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Di Battista A.,Neurosciences and Mental Health Program | Hancock K.,Hospital for Sick Children | Cataudella D.,London Health Sciences Center | Johnston D.,Childrens Hospital of Eastern Ontario | And 4 more authors.
Oncology Nursing Forum | Year: 2015

Purpose/Objectives: To examine the perceptions of healthcare providers (HCPs) regarding the utility of two psychosocial screening tools designed for pediatric oncology, the Psychosocial Assessment Tool-Revised (PATrev) and the Psychosocial Care Checklist (PCCL). Design: Repeated measures comparative study. Setting: Four pediatric health centers in Ontario, Canada. Sample: 15 oncologists, 14 nurses, and 8 social workers. Methods: Using a visual analog scale (VAS), participants were asked to rate how useful they found (a) the psychosocial summary derived from the parent-completed PATrev, used to assess family psychosocial risk, and (b) the HCP-completed PCCL, used to identify family psychosocial needs. Measures were completed soon after diagnosis and six months later. Mann-Whitney U tests were used for analyses. Main Research Variable: VAS scores. Findings: Pediatric oncology HCPs differ in their acceptance of the psychosocial screening tools tested. The highest utility ratings for both instruments were from nurses, and the lowest utility ratings were from social workers; moderate ratings were obtained from oncologists. Conclusions: Psychosocial screening tools can identify the psychosocial needs of children with cancer and their families throughout the cancer trajectory. Consequently, these tools could foster communication among colleagues (medical and nonmedical) who are caring for children with cancer about the psychosocial needs of this population and the allocation of resources to address those needs. Implications for Nursing: Nurses seem to value these tools more than other HCPs, which may have positive implications for their clinical practice. Copyright 2015 by the Oncology Nursing Society.

Till C.,York University | Ho C.,York University | Dudani A.,York University | Garcia-Lorenzo D.,Montreal Neurological Institute | And 3 more authors.
Archives of Clinical Neuropsychology | Year: 2012

Executive functions (EFs) are vulnerable to disruption in pediatric-onset multiple sclerosis (MS) patients. We describe the pattern and correlates of executive dysfunction in 34 adolescents with MS on neuropsychological tests and the parent version of the Behavior Rating Inventory of Executive Function (BRIEF). The adolescents with MS performed lower than age-matched controls in several areas of executive functioning, with 44% of patients being impaired on the Trail Making Test-Part B. On the BRIEF, problems in working memory and planning/organization were identified in the patient group compared with controls, particularly in patients with a younger age at disease onset. Task performance and parent-ratings of EF skills were strongly related to whole brain and regional brain volume metrics and, to a lesser extent, T 2-weighted lesion volume. Working memory and attention switching are at greatest risk of impairment. Results support the inclusion of neuropsychological assessment alongside parent-report measures of EF skills in childhood-onset MS. © The Author 2012.

Till C.,York University | Udler E.,York University | Ghassemi R.,Montreal Neurological Institute | Narayanan S.,Montreal Neurological Institute | And 3 more authors.
Multiple Sclerosis Journal | Year: 2012

Background: Multiple sclerosis (MS) onset during adolescence has the potential to disrupt a key period of psychosocial maturation. Objective: We aimed to examine the prevalence and risk factors associated with emotional and behavioral outcomes in adolescents with MS. Methods: The Behavioral Assessment System for Children-2nd Edition (BASC-2) was completed by 31 adolescents with MS (mean age = 16.1 years), 31 age-matched controls, and parents of all participants. BASC-2 outcomes were compared between groups. Base rates were examined for scores falling at least one or two standard deviations below norm. Associations between BASC-2 outcomes and features of disease severity and IQ were examined. Results: Youth with MS were reported by their parents to have more symptoms of depression and somatization and lower adaptive skills compared with reports by parents of controls. On the self-report, patients endorsed more problems of inattention/hyperactivity and lower self-reliance relative to controls. Behavioral concerns and reduced adaptive functioning in the MS group were associated with fatigue, poor relations with parents, and perceived social stress. Psychosocial outcomes did not associate with number of relapses, Expanded Disability Status Scale score, disease duration, brain lesion volume or IQ. Conclusion: Youth with MS are at risk of difficulties in behavioral and emotional health. Relations with parents emerged as a key factor influencing the emotional well-being of youth with MS, suggesting an important role for family-centered care in this population. © The Author(s) 2012.

Todorow M.,York University | Desouza J.F.,York University | Banwell B.L.,Neurosciences and Mental Health Program | Till C.,York University
Journal of Clinical and Experimental Neuropsychology | Year: 2014

Impairments in visuospatial abilities are commonly reported in children and adolescents with multiple sclerosis (MS). Corpus callosum (CC) pathology occurs in patients with MS and may contribute to impairment in visuospatial perception, particularly when interhemispheric information transfer is required. This study used a global-local hierarchical letter paradigm to examine the relationship between interhemispheric information transfer and white matter integrity in the CC assessed using diffusion tensor imaging. Thirteen cognitively preserved pediatric-onset MS patients and 15 age-matched healthy controls were asked to determine whether a target letter E appeared at the attended level of the stimulus. As expected, both groups processed global and local information more slowly under divided than selective attention conditions. The MS group performed similarly to the control group with respect to reaction time and accuracy on selective and divided attention conditions, with one exception. Specifically, the presence of a global target when attending to a local target caused greater response conflict in the MS group than in controls (p =.01). Pooling both the patient and control data, greater response conflict was associated with reduced white matter integrity as indicated by lower fractional anisotropy in the anterior body of the CC (r = -.33, p <.05). Results suggest that reduced white matter integrity in anterior regions of the CC may lead to less efficient inhibition of task-irrelevant global information in the hierarchal processing of visual information. © 2014 © 2014 Taylor & Francis.

Clairman H.,Neurosciences and Mental Health Program | Skocic J.,Neurosciences and Mental Health Program | Lischinsky J.E.,George Washington University | Rovet J.,Neurosciences and Mental Health Program | Rovet J.,University of Toronto
Pediatric Research | Year: 2015

Background:Given thyroid hormone (TH)'s essential role in multiple aspects of early brain development, children with congenital hypothyroidism (CH) detected and treated early may still display subtle cognitive and behavioral impairments as well as brain abnormalities. However, effects on their cortical development are not yet known. We used an automated neuroimaging technique to determine if these children differ in cortical thickness (CT) from typically developing controls (TDC) and if the regions showing CT differences reflect severity of initial hypothyroidism and predict later neuropsychological functioning.Methods:FreeSurfer Image Analysis Suite was used on archived MRI scans from 41 CH and 42 TDC children aged 9-16 y. Vertex-based procedures were used to compare groups and perform correlations between CT and indices of disease severity and neuropsychological outcome.Results:The CH group showed multiple regions of cortical thinning or cortical thickening within right and left hemispheres relative to TDC. CT values were significantly correlated with early T4 and thyroid-stimulating hormone (TSH) levels and current neuropsychological test indices.Conclusion:The developing cortex is sensitive to early TH loss in CH. Different patterns of cortical thinning or cortical thickening among brain regions may reflect timing of TH deficiency relative to timing of cortical development.

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