Determining predictors of outcome on factors of att ention following paediatric arterial ischemic stroke

Abstract

Attention is a facet of cognition that is responsible for the development of most cognitive processes. Insult to the brain prior to or during the development of attention can be detrimental to various aspects of cognitive development and, as a result, to a child's ability to acquire new knowledge and skills. One example of cerebral insult in childhood is stroke. Given the importance of attention for the development of cognitive skills, identifying the factors of attention is critical to understanding cognitive outcomes in children with stroke. In the present investigation, a three-factor and a four-factor model of attention were tested using confirmatory factor analysis on a set of neuropsychological tests purported to measure various aspects of attention, in order to determine the model of attention best represented by a sample of children with arterial ischemic stroke. It was determined that both a three- and four-factor model of attention fit the data equally well when the same measures were included in both models. Despite similarities between the models, the four-factor model of attention was argued to be the best fit, due to theoretical, neuroanatomical, and developmental considerations. When the four-factor model was used to determine predictors of outcome, both Age at Stroke and Age at Testing were significant predictors of outcome on the Shift and Focus/Execute factors of attention, but not on the Encode and Sustain factors. The findings are discussed within the framework of a vulnerability vs. a plasticity model. Implications for clinical practice are also considered.

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