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Published February 2025 | Supplemental Material
Journal Article Open

Daily executive functioning in adults with pediatric hemispherectomy

Kowalski, Cory E.1, 2
Brown, Warren S.1, 3
Nolty, Anne A.T.1 ORCID icon
Panos, Amanda1 ORCID icon
Jones, Monika4 ORCID icon
Paul, Lynn K.5 ORCID icon
  • 1. ROR icon Fuller Theological Seminary
  • 2. ROR icon VA Loma Linda Healthcare System
  • 3. International Research Consortium for the Corpus Callosum and Cerebral Connectivity (IRC5), Pasadena, CA 91101 USA
  • 4. Pediatric Epilepsy Surgery Alliance, Los Angeles, CA, 90041 USA
  • 5. ROR icon California Institute of Technology

Abstract

Background and aims

For young children with intractable epilepsy caused by congenital abnormalities or acquired cortical lesions, pediatric hemispherectomy surgery (pHS) may offer the only path to seizure remediation. Although some sensory and motor outcomes of pHS are highly predictable, the long-term cognitive and functional sequelae of pHS are far more variable. With the aim of identifying potential post-pHS intervention targets, the current study examined daily executive functioning and self-awareness in adults with pHS and broadly intact cognitive outcomes (indicated by average or above performance on intelligence tests).

Methods

This study used self- and informant-ratings on the Behavior Rating Inventory of Executive Functioning, Adult Version (BRIEF-A) everyday executive functioning in to evaluate adaptive behavior in 16 adults with pHS and Full-Scale IQ (FSIQ) of 77 or greater. Self- and informant-report results were compared to the normative sample, as was the proportion of participants with self vs. informant discrepancy scores of > 1 standard deviation.

Results

Both participants and informants reported each participants’ behaviors and executive functioning were largely commensurate with average range from test norms. On average, participants with pHS rated themselves as stronger than their peers at Self-Monitoring, possibly suggesting compensatory attention to issues surrounding their sensory-motor disabilities (e.g., hemiplegia and hemianopsia). Informant- and self-reports were generally consistent, with the exception of an elevated number of participants whose self-ratings indicated less impairment than informant-ratings on the Initiate subscale.

Conclusions

This study demonstrates that following pHS, adults with average (or higher) general cognition also exhibit daily executive functioning broadly commensurate with their peers, with the possible exceptions of elevated self-monitoring and greater likelihood of overestimating their initiation (compared to informant ratings).

Copyright and License

© 2025 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Funding

This project was funded in large part by the Pediatric Epilepsy Surgery Alliance. Additional support was provided by a grant from Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD092430 (LP).

Acknowledgement

Portions of this study were included in the doctoral dissertation of C. Kowalski at the Fuller Graduate School of Psychology.

Contributions

Cory E. Kowalski: Writing – review & editing, Writing – original draft, Project administration, Formal analysis, Data curation, Conceptualization. Lynn K. Paul: Writing – review & editing, Visualization, Supervision, Project administration, Methodology, Formal analysis, Conceptualization. Monika Jones: Writing – review & editing, Project administration, Conceptualization. Amanda Panos: Writing – review & editing, Project administration, Investigation. Anne A. T. Nolty: Writing – review & editing, Supervision, Conceptualization. Warren S. Brown: Writing – review & editing, Supervision, Methodology, Conceptualization.

Cory E. Kowalski conceptualized and designed the study, conducted the investigation (including participant recruitment and data collection), conducted original analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript. Warren Brown conceptualized and designed the study, supervised planning and execution of the investigation, served as primary doctoral mentor for C. Kowalski, and critically reviewed and revised the manuscript. Amanda Panos conducted the investigation (including participant recruitment and data collection) and critically reviewed and revised the manuscript. Anne Nolty conceptualized and designed the study, supervised initial data analysis, and critically reviewed and revised the manuscript. Monika Jones conceptualized and designed the study, assisted with participant recruitment, and critically reviewed and revised the manuscript. Lynn Paul conceptualized and designed the study, implemented data-collection software, supervised planning and execution of the investigation, conducted secondary analysis and data visualization, and critically reviewed and revised the manuscript.

Supplemental Material

Supplementary material: https://ars.els-cdn.com/content/image/1-s2.0-S0920121125000105-mmc1.docx

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Additional details

Funding Dates Caltech Custom Metadata
Created:
April 3, 2025
Modified:
April 3, 2025