Personalized Innovative Intervention Pathways to Promote EF in Children With CP

In the study the investigators will assess the Inhibition subtest at the NEPSY-II (Urgesi et al., 2011). that valuates the ability to inhibit automatic responses in favour of novel responses and to switch between response types. It is divided into three conditions: naming, inhibition and switching. Both accuracy and speed are obtained for each condition, with standardised score range from 1 to 19. Higher scores revealed better performances.

In this study, the investigators will use the Sustained Attention subtest at the Leiter International Performance Scale (Leiter-3) (Roid et al., 2013), which assesses visual attention and consists of repetitive barrage tasks to be performed in a predefined time. The number of correctly selected target elements are recorded. Raw scores range from 0 to 217, while standardised score range from 1 to19. Higher scores revealed better performances.

VMI (Beery & Buktenica, 2000) is a paper-pencil test used to determine the level of integration between visual and motor systems. The child will be asked to copy different geometric forms shown on the paper within a certain time frame. The number of figures correctly reproduced is recorded and then converted in standardized scores. Raw scores range from 0 to 27. Higher scores reveal a better performance.

MOXO evaluates sustained attention and is provided via a computer. The test requires the child to sustain attention over a continuous stream of stimuli (visual or auditory) and to respond to a specific target stimulus. Four scales are extracted and converted in z scores: attentiveness, timeliness, impulsiveness, hyper-reactivity. Higher scores reveal a better performance.

The Corsi block-tapping subtest at the BVS-corsi (Mammarella et al., 2008) evaluates visuo-spatial short-term and working memory. The child is asked to retrieve a sequence previously seen by the examiner by tapping blocks with the preferred finger following the same order for the forward condition or reversing the order for the backward condition. The length of the last sequence correctly retrieved is recorded as the span, ranging from 3 to 8 in the forward condition and from 2 to 7 in the backward. Higher span reveals better performance.

BRIEF-P/2 (Gerard et al, 2016) is a questionnaire filled in by the parents/legal guardians and dives into everyday behaviour associated with specific domains of the executive functions (i.e., mental processes that enable us to plan, focus attention, remember instructions). Parents rate items (e.g., "does not think before doing") on a three-point scale ranging from 1 (never) to 3 (often). In the BRIEF 2 version, 9 scales are then extracted and converted in T scores: inhibition (ranging 8-24), self-monitoring (ranging 4-12), shift (ranging 8-24), emotional regulation (ranging 8-24), initiate (ranging 5-15), working memory (ranging 8-24), plan/organize (ranging 8-24), task monitoring (ranging 5-15), material organization (ranging 6-18); in the BRIEF P version, 5 scales are then extracted and converted in T scores: inhibition (ranging 16-48), shift (ranging 10-30), emotional regulation (ranging 10-30), working memory (ranging 17-51), plan/organize (ranging 10-30).

In the study the investigators will assess the subtest rapid visual naming (RAN) at the rapid automatized naming and visual search of colours, figures and numbers test (De Luca et al., 2005): the task consists in naming aloud all the stimuli contained in each matrix (colours, figures and numbers). For both tests time and number of errors are measured.

ALCE (Bonifacci et al., 2014) is a test for the evaluation of learning difficulties and for the evaluation of reading and comprehension skills. In the study the investigators will assess two subtests:

• Reading of the passage (in which the child is asked to read a passage, considering speed and correctness).
• Reading comprehension (in which the comprehension skills of a read text are tested).

The battery for the Evaluation of Dyslexia and Developmental Dysortography-2 (DDE-2) (Sartori et al., 2007) is a test to evaluate reading and writing skills in children. In the study the investigators will assess two subtests:

• Test 2 and 3 (reading words and non-words, in which the child is asked to read aloud as quickly and as accurately as possible 4 lists of 28 concrete and abstract words with high or low frequency and 3 lists of 16 non-words, in line with the phonotactic and phonographic rules of the Italian language).
• Test 6 and 7 (writing words and non-words under dictation, in which the child is asked to write 48 concrete and abstract words with high or low frequency and 24 non-words).

In the study the investigators will assess the subtests digit span forwards and backwards at the BVN 5-11 (Bisiacchi et al., 2005) and BVN 12-18 (Gugliotta et al., 2009) for assess short-term and working memory, the child is asked to repeat the numbers spoken by the examiner following the same order for the forward condition or reversing the order for the backward condition. The length of the last sequence correctly retrieved is recorded as the span, ranging from 3 to 9 in the forward condition and from 2 to 8 in the backward. Higher span reveals better performance.

TeleFE (Cooperativa Sociale Anastasis) is a web platform for the multidimensional assessment of Executive Functions in developmental ages from 6 to 13 years. In the study the investigators will assess three subtests:

• In the go/no-go subtest children are asked to press a button when they see only the target stimulus between distracting stimuli that appear on the screen.
• In subtest n-back 1, children are asked to remember the same item as the previous one within a string of stimuli that appear on the screen.

Both accuracy and speed are scored for each subtest, with percentile score. Higher scores revealed better performances.

In the study the investigators will assess the Verbal Fluency Subtest at the NEPSY-II (Urgesi et al., 2011), in which the child is asked to generate in one minutes as many words as possible from a given category (animals, food and drinks) or with an initial phoneme (F and S). The test evaluates lexical access and total number of correctly generated word is scored for both the semantic and the phonological condition. The standardised score range is from 1 to 19. Higher scores revealed better performances.

TPV (Hammill, 1994) is a test for the evaluation of visuo-perceptual and visuo-motor integration skills. In the study the investigators will assess the subtests:

• Copying\\ reproduction Subtest: the child sees figures that he must copy
• Visual\\motor speed: the child is asked to draw distinctive designs inside the target figures.
• Hand-eye coordination: the child is asked to draw some lines inside bands of different widths.
• Spatial relationships: the child is asked to connect some dots to reproduce the target figure.

From these four subtests, the visual-motor integration score can be calculated and converted into a percentile score. Higher scores revealed better performances.

APCM-2 (Sabbadini, 2015) aims to assess motor and praxis skills in children aged between 2-8 years, with age goup-specific performance tests.APCM-2 enables the early identification of deficits in motor-praxic coordination. The obtained scores facilitate a comprehensive assessment of each case, delineating the functional profile by calculating the deviation from the normative mean and referencing percentile values (5°, 10°, 25°). This approach aids in pinpointing specific functions for each scale, ranging from the most intact to the most impaired.

Movement ABC-2 (Henderson, 2013) evaluates movement difficulties in 3 to 16 years children and adolescents. This assessment battery examines motor difficulties in children and adolescents aged 3 to 16 years. Tasks are categorized by age group and distributed across three sections: manual dexterity, aiming and catching, and balance. Scores are presented in standard scores and percentiles, with interpretation facilitated by a traffic light system. A green light signifies typical motor performance (scores above the 15th percentile), a yellow light indicates a risk for motor impairment (scores between the 5th and 15th percentile), and a red light identifies a significant motor function impairment (scores below the 5th percentile).

The BHK test (Hamstra-Bletz et al., 2010) evaluates developmental dysgraphia, both the poor quality of the graphic sign (morphological analysis) and the disfluency (speed in the production of graphemes). Both accuracy and speed are evaluated with a z score and a percentile score, respectively. Higher scores reveal better performance.