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In this thesis, deficits in theory of mind (ToM) and executive function (EF) were examined in tandem and separately as risk factors for conduct problems, including different forms and functions of aggressive behavior. All three reported studies and the additional analyses were based on a large community sample of N = 1,657 children, including three waves of a longitudinal study covering middle childhood and the transition to early adolescence (range 6 to 13 years) over a total of about three years. All data were analyzed with structural equation modeling.
Altogether, the results of all the conducted studies in this thesis extend previous research and confirm the propositions of the SIP model (Crick & Dodge, 1994) and of the amygdala theory of violent behavior (e.g., Blair et al., 2014) besides other accounts. Considering the three main research questions, the results of the thesis suggest first that deficits in ToM are a risk factor for relational and physical aggression from a mean age of 8 to 11 years under the control of stable between-person differences in aggression. In addition, earlier relationally aggressive behavior predicts later deficits in ToM in this age range, which confirms transactional relations between deficits in ToM and aggressive behavior in children (Crick & Dodge, 1994). Further, deficits in ToM seem to be a risk factor for parent-rated conduct problems cross-sectionally in an age range from 9 to 13 years. Second, deficits in cool EF are a risk factor for later physical, relational, and reactive aggression but not for proactive aggression over a course of three years from middle childhood to early adolescence. Habitual anger seems to mediate the relation between cool EF and physical, and as a trend also relational, aggression. Deficits in emotional and inhibitory control and planning have a direct effect on the individual level of conduct problems under the control of interindividual differences in conduct problems at a mean age of 8 years, but not on the trajectory of conduct problems over the course from age 8 to 11. Third, when deficits in cool EF and ToM are studied in tandem cross-sectionally at the transition from middle childhood to early adolescence, deficits in cool EF seem to play only an indirect role through deficits in ToM as a risk factor for conduct problems. Finally, all results hold equal for females and males in the conducted studies.
The results of this thesis emphasize the need to intervene in the transactional processes between deficits in ToM and in EF and conduct problems, including different forms and functions of aggression, particularly in the socially sensible period from middle and late childhood to early adolescence.
Background
In patients with mild cognitive impairment (MCI), gait instability, particularly in dual-task situations, has been associated with impaired executive function and an increased fall risk. Ginkgo biloba extract (GBE) could be an effective mean to improve gait stability.
Aims
This study investigated the effect of GBE on spatiotemporal gait parameters of MCI patients while walking under single and dual-task conditions.
Methods
Fifty patients aged 50-85 years with MCI and associated dual-task-related gait impairment participated in this randomised, double-blind, placebo-controlled, exploratory phase IV drug trial. Intervention group (IG) patients received GBE (Symfona (R) forte 120 mg) twice-daily for 6 months while control group (CG) patients received placebo capsules. A 6-month open-label phase with identical GBE dosage followed. Gait was quantified at months 0, 3, 6 and 12.
Results
After 6 months, dual-task-related cadence increased in the IG compared to the CG (p = 0.019, d = 0.71). No significant changes, but GBE-associated numerical non-significant trends were found after 6-month treatment for dual-task-related gait velocity and stride time variability.
Discussion
Findings suggest that 120 mg of GBE twice-daily for at least 6 months may improve dual-task-related gait performance in patients with MCI.
Conclusions
The observed gait improvements add to the understanding of the self-reported unspecified improvements among MCI patients when treated with standardised GBE.
The Feasibility and Effectiveness of a New Practical Multidisciplinary Treatment for Low-Back Pain
(2020)
Low-back pain is a major health problem exacerbated by the fact that most treatments are not suitable for self-management in everyday life. Particularly, interdisciplinary programs consist of intensive therapy lasting several weeks. Additionally, therapy components are rarely coordinated regarding reinforcing effects, which would improve complaints in persons with higher pain. This study assesses the effectiveness of a self-management program, firstly for persons suffering from higher pain and secondly compared to regular routines. Study objectives were treated in a single-blind multicenter controlled trial. A total of n = 439 volunteers (age 18–65 years) were randomly assigned to a twelve-week multidisciplinary sensorimotor training (3-weeks-center- and 9-weeks-homebased) or control group. The primary outcome pain (Chronic-Pain-Grade) as well as mental health were assessed by questionnaires at baseline and follow-up (3/6/12/24 weeks, M2-M5). For statistical analysis, multiple linear regression models were used. N = 291 (age 39.7 ± 12.7 years, female = 61.1%, 77% CPG = 1) completed training (M1/M4/M5), showing a significantly stronger reduction of mental health complaints (anxiety, vital exhaustion) in people with higher than those with lower pain in multidisciplinary treatment. Compared to regular routines, the self-management–multidisciplinary treatment led to a clinically relevant reduction of pain–disability and significant mental health improvements. Low-cost exercise programs may provide enormous relief for therapeutic processes, rehabilitation aftercare, and thus, cost savings for the health system
Previous research has indicated that executive function (EF) is negatively associated with aggressive behavior in childhood. However, there is a lack of longitudinal studies that have examined the effect of deficits in EF on aggression over time and taken into account different forms and functions of aggression at the same time. Furthermore, only few studies have analyzed the role of underlying variables that may explain the association between EF and aggression. The present study examined the prospective paths between EF and different forms (physical and relational) and functions (reactive and proactive) of aggression. The habitual experience of anger was examined as a potential underlying mechanism of the link between EF and aggression, because the tendency to get angry easily has been found to be both a consequence of deficits in EF and a predictor of aggression. The study included 1,652 children (between 6 and 11 years old at the first time point), who were followed over three time points (T1, T2, and T3) covering 3 years. At T1, a latent factor of EF comprised measures of planning, rated via teacher reports, as well as inhibition, set shifting, and working-memory updating, assessed experimentally. Habitual anger experience was assessed via parent reports at T1 and T2. The forms and functions of aggression were measured via teacher reports at all three time points. Structural equation modeling revealed that EF at T1 predicted physical, relational, and reactive aggression at T3, but was unrelated to proactive aggression at T3. Furthermore, EF at T1 was indirectly linked to physical aggression at T3, mediated through habitual anger experience at T2. The results indicate that deficits in EF influence the later occurrence of aggression in middle childhood, and the tendency to get angry easily mediates this relation.