Neuropsychological performance in neurofibromatosis type 1

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array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Neuropsychological performance in neurofibromatosis type 1" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "73" "paginaFinal" => "77" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Lilia Hernández del Castillo, Antonio Martínez Bermejo, José Antonio Portellano Pérez, Pilar Tirado Requero, Alexandra Garriz Luis, Ramón Velázquez Fragua" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Lilia" "apellidos" => "Hernández del Castillo" "email" => array:1 [ 0 => "lilcasti@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Antonio" "apellidos" => "Martínez Bermejo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "José Antonio" "apellidos" => "Portellano Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Pilar" "apellidos" => "Tirado Requero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Alexandra" "apellidos" => "Garriz Luis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Ramón" "apellidos" => "Velázquez Fragua" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neuropediatría, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Psicobiología, Facultad de Psicología, Universidad Complutense, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centros Nuestra Señora del Buen Consejo y Pinosierra, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Rendimiento neuropsicológico en la neurofibromatosis tipo 1" ] ] "textoCompleto" => "IntroductionNeurofibromatosis (NF) is a hereditary autosomal dominant disease with a variable expression, although half of the cases result from de novo mutations. It affects the tissues that support the central and peripheral nervous systems. It is a neurocutaneous disorder that causes changes in skin pigmentation (“café au lait” macules), the cranial nerves and the spinal cord. It can also manifest with additional features, such as neurofibromas (cutaneous, subcutaneous or intraspinal tumours), pain in affected nerves, epileptic seizures, blindness or deafness secondary to gliomas in the optic or vesticulocochlear nerves, or hydrocephalus due to aqueductal stenosis.There are two distinct forms of NF based on clinical, genetic and pathophysiological features, both of which belong to the broader category of neurocutaneous syndromes or phakomatoses. One is the peripheral form, known as NF type 1 (NF1), formerly von Recklinghausen disease. The other is the central form, also known as NF type 2 (NF2).<a class="elsevierStyleCrossRef" href="#bib0105">1</a> Like NF1, it is a hereditary autosomal dominant disease, which in this case is caused by a gene located in chromosome 22q21.The incidence of NF1 is of 1 per 3000–4000 individuals. The disease is caused by mutations in the NF1 gene located in chromosome 17q11.2. Approximately half of the cases are de novo mutations.<a class="elsevierStyleCrossRef" href="#bib0110">2</a> The clinical diagnosis of NF1 requires the presence of at least 2 of the criteria established at the National Institute of Health Consensus Development Conference<a class="elsevierStyleCrossRef" href="#bib0115">3</a> held in 1988 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Neurofibromatosis type 1 can affect early developmental processes, increasing the risk of learning difficulties in childhood. Approximately 80% of children with NF1 have cognitive comorbidities, with marked impairment in one or more cognitive functions, which has a negative impact on academic achievement and quality of life. In the past, these children received diagnoses of mental retardation, but more recent studies have confirmed that only 4%–8% of individuals with NF1 have an intellectual quotient (IQ) of less than 70. A study by Hyman et al.<a class="elsevierStyleCrossRef" href="#bib0120">4</a> tested the IQ of 81 children with NF1 and compared it to the IQ of their siblings. Sixty-one percent of children with NF1 had IQ scores that were at least 10 points lower than their siblings. The study concluded that in more than 70% of children with NF1, academic performance is inferior to what would be expected based on their intellectual ability.Individuals with NF1 usually have neuropsychological deficits in various cognitive domains: executive function, visual perception, memory etc. However, there is no widespread agreement on the definition of the cognitive profile of NF1, as 2 different criteria are currently in use. Some authors believe that the differential factors that distinguish NF1 are deficits in visual-spatial skills and problems in attention and executive functioning.<a class="elsevierStyleCrossRef" href="#bib0125">5</a> Others emphasise the usual presence of language deficits combined with problems in visual-spatial skills, attention and executive functioning. There is evidence in the literature that due to the associated neuropsychological changes, between 30% and 65% of children with NF1 have learning difficulties in school in the areas of reading, writing, spelling, mathematics and language.<a class="elsevierStyleCrossRefs" href="#bib0130">6,7</a>The aim of our study was to assess the global intellectual ability of children with NF1 and their performance in different cognitive domains assessed by means of the Wechsler Intelligence Scale for Children (WISC-IV).Participants and methodsSampleExperimental group with neurofibromatosis type 1 (NF1G)This group comprehended 23 children (8 boys and 15 girls) with a NF1 diagnosis. The mean age was 8.7±1.39 years. We selected the participants from the patients that received care at the Department of Paediatric Neurology of the Hospital Universitario La Paz in Madrid. The inclusion criteria for the NF1G were: confirmed diagnosis of NF1; age 6–10 years; absence of sensory, neurologic or psychiatric comorbidities; not being under psychopharmacological treatment at the time of assessment.Control groupIt consisted of 21 healthy children (8 boys and 13 girls). The mean age was 8.9±1.41 years. We selected these children from two schools in the northern area of the city of Madrid. The inclusion criteria were: age 6–10 years; sociodemographic characteristics similar to those of patients in the NF1 group; absence of sensory, neurologic or psychiatric disorders; and not being under psychopharmacological treatment at the time of assessment.Tests performedWe administered the full version of the Spanish adaptation of the WISC-IV<a class="elsevierStyleCrossRef" href="#bib0140">8</a> to each participant in the study separately. This scale allows the evaluation of overall IQ as well as performance in different cognitive domains: verbal comprehension, perceptual reasoning, working memory and processing speed.ProtocolParticipants in the NF1G were assessed in the facilities of the Department of Paediatric Neurology of the Hospital Universitario La Paz of Madrid in the course of previously scheduled appointments. The study had been approved by the Clinical Research Ethics Committee of the Hospital Universitario La Paz. The CG was assessed in the school counselling department offices of 2 schools located in northern Madrid (Colegio Nuestra Señora del Buen Consejo and Colegio Internacional Pinosierra); all assessments were performed in individual morning sessions. The Department of Biostatistics of the Instituto de Investigación (Research Institute) of the Hospital Universitario La Paz (IdiPAZ) performed the statistical analysis. Data were processed in a Microsoft Excel database that was subsequently exported for statistical analysis with the SPSS software version 11.5.ResultsCognitive performance in children with NF1 was inferior to that of children in the CG for the 5 composite indices of the WISC-IV: verbal comprehension, perceptual reasoning, working memory, processing speed and the full scale IQ. The NF1G scored lower than the CG in every WISC-IV subtest save for the coding and similarities subtests, in which we observed no significant differences between groups. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarises the results.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionIn this study, we analysed the cognitive performance of a group of children with NF1 compared to another group of healthy children of similar socioeconomic characteristics. We observed significant differences in all composite indices and in 12 of the 14 subtests of the WISC-IV, with children with NF1 obtaining lower scores than children in the CG.The IQ of the NF1G was below the normal psychometric threshold, and was significantly lower than the IQ of the CG, with a difference of 31 points. But obtaining an IQ score within the normal range does not suffice to determine that cognitive performance is at a comparable level. Intellectual ability and cognitive performance are not always equivalent, as there may be weak areas in the individual's cognitive profile that hinder performance. On the other hand, there is widespread agreement that in addition to intelligence understood as a global parameter, there are different specific intellectual abilities that develop to different degrees, which is referred to as multiple intelligences.<a class="elsevierStyleCrossRefs" href="#bib0145">9,10</a>The first publications on the cognitive ability of children with NF1 described levels of cognitive impairment that were significantly greater than those found in recent studies. Thus, Mulvihill reported an average IQ of 45 for a sample of 20 patients with NF1.<a class="elsevierStyleCrossRef" href="#bib0155">11</a> Studies conducted more recently have not corroborated those differences, but placed the IQ of children with NF1 closer to the normal range. For instance, one study found that only 6% of children with NF1 had IQ scores significantly below average.<a class="elsevierStyleCrossRef" href="#bib0160">12</a>In our study, the performance of children with NF1 was inferior to that of the CG for every cognitive domain assessed by the WISC-IV, with the exception of the coding and similarities subtests. These results are not exactly consistent with those of other studies; Cutting and Levine assert that the cognitive profile of NF1 fits the pattern of a “nonverbal” disorder, as most individuals with NF1 exhibit visual-perceptual abnormalities (specifically in visual-spatial skills).<a class="elsevierStyleCrossRef" href="#bib0165">13</a> However, difficulties in verbal language, learning, reading and writing are also frequent in NF1.<a class="elsevierStyleCrossRef" href="#bib0170">14</a> In our study, we found both verbal and nonverbal impairments that had a generalised impact on cognitive performance in children with a NF1 diagnosis.Other cognitive domains, such as executive functioning, which encompasses the performance of more complex reasoning processes and the organisation of goal-directed behaviour, are also usually affected in children with NF1. The results of our study are consistent with those of other authors, who also found difficulties in reasoning and abstract concept formation in children with NF1; assessment with the WISC-IV has shown performance deficits in the comprehension, similarities, incomplete pictures, arithmetic or picture arrangement subtests.<a class="elsevierStyleCrossRef" href="#bib0175">15</a> In our study, the perceptual reasoning and working memory indices in the NF1G were lower than those of the CG. Both indices are intimately associated with the efficiency of executive functioning.Most children with NF1 score lower in many cognitive functioning tests compared to controls.<a class="elsevierStyleCrossRef" href="#bib0180">16</a> However, there are studies that challenge this conclusion. For instance, some authors have not found differences in the performance of children with NF1 in the picture arrangement subtest of the WISC.<a class="elsevierStyleCrossRef" href="#bib0120">4</a> Others have reported on the results of the arithmetic subtest, in which children with NF1 did not have deficits compared to a children unaffected by the disease. Thus, the results of the latter study contradict ours, as we did find a statistically significant difference in the arithmetic subtest.<a class="elsevierStyleCrossRef" href="#bib0185">17</a>Attention is one of the cognitive domains that have been studied most extensively in NF1. The work of Watt et al.<a class="elsevierStyleCrossRef" href="#bib0190">18</a> has confirmed that affected children have difficulties performing tasks that require sustained attention. Our study corroborated this finding, as children in the NF1 group scored lower in the subtests that required a higher degree of sustained attention (incomplete pictures, digits and symbol search). We need to take into account that attention is the mechanism involved in accessing the information stored in the nervous system, so that problems with attention hinder learning and memory consolidation. Other cognitive domains, such as memory and language, are not as affected by NF1.<a class="elsevierStyleCrossRefs" href="#bib0195">19,20</a>In conclusion, our study revealed the presence of generalised cognitive deficits in the NF1 group. Along with impaired cognitive performance, assessed by the full scale IQ, we observed significant deficits in every assessed cognitive domain. Based on these findings, it would be advisable to offer individualised attention to children with NF1 during their schooling, as they are at higher risk of having learning difficulties. Early identification of children with NF1, along with their neuropsychological assessment and the development of cognitive stimulation programmes, could improve their academic outcomes and reduce the risk of school failure.Conflict of interestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres874576" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aims" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Subjects and method" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec862967" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres874575" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Sujetos y método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec862968" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Participants and methods" "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0015" "titulo" => "Sample" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Experimental group with neurofibromatosis type 1 (NF1G)" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Control group" ] ] ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Tests performed" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Protocol" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-06-02" "fechaAceptado" => "2016-07-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec862967" "palabras" => array:6 [ 0 => "Cognitive deficit" 1 => "Intelligence quotient" 2 => "Learning difficulties" 3 => "Neurofibromatosis type 1" 4 => "Neuropsychological performance" 5 => "WISC-IV" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec862968" "palabras" => array:6 [ 0 => "Cociente intelectual" 1 => "Déficit cognitivo" 2 => "Dificultades de aprendizaje" 3 => "Neurofibromatosis tipo 1" 4 => "Rendimiento neuropsicológico" 5 => "Escala de inteligencia de Wechsler para niños-IV" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionNeurofibromatosis type 1 (NF1) is a genetic disorder with various clinical manifestations that affect the peripheral and central nervous system, as well as the skin, bones and endocrine and vascular system. There is still insufficient knowledge of neuropsychological effects of NF1 on children, and there is some controversy about the cognitive deficits that defines the cognitive profile of patients affected by this disorder. AimsIn this study an analysis is made of the neuropsychological performance of a group of patients affected by NF1, compared with a control group of healthy children. Subjects and methodA comparison was made between the neuropsychological performance of a group of 23 boys and girls with a mean age of 8.7 years (+/−1.39) and diagnosed with NF1, and a control group consisting of 21 healthy children, with mean age of 8.9 years (+/−1.41) and with similar socio-demographic characteristics. The Wechsler Intelligence Scale for Children (WISC) was applied to evaluate the subjects of both groups. ResultsThe group of patients affected with NF1 showed a lower performance in every primary index of WISC IV: Verbal Comprehension Index, Fluid Reasoning Index, Working Memory Index, Processing Speed Index, and full scale IQ. Only in two subscales were no statistically significant differences observed: similarities and coding. ConclusionThe results show subtle and generalised neuropsychological alterations in the sample of children affected with NF1, which affect most of cognitive domains that have been evaluated. Proper specific and early neuropsychological treatment should be provided in order to prevent the high risk for these children of presenting learning difficulties and school failure." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aims" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Subjects and method" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa neurofibromatosis tipo 1 (NF1) es un trastorno genético con manifestaciones clínicas muy variables que pueden expresarse en el sistema nervioso central y periférico, así como en piel, hueso, sistema endocrinológico y vascular. Los aspectos neuropsicológicos de la NF1 en la infancia continúan sin ser suficientemente conocidos, existiendo controversia acerca de los posibles déficits que definen el perfil cognitivo de estos niños. ObjetivoEstudiar el rendimiento neuropsicológico de un grupo de pacientes con NF1 en comparación con un grupo de control de niños sanos. Sujetos y métodoSe estudia el rendimiento neuropsicológico de un grupo de 23 niños y niñas con diagnóstico de NF1, con una edad media de 8,7 años ± 1,39 comparado con otro grupo formado por 21 niños sanos con una edad media de 8,9 años ± 1,41 con características sociodemográficas similares. A todos los sujetos se les aplicó la Escala de Inteligencia de Wechsler infantil (WISC-IV). ResultadosSe observa en el grupo con NF1 un rendimiento menor que el grupo control en los índices globales del WISC-IV: comprensión verbal, razonamiento perceptivo, memoria de trabajo, velocidad de procesamiento y cociente intelectual global. Únicamente en los subtest de claves y semejanzas no se han apreciado diferencias estadísticamente significativas entre ambos grupos. ConclusiónLos resultados reflejan la existencia de alteraciones neurocognitivas sutiles y generalizadas en la muestra de niños con NF1, que afectan a la mayoría de los dominios cognitivos evaluados. Se subraya la necesidad de que reciban una atención neuropsicológica específica precoz para prevenir el mayor riesgo de presentar dificultades de aprendizaje y fracaso escolar." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Sujetos y método" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Hernández del Castillo L, Martínez Bermejo A, Portellano Pérez JA, Tirado Requero P, Garriz Luis A, Velázquez Fragua R. Rendimiento neuropsicológico en la neurofibromatosis tipo 1. An Pediatr (Barc). 2017;87:73–77." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Source: National Health Institute.<a class="elsevierStyleCrossRef" href="#bib0115">3</a>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">The individual must present with 2 or more of the following: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1. Six or more “cafe au lait” macules. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Over 0.5mm in greatest diameter in prepubertal children \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Over 1.5cm in greatest diameter in postpubertal children \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2. Two or more neurofibroma of any type or one plexiform neurofibroma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3. Freckling in the axillary and/or inguinal regions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4. Optic pathway glioma \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5. Two or more Lisch modules (benign iris hamartomas) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6. A distinctive osseous lesion \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sphenoid dysplasia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dysplasia or thinning of the long bone cortex with or without pseudarthrosis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7. A first-degree relative with NF1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1475965.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Diagnostic criteria for neurofibromatosis type 1." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "NS: difference is not significant." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GNF1</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GC</th><th class="td" title="table-head " align="left" valign="top" scope="col">P \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">□ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">□ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Block design \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.007<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Similarities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.42 NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Digit span \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.000<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Concepts \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.000<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.346 NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vocabulary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.016<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Letter-number sequencing \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.046<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Matrix reasoning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.005<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Comprehension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.001<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Symbol search \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.002<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Picture completion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.009<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Information \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.009<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arithmetic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.001<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Riddles \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.000<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Verbal comprehension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.000<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Perceptual reasoning \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.000<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Working memory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.010<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Processing speed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.007<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Full scale IQ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">124.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.000<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1475966.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "P<.05." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "P<.01." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "***" "nota" => "P<.001." ] ] ] "descripcion" => array:1 [ "en" => "Scores in the Wechsler Intelligence Scale for Children (WISC-IV)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0105" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Type 1 neurofibromatosis gene: identification of a large transcript disrupted in three NF1 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.R. 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Original Article

Neuropsychological performance in neurofibromatosis type 1

Rendimiento neuropsicológico en la neurofibromatosis tipo 1

Lilia Hernández del Castilloa,

Corresponding author

lilcasti@hotmail.com

Corresponding author.

, Antonio Martínez Bermejoa, José Antonio Portellano Pérezb, Pilar Tirado Requeroa, Alexandra Garriz Luisc, Ramón Velázquez Fraguaa

a Servicio de Neuropediatría, Hospital Universitario La Paz, Madrid, Spain

b Departamento de Psicobiología, Facultad de Psicología, Universidad Complutense, Madrid, Spain

c Centros Nuestra Señora del Buen Consejo y Pinosierra, Madrid, Spain

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        "titulo" => "Rendimiento neuropsicol&#243;gico en la neurofibromatosis tipo 1"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Neurofibromatosis &#40;NF&#41; is a hereditary autosomal dominant disease with a variable expression&#44; although half of the cases result from de novo mutations&#46; It affects the tissues that support the central and peripheral nervous systems&#46; It is a neurocutaneous disorder that causes changes in skin pigmentation &#40;&#8220;caf&#233; au lait&#8221; macules&#41;&#44; the cranial nerves and the spinal cord&#46; It can also manifest with additional features&#44; such as neurofibromas &#40;cutaneous&#44; subcutaneous or intraspinal tumours&#41;&#44; pain in affected nerves&#44; epileptic seizures&#44; blindness or deafness secondary to gliomas in the optic or vesticulocochlear nerves&#44; or hydrocephalus due to aqueductal stenosis&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">There are two distinct forms of NF based on clinical&#44; genetic and pathophysiological features&#44; both of which belong to the broader category of neurocutaneous syndromes or phakomatoses&#46; One is the peripheral form&#44; known as NF type 1 &#40;NF1&#41;&#44; formerly von Recklinghausen disease&#46; The other is the central form&#44; also known as NF type 2 &#40;NF2&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> Like NF1&#44; it is a hereditary autosomal dominant disease&#44; which in this case is caused by a gene located in chromosome 22q21&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The incidence of NF1 is of 1 per 3000&#8211;4000 individuals&#46; The disease is caused by mutations in the <span class="elsevierStyleItalic">NF1</span> gene located in chromosome 17q11&#46;2&#46; Approximately half of the cases are de novo mutations&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> The clinical diagnosis of NF1 requires the presence of at least 2 of the criteria established at the National Institute of Health Consensus Development Conference<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> held in 1988 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Neurofibromatosis type 1 can affect early developmental processes&#44; increasing the risk of learning difficulties in childhood&#46; Approximately 80&#37; of children with NF1 have cognitive comorbidities&#44; with marked impairment in one or more cognitive functions&#44; which has a negative impact on academic achievement and quality of life&#46; In the past&#44; these children received diagnoses of mental retardation&#44; but more recent studies have confirmed that only 4&#37;&#8211;8&#37; of individuals with NF1 have an intellectual quotient &#40;IQ&#41; of less than 70&#46; A study by Hyman et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> tested the IQ of 81 children with NF1 and compared it to the IQ of their siblings&#46; Sixty-one percent of children with NF1 had IQ scores that were at least 10 points lower than their siblings&#46; The study concluded that in more than 70&#37; of children with NF1&#44; academic performance is inferior to what would be expected based on their intellectual ability&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Individuals with NF1 usually have neuropsychological deficits in various cognitive domains&#58; executive function&#44; visual perception&#44; memory etc&#46; However&#44; there is no widespread agreement on the definition of the cognitive profile of NF1&#44; as 2 different criteria are currently in use&#46; Some authors believe that the differential factors that distinguish NF1 are deficits in visual-spatial skills and problems in attention and executive functioning&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> Others emphasise the usual presence of language deficits combined with problems in visual-spatial skills&#44; attention and executive functioning&#46; There is evidence in the literature that due to the associated neuropsychological changes&#44; between 30&#37; and 65&#37; of children with NF1 have learning difficulties in school in the areas of reading&#44; writing&#44; spelling&#44; mathematics and language&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of our study was to assess the global intellectual ability of children with NF1 and their performance in different cognitive domains assessed by means of the Wechsler Intelligence Scale for Children &#40;WISC-IV&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Participants and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Sample</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Experimental group with neurofibromatosis type 1 &#40;NF1G&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall">This group comprehended 23 children &#40;8 boys and 15 girls&#41; with a NF1 diagnosis&#46; The mean age was 8&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;39 years&#46; We selected the participants from the patients that received care at the Department of Paediatric Neurology of the Hospital Universitario La Paz in Madrid&#46; The inclusion criteria for the NF1G were&#58; confirmed diagnosis of NF1&#59; age 6&#8211;10 years&#59; absence of sensory&#44; neurologic or psychiatric comorbidities&#59; not being under psychopharmacological treatment at the time of assessment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Control group</span><p id="par0040" class="elsevierStylePara elsevierViewall">It consisted of 21 healthy children &#40;8 boys and 13 girls&#41;&#46; The mean age was 8&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;41 years&#46; We selected these children from two schools in the northern area of the city of Madrid&#46; The inclusion criteria were&#58; age 6&#8211;10 years&#59; sociodemographic characteristics similar to those of patients in the NF1 group&#59; absence of sensory&#44; neurologic or psychiatric disorders&#59; and not being under psychopharmacological treatment at the time of assessment&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Tests performed</span><p id="par0045" class="elsevierStylePara elsevierViewall">We administered the full version of the Spanish adaptation of the WISC-IV<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> to each participant in the study separately&#46; This scale allows the evaluation of overall IQ as well as performance in different cognitive domains&#58; verbal comprehension&#44; perceptual reasoning&#44; working memory and processing speed&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protocol</span><p id="par0050" class="elsevierStylePara elsevierViewall">Participants in the NF1G were assessed in the facilities of the Department of Paediatric Neurology of the Hospital Universitario La Paz of Madrid in the course of previously scheduled appointments&#46; The study had been approved by the Clinical Research Ethics Committee of the Hospital Universitario La Paz&#46; The CG was assessed in the school counselling department offices of 2 schools located in northern Madrid &#40;Colegio Nuestra Se&#241;ora del Buen Consejo and Colegio Internacional Pinosierra&#41;&#59; all assessments were performed in individual morning sessions&#46; The Department of Biostatistics of the Instituto de Investigaci&#243;n &#40;Research Institute&#41; of the Hospital Universitario La Paz &#40;IdiPAZ&#41; performed the statistical analysis&#46; Data were processed in a Microsoft Excel database that was subsequently exported for statistical analysis with the SPSS software version 11&#46;5&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Cognitive performance in children with NF1 was inferior to that of children in the CG for the 5 composite indices of the WISC-IV&#58; verbal comprehension&#44; perceptual reasoning&#44; working memory&#44; processing speed and the full scale IQ&#46; The NF1G scored lower than the CG in every WISC-IV subtest save for the coding and similarities subtests&#44; in which we observed no significant differences between groups&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarises the results&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">In this study&#44; we analysed the cognitive performance of a group of children with NF1 compared to another group of healthy children of similar socioeconomic characteristics&#46; We observed significant differences in all composite indices and in 12 of the 14 subtests of the WISC-IV&#44; with children with NF1 obtaining lower scores than children in the CG&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The IQ of the NF1G was below the normal psychometric threshold&#44; and was significantly lower than the IQ of the CG&#44; with a difference of 31 points&#46; But obtaining an IQ score within the normal range does not suffice to determine that cognitive performance is at a comparable level&#46; Intellectual ability and cognitive performance are not always equivalent&#44; as there may be weak areas in the individual&#39;s cognitive profile that hinder performance&#46; On the other hand&#44; there is widespread agreement that in addition to intelligence understood as a global parameter&#44; there are different specific intellectual abilities that develop to different degrees&#44; which is referred to as multiple intelligences&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The first publications on the cognitive ability of children with NF1 described levels of cognitive impairment that were significantly greater than those found in recent studies&#46; Thus&#44; Mulvihill reported an average IQ of 45 for a sample of 20 patients with NF1&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> Studies conducted more recently have not corroborated those differences&#44; but placed the IQ of children with NF1 closer to the normal range&#46; For instance&#44; one study found that only 6&#37; of children with NF1 had IQ scores significantly below average&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In our study&#44; the performance of children with NF1 was inferior to that of the CG for every cognitive domain assessed by the WISC-IV&#44; with the exception of the coding and similarities subtests&#46; These results are not exactly consistent with those of other studies&#59; Cutting and Levine assert that the cognitive profile of NF1 fits the pattern of a &#8220;nonverbal&#8221; disorder&#44; as most individuals with NF1 exhibit visual-perceptual abnormalities &#40;specifically in visual-spatial skills&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> However&#44; difficulties in verbal language&#44; learning&#44; reading and writing are also frequent in NF1&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> In our study&#44; we found both verbal and nonverbal impairments that had a generalised impact on cognitive performance in children with a NF1 diagnosis&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Other cognitive domains&#44; such as executive functioning&#44; which encompasses the performance of more complex reasoning processes and the organisation of goal-directed behaviour&#44; are also usually affected in children with NF1&#46; The results of our study are consistent with those of other authors&#44; who also found difficulties in reasoning and abstract concept formation in children with NF1&#59; assessment with the WISC-IV has shown performance deficits in the comprehension&#44; similarities&#44; incomplete pictures&#44; arithmetic or picture arrangement subtests&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> In our study&#44; the perceptual reasoning and working memory indices in the NF1G were lower than those of the CG&#46; Both indices are intimately associated with the efficiency of executive functioning&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Most children with NF1 score lower in many cognitive functioning tests compared to controls&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> However&#44; there are studies that challenge this conclusion&#46; For instance&#44; some authors have not found differences in the performance of children with NF1 in the picture arrangement subtest of the WISC&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> Others have reported on the results of the arithmetic subtest&#44; in which children with NF1 did not have deficits compared to a children unaffected by the disease&#46; Thus&#44; the results of the latter study contradict ours&#44; as we did find a statistically significant difference in the arithmetic subtest&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Attention is one of the cognitive domains that have been studied most extensively in NF1&#46; The work of Watt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> has confirmed that affected children have difficulties performing tasks that require sustained attention&#46; Our study corroborated this finding&#44; as children in the NF1 group scored lower in the subtests that required a higher degree of sustained attention &#40;incomplete pictures&#44; digits and symbol search&#41;&#46; We need to take into account that attention is the mechanism involved in accessing the information stored in the nervous system&#44; so that problems with attention hinder learning and memory consolidation&#46; Other cognitive domains&#44; such as memory and language&#44; are not as affected by NF1&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">19&#44;20</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study revealed the presence of generalised cognitive deficits in the NF1 group&#46; Along with impaired cognitive performance&#44; assessed by the full scale IQ&#44; we observed significant deficits in every assessed cognitive domain&#46; Based on these findings&#44; it would be advisable to offer individualised attention to children with NF1 during their schooling&#44; as they are at higher risk of having learning difficulties&#46; Early identification of children with NF1&#44; along with their neuropsychological assessment and the development of cognitive stimulation programmes&#44; could improve their academic outcomes and reduce the risk of school failure&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of interests</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Neurofibromatosis type 1 &#40;NF1&#41; is a genetic disorder with various clinical manifestations that affect the peripheral and central nervous system&#44; as well as the skin&#44; bones and endocrine and vascular system&#46; There is still insufficient knowledge of neuropsychological effects of NF1 on children&#44; and there is some controversy about the cognitive deficits that defines the cognitive profile of patients affected by this disorder&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Aims</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this study an analysis is made of the neuropsychological performance of a group of patients affected by NF1&#44; compared with a control group of healthy children&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Subjects and method</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A comparison was made between the neuropsychological performance of a group of 23 boys and girls with a mean age of 8&#46;7 years &#40;&#43;&#47;&#8722;1&#46;39&#41; and diagnosed with NF1&#44; and a control group consisting of 21 healthy children&#44; with mean age of 8&#46;9 years &#40;&#43;&#47;&#8722;1&#46;41&#41; and with similar socio-demographic characteristics&#46; The Wechsler Intelligence Scale for Children &#40;WISC&#41; was applied to evaluate the subjects of both groups&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The group of patients affected with NF1 showed a lower performance in every primary index of WISC IV&#58; Verbal Comprehension Index&#44; Fluid Reasoning Index&#44; Working Memory Index&#44; Processing Speed Index&#44; and full scale IQ&#46; Only in two subscales were no statistically significant differences observed&#58; similarities and coding&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The results show subtle and generalised neuropsychological alterations in the sample of children affected with NF1&#44; which affect most of cognitive domains that have been evaluated&#46; Proper specific and early neuropsychological treatment should be provided in order to prevent the high risk for these children of presenting learning difficulties and school failure&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La neurofibromatosis tipo 1 &#40;NF1&#41; es un trastorno gen&#233;tico con manifestaciones cl&#237;nicas muy variables que pueden expresarse en el sistema nervioso central y perif&#233;rico&#44; as&#237; como en piel&#44; hueso&#44; sistema endocrinol&#243;gico y vascular&#46; Los aspectos neuropsicol&#243;gicos de la NF1 en la infancia contin&#250;an sin ser suficientemente conocidos&#44; existiendo controversia acerca de los posibles d&#233;ficits que definen el perfil cognitivo de estos ni&#241;os&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudiar el rendimiento neuropsicol&#243;gico de un grupo de pacientes con NF1 en comparaci&#243;n con un grupo de control de ni&#241;os sanos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Sujetos y m&#233;todo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se estudia el rendimiento neuropsicol&#243;gico de un grupo de 23 ni&#241;os y ni&#241;as con diagn&#243;stico de NF1&#44; con una edad media de 8&#44;7 a&#241;os &#177; 1&#44;39 comparado con otro grupo formado por 21 ni&#241;os sanos con una edad media de 8&#44;9 a&#241;os &#177; 1&#44;41 con caracter&#237;sticas sociodemogr&#225;ficas similares&#46; A todos los sujetos se les aplic&#243; la Escala de Inteligencia de Wechsler infantil &#40;WISC-IV&#41;&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se observa en el grupo con NF1 un rendimiento menor que el grupo control en los &#237;ndices globales del WISC-IV&#58; comprensi&#243;n verbal&#44; razonamiento perceptivo&#44; memoria de trabajo&#44; velocidad de procesamiento y cociente intelectual global&#46; &#218;nicamente en los subtest de claves y semejanzas no se han apreciado diferencias estad&#237;sticamente significativas entre ambos grupos&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los resultados reflejan la existencia de alteraciones neurocognitivas sutiles y generalizadas en la muestra de ni&#241;os con NF1&#44; que afectan a la mayor&#237;a de los dominios cognitivos evaluados&#46; Se subraya la necesidad de que reciban una atenci&#243;n neuropsicol&#243;gica espec&#237;fica precoz para prevenir el mayor riesgo de presentar dificultades de aprendizaje y fracaso escolar&#46;</p></span>"
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            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
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            "identificador" => "abst0035"
            "titulo" => "Objetivo"
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          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Sujetos y m&#233;todo"
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            "titulo" => "Conclusi&#243;n"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Hern&#225;ndez del Castillo L&#44; Mart&#237;nez Bermejo A&#44; Portellano P&#233;rez JA&#44; Tirado Requero P&#44; Garriz Luis A&#44; Vel&#225;zquez Fragua R&#46; Rendimiento neuropsicol&#243;gico en la neurofibromatosis tipo 1&#46; An Pediatr &#40;Barc&#41;&#46; 2017&#59;87&#58;73&#8211;77&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>&#58; National Health Institute&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a></p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">The individual must present with 2 or more of the following&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46; Six or more &#8220;cafe au lait&#8221; macules&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Over 0&#46;5<span class="elsevierStyleHsp" style=""></span>mm in greatest diameter in prepubertal children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Over 1&#46;5<span class="elsevierStyleHsp" style=""></span>cm in greatest diameter in postpubertal children&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#46; Two or more neurofibroma of any type or one plexiform neurofibroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#46; Freckling in the axillary and&#47;or inguinal regions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4&#46; Optic pathway glioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#46; Two or more Lisch modules &#40;benign iris hamartomas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6&#46; A distinctive osseous lesion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sphenoid dysplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Dysplasia or thinning of the long bone cortex with or without pseudarthrosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>7&#46; A first-degree relative with NF1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Diagnostic criteria for neurofibromatosis type 1&#46;</p>"
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      1 => array:8 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">NS&#58; difference is not significant&#46;</p>"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GNF1</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">GC</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#9633;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#9633;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Block design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;007<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Similarities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;42 NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Digit span&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Concepts&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;346 NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vocabulary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;016<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Letter-number sequencing&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;046<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Matrix reasoning&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;005<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Comprehension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Symbol search&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Picture completion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;009<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">&#42;&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2016.07.006

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Year/Month	Html	Pdf	Total

2024 November	10	9	19
2024 October	66	35	101
2024 September	76	29	105
2024 August	86	60	146
2024 July	90	32	122
2024 June	70	20	90
2024 May	65	37	102
2024 April	71	36	107
2024 March	52	21	73
2024 February	46	31	77
2024 January	48	33	81
2023 December	59	29	88
2023 November	57	42	99
2023 October	47	53	100
2023 September	29	27	56
2023 August	29	15	44
2023 July	34	23	57
2023 June	45	34	79
2023 May	52	19	71
2023 April	29	17	46
2023 March	60	25	85
2023 February	35	13	48
2023 January	21	27	48
2022 December	52	25	77
2022 November	48	38	86
2022 October	40	43	83
2022 September	22	20	42
2022 August	40	49	89
2022 July	32	41	73
2022 June	35	30	65
2022 May	32	39	71
2022 April	36	25	61
2022 March	35	43	78
2022 February	34	27	61
2022 January	34	36	70
2021 December	65	36	101
2021 November	56	44	100
2021 October	59	73	132
2021 September	27	31	58
2021 August	36	45	81
2021 July	42	44	86
2021 June	50	59	109
2021 May	58	37	95
2021 April	160	56	216
2021 March	59	41	100
2021 February	37	26	63
2021 January	38	25	63
2020 December	38	17	55
2020 November	41	25	66
2020 October	41	17	58
2020 September	59	17	76
2020 August	49	16	65
2020 July	45	21	66
2020 June	73	10	83
2020 May	79	19	98
2020 April	54	12	66
2020 March	51	14	65
2020 February	48	15	63
2020 January	37	12	49
2019 December	43	20	63
2019 November	138	11	149
2019 October	163	13	176
2019 September	179	17	196
2019 August	166	20	186
2019 July	110	26	136
2019 June	78	27	105
2019 May	121	40	161
2019 April	139	23	162
2019 March	115	16	131
2019 February	135	17	152
2019 January	138	15	153
2018 December	132	28	160
2018 November	145	22	167
2018 October	220	17	237
2018 September	112	19	131
2018 August	2	0	2
2018 July	1	0	1
2018 June	5	0	5
2018 May	8	0	8
2018 April	74	0	74
2018 March	61	0	61
2018 February	57	0	57
2018 January	12	0	12
2017 December	149	0	149
2017 November	15	0	15
2017 October	43	0	43
2017 September	19	0	19
2017 August	1	0	1
2017 July	0	4	4

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