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Psychosocial well-being requires effective regulation of emotional responding in context of threat or stress. Neuroimaging studies have focused on instructed, volitional regulation (e.g., reappraisal or distancing), largely ignoring implicit regulation that does not involve purposeful effort to alter emotional experience. These implicit processes may or may not involve the same neural pathways as explicit regulatory strategies. We examined the neurobiology of implicit emotional regulation processes and the impact of the stress hormone cortisol on these processes. Our study task employed composite pictures of faces and places to examine neural activity during implicit emotional processing (of emotional faces), while these responses were implicitly regulated by attention shift away from the emotionally evocative stimuli, and while subjects reflectively appraised their own emotional response to them. Subjects completed the task in an fMRI scanner after random assignment to receive placebo or hydrocortisone (HCT), an orally administered version of cortisol. Implicit emotional processing activated insula/IFG, dACC/dMPFC, midbrain and amygdala. With attention shifting, we saw diminished signal in emotion generating/response regions (e.g., amygdala) and increased activations in task specific attention regions like parahippocampus. With appraisal of emotions, we observed robust activations in medial prefrontal areas, where activation is also seen in instructed reappraisal studies. We observed no main effects of HCT administration on brain, but males and females showed opposing neural effects in prefrontal areas. The data suggest that different types of emotion regulation utilize overlapping circuits, but with some strategy specific activation. Further study of the dimorphic sex response to cortisol is needed.

Background Despite the high prevalence of fetal alcohol spectrum disorder (FASD), there are few interventions targeting its core neurocognitive and behavioral deficits. FASD is often conceptualized as static and permanent, but interventions that capitalize on brain plasticity and critical developmental windows are emerging. We present a long-term follow-up study evaluating the neurodevelopmental effects of choline supplementation in children with FASD 4 years after an initial efficacy trial. Methods The initial study was a randomized, double-blind, placebo-controlled trial of choline vs. placebo in 2–5-year-olds with FASD. Participants include 31 children (16 placebo; 15 choline) seen 4 years after trial completion. The mean age at follow-up was 8.6 years. Diagnoses were 12.9% fetal alcohol syndrome (FAS), 41.9% partial FAS, and 45.1% alcohol-related neurodevelopmental disorder. The follow-up included measures of intelligence, memory, executive functioning, and behavior. Results Children who received choline had higher non-verbal intelligence, higher visual-spatial skill, higher working memory ability, better verbal memory, and fewer behavioral symptoms of attention deficit hyperactivity disorder than the placebo group. No differences were seen for verbal intelligence, visual memory, or other executive functions. Conclusions These data support choline as a potential neurodevelopmental intervention for FASD and highlight the need for long-term follow-up to capture treatment effects on neurodevelopmental trajectories. Trial registration ClinicalTrials.Gov #NCT01149538 ; Registered: June 23, 2010; first enrollment July 2, 2010

In an earlier placebo-controlled trial, dexamethasone was administered to neonates as a treatment for respiratory distress syndrome. When children who had participated in that trial were about eight years of age, the investigators conducted a second study to determine the long-term effects of treatment. Children in the dexamethasone group were shorter, had smaller head circumferences, and had poorer scores than control children on a number of tests of cognitive and motor function. Children were shorter and had poorer scores on tests of cognitive and motor function. Postnatal dexamethasone therapy has been used to treat or prevent chronic lung disease of prematurity 1 – 8 ; however, the long-term effects of dexamethasone on development are not known. We previously reported results from our two-year follow-up study of dexamethasone treatment 9 and from other studies conducted in young children. 10 – 21 These studies indicated that early postnatal dexamethasone therapy might affect somatic growth and neurodevelopmental outcome. Since the results of two-year follow-up cannot always predict future morbidity, there is a compelling need for long-term follow-up. In the current study, we analyzed the outcomes in the same cohort of children at school age. . . .

Objective To determine if improvements in cognitive outcome detected at 18 months’ corrected age (CA) in infants born <33 weeks’ gestation receiving a high-docosahexaenoic acid (DHA) compared with standard-DHA diet were sustained in early childhood. Design Follow-up of a multicentre randomised controlled trial. Randomisation was stratified for sex, birth weight (<1250 vs ≥1250 g) and hospital. Setting Five Australian tertiary hospitals from 2008 to 2013. Participants 626 of the 657 participants randomised between 2001 and 2005 were eligible to participate. Interventions High-DHA (≈1% total fatty acids) enteral feeds compared with standard-DHA (≈0.3% total fatty acids) from age 2–4 days until term CA. Primary outcome Full Scale IQ of the Wechsler Abbreviated Scale of Intelligence (WASI) at 7 years CA. Prespecified subgroup analyses based on the randomisation strata (sex, birth weight) were conducted. Results 604 (92% of the 657 originally randomised) consented to participate (291 high-DHA, 313 standard-DHA). To address missing data in the 604 consenting participants (22 for primary outcome), multiple imputation was performed. The Full Scale IQ was not significantly different between groups (high-DHA 98.3, SD 14.0, standard-DHA 98.5, SD 14.9; mean difference adjusted for sex, birthweight strata and hospital −0.3, 95% CI −2.9 to 2.2; p=0.79). There were no significant differences in any secondary outcomes. In prespecified subgroup analyses, there was a significant sex by treatment interaction on measures of parent-reported executive function and behaviour. Scores were within the normal range but girls receiving the high-DHA diet scored significantly higher (poorer outcome) compared with girls receiving the standard-DHA diet. Conclusions Supplementing the diets of preterm infants with a DHA dose of approximately 1% total fatty acids from days 2–4 until term CA showed no evidence of benefit at 7 years’ CA. Trial registration number Australian New Zealand Clinical Trials Registry: ACTRN12606000327583.

This study aimed to investigate the impacts of methylphenidate hydrochloride extended-release tablets on intelligence and behavior in children with attention deficit hyperactivity disorder. One hundred and twenty children with attention deficit hyperactivity disorder admitted to Nanjing First Hospital, Nanjing Medical University, Nanjing, China from January 2023 to January 2025 were included and randomly divided into a control group and a study group. The study group adopted methylphenidate hydrochloride extended-release tablets. The control group adopted placebo. Compared with the control group, the study group had an increase in intelligence level scores, self-awareness scores and quality of life scores as well as a decrease in behavior scores and clinical symptoms scores following 12 weeks of treatment. Compared with the control group, 5-hydroxytryptamine, norepinephrine and dopamine levels in the study group were higher after 12 weeks of treatment. However, the above indicators showed no differences in the control group between before and after treatment. We conclude that methylphenidate hydrochloride extended-release tablets improve the intelligence level, attention and behavior problems, promote self-awareness and quality of life, and improve the levels of monoamine neurotransmitters in children with attention deficit hyperactivity disorder. Cette étude visait à évaluer l'impact des comprimés de chlorhydrate de méthylphénidate à libération prolongée sur l'intelligence et le comportement d'enfants atteints de trouble déficitaire de l'attention avec hyperactivité (TDAH). Cent vingt enfants atteints de TDAH, admis au Nanjing First Hospital, Université de médecine de Nanjing, en Chine, entre janvier 2023 et janvier 2025, ont été inclus et répartis aléatoirement en un groupe témoin et un groupe d'étude. Le groupe d'étude a pris des comprimés de chlorhydrate de méthylphénidate à libération prolongée. Le groupe témoin a pris un placebo. Comparativement au groupe témoin, le groupe d'étude a présenté une augmentation des scores d'intelligence, de conscience de soi et de qualité de vie, ainsi qu'une diminution des scores de comportement et des symptômes cliniques après 12 semaines de traitement. Comparativement au groupe témoin, les taux de 5-hydroxytryptamine, de noradrénaline et de dopamine étaient plus élevés après 12 semaines de traitement. Cependant, les indicateurs mentionnés ci-dessus n'ont montré aucune différence entre le groupe témoin avant et après le traitement. Nous concluons que les comprimés de chlorhydrate de méthylphénidate à libération prolongée améliorent le niveau d'intelligence, l'attention et les troubles du comportement, favorisent la conscience de soi et la qualité de vie, et améliorent les taux de neurotransmetteurs monoamines chez les enfants atteints de trouble déficitaire de l'attention avec hyperactivité.

Background The goals of intentional curative pediatric epilepsy surgery are to achieve seizure-freedom and antiepileptic drug (AED) freedom. Retrospective cohort studies have indicated that early postoperative AED withdrawal unmasks incomplete surgical success and AED dependency sooner, but not at the cost of long-term seizure outcome. Moreover, AED withdrawal seemed to improve cognitive outcome. A randomized trial is needed to confirm these findings. We hypothesized that early AED withdrawal in children is not only safe, but also beneficial with respect to cognitive functioning. Design This is a multi-center pragmatic randomized clinical trial to investigate whether early AED withdrawal improves cognitive function, in terms of attention, executive function and intelligence, quality of life and behavior, and to confirm safety in terms of eventual seizure freedom, seizure recurrences and “seizure and AED freedom.” Patients will be randomly allocated in parallel groups (1:1) to either early or late AED withdrawal. Randomization will be concealed and stratified for preoperative IQ and medical center. In the early withdrawal arm reduction of AEDs will start 4 months after surgery, while in the late withdrawal arm reduction starts 12 months after surgery, with intended complete cessation of drugs after 12 and 20 months respectively. Cognitive outcome measurements will be performed preoperatively, and at 1 and 2 years following surgery, and consist of assessment of attention and executive functioning using the EpiTrack Junior test and intelligence expressed as IQ (Wechsler Intelligence Scales). Seizure outcomes will be assessed at 24 months after surgery, and at 20 months following start of AED reduction. We aim to randomize 180 patients who underwent anticipated curative epilepsy surgery below 16 years of age, were able to perform the EpiTrack Junior test preoperatively, and have no predictors of poor postoperative seizure prognosis (multifocal magnetic resonance imaging (MRI) abnormalities, incomplete resection of the lesion, epileptic postoperative electroencephalogram (EEG) abnormalities, or more than three AEDs at the time of surgery). Discussion Growing experience with epilepsy surgery has changed the view towards postoperative medication policy. In a European collaboration, we designed a multi-center pragmatic randomized clinical trial comparing early with late AED withdrawal to investigate benefits and safety of early AED withdrawal. The TTS trial is supported by the Dutch Epilepsy Fund (NL 08-10) ISRCTN88423240/ 08/05/2013.

The study is a follow-up of a randomized, double-blinded, placebo-controlled trial of supplementation with docosahexaenoic acid (DHA) and arachidonic acid (AA) to 129 very low birth weight (VLBW; birth weight <1500 g) infants fed human milk. The main hypothesis was that supplementation would affect growth, metabolic markers, and cognitive function. The secondary aim was to describe predictors of metabolic markers and cognitive status at follow-up. Ninety-eight children met for 8-year follow-up with anthropometric measures, blood biomarkers, and cognitive testing. The intervention group had significantly lower insulin-like growth factor-1 (IGF-1) at 8 years, whereas no differences in growth or intelligence quotient (IQ) were found. For the total cohort, weight gain during first year of life was neither associated with BMI, metabolic markers, nor IQ at follow-up. Blood DHA at 8 years was positively associated with IQ. Conclusions : The study is the first long-term follow-up of a randomized controlled trial with essential fatty acids investigating growth, metabolic factors, and IQ. IGF-1 levels were significantly lower in the intervention group at 8 years. First-year growth was not associated with BMI, metabolic markers, or IQ at follow-up. Current DHA status was a significant predictor of higher IQ at follow-up. What is Known: • Preterm children have increased risk of lower intelligence quotient (IQ), reduced growth, and abnormal metabolic status. • Early intake of docosahexaenoic acid (DHA) and arachidonic acid (AA), as well as early growth pattern, may influence both IQ and metabolic status. What is New: • Early intervention with DHA and AA led to reduced insulin-like growth factor-1 in blood at 8 years of age. • Weight gain during first year of life was neither associated with impaired metabolic markers nor improved IQ at follow-up. • Current DHA status was a significant predictor of higher IQ at 8 years, also when maternal education and birth weight were included in the model.

Creatine supplementation is in widespread use to enhance sports-fitness performance, and has been trialled successfully in the treatment of neurological, neuromuscular and atherosclerotic disease. Creatine plays a pivotal role in brain energy homeostasis, being a temporal and spatial buffer for cytosolic and mitochondrial pools of the cellular energy currency, adenosine triphosphate and its regulator, adenosine diphosphate. In this work, we tested the hypothesis that oral creatine supplementation (5 g d-1 for six weeks) would enhance intelligence test scores and working memory performance in 45 young adult, vegetarian subjects in a double-blind, placebo-controlled, cross-over design. Creatine supplementation had a significant positive effect (p < 0.0001) on both working memory (backward digit span) and intelligence (Raven's Advanced Progressive Matrices), both tasks that require speed of processing. These findings underline a dynamic and significant role of brain energy capacity in influencing brain performance.

In children, peak blood lead levels as low as 10 to 20 μg per deciliter (0.5 to 1.0 μmol per liter) are associated with reduced scores on developmental tests at 4 to 10 years of age. 1 – 5 Such blood lead levels occur in tens of thousands of children in the United States each year, 6 usually at about two years of age. It is not known whether chelation therapy can protect these children from the developmental consequences of exposure to lead. In 1991, the Food and Drug Administration licensed succimer (dimercaptosuccinic acid), the first approved oral lead chelator, for use in . . .

Little attention has been paid to the possible protective role of ω-3 polyunsaturated fatty acids (PUFAs) on the visual acuity of school-age children with lower IQs or attention-deficit hyperactivity disorder (ADHD). The aim of this study was to evaluate the effect of dietary ω-3 PUFAs on the visual acuity and red blood cell (RBC) fatty acid compositions of these children. We randomly assigned 179 children with lower IQs or ADHD to receive ordinary eggs (control group, n = 90) or eggs rich in C18:3 ω-3, eicosapentaenoic acid (EPA, 20:5 ω-3) and docosahexaenoic acid (DHA, 22:6 ω-3) for 3 mo (study group, n = 89). Before and after the intervention, distance visual acuity was tested using an E chart and the RBC fatty acid composition was determined using capillary gas chromatography. Three months later, 171 children completed the follow-up with the exception of 8 children who were unavailable during follow-up. Both groups of children showed a significant improvement in visual acuity (P < 0.05), however, visual acuity in the study group was significantly better than that of the control group (P = 0.013). The C18:3 ω-3 (P = 0.009), DHA (P = 0.009) and ∑ω-3 (P = 0.022) levels of the intervention group were significantly higher than those of the control group, while the C20:4 ω-6 (P = 0.003), C22:4 ω-6 (P = 0.000), ∑ω-6 (P = 0.001), ∑ω-6/∑ω-3 (P = 0.000) and arachidonic acid/DHA (P = 0.000) of the study group were significantly lower than those of the control group. No significant differences in the levels of C18:2 ω-6 (P = 0.723), C20:2 ω-6 (P = 0.249), C20:3 ω-6 (P = 0.258), C20:5 ω-3 (P = 0.051), or C22:5 (P = 0.200) were found between the two groups. Dietary supplementation with ω-3 PUFAs improves both visual acuity and the RBC fatty acid profile in school-age children with lower IQs or ADHD. •ω-3 Polyunsaturated fatty acids (PUFAs) and visual acuity of school-age children were addressed.•Two types of natural eggs with different contents of ω-3 PUFAs were used.•Dietary ω-3 PUFAs improve visual acuity of school-age children.•Dietary ω-3 PUFAs improve erythrocyte fatty acid profile of school-age children.