adverse outcomes after pediatric arterial ischemic stroke (AIS), affecting approximately half of survivors. The development of motor and cognitive skills is closely interrelated, and they share common neural substrates. The objective of this study was to examine whether motor functioning after the acute phase of stroke is associated with school-age intellectual abilities. We also examined associations between concurrent motor functioning and intellectual abilities. Finally, we explored clinical features associated with motor impairments.

Participants were 64 children, 34 childhood AIS (Meanage= 11.90[2.38]); 30 perinatal AIS (Meanage= 8.75[2.22]), from the Children’s Stroke Program at SickKids Hospital. Motor functioning was assessed with the Pediatric Stroke Outcome Measure sensorimotor subscale at two timepoints, Time 1 or early recovery (childhood group between 30 days post-stroke to 1 year; perinatal group between 2-5 years of age) and Time 2, closest to neuropsychological testing. Intellectual abilities were measured using the Wechsler Intelligence Scale for Children 4th or 5th edition. Associations between motor and intellectual functioning were examined separately in childhood and perinatal AIS groups. Clinical features associated with motor impairment were examined across the full sample.

Motor functioning during early recovery was significantly associated with processing speed (r= -.391, p= .036) in the perinatal group and with overall intellectual functioning (r= -.414, p= .018) verbal intellectual abilities (r= -.444, p= .011), working memory (r= .393, p= .026), and processing speed (r= -.351, p= .042) in the childhood group. There were no associations between concurrent motor and intellectual functioning in the perinatal group, and only with processing speed (r= -.525, p= .002) in the childhood group. When motor functioning was dichotomized as no/mild motor deficit and moderate/severe motor deficit at Time 1, children in the perinatal group with moderate/severe motor deficit had significantly lower perceptual reasoning scores (f[28]= 2.15, p= .040) and participants in the childhood group with moderate/severe motor deficit had significantly lower perceptual reasoning (f[32]= 2.35, p= .025) and processing speed (f[32]= 2.14, p= 0.41) scores. There were no differences between no/mild and moderate/severe motor deficit groups for either perinatal or childhood AIS at Time 2. Clinical features associated with moderate/severe motor deficit at Time 1 were cortical+subcortical infarcts, large lesions, presenting with hemiparesis and seizures at time of neuropsychological assessment, and accessing occupational therapy and physical therapy.

Results suggest that motor functioning during early stroke recovery is associated with intellectual outcome, whereas motor functioning at time closest to neuropsychological assessment is not. This may be related neuroplastic changes post-injury, likely in frontal-subcortical connections, that result in observable motor deficits after stroke and affect subsequent hierarchal brain maturational processes thereby impacting later cognitive outcome. Different patterns of associations between motor functioning and specific intellectual abilities in perinatal and childhood groups suggest possible age-mediated effects on this relationship.

Early life exposures to lead, mercury, polychlorinated biphenyls (PCBs), polybromide diphenyl ethers (PBDEs), organophosphate pesticides (OPPs), and phthalates have been associated with diminished IQ scores in children. Some studies suggest that these neurotoxicants impact boys and girls differently. We conducted a systematic review and meta-analysis to identify and quantify sex differences in IQ deficits from pre- and post-natal exposures to these developmental neurotoxicants.

We used PubMed and PsychINFO to screen abstracts of articles published between January 1, 1950 and December 31, 2021 for empirical studies of six neurotoxicants [lead, mercury, PCBs, PBDEs, OPPs, and/or phthalates] that (1) used an individualized biomarker; (2) measured exposure during the prenatal period or within the first six years of life; and (3) provided different effect estimates on children's intellectual abilities by sex. We assessed each study for risk of bias using Navigation Guide (Woodruff & Sutton, 2014). For studies with combinable data, we performed separate random effects meta-analyses for boys and girls with subgroup analyses by neurotoxicant. To homogenize the magnitude of effect observed in each study, we recalculated results to be expressed as the absolute change in intellectual abilities for a relative change of 1.5 times (i.e., 50% increase) in the exposure variable.

Of 3205 studies screened, 53 met inclusion criteria: 34 evaluated prenatal exposure, 11 postnatal exposure, and 8 both pre- and post-natal exposure. We generally rated these studies as "low" to "probably low" risk of bias. Among the studies examining prenatal exposure, 27 reported no significant differences between the sexes, 7 found negative associations in boys, 4 found negative associations in girls, 5 found negative nonsignificant associations in boys and positive nonsignificant associations in girls, and 3 found no clear pattern, where differences by sex depended on the specific phthalate compound or outcome measurement. Among the studies examining postnatal exposure, 14 reported no significant differences between the sexes, 1 found a negative association in boys, 2 found negative associations in girls, and 2 found positive associations for either boys or girls. In our meta-analysis of 16 studies (4 lead, 4 mercury, 2 PBDEs, 2 OPPs, 4 phthalates), we found that prenatal exposure to developmental neurotoxicants was associated with decreased full-scale intelligence in boys (B = -0.26; 95% CI: -0.45, -0.08), but not girls (B = 0.09; 95% CI: -0.14, 0.31). In subgroup analyses by neurotoxicant, prenatal exposure to lead (B = -1.07; 95% CI: -1.63, -0.52), and ZPBDEs (B = -0.57; 95% CI: -1.14, -0.01) were associated with decreased full-scale intelligence in boys, whereas the girls' effect sizes were consistently near zero.

During fetal development, boys appear to be more vulnerable than girls to IQ deficits from neurotoxic exposures, and especially from lead and PBDEs. More research is needed to examine the nuanced sex-specific effects found for postnatal exposures to toxic chemicals.

Children who are HIV-exposed uninfected (CHEU) are at risk of neurodevelopmental impairments due to perinatal HIV and antiretroviral therapy exposure as well as additional health and psychosocial burdens. There is limited understanding of the impact of perinatal risk factors on long-term outcomes of CHEU. The present study investigated the association between perinatal risk factors and the intellectual and language abilities in CHEU and children who are HIV-unexposed uninfected (CHUU).

CHEU and CHUU, 6 to 10 years, of age underwent neurodevelopmental assessments through the Kids Imaging and Neurocognitive Development (KIND) study at the Hospital for Sick Children in Toronto, Canada between January 2020 and August 2022. CHUU were recruited from the community with similar sociodemographic backgrounds based on residential area in Toronto and parental income levels. Measures of Full-Scale IQ (FSIQ), Verbal Comprehension (VCI), Visual Spatial skills (VSI), Fluid Reasoning (FRI), Working Memory (WMI), and Processing Speed (PSI) were evaluated with the Wechsler Intelligence Scale for Children - Fifth Edition. Core Language, Receptive Language, and Expressive Language skills were assessed with the Clinical Evaluation of Language Fundamentals - Fifth Edition. Perinatal risk factors included birthweight, birth complications (e.g., premature rupture of membranes, jaundice, etc.), maternal smoking and alcohol use during pregnancy, and NICU admission. Analyses of variance and chi-square tests were performed to investigate group differences and multiple regression analyses tested the relation between neurodevelopmental measures and birth factors. Significance was held at p <0.05.

36 CHEU (21 female, 8.74 ±1.56 years) and 26 CHUU (12 female, 8.53 ±1.50 years) children were included. For both groups, mean standardized scores of the cognitive abilities assessed were in the average range. CHEU had significantly lower birth weight than CHUU, but there were no differences between these groups with respect to maternal smoking and alcohol use, birth complications or NICU admission. There were no between group differences identified for the intellectual and language abilities. In the CHEU group, birthweight was significantly associated with lower VCI, WMI, and expressive language. In the CHUU group, prenatal alcohol and smoking exposure was associated with lower VCI scores. Birth complications were associated with lower WMI, PSI, and FSIQ scores.

In this interim analysis, perinatal risk factors impacted neurodevelopmental outcomes of CHEU and CHUU differently. While the groups did not differ in frequency of birth complications and maternal smoking and alcohol use, these factors negatively impacted aspects of intellectual ability in the CHUU group. CHEU with lower birthweight are at greater risk of working memory and language difficulties, supporting the need for early interventions and close neuropsychological follow-up of this population throughout childhood.

The Pediatric Epilepsy Research Consortium (PERC) Epilepsy Surgery Database Project is a multisite collaborative that includes neuropsychological evaluations of children presenting for epilepsy surgery. There is some evidence for specific neuropsychological phenotypes within epilepsy (Hermann et al, 2016); however, this is less clear in pediatric patients. As a first step, we applied an empirically-based subtyping approach to determine if there were specific profiles using indices from the Wechsler scales [Verbal IQ (VIQ), Nonverbal IQ (NVIQ), Processing Speed Index (PSI), Working Memory Index (WMI)]. We hypothesized that there would be at least four profiles that are distinguished by slow processing speed and poor working memory as well as profiles with significant differences between verbal and nonverbal reasoning abilities.

Our study included 372 children (M=12.1 years SD=4.1; 77.4% White; 48% male) who completed an age-appropriate Wechsler measure, enough to render at least two index scores. Epilepsy characteristics included 84.4% with focal epilepsy (evenly distributed between left and right focus) and 13.5% with generalized or mixed seizure types; mean age of onset = 6.7 years, SD = 4.5; seizure frequency ranged from daily to less than monthly; 53% had structural etiology; 71% had an abnormal MRI; and mean number of antiseizure medications was two. Latent profile analysis was used to identify discrete underlying cognitive profiles based on intellectual functioning. Demographic and epilepsy characteristics were compared among profiles.

Based on class enumeration procedures, a 3-cluster solution provided the best fit for the data, with profiles characterized by generally Average, Low Average, or Below Average functioning. 32.8% were in the Average profile with mean index scores ranging from 91.7-103.2; 47.6% were in the Low Average profile with mean index ranging from 80.7 to 84.5; and 19.6% were in the Below Average profile with mean index scores ranging from 55.0-63.1. Across all profiles, the lowest mean score was the PSI, followed by WMI. VIQ and NVIQ represented relatively higher scores for all three profiles. Mean discrepancy between indices within a profile was as large as 11.5 IQ points. No demographics or epilepsy characteristics were significantly different across cognitive phenotypes.

Latent cognitive phenotypes in a pediatric presurgical cohort were differentiated by general level of functioning; however, across profiles, processing speed was consistently the lowest index followed by working memory. These findings across phenotypes suggest a common relative weakness which may result from a global effect of antiseizure medications and/or the widespread impact of seizures on neural networks even in a largely focal epilepsy cohort; similar to adult studies with temporal lobe epilepsy (Hermann et al, 2007). Future work will use latent profile analysis to examine phenotypes across other domains relevant to pediatric epilepsy including attention, naming, motor, and memory functioning. These findings are in line with collaborative efforts towards cognitive phenotyping which is the aim of our PERC Epilepsy Surgery Database Project that has already established one of the largest pediatric epilepsy surgery cohorts.

Individuals with sickle cell disease (SCD) are at increased risk for developing impairment across cognitive domains, although the most common deficits are thought to be related to processing speed and executive functions. One of the most common ways of evaluating cognitive functioning is through the administration of intellectual tests. While lower overall intellectual functioning in individuals with SCD compared to healthy controls has been found, the specific pattern of strengths and weaknesses across indices is not well known. Anecdotally, it has been observed at our clinic that individuals with SCD are more likely to show relative or significant weaknesses in visuospatial abilities, but this has not been formally investigated. Further, based on the extant research, individuals with SCD would likely demonstrate lower working memory and processing speed indices, but, as far as we are aware, this has not been investigated either. The purpose of the present study is to examine the intellectual profiles, including areas of relative and significant strengths and weaknesses, of children and adolescents with SCD.

Participants are children and adolescents (age 6-16) with SCD who were referred for a neuropsychological evaluation at Montefiore Medical Center’s Neuropsychological Assessment Service from 2015 to 2022. These participants (N=54) were identified through a thorough review of patients seen through this service and were administered the Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V; Wechsler, 2014). Mean scores were calculated for WISC-V indices. In addition, differences were calculated between WISC-V indices (e.g., VCI-VSI, etc.), and a discrepancy analysis was conducted comparing the base rates of these differences in the present sample to the WISC-V standardization sample.

In our sample, the mean total FSIQ of our sample was 85 (SD=14.5). The following mean scores were obtained across indices: VCI, SS=90 (SD=14.5); VSI, SS=86.5 (SD=14.9); FRI, SS=90 (15.5); WMI, SS=89 (SD=15.6); and PSI, SS=82 (SD=17.4). Many of the index score discrepancy base rates were similar to the standardization sample. However, our sample had greater discrepancies between several indices compared to the standardization sample. In particular, the following base rate discrepancies between index scores emerged as being different in our sample compared to the standardization sample: VCI>VSI and VCI>PSI. Notably, a 30+ point difference VCI>VSI was found in 6% of our sample (compared to 1.6% of the standardization sample) and a 30+ point difference between VCI>PSI was found in 12% of our sample (compared to 4.6% of the standardization sample). In addition, a 10+ point difference found between VCI>PSI was found in 50% of our sample (compared to 29% of standardization sample).

In our sample, FSIQ and index scores fell approximately 0.5-1.33 SD below the standardization sample means, with the lowest index scores being PSI and VSI. Consistent with the literature, the PSI (but not WMI) emerged as an area most discrepant to other indices (particularly VCI). In line with our observations, the VSI emerged as an area of relative difficulty as compared to the VCI. These results suggest that, in addition to processing speed, visuospatial/constructional ability is an area that warrants consideration in the assessment of individuals with SCD.

The Neurological Predictor Scale (NPS) quantifies cumulative exposure to tumor- and treatment-related neurological risks. The Pediatric Neuro-Oncology Rating of Treatment Intensity (PNORTI) measures the intensity of different treatment modalities, but research is needed to establish whether it is associated with late effects. This study evaluated the predictive validity of the NPS and PNORTI for neuropsychological outcomes in pediatric brain tumor survivors.

A retrospective chart review was completed of pediatric brain tumor survivors (PBTS) (n = 161, Mage = 13.47, SD = 2.80) who were at least 2 years from the end of tumor-directed treatment. Attention, intellectual functioning, perceptual reasoning, processing speed, verbal reasoning, and working memory were analyzed in relation to the NPS and PNORTI.

NPS scores ranged from 1 to 11 (M = 5.57, SD = 2.27) and PNORTI scores ranged from 1 (n = 101; 62.7%) to 3 (n = 18; 11.2%). When controlling for age, sex, SES factors, and time since treatment, NPS scores significantly predicted intellectual functioning [F(7,149) = 12.86, p < .001, R2 = .38] and processing speed [F(7,84) = 5.28, p < .001, R2 = .31]. PNORTI scores did not significantly predict neuropsychological outcomes.

The findings suggest that the NPS has value in predicting IF and processing speed above-and-beyond demographic variables. The PNORTI was not associated with neuropsychological outcomes. Future research should consider establishing clinical cutoff scores for the NPS to help determine which survivors are most at risk for neuropsychological late effects and warrant additional assessment.

Intellectual functioning (IQ) is lower in schizophrenia patients compared to healthy controls, with bipolar patients intermediate between the two. Declines in IQ mark the onset of schizophrenia, while stability is generally found post-onset. There are to date few studies on long-term IQ development in bipolar disorder. This study presents 10-year follow-up data on IQ, including premorbid IQ estimates, to track the developmental course from pre-onset levels to long-term outcomes in both patient groups compared to healthy controls.

We included 139 participants with schizophrenia, 76 with bipolar disorder and 125 healthy controls. Mixed model analyses were used to estimate developmental slopes for IQ scores from estimated premorbid level (NART IQ) through baseline (WASI IQ) measured within 12 months post-onset, to 10-year follow-up (WASI IQ), with pairwise group comparisons. The best fit was found using a model with a breakpoint at baseline assessment.

Only the schizophrenia group had significant declines from estimated premorbid to baseline IQ levels compared to controls. When comparing patient groups, schizophrenia patients had steeper declines than the bipolar group. Increases in IQ were found in all groups over the follow-up period.

Trajectories of IQ from premorbid level to 10-year follow-up indicated declines from estimated premorbid level to illness onset in both patient groups, followed by increases during the follow-up period. Schizophrenia patients had a steeper decline than bipolar patients. During follow-up, increases indicate developmental improvement for both patient groups, but with a maintained lag compared to healthy controls due to lower premorbid levels.

Learning Difficulties relates to significant and unusual difficulties in the acquisition and use of one or more of the following areas: listening, speaking, reading, writing and mathematical skills. In the last twenty years, following the research conducted by cognitive psychology, from neuropsychology, from pedagogy and from the confrontation between educators and psychologists, the attention was focused on the cognitive modalities of the subjects engaged in learning tasks.

Thanks to the study of cognitive styles and Learning Styles thelearning subject was placed at the center of the educational project, stimulating from on the one hand there is also reflection on teaching styles and the most appropriate ones methodologies, teaching methods and methods of approaching the individual disciplines and, on the other hand, prompting clinicians to research around the intellectual peculiarities of each subject and a outline a descriptive criterion of his / her cognitive functioning profile.

The intellectual scale (WISC IV) of 32 children (aged between 7 and 15 years) with specific learning disabilities was analyzed, in order to highlight the underlying intellectual functioning and any cognitive styles.

According to the international scientific literature, the results show a greater fall in the area of working memory, followed by the cognitive domain concerning processing speed.

In detail, by analyzing the individual subtests, greater difficulties are noted, at all ages, in the processes of abstraction and conceptualization, in short-term auditory memory, in the speed of processing and visual-praxic motor coordination.