title: Clinical Predictors of Attention and Executive Functioning Outcomes in Children After Perinatal Arterial Ischemic Stroke.
abstract: Children with perinatal arterial ischemic stroke (PAIS) are at risk for later neurocognitive and behavioral deficits, yet the clinical predictors of these outcomes are understudied. We examined the influence of clinical and infarct characteristics on attention and executive functioning in children following PAIS.
  
  
  
  Forty children born at term (≥37 weeks' gestation) with PAIS (28 with neonatal arterial ischemic stroke and 12 with presumed PAIS) underwent a comprehensive neuropsychological battery at age three to 16 years (median age 7.2 years; 58% male) to assess attention and executive functioning. Parents also completed questionnaires regarding real-world functioning. Clinical variables including perinatal stroke subtype, infarct characteristics (location, laterality, and volume), and the presence of comorbid epilepsy were ascertained from the medical record.
  
  
  
  Presumed PAIS, larger infarct volume, and comorbid epilepsy negatively influenced the performance on attention and executive functioning measures. These clinical variables were also associated with greater functional problems on parent reports, including a higher frequency of attention-deficit/hyperactivity disorder symptoms and greater difficulties in some subdomains of executive functioning. Infarct location and laterality were not associated with performance measures or parental report of functioning.
  
  
  
  Although all children with PAIS are at risk for later deficits in attention and executive functioning, those with presumed PAIS, larger infarct size, and comorbid epilepsy appear to be the most vulnerable. As they approach and reach school age, these children should undergo neuropsychological assessment to ensure timely implementation of therapeutic interventions and behavioral strategies.
authors.affiliation: Department of Psychology, Drexel University, Philadelphia, Pennsylvania; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Danielle D
authors.initials: DD
authors.lastname: Bosenbark
authors.affiliation: Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Lauren
authors.initials: L
authors.lastname: Krivitzky
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ichord
authors.affiliation: Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Arastoo
authors.initials: A
authors.lastname: Vossough
authors.affiliation: Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Aashim
authors.initials: A
authors.lastname: Bhatia
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Jastrzab
authors.affiliation: Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: billinghurstl@email.chop.edu.
authors.forename: Lori
authors.initials: L
authors.lastname: Billinghurst
mesh_terms: D000293:Adolescent; D001288:Attention; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D056344:Executive Function; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011379:Prognosis; D012042:Registries; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*
keywords: cognition; neonatal ischemia; outcome; perinatal stroke; predictors