Acta Pædiatrica ISSN 0803–5253

REGULAR ARTICLE

Training of attention and memory deficits in children with acquired brain

injury
N Madsen Sjö ([email protected])1, S Spellerberg1, S Weidner1, M Kihlgren2
1. Center for Rehabilitation of Brain Injury, Copenhagen, Denmark
2. Child and Youth Rehabilitation Centre in Skåne, Lund, Sweden

Keywords Abstract
Acquired, Brain, Children, Cognitive, Injury
This pilot study concerns cognitive rehabilitation of children with acquired brain injury (ABI).
Correspondence Aim: The aim is threefold; to determine (1) whether the Amsterdam Memory and Attention
NM Sjö, Center for Rehabilitation of Brain Injury,
Training for Children (AMAT-C) programme for children with ABI can be integrated in the child’s school,
University of Copenhagen, 88 Njalsgade, DK-2300
Copenhagen S, Denmark. (2) whether supervision in the school-setting maintains the child’s motivation throughout the training
Tel: +45 35329006 | programme and (3) whether positive changes in memory, attention and executive functions are found
Fax: +45 32546777 |
with this implementation of the training method.
Email: [email protected]
Methods: Seven children with memory and ⁄ or attention deficits after ABI were trained with
Received AMAT-C. Measures used were programme evaluation questions, neuropsychological tests and a
18 February 2009; revised 17 August 2009;
accepted 12 October 2009. questionnaire concerning executive functions.
Results: Overall, children, parents and trainers were satisfied with the programme and the chil-
DOI:10.1111/j.1651-2227.2009.01587.x
dren were motivated throughout the programme. The children showed significant improvements in
neuropsychological subtests, primarily in tests of learning and memory. No overall change in executive
functions was noted.

Conclusion: Provision of AMAT-C training and supervision at the child’s school appears to ensure (1) satisfaction
with the programme, (2) sustaining of motivation and (3) improvements in learning and memory.

INTRODUCTION methods for children with ABI as well as meeting criteria

Children with acquired brain injury (ABI) are rarely offered for evidence-based interventions. For reviews see e.g. (5–7),
training programmes designed for children focussing specif- for level 2 intervention studies [as defined by the Clinical
ically on reducing memory as well as attention deficits. This Practice Guideline Process Manual(8)] see (9–11).
despite the fact that memory deficits are a known ABI Several different intervention models targeting ABI seque-
sequela, at least for some aetiologies such as traumatic brain lae exist and it is debated which model is most effective and
injury (1), and that attention deficits are a documented ABI cost-efficient in the post-acute phase. The intervention
sequela typically affecting selective and sustained attention models differ depending on whether focus is on functional
(2). adaptation, restorative intervention or a more holistic,
Attention and memory deficits in children with ABI are context-sensitive approach focussing on quality of life (12).
very important issues to address as such deficits reduce the The models also differ regarding locus of intervention, length
child’s ability to acquire essential knowledge, which in turn and intensity. Some take place in centralized, intensive
influences quality of life both from short- and long-term per- rehabilitation facilities, which are often offered in the post-
spectives (3). For example, memory and attention deficits acute phase (4,11,13), while less intensive rehabilitation facil-
reduce the child’s ability to acquire full education thereby ities may offer services on a weekly or monthly basis (14),
jeopardizing job opportunities (4). potentially throughout childhood. Sohlberg and Mateer state
Unfortunately, only a few studies exist which focus on that the primary context for rehabilitation for children with
developing and evaluating paediatric rehabilitation ABI after the acute and sub-acute stages is the school (15).
The focus of this study was to find an intervention
method suitable for adaptation into the individual child’s
Abbreviations school, which included training of memory and attention as
ABI, acquired brain injury; AMAT-C, Amsterdam Memory and well as metacognitive elements.
Attention Training for Children; BRIEF, behaviour rating inven- The purpose of placing intervention in the school-setting
tory of executive functions; N, number; P, probability; RAVLT,
was to augment possibilities of transferring trained skills to
Rey auditory verbal learning test; RCFT, Rey complex figure test
and recognition trial; SD, standard deviation; SPSS, Statistical the child’s everyday learning context and to prevent nega-
Package for the Social Sciences; TEA-Ch, Test of Everyday Atten- tive social consequences of an intensive training programme
tion for Children; WISC-III, Wechsler Intelligence Scale for Chil- that keeps the child from participating in daily school life
dren III. with peers.

230 ª2009 The Author(s)/Journal Compilation ª2009 Foundation Acta Pædiatrica/Acta Pædiatrica 2010 99, pp. 230–236
Sjö et al. Cognitive training of children with ABI

No standardized intervention to reduce memory- and influenced the children’s motivation. This hypothesis
attention deficits was available in Danish at commencement became the impetus for this pilot study where seven chil-
of the study. A review of the international literature at that dren with ABI were trained and supervised with AMAT-C
time revealed no well-described child-friendly cognitive in their local school-setting. This is the first study to fully
training methods except for a Dutch method called Amster- integrate the entire AMAT-C training programme in the
dam Memory and Attention Training for Children (AMAT- school-setting.
C) (16). This pilot study took place in a rehabilitation setting as
The theoretical basis of AMAT-C is modelled upon cogni- part of an outreach programme aiming to keep the child in
tive rehabilitation as described by Sohlberg and Mateer its usual environment through providing the majority of the
(17). One of the strengths of the AMAT-C is that the method services in the child’s local area (22). The aim of this study
was developed for children rather than being an adaptation was to determine whether the training programme includ-
of an adult training programme, a common practice in, and ing the weekly supervision could be integrated in the child’s
a general criticism of traditional paediatric rehabilitation, school within the child’s normal schedule. There are two
see e.g. (18). The programme runs for 18–20 weeks (weeks reasons for placing supervision at the school: a) to maintain
19–20 are repetition weeks and may thus be left out), during the child’s motivation and b) to augment possibilities of
which the child practices different assignments for approxi- transferring trained skills into the child’s everyday learning
mately 45 min per day every weekday. The training takes situation (school-setting).
place on a one-to-one basis. The child is coached by a trai- This study thus differs from previous studies mainly in
ner, who receives weekly supervision from a specialist with provision of supervision at the child’s school. Also, it was
expert knowledge on children with cognitive deficits. Sev- decided to complete the full length of the training pro-
eral cognitive areas are trained: sustained, focussed and gramme, as far as possible, in the present pilot study.
divided attention; strategies for verbal, visual, episodic and
semantic memory; and mental tracking. See Figure 1 for an
overview of training phases and elements. METHODS
The AMAT-C has previously been seen to have a signifi- Objectives
cant effect in a controlled study of children treated for can- The objectives of the study were to investigate (1) whether
cer with attention and memory deficits in the Netherlands the training programme can be integrated into the school-
(Treatment group: n = 25, Control group: n = 19) (19). In setting, i.e. providing training and weekly supervision at the
addition to cognitive gains, the Dutch study also showed a child’s school (measured by programme evaluation), (2)
significant decrease in learning difficulties for the treatment whether supervision provided at the school helps maintain
group. Another study on AMAT-C, undertaken in Sweden, the child’s motivation throughout the training period (mea-
consisted of a randomized controlled study (Treatment sured by programme evaluation) and (3) whether changes
group: n = 18, Control group: n = 20) (10) and a 6-month in memory, attention and executive functions are found
follow-up study of the same group (20). Results of these when supervision is provided in the school-setting (mea-
studies showed that the children in the AMAT-C treatment sured by neuropsychological tests and questionnaires).
group significantly improved their attention and memory
functions as compared with the control group. Furthermore, Participants
the follow-up study showed that the treatment group main- Eight children with ABI commenced cognitive training with
tained significant gains on tests of selective attention and AMAT-C during the period between 2002 and 2006. Inclu-
working memory as compared with the control group sion criteria were attention and ⁄ or memory sequelae after
6 months after completing the training programme. ABI (time since injury at least 1 year) and age between 8–
In the Swedish studies, it was noted that it could be diffi- 16 years. Exclusion criteria were premorbid history of a
cult to maintain the children’s motivation throughout the diagnosed psychiatric disorder or premorbid learning diffi-
training programme (10,21). Therefore, the following modi- culties. One participant did not complete the training pro-
fications were made: (1) the training period was reduced gramme because of problems related to being trained by
from 20 to 17 weeks, (2) the level of difficulty was individu- two teachers concurrently (one teacher trained the child on
alized (3) a reward system was used and (4) a schematic certain weekdays, the other teacher on the remaining week-
outline of the training programme over the 17 weeks was days). One child was included although the child’s time
developed. since injury was <1 year (10 months). The reason for inclu-
It is our hypothesis that hospital-based weekly supervi- sion was that allowing him to participate at the given time
sion in the Swedish study might be one of the factors that was the only way that the training could take place before

Sustained Focussed Divided Memory

Repetition
attention attention attention strategies

Week 1–4 Week 5–8 Week 9–12 Week 13–18 Week 19–20

Figure 1 AMAT-C phases and training elements.

ª2009 The Author(s)/Journal Compilation ª2009 Foundation Acta Pædiatrica/Acta Pædiatrica 2010 99, pp. 230–236 231
Cognitive training of children with ABI Sjö et al.

Table 1 Characteristics of participants

Child Gender Age Type of injury Time since injury (years) Weeks of training School

A # 15.8 Stroke 0.8 20 Ordinary

B # 13.8 Traffic accident 1 20 Ordinary
C $ 13.2 Brain tumour 8 18 Specialist
D $ 12.8 Traffic accident 8 18 Specialist
E # 11.3 Stroke 1 20 Ordinary
F $ 12.9 Traffic accident 4 18 Specialist
G $ 14.8 Brain tumour 4 18 Ordinary

he finished school. The group that completed the training and ⁄ or work with new subjects post-training? (4) Have you
programme thus consisted of seven subjects (three male and noticed other things becoming easier to do post-training?
four female subjects). Trainers of the children who completed 20 weeks of train-
Demographic data for each child is shown in Table 1. ing were interviewed about the relevance and significance
Mean age at pre-testing was 13.5 ranging from 11–15 years of the two repetition weeks (weeks 19–20).
of age (SD = 1.5). Types of brain injury were traumatic Neuropsychological evaluation was carried out using sub-
(n = 3), brain tumour (n = 2), stroke (n = 2). Time since tests from Wechsler Intelligence Scale for Children III
injury varied between 10 months and 8 years (x = 3.8 years, (WISC-III) (24,25), Neuropsychological Assessment of the
SD = 3.2). Four of the children attended a mainstream school-aged child (26,27) and Test of Everyday Attention
school while three attended a special school. The children for Children (TEA-Ch) (28). All children were tested before
were recruited through a brain injury rehabilitation facility and after training with AMAT-C. The tests cover the follow-
(22). Unfortunately, information on family social back- ing domains: attention ⁄ concentration, tempo, visuo-con-
ground (such as general family functioning and socio-eco- structive abilities, learning and memory, and executive
nomic status) was not collected; this is a variable that has functions. See Table S1 (in Supplementary Material online)
previously been shown to influence outcome for children for specific subtests used.
with traumatic brain injury (23). In order to gain information about the children’s behav-
iour, the Behaviour Rating Inventory of Executive Func-
Materials tions (BRIEF) (29) questionnaire was answered by parents
The AMAT-C material is published in Dutch, Danish (2005) and trainers before and after the training programme.
and Swedish (2008) respectively. The material consists of a
trainer’s manual, a supervisor’s manual, a folder for the Data analyses
child and a number of materials needed for specific exer- Answers to one selected evaluation question are described
cises. The child’s folder includes daily report sheets on in percentages. The Wilcoxon signed-rank test was carried
which the child notes results for each specific exercise and out to determine differences between pre- and post neuro-
answers open-ended questions regarding evaluation of per- psychological test results. Statistical tests were made using
formance. SPSS (Statistical Package for the Social Sciences; SPSS Inc.
Each week focusses on a specific cognitive skill, the exer- Headquarters, Chicago, IL, USA), version 15.0. All given p-
cises become more challenging throughout the week and values are one-tailed, and p < 0.05 is the chosen accepted
each week builds on skills trained OR practised during pre- level of significance.
vious weeks. In addition to the exercises, which are primar- Certain limitations apply to the use of tests and question-
ily drill-based, AMAT-C includes more metacognitive naires in the chosen battery. There only existed Scandina-
elements (e.g. ‘How do you best remember visual mate- vian norms for WISC-III. Therefore, American ⁄ Australian
rial?’). Weeks 19 and 20 are repetition weeks, during which original norms were applied for the remaining test battery
exercises from the previous 18 weeks are repeated in order and the BRIEF questionnaire. Furthermore, the study target
to (1) give the child an opportunity to apply all trained skills group differed from the normative population in some of
on previous tasks and (2) to raise the child’s awareness of the test batteries. With respect to age, the chosen procedure
own strategies, strengths and weaknesses. was that raw scores of children who were younger ⁄ older
Programme evaluation consisted of four evaluation ques- than the norm groups were converted using norms of the
tions to parents, trainers and children made specifically to youngest ⁄ oldest groups respectively. Some raw scores were
evaluate the AMAT-C training programme. The questions converted to stanine (abbreviation for ‘standard nine’)
were based on clinical significance, formulated by personnel scores based on the norms available. The mean of the sta-
at the rehabilitation facility and answers were given on a nine measure is 5 and the standard deviation is 2.
three-point scale (e.g. Very good, Good, Not so good). The
questions were as follows: (1) What is your opinion about Procedures
the training programme? (2) Did you ⁄ your child ⁄ the pupil One of the children’s regular teachers was chosen as trainer
want to start doing the programme every day? (3) Is it easier and carried out the daily training with the child. Weekly
for you ⁄ your child ⁄ the pupil to concentrate ⁄ remember supervision was provided by personnel from the

232 ª2009 The Author(s)/Journal Compilation ª2009 Foundation Acta Pædiatrica/Acta Pædiatrica 2010 99, pp. 230–236
Sjö et al. Cognitive training of children with ABI

rehabilitation facility. Supervision was provided at the Table 2 Distribution of responses to the question of whether the child wanted
school with participation of supervisor, trainer and child to start the training
and lasted 30–45 min. The supervisor takes over the train- Often (%) Sometimes (%) Not at all (%)
ing session and acts as trainer for the child while the trainer
Child (n = 7) 14 86 0
observes. The purpose of the weekly supervision is to not
Parent (n = 6) 100 0 0
only explain and demonstrate the following week’s training
Trainer (n = 7) 100 0 0
elements but also to evaluate the past week’s training.
The supervisor had access to the child’s neuropsychologi-
cal testing, which facilitated adapting and individualizing
the cognitive training to the child’s specific strengths and Table 3 Comments to the evaluation question ‘Have you noticed other things
weaknesses. If the full 20 weeks of training was completed, becoming easier to do post-training?’
the child had trained for 100 sessions on a one-to-one basis. Respondent Comment
Given smaller breaks for holidays, illness, project weeks,
Child ‘Math and written assignments seem easier for me to do as well as
school camps etc., a full training period typically varied in
learning techniques at basketball practice and remembering
duration from 6 to 9 months.
TV programmes’.
The children were tested by trained child neuropsycholo- Child ‘Remembering things if I have made plans’.
gists within 3 weeks prior to commencement and within Parent ‘Personally, I have gained a better contact with her’.
3 weeks after completion of the training programme. Parent ‘He has become more aware of his own situation’.
All seven children were trained by one of their teachers at Parent ‘She manages her temper better’.
school within normal school hours. Four children trained Trainer ‘It is easier to get her started - by referring to tasks from the
for 18 weeks while three trained for 20 weeks. The length of training programme’.
the training depended on practical issues such as resources
at the child’s school and unexpected illness. Therefore,
some programmes ended at 18 weeks in order to complete Also, statistically significant improvements were seen on
the training before the school holidays. tests of attention (one of 11 subtests), tempo (one of four
subtests), visuo-constructive abilities (one of one subtest),
learning and memory (four of seven subtests) and executive
RESULTS functions (one of five subtests). An overview of the neuro-
Programme evaluation psychological results is presented in Table S1 (in Supple-
All parents, trainers and children answered evaluation ques- mentary Material online).
tions. Overall, responses were positive, as can be expected
when such an extensive intervention has been carried out. Questionnaire results on executive functions
We have therefore chosen only to focus on one question The questionnaire results (BRIEF) from the parental
here, as it pertains to the children’s motivation, namely: Did responses for the children as a group showed an increase in
you ⁄ your child ⁄ the pupil want to start doing the programme T-scores indicating that the parents observed a slight nega-
every day? The parent(s) of one child did not answer this tive change in the children’s executive functions post-train-
question. Responses are given in percentages and distribu- ing. The trainers, on the other hand, reported a decrease in
tion of responses as well as number of replies is shown in T-scores indicating a positive change in the children’s exec-
Table 2. utive functions. There was one positively significant result
All trainers and parents reported that the children ‘often’ in the trainer responses indicating that the children as a
wanted to start the training session. This does not quite cor- group improved their emotional control significantly post-
respond to the children’s replies as six children (86%) training. An overview of the questionnaire responses is
answered that they ‘sometimes’ wanted to start the training given in Table S2 (in Supplementary Material online).
and one child (14%) answered ‘often’.
Besides answering on a three-point scale, respondents
were given space to comment on question number four DISCUSSION
(whether they noticed any things besides memory and Answers to the evaluation questions indicate that motiva-
attention becoming easier post-training). Examples of the tion for beginning each training session was maintained
comments are given in Table 3. throughout the programme, although parents and trainers
The comments indicate that skills and behaviour not rate this more positively than the children. However, as
directly related to the children’s cognitive impairment the children were satisfied with the programme overall, we
improved after the training programme. believe that they were able to keep up motivation through-
out the programme, whether it lasted 18 or 20 weeks. This
Neuropsychological evaluation is very positive in light of previous reported difficulties
The neuropsychological test results showed that the chil- with maintaining motivation (10,21). One explanation for
dren as a group achieved better results in terms of higher- the children’s maintained motivation could be that the
scaled scores and improved speed after having completed supervision did not take place at the hospital, a place that
the training programme than they did prior to the training. could be associated with their illness ⁄ injury. Also,

ª2009 The Author(s)/Journal Compilation ª2009 Foundation Acta Pædiatrica/Acta Pædiatrica 2010 99, pp. 230–236 233
Cognitive training of children with ABI Sjö et al.

everyday school life is less disturbed when supervision It is our clinical experience that the programme opens up
takes place in the child’s school, giving possibility of more several possibilities for generalizing skills acquired through
classroom participation, with respect to both curriculum the training to everyday situations. These possibilities for
and social activities. transfer arise because (1) the material incorporates meta-
Comments from trainers, parents and children regarding cognitive elements in the daily training sessions, (2) the
issues other than memory and attention becoming easier training involves use of everyday situations such as applying
post-training indicate that AMAT-C training affects other learned AMAT-C methods to reading assignments and
aspects of the child’s everyday life. While this may be related because (3) the daily one-to-one sessions in the school-set-
to improved memory and attention (3) it could also be ting often improves the pupil-teacher relationship.
attributed to the close co-operation between trainer and Time post injury varies a great deal for the children in the
child. study and is a factor which could influence motivation and
Feedback from the trainers of the three children who improvement. However, it has not been possible to investi-
completed the full 20-week programme suggested that the gate the importance of time since injury statistically because
two repetition weeks added greatly to the programme. The of the small number of subjects. Our clinical experience
trainers stressed that the children who went through the from this study as well as later AMAT-C training supervised
repetition phase benefited from experiencing how much from our rehabilitation facility does not indicate a particular
better they had become at tasks that initially required a pattern between time since injury and motivation and ⁄ or
much greater effort, which confirmed the supervisors’ clini- cognitive or other improvements after AMAT-C.
cal observations of the positive effect of the repetition Finally, we wish to stress that pilot studies such as this are
weeks. necessary in order to refine and improve rehabilitation
As mentioned, four children attended ordinary school interventions. Without such pilot studies it is not possible to
while three attended a special school. Based on the positive evaluate adapted implementations of an intervention pro-
programme evaluation from all participants, it appears that gramme, an essential step if considering a larger study and
AMAT-C is useful in both settings. possible inclusion into clinical care.
As there is no control group included in this study, it is
not possible to determine to what extent improvements on
the neuropsychological tests can be considered valid or sim- LIMITATIONS
ply be attributed to practice effect (time from pre- to post- There are several limitations to this study. As is often seen
testing was on average 8 months) (30). However, the statis- in pilot studies, there were only a small number of subjects,
tical data analysis was made on standard scores rather than and no control group was included. Furthermore, although
raw scores. Significant improvements on normed neuropsy- one purpose of placing intervention in the school-setting
chological tests are noteworthy, as children with memory was to augment possibilities of transferring trained skills to
and ⁄ or attentional problems after ABI generally have a the child’s everyday learning context, there was no measure
decelerated learning curve as compared with non-injured for such transfer. In other words, there could have been a
peers (31). greater focus on functional outcome measures.
In light of the positive results in the controlled Swedish Unfortunately, this study did not examine what the effec-
study (10,20), and given the fact that the data analyses in tive component of the AMAT-C programme is (this is also
this study were carried out on scaled scores, we would sug- the case for the other AMAT-C studies undertaken to date).
gest that the statistically significant results presented in this Our clinical experience is that positive effects are attribut-
article signify a positive effect of the AMAT-C training on able to the multifactorial efforts including the child’s gained
the children’s memory and attention skills, although these insight into his ⁄ her own cognitive strengths and deficits, the
results should be interpreted with caution. For instance, the cognitive training per se as well as the explicit metacognitive
improved speed found in this study should not be attributed elements of the training programme.
to the AMAT-C training alone as there was no significant
difference in tests of reaction time between the treatment
and the control group in the Swedish study (both groups FUTURE DIRECTIONS
improved their reaction time). Based on the fact that one child that did not complete the
This is the first AMAT-C study where executive functions training programme because of having two concurrent
are evaluated through questionnaires. Unfortunately, results trainers, we recommend that there be only one trainer and
from the BRIEF questionnaire responses do not show an that it is the same trainer throughout the training pro-
overall improvement in function. In fact, the parents report gramme. Having more than one trainer places too much
a significant worsening within two domains. This ‘worsen- responsibility on the child with respect to keeping track of
ing’ of the parents’ responses can be seen after rehabilitation process and progression.
and may be explained by the increase in knowledge about Also, based on the positive feedback concerning the two
the child’s difficulties that parents gain as part of the reha- repetition weeks, we recommend that in planning future
bilitation efforts. Also, it should be noted that results of the training setups that the 20-week of training be chosen.
parental responses before as well as after the training pro- Although we see considerable advantages in providing
gramme are within the normal range. supervision in the child’s school, we recognize that this is a

234 ª2009 The Author(s)/Journal Compilation ª2009 Foundation Acta Pædiatrica/Acta Pædiatrica 2010 99, pp. 230–236
Sjö et al. Cognitive training of children with ABI

very costly solution. Therefore, a less costly way of provid- 10. van’t Hooft I, Andersson K, Bergman B, Sejersen T, Von Wendt
ing supervision in the local setting could be considered e.g. L, Bartfai A. Beneficial effect from a cognitive training pro-
supervision to the trainer by phone or supervision to child gramme on children with acquired brain injuries demonstrated
in a controlled study. Brain Inj 2005; 19: 511–8.
and trainer by webcam.
11. Braga LW, Da Paz AC, Ylvisaker M. Direct clinician-delivered
versus indirect family-supported rehabilitation of children with
traumatic brain injury: a randomized controlled trial. Brain Inj
CONCLUSION 2005; 19: 819–31.
First, this pilot study shows that the AMAT-C programme 12. Anderson V, Catroppa C. Advances in postacute rehabilitation
can successfully be integrated into the child’s school within after childhood-acquired brain injury: a focus on cognitive,
behavioral, and social domains. Am J Phys Med Rehabil 2006;
the child’s normal school schedule. Second, the study sug-
85: 767–78.
gests that school-based supervision may have a positive 13. Marcantuono JT, Prigatano GP. A holistic brain injury rehabili-
influence on the children’s motivation. Third, improve- tation program for school-age children. NeuroRehabilitation
ments on neuropsychological tests are also seen when train- 2008; 23: 457–66.
ing and supervision takes place in the school-setting. In 14. Gillett J. The Pediatric Acquired Brain Injury Community
summary, school-based implementation of the supervision Outreach Program (PABICOP) – an innovative compre-
seems promising and further research is needed to confirm hensive model of care for children and youth with an
acquired brain injury. NeuroRehabilitation 2004; 19: 207–
the results and conclusions presented in this article.
18.
15. Sohlberg MM, Mateer CA. Cognitive rehabilitation. An integra-
tive neuropsychological approach. New York: The Guilford
ACKNOWLEDGEMENTS Press, 2001.
We wish to thank the Egmont Foundation for funding and 16. Hendriks CM, van den Broek-Sandmann TM. Amsterdamse
initiating use of AMAT-C in Denmark as part of the project training van aandacht en geheugen vorr kinderen (ATAG-K).
Children’s Center for Rehabilitation of Brain Injury (1999– Amsterdam: Harcourt Test Publisher, 1996.
17. Sohlberg MM, Mateer CA. Introduction to cognitive
2003) (22), Dr.Med. Tom Teasdale for his advice on statisti-
rehabilitation. New York: Guilford Press, 1989.
cal as well as content matters and last but not least the chil- 18. Spevak T. A developmental approach to pediatric neuropsy-
dren, parents, schools and trainers who participated in this chological intervention. In: Hunter JV, Donders J, editors.
study. Pediatric neuropsychological intervention. Cambridge:
Cambridge University Press, 2007: 6–29.
19. Hendriks CM. Attention and memory training in
References childhood cancer survivors. Eur Cancer Soc Newsl 1996; 5:
13–4.
1. Anderson V, Catroppa C. Memory outcome at 5 years post-
20. van‘t Hooft I, Andersson K, Bergman B, Sejersen T, von Wendt
childhood traumatic brain injury. Brain Inj 2007; 21: 1399–
L, Bartfai A. Sustained favorable effects of cognitive training in
409.
children with acquired brain injuries. NeuroRehabilitation
2. Anderson V, Catroppa C, Morse S, Haritou F, Rosenfeld J.
2007; 22: 109–16.
Attentional and processing skills following traumatic brain
21. van’t Hooft I, Andersson K, Sejersen T, Bartfai A, von Wendt L.
injury in early childhood. Brain Inj 2005; 19: 699–710.
Attention and memory training in children with acquired brain
3. Souza LM, Braga LW, Filho GN, Dellatolas G. Quality-of-life:
injuries. Acta Paediatr 2003; 92: 935–40.
child and parent perspectives following severe traumatic brain
22. Kihlgren M, Weidner S, Sjö NM. Experiences from a holistic
injury. Dev Neurorehabil 2007; 10: 35–47.
approach to outpatient neuropsychological rehabilitation: a
4. van Heugten CM, Hendriksen J, Rasquin S, Dijcks B, Jaeken D,
development project under the Egmont Foundation: The Eg-
Vles JH. Long-term neuropsychological performance in a
mont Foundation Annual Report, 2003.
cohort of children and adolescents after severe paediatric trau-
23. Wassenberg R, Max JE, Lindgren SD, Schatz A. Sustained
matic brain injury. Brain Inj 2006; 20: 895–903.
attention in children and adolescents after traumatic
5. Limond J, Leeke R. Practitioner review: cognitive rehabilitation
brain injury: relation to severity of injury, adaptive
for children with acquired brain injury. J Child Psychol Psychi-
functioning, ADHD and social background. Brain Inj 2004;
atry 2005; 46: 339–52.
18: 751–64.
6. Savage RC, DePompei R, Tyler J, Lash M. Paediatric traumatic
24. Sonnander K, Ramund B. WISC-III Manual (Swedish version).
brain injury: a review of pertinent issues. Pediatr Rehabil 2005;
Stockholm: Psykologiförlaget AB, 1999.
8: 92–103.
25. Wechsler D. WISC-IIIDK (Danish version). Denmark: Dansk
7. Laatsch L, Harrington D, Hotz G, Marcantuono J, Mozzoni
Psykologisk Forlag, 2004.
MP, Walsh V, et al. An evidence-based review of cognitive
26. Anderson V, Lajoie G, Bell R. Neuropsychological
and behavioral rehabilitation treatment studies in children
assessment of the school-aged child. Melbourne: University
with acquired brain injury. J Head Trauma Rehabil 2007; 22:
of Melbourne, Department of Psychology, Royal Children’s
248–56.
Hospital, 1997.
8. Edlund W, Gronseth G, So Y, Franklin G.Clinical practice
27. Croona C, Hulterström J, Kihlgren M. Neuropsykologiska
guideline process manual. St. Paul, MN: American Academy of
utredningsmetoder för inlärning, minne och exekutiva funk-
Neurology (AAN), 2004.
tioner hos barn i skolåldern. Uppsala: NIMES, 2000.
9. Butler RW, Copeland DR. Attentional processes and their
28. Manly T, Robertson IH, Anderson V, Nimmo-Smith I. Test of
remediation in children treated for cancer: a literature review
Everyday Attention for Children (TEA-ch). London: Harcourt
and the development of a therapeutic approach. J Int Neuropsy-
Assesment, 1999.
chol Soc 2002; 8: 115–24.

ª2009 The Author(s)/Journal Compilation ª2009 Foundation Acta Pædiatrica/Acta Pædiatrica 2010 99, pp. 230–236 235
Cognitive training of children with ABI Sjö et al.

29. Gioia GA, Isquith PK, Guy SC, Kenworthy L. Behavior rating Table S1 Neuropsychological test results.
inventory of executive function. Odessa: Psychological Assess- Table S2 Results from the behaviour rating inventory of
ment Ressources, 1996, 1998 & 2000. executive function.
30. Strauss E, Sherman EMS, Spreen O. A compendium of neuro-
psychological tests. Administration, norms, and commentary. Please note: Wiley-Blackwell are not responsible for the
New York: Oxford University Press, 2006. content or functionality of any supporting materials sup-
31. Nelson JE, Kelly TP. Long-term outcome of learning and
plied by the authors. Any queries (other than missing mate-
memory in children following severe closed head injury.
Pediatr Rehabil 2002; 5: 37–41.
rial) should be directed to the corresponding author for the
article.
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