English summaries

English Summaries (02/2021)

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Laura Hokkanen, Marja Laasonen, Liisa Klenberg, Kaisa Peltomaa & Vesa Närhi

Pediatric neuropsychological rehabilitation in Finland – A survey of practitioners and practices

This study surveyed the situation of neuropsychological rehabilitation for children in Finland. Information was collected on the practitioners, content areas and practices of rehabilitation. The survey was conducted online and practitioners within the capital region and Southern Finland (= 33) were compared with practitioners working elsewhere in Finland (= 37). The respondents were well educated; 86 percent had specialist training in neuropsychology, and many also had other training. The volume or content of rehabilitation did not differ between groups from different geographical regions. Rehabilitation mostly targeted school-aged children, with referrals related to reading difficulty or attention problems, and rehabilitation focused on academic skills (reading, writing and arithmetic) or attention and executive skills. Approximately half of the working hours involved cognitive training while the other half was split between psycho-education and psychological or psychosocial support. Individualized tasks, guidance for the family, and meetings with the daycare or school were the most frequents methods of work. Practitioners from different geographical regions differed only in the ways of conducting pre-intervention and post-intervention evaluations. In Southern Finland they were more often both conducted by another neuropsychologist. Based on the results of the study, the neuropsychological rehabilitation of children requires knowledge of many different developmental problems, therapeutic skill, and the ability to collaborate with the child’s support network. This information can be used to develop work practices.

Keywords: neuropsychological rehabilitation, children, adolescents, practices, survey

Laura Hokkanen, Marja Laasonen, Liisa Klenberg, Kaisa Peltomaa & Vesa Närhi

The efficacy of neuropsychological rehabilitation in children and adolescents – A summary of umbrella reviews

This article gathers evidence on the efficacy of neuropsychological rehabilitation in children and adolescents. The work is linked to the Scientific Advisory Board of the Finnish Psychological Association and Finnish Psychological Society’s project to prepare guidelines for good clinical practice for different fields of psychology. Efficacy has earlier been evaluated for adult neuropsychological rehabilitation. This article on children and adolescents is based on seven systematic umbrella reviews, focusing on the efficacy of impairments in language, reading abilities, mathematical abilities, visual and visuospatial abilities, memory, executive functions, and social skills. These reviews form the current special issue. The seven umbrella reviews screened a total of 5,897 systematic reviews or meta-analyses, with 165 selected for inclusion. The results indicate that a wide range of interventions relevant to neuropsychological rehabilitation exist, but the quality of research has been heterogeneous. The few high-quality studies have yielded medium or even large effects, but for the large part, evidence is incomplete. In addition to cognitive training, the interventions include a wide variety of teacher and parent supervision, behavioral therapy, and other psychosocial treatments. Based on the extracted evidence, guidelines for the neuropsychological rehabilitation of children and adolescents are provided.

Keywords: neuropsychological interventions, children and adolescents, efficacy, systematic review

Katja Mäkiluoma, Kaisa Peltomaa & Kuntoutuksen vaikuttavuustyöryhmä (KVT)

The effectiveness of neuropsychological rehabilitation in strengthening the social skills of children and adolescents – A systematic review

Rehabilitation studies on the social skills of children and adolescents have yielded conflicting results. Existing international research promotes the use of early, versatile forms of interventions, including guiding networks. The objective of this review is to synthesize the current scientific evidence on the rehabilitation of social skills of children and adolescents. Included in this review are the results of rehabilitation programs relevant to the context of neuropsychological rehabilitation in Finland. Of the 455 articles considered, 25 were selected. The articles were heterogenous in terms of methodology, execution, interventions, findings and quality. Most of the studies had been carried out with children with autism spectrum disorder. The results were positive, but mainly not statistically significant. Positive results were obtained from pervasive programs, combination treatment, video- and technology-assisted interventions, social skill groups for children and guidance of parents. Guiding professionals, the intensity of rehabilitation and early timing increased effectiveness. The results provide supporting evidence of the effectiveness of early interventions for children with autism spectrum disorder and combination treatments for ADHD children.

Keywords: social competence, social skills, self-regulation, neuropsychology, rehabilitation

Salla Saarela, Kaisa Peltomaa & Kuntoutuksen vaikuttavuustyöryhmä (KVT)

The effectiveness of neuropsychological rehabilitation in enhancing children’s fluent technical reading – A systematic review

Fluent technical reading requires a mastery of basic reading skills, that is, decoding and automatic word recognition, both of which are prerequisites for understanding and interpreting meaning in text. Research on remedial reading programs have primarily focused on supporting literacy skills and preventing reading difficulties. Significantly less research is available on reinforcing reading fluency. The objective of this review is to synthesize scientific evidence on remedial reading programs for technical reading relevant to neuropsychology. The search process produced 206 articles, of which 22 were selected. The studies were heterogeneous and varied in experimental design. The results were largely positive, with effect sizes varying from 0.13 to 0.84. The overall quality of the original articles ranged from low to good. Phonological exercises were found to be helpful in positively influencing the development of emerging reading skills in children. Repeated reading was found to be effective in reinforcing. Many studies highlighted the role of a supportive adult in the development of a child’s technical reading skills.

Keywords: word recognition, reading skills, remedial reading programs, neuropsychological rehabilitation, rehabilitation

Laura Ermi, Tuire Koponen & Kuntoutuksen vaikuttavuustyöryhmä (KVT)

Effective interventions for mathematical learning difficulties: An umbrella review

Mathematical learning difficulties are common difficulties that can impair everyday functioning and participation from school years to adulthood. This review brings together research data published in systematic reviews and meta-analyses on the effectiveness of remediation for children and adolescents with mathematical learning difficulties. We focus on promising and evidence-based practices that could be used in the context of the neuropsychological rehabilitation of children and adolescents with mathematical learning difficulties. A systematic literature search yielded 32 articles published between 2002 and 2017. In relation to the AMSTAR 2 criteria, the methodological quality of the studies was generally low, so this umbrella review focuses on interventions of preparatory skills, basic computations and word problem-solving that show positive effects in more than one review or meta-analysis. Supported by the research were especially direct and explicit teacher-led, structured methods that gradually advance from concrete modelling and supervised practice to independent practice, as well as cognitive and metacognitive strategy interventions. Children and adolescents with mathematical learning difficulties did not seem to benefit as much from computer-assisted instruction compared to other interventions, and working memory training did not produce transfer effects to mathematical performance.

Keywords: mathematical difficulties, mathematical learning disabilities, dyscalculia, interventions, remediation, evidence-based practices

Hanna Suominen, Liisa Klenberg & Kuntoutuksen vaikuttavuustyöryhmä (KVT)

The effectiveness of neuropsychological rehabilitation on visual skills in children and adolescents

The difficulties and rehabilitation of children’s visual skills have been studied surprisingly little. The purpose of this review was to determine which methods of neuropsychological rehabilitation are beneficial for treating visual skills in children and adolescents. Through a literature search, we found 70 reviews or meta-analyses, of which two were chosen for the present review. The first review showed that virtual reality therapy is motivational, beneficial for self-perception, and engaging for children suffering from cerebral palsy. However, no changes in fMRI, visual skills, or daily functioning were found. The second review studied the malleability of spatial skills in typical populations. The results showed that spatial skills can be trained and the training effect can generalize in other, non-trained, skills. Age, gender, and method of training had no effect on the skills. The present systematic review found preliminary benefits of training visual skills in children and adolescents. Only a few reviews of good quality and using methods applicable to neuropsychological rehabilitation were found from existing literature. Due to the large variation of the included interventions and the paucity of studies with clinical groups, it was not possible to determine how specific interventions affect sub-types of difficulties in visual skills. In future studies, further development of neuropsychological rehabilitation for children and adolescents with difficulties in visual skills is important in order to avoid cumulative problems in learning and daily life.

Keywords: visual skills, visuospatial skills, neuropsychological rehabilitation, children, virtual reality, systematic review

Kaisa Kanerva, Marja Laasonen & Kuntoutuksen vaikuttavuustyöryhmä (KVT)

The effects of neuropsychological rehabilitation on memory in children and adolescents

Based on the systematic review of previous review articles, we investigated whether neuropsychological rehabilitation has effects on memory functions in children and adolescents. A systematic literature search found 16 reviews, which included a total of 11,074 children and adolescents. Participants’ age ranged between 1.4 to 20 years, and the main diagnoses were acquired brain injuries, ADHD and learning difficulties. The targets of rehabilitation in reviewed articles were 1) a specific memory component, such as working memory or prospective memory, 2) a combination of memory components, or 3) more comprehensive cognitive development, including memory. The total duration or intensity of the interventions varied, and the duration and circumstances of rehabilitation were not reported systematically. For that reason, any conclusions about the effects of circumstances are not warranted. The results demonstrate that neuropsychological rehabilitation can have positive effects on prospective memory, explicit memory and working memory performance in various clinical groups. However, the effects of training on working memory does not seem to generalize to other relevant everyday skills or academic learning. Comprehensive cognitive rehabilitation, in turn, produced variable, but moderate effects on memory functions, but also on other cognitive functions in various clinical groups. The articles reviewed in the present study varied in their quality and in several studies the role of memory was minor.

Keywords: rehabilitation, intervention, neuropsychology, memory, working memory

Sirkku Einola, Tuire Kangas, Liisa Klenberg & Kuntoutuksen vaikuttavuustyöryhmä (KVT)

The effectiveness of neuropsychological rehabilitation on executive functions in children and adolescents

Children with neurodevelopmental and neurological disorders typically have difficulties with executive functions and attention. This systematic review evaluated the efficacy of interventions targeting executive functions among children and adolescents who suffer from these deficits. After a systematic literature search, 40 meta-analyses or systematic reviews were included. Most established evidence concerns children with ADHD who benefit from behavioral interventions. The effectiveness of cognitive training among children with ADHD symptoms was very limited, but practicing organizational skills was more beneficial. Preliminary evidence suggests that cognitive training may improve attention skills among children with acquired brain injuries. Within some diagnostic groups (e.g., children with externalizing problems or fetal alcohol spectrum disorders) and interventions (e.g., cognitive behavioral therapy, neurofeedback and mindfulness) the amount of existing research data is still very limited to be able to draw conclusions about intervention efficacy. Overall, the evidence is inconsistent and there is a need for more research with more uniform procedures.

Keywords: executive functions, attention, rehabilitation, intervention, effectiveness, children, adolescents, ADHD, acquired brain injury, conduct disorder, FASD

Inkeri Äärinen, Marja Laasonen & Kuntoutuksen vaikuttavuustyöryhmä (KVT)

The efficacy of neuropsychological rehabilitation in the treatment of children’s specific language impairment

Literature reviews have shown that rehabilitation can efficiently treat an adult’s social communication problems, as well as speech and language problems. The same kind of review is not available when it comes to children. The purpose of this systematic review is to evaluate if neuropsychological rehabilitation is efficient in the treatment of children’s specific language impairment. In this review, a total of 2,856 articles were screened, of which 28 systematic reviews and meta-analyses were chosen. These articles were very heterogeneous, and participants, research settings, interventions used, results, and reliability all varied considerably. The most common rehabilitation method examined in the articles was speech therapy, either directly performed by a speech therapist or indirectly performed by another specialist or parents. Speech therapy interventions were mostly efficient in the treatment of language problems. The efficacy size varied from preliminary evidence (for example, the improvement of language skills of children with cerebral palsy) to strong evidence achieved through meta-analysis (for example, the development of active vocabulary). The positive results must be considered with caution because of some of the articles included were qualified with poor reliability according to the AMSTAR 2 -tool. A psychologist was mentioned as performing the intervention only in two articles. However, psychologists or neuropsychologists can adapt most of the interventions described in the articles for working directly with clients or working indirectly with parents or other specialists.

Keywords: specific language impairment, SLI, rehabilitation, treatment methods, neuropsychology, psychology, speech therapy