Executive dysfunction can affect community integration in adults with traumatic brain injury (TBI). The Cognitive Orientation to daily Occupational Performance (CO-OP) approach has shown some promise in promoting functional improvements in adults with executive dysfunctions post TBI. However, access to rehabilitation is often limited especially in rural communities. This study aimed to (1) investigate the feasibility of administering the CO-OP approach in a tele-rehabilitation format and (2) examine its impact on community integration and executive dysfunction. A pilot series of 3 case studies was conducted. Participants identified 5 goals; 3 were trained and 2 were untrained to allow examination of transfer. Outcome measures included the Canadian Occupational Performance Measure, the Mayo-Portland Adaptability Inventory-4 Participation Index, and the Dysexecutive Questionnaire. Descriptive analyses demonstrated goal achievement and transfer, suggesting it is feasible to implement the CO-OP approach in a tele-rehabilitation format. Community integration and executive dysfunction behaviours also showed trends towards improvement.

Executive dysfunction can affect community integration in adults with traumatic brain injury (TBI). The Cognitive Orientation to daily Occupational Performance (CO-OP) approach has shown some promise in promoting functional improvements in adults with executive dysfunctions post TBI. However, access to rehabilitation is often limited especially in rural communities. This study aimed to (1) investigate the feasibility of administering the CO-OP approach in a tele-rehabilitation format and (2) examine its impact on community integration and executive dysfunction. A pilot series of 3 case studies was conducted. Participants identified 5 goals; 3 were trained and 2 were untrained to allow examination of transfer. Outcome measures included the Canadian Occupational Performance Measure, the Mayo-Portland Adaptability Inventory-4 Participation Index, and the Dysexecutive Questionnaire. Descriptive analyses demonstrated goal achievement and transfer, suggesting it is feasible to implement the CO-OP approach in a tele-rehabilitation format. Community integration and executive dysfunction behaviours also showed trends towards improvement.

Pediatric overweight has become a topic of interest primarily due to the severity of potential physical and socioemotional consequences and escalating rates of weight status in children. Legislative initiatives have called for the creation of intervention and prevention programs; however, the efficacy and effectiveness of most of these programs have either not been established or are limited. The limited effect programs have on pediatric obesity may be due to a lack of understanding of the complexity of risk and protective factors associated with weight status. Pediatric overweight occurs when social, familial, psychological, and biological factors interact to disrupt the balance of energy intake and energy expenditure. In order to impact weight status, it is important to understand specific factors that are associated with overweight and obesity. Research has started to examine social, familial, and psychological factors that can be addressed in prevention and intervention programs. The present study examines potential relations between aspects of executive function and pediatric weight status as well as obesity-prone eating behaviors. Executive function is operationally defined as a problem-solving construct with four steps that work together to solve a problem: recognizing the problem, planning a course of action, executing the action, and evaluating the success of the action. Participants (78 children and their caregivers) between the ages of four and seven had their heights and weights measured, completed language-appropriate receptive language assessments, and were engaged in four tasks that theoretically correspond to the four aspects of problem-solving. Caregivers of the participating children completed demographic, economic hardship, child eating behaviors, and child daily executive functioning measures. No significant findings were indicated between problem-solving phases of executive function and current weight status. Using multiple linear regression analyses, findings indicated that children who have high general appetites for food demonstrated deficits in the problem recognition and plan execution phases of executive function on caregiver-report measures even when accounting for racial/ethnic membership and socioeconomic hardship. In addition, children who cope with their emotions through eating (i.e., Emotional Overeating) rather than through other means also exhibit deficits in problem recognition, problem analysis, and plan execution on caregiver-report measures even when accounting for racial/ethnic membership and socioeconomic hardship. The findings presented in this study are discussed in light of the current literature and their implications for the future direction of intervention and prevention programs for pediatric overweight and obesity.

In New Zealand, approximately 10% of births are considered premature, that is less than 37 weeks gestation. With advances in medical technology, young infants are surviving gestation periods as few as 23 weeks. It is expected that many of these severely premature infants will demonstrate some problem in their academic, or cognitive function including language functioning. It is agreed that children who are born severely premature often present with language problems, the nature of the difficulties are not clear. Research examining language abilities that involve cognitive functions such as inference generation have demonstrated that children born prematurely exhibit difficulties with phonologic short-term memory and executive function. Language tasks such as inference understanding require children to integrate real-world knowledge with the linguistic information to generate and produce language that is more complex. The aim of this study was to discover if the language of children born severely premature differs from that of language-age matched peers. This study examined high-level language abilities of school-age children born severely prematurely, specifically, language tasks that involved executive functions including working memory, story inferencing, and recognising absurdities. Six children who were born less than 28 weeks gestation participated in this study. Their results on the above measures were compared to a language-aged matched comparison group, determined by performance on a standardised test. It was hypothesised that the children born severely premature would not differ from their language-age matched peers on measures of general language ability but differences would exist on measures of language processing and inferencing. The findings overall showed little difference between the preterm group and their language-age matched peers on measures except for the measure of chronological age. Although no group difference was found for the measure of working memory, a larger variance on this measure was observed in the preterm group.

Background: Maltreated children, including those who are looked after away from home, are amongst the most vulnerable members of society. Due to the relational trauma that most looked after children have experienced they are at increased risk of attachment and mental health difficulties, which can impede their ability to form close relationships with new carers. Indeed, many such children behave in ways that fail to elicit caregiving or even as if they do not need caregivers, and providing sensitive, therapeutic care to these vulnerable children can be a considerable challenge. Aims: The aims of this thesis were threefold: to review the impact of maltreatment experiences on children’s executive functioning, to investigate the prevalence of attachment and trauma-related difficulties in children in foster care, and their impact on the parenting task of foster carers. Methods: Aims are addressed in two journal articles. To address the first aim, a systematic review of research regarding the association between maltreatment and executive function in children and adolescents is presented in journal article one. Subsequent aims are addressed in journal article two, a cross-sectional study with foster carers of children in care aged 3-12 years who completed self-report measures investigating the emotional, behavioural, attachment and trauma related difficulties of their foster child, the perceived quality of the relationship, and levels of parenting stress and sense of competence. Results: The systematic review revealed that the majority of studies demonstrated a significant impairment in one or more areas of executive ability in maltreated children, with particular support for impairments in inhibitory control, executive working memory and decision making. However, there was only limited support for impairments in cognitive flexibility, planning/problem solving, and fluency. Furthermore, there was considerable variability between studies in the specific deficits reported. Results from the empirical study highlight the prevalence of attachment and trauma-related difficulties in children in foster care. Hierarchical regression analyses revealed that levels of foster carer-rated inhibited attachment behaviour was a significant predictor of quality of the foster carer-child relationship and parenting stress. The level of emotional and behavioural difficulties also emerged as a significant predictor of quality of the foster carer-child relationship, and parenting sense of competence. Conclusions: This thesis highlights the pervasive impact of relational trauma on children. Results of the systematic review indicate its impact on children’s executive ability. The empirical study reveals the high prevalence of attachment and trauma-related difficulties in children in foster care, and provides insight into factors related to quality of the foster carer-child relationship, and the stress and sense of competence of foster carers. Implications for interventions and service provision regarding maltreated children who become looked after away from home, and their carers, are discussed.

At least 20% of the US population is estimated to be bilingual, and there is wide popular and academic interest in the neurocognitive consequences of bilingualism. A controversial body of literature points to “bilingual advantages” in executive function (EF) skills involving attention, inhibitory control, and cognitive flexibility. However, while bilingual advantages are thought to be a result of neuroplasticity, we do not currently understand the specific neural mechanisms shaped in childhood. Further, studies have failed to account for the distinction between “cool,” more purely cognitive, and “hot,” more affective and motivationally relevant EF systems. Lastly, the study of bilingual EF development has been sparse in preschool children, when EF skills are most rapidly developing. The present research compared behavioral, neurocognitive, and demographic correlates of cool (cognitive) and hot (affective) EF, in healthy monolingual and bilingual children with at least 20% exposure to a second language. In Study 1, I examined whether 3.5. - 4.5 year old bilinguals show better and faster conflict inhibition and cognitive flexibility, and neural differences in inhibition, monitoring, and error-processing, in cool and hot contexts. Results showed faster cool inhibition and faster hot cognitive flexibility in bilinguals, accompanied by neural differences in cool error-processing. In Study 2, I examined whether 6-8 year old bilinguals show better and faster interference control in cool and hot tasks, and neural difference in inhibition, monitoring, error-processing, and response preparation. Results showed no performance or neural differences between groups. In Study 3, I examined whether 6-8 year old bilinguals show better and faster flexible switching in linguistic and non-linguistic contexts, and better word-object mapping in an unfamiliar language. Results showed no performance differences between groups. In addition to the behavioral and neural findings, all three studies revealed group differences in demographic and cognitive correlates of EF. Together, results suggest that bilingual advantages may be most relevant in preschoolers, susceptible to motivational context, supported by error-awareness mechanisms, and unrelated to motor processing. Future studies of error-processing and response-preparation mechanisms can shed light on how bilingualism shapes brain function, and can elucidate group differences in the behind-the-scenes of inhibitory and switching processes.

In Scotland, Health and Well-Being (HWB) has become a core area in school curricula following the introduction of Scotland’s Curriculum for Excellence in 2004. Physical Education (PE) is one of the subjects within HWB, which places it within a prominent position to positively influence children’s decisions to live a healthy and active lifestyle. Scottish Government guidelines indicate that each child aged 3 – 11 years should receive 2 hours of PE each week and children aged 12 – 18 years should receive 2 periods of PE each week. The percentage of schools achieving 2 hours/2 periods each week is encouraging with 99% of primary schools and 93% of secondary schools in 2015. Some head teachers might have had concerns that increasing the time spent in PE would detrimentally affect academic attainment and achievement in other curricula areas such as numeracy and literacy. Evidence does not support these concerns; some studies showed no detrimental effect whilst other studies identified a beneficial effect as a result of increased time spent in PE. However, the understanding of how these positive effects were mediated remains unclear. The literature considers physical activity (PA) as a potential mediator with more recent studies evaluating the impact of physical activity (PA) on academic achievement and attainment. A clearer understanding about which approaches to PE and PA are most effective in positively influencing children’s learning would be of value aligned with the knowledge of student’s experiences and perceptions of PE. The aim of this thesis was to evaluate if a novel approach to PE known as ‘Better Movers and Thinkers (BMT)’ could positively influence children’s coordination and cognition and to evaluate student’s experiences of this approach. Three studies were planned to explore this aim. Study one involved a feasibility study being undertaken with students who were in their sixth year of education (n = 46) within two primary schools from one local authority to evaluate the feasibility of running BMT as an intervention within school. The study involved pre- and post-testing of two quantitative outcome measures; the Movement Assessment Battery for Children – 2nd Edition and the Lucid Assessment for Schools System as well as collecting qualitative data from the students and class teachers using focus groups and semi-structured interviews to obtain an understanding of their experiences following a 16-week intervention phase. Academic skills were assessed using the Lucid Assessment System for Schools 8 – 11 and physical testing was undertaken using balance and coordination subtests from the Movement Assessment Battery for Children (2nd Edition). Quantitative results revealed significant increased score changes between pre- and post-test conditions in the areas of phonological skills (p = .042), segmentation skills (p = .014) and working memory (p = .040) in favour of the intervention condition. Analysis of qualitative data from a sample of students from the intervention condition (n = 8) and their class teacher indicated good acceptability of BMT as an alternative approach to PE. The results and reflections from study one informed the design of study two. In response to study one, more specific measures of cognition were used as the nature of the academic skills testing was limited in this area. Similarly, the physical testing did not specifically measure coordination and new physical subtests were added to the outcome variable. Further PA habits were included as an additional outcome measure to control for the effects of student activity levels. Finally, the addition of a follow-up testing phase helped to evaluate if changes did occur between pre- and post-testing similar to study one, would these changes be maintained over time. The aim of study two was to identify what impact BMT had on children’s coordination and cognition. The study involved 6 schools from within the same local authority, 3 acting as the control condition schools (C-schools) and 3 as the intervention condition schools (I-Schools). The schools were selected at random by the Quality Improvement Officer (QIO) within the local authority. There were a number of potential schools and the QIO chose schools based on two criteria: their proximity with one another ensuring that catchment areas would be similar in regard to local history, geography and socioeconomic variables and schools where it would be feasible to run the research. Once the schools were identified, their names were placed within opaque-sealed envelopes and a person external to the study chose 3 schools and allocated them to the intervention condition leaving the other 3 as the control condition. Students (n = 150) were all in their sixth year of primary education attending mainstream public school. Study two involved four phases; pre-test, a 16-week intervention phase, post-testing, and, 6-month follow-up testing. Physical activity habits were assessed using the ‘Physical Activity Habits Questionnaire for Children (PAQ-C),’ coordination was assessed using four patterns of locomotion (crawling on the stomach, creeping on hands and knees, marching and skipping) and cognition was assessed using the ‘Cognitive Assessment System (CAS).’ Overall findings from study two suggested significant intervention effects in coordination (p = .001) and cognition (p = .001) with no significant effects for physical activity habits (p = .200). Semi-structured focus group interviews were conducted in each of the 6 schools. Grounded theory was used to identify emergent themes and categories to evaluate student perceptions of their PE experiences following completion of the intervention phase. Analysis identified that BMT provided different experiences compared with traditional approaches to PE suggesting that key aspects of BMT should be incorporated into the delivery of PE lessons to build on current good practice. These aspects include the direct focus on developing the children’s ability to move and think simultaneously and, directly targeting the development of Executive Function (EF) skills. The findings from this thesis have implications for Continued Lifelong Professional Learning (CLPL) for primary school teachers and for specialist PE teachers. The findings may also influence course programmes within Initial Teacher Education (ITE) and specialist PE training and for future PE programme design.

Background: Heading is an important part of soccer, yet recent research has indicated that cumulative effects of repetitive heading may cause sub-concussive injury (Koerte et al., 2015). Objective: The current study aimed to prospectively investigate the effects of repetitive, intentional heading in soccer practice on brain structure and cognitive function using a within-subjects design. Methods: Participants included 11 soccer players (M=20.09, SD=2.88) that were examined immediately pre and post heading practice. Magnetic resonance imaging data were acquired on a 3T GE Scanner with diffusion tensor imaging (DTI). Behavioural measures were also completed pre and post soccer heading and included the Sideline Concussion Assessment Tool 3 (SCAT-3) and several short-computerized executive function tasks. An accelerometer was used to measure the force of the impact during soccer heading. Heart-rate data was collected on Polar Monitors. DTI analyses were completed using FSL’s Tract Based Spatial Statistics to examine changes in both fractional anisotropy (FA) and mean diffusivity (MD) due to heading the soccer ball. The current study investigated microstructural changes and behavioural performance in young soccer players. Heart rate variability data were not available for analyses due to technical difficulties. Results: Heading impacts were not greater than 10g. At this level of impact, there were no significant pre-post heading differences in either FA or MD. There were no significant differences between pre and post heading in the three behavioural tasks. Additionally, there were no significant differences in SCAT-3 scores between groups. Some practice effects were demonstrated in one behavioural task and a section of the SCAT-3. Conclusion: The current work shows initial evidence that repetitive heading in soccer in a practice setting does not cause changes in brain structure or cognitive function. Future research should investigate heading in games and sex differences with a greater sample size. / Graduate

Prospective memory (PM) is the ability to remember to carry out one's intentions. This is a critical ability for children to develop in order to function independently in their daily activities. This dissertation examines the role of executive functioning in preschoolers' PM in two studies that vary the executive demand at different stages of the PM task. Study 1 investigated the role of task difficulty during the retention interval prior to the PM task. A difficult working memory task during the delay period resulted in worse PM performance in 4- and 5-year-olds compared to an easy working memory task. In addition, children's working memory, planning ability, and theory of mind correlated with PM but only in the difficult filler task condition. Study 2 examined age differences between 4- and 5-year-olds in PM task performance when the task: (1) was embedded in an easy or difficult ongoing task, (2) had an instruction to focus on the intention versus an instruction to focus on the distractor activity during the retention interval, and (3) varied in the salience of prospective targets. Overall, 5-year-olds performed better on the PM task than 4-year-olds. Children also had superior PM when targets were salient compared to non-salient and marginally superior PM when they received an instruction to monitor their intention compared to when they received an instruction to focus on the distractor activity. In addition, positive relations between executive functioning and PM were documented. Taken together, these studies suggest that disrupting or encouraging monitoring has a direct impact on PM performance in certain conditions. The implications of these results for theories that suggest differing roles for controlled processes in PM are discussed.

Success in early childhood requires fluent cognitive control functioning and the ability to select and execute effective regulatory strategies across many new contexts including academics and social interactions. Cognitive control functioning has been positively linked to a host of important short- and long-term outcomes across many diverse domains. A wealth of research on self-efficacy, self-concept, and implicit theories of cognitive processes demonstrates that individuals’ self-perceptions of ability and cognition substantially influence important behavioral outcomes, namely academic performance. Investigations into the mechanisms underlying these links suggest that self-perceptions of abilities impact academic outcomes by differentially influencing the self-regulated learning behaviors that individuals choose to engage. Despite this knowledge, and evidence suggesting that capturing such self-perceptions from young children is highly plausible, the extent to which young children can reflect and report on their own cognitive control abilities has not been investigated. In this dissertation, I develop and validate an interview scale that aims to probe children’s self-perceptions of their cognitive control abilities using the Berkeley Puppet Interview administration format. Scale analyses of interviews from 125 children aged 4- through 7-years suggest the scale elicits responses that cluster around two correlated, but separable components: Self- and Emotion-Regulation and Attention Modulation. Responses on these two subscales were reliable, showing moderate to strong internal consistency. Subscale scores were strongly correlated with parent reports of similar skills, and self-reports of related constructs, but showed no such relations with behavioral tasks measuring executive functioning abilities. The findings suggest that young children are capable of reflecting and reporting on their own cognitive control skills, and that these skills correspond to parent reports of similar abilities. Further scale refinement and targeted validation efforts are called for; however, these encouraging early results suggest the new scale holds potential to play a key role in uncovering ways in which children’s self-perceptions influence their learning success.