51
|
Lobo MA, Paul DA, Mackley A, Maher J, Galloway JC. Instability of delay classification and determination of early intervention eligibility in the first two years of life. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:117-126. [PMID: 24176257 PMCID: PMC3863394 DOI: 10.1016/j.ridd.2013.10.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/13/2013] [Accepted: 10/14/2013] [Indexed: 05/31/2023]
Abstract
The purpose of this study was to determine the effectiveness of the Bayley Scales of Infant Development, Third Edition (Bayley-III) to track development and classify delays in low- and high-risk infants across the first two years of life. We assessed cognitive, language, and motor development in 24 low-risk full-term and 30 high-risk preterm infants via seven assessments performed between 3 and 24 months corrected age. The Bayley-III resulted in highly unstable delay classifications, low sensitivities, and poor positive predictive values across time. The results highlight that early intervention professionals, researchers, and policy makers should: (1) emphasize clinical opinion and prevalence of risk factors rather than standardized assessment findings when classifying delays and determining eligibility for services, and (2) develop more effective developmental assessments for infants and young children.
Collapse
Affiliation(s)
- M A Lobo
- Physical Therapy Department, University of Delaware, Newark, DE 19716, United States.
| | | | | | | | | |
Collapse
|
52
|
Clark CAC, Fang H, Espy KA, Filipek PA, Juranek J, Bangert B, Hack M, Taylor HG. Relation of neural structure to persistently low academic achievement: a longitudinal study of children with differing birth weights. Neuropsychology 2013; 27:364-377. [PMID: 23688218 DOI: 10.1037/a0032273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This study examined the relation of cerebral tissue reductions associated with VLBW to patterns of growth in core academic domains. METHOD Children born <750 g, 750 to 1,499 g, or >2,500 g completed measures of calculation, mathematical problem solving, and word decoding at time points spanning middle childhood and adolescence. K. A. Espy, H. Fang, D. Charak, N. M. Minich, and H. G. Taylor (2009, Growth mixture modeling of academic achievement in children of varying birth weight risk, Neuropsychology, Vol. 23, pp. 460-474) used growth mixture modeling to identify two growth trajectories (clusters) for each academic domain: an average achievement trajectory and a persistently low trajectory. In this study, 97 of the same participants underwent magnetic resonance imaging (MRI) in late adolescence, and cerebral tissue volumes were used to predict the probability of low growth cluster membership for each domain. RESULTS Adjusting for whole brain volume (wbv), each 1-cm(3) reduction in caudate volume was associated with a 1.7- to 2.1-fold increase in the odds of low cluster membership for each domain. Each 1-mm(2) decrease in corpus callosum surface area increased these odds approximately 1.02-fold. Reduced cerebellar white matter volume was associated specifically with low calculation and decoding growth, and reduced cerebral white matter volume was associated with low calculation growth. Findings were similar when analyses were confined to the VLBW groups. CONCLUSIONS Reduced volume of structures involved in connectivity, executive attention, and motor control may contribute to heterogeneous academic trajectories among children with VLBW.
Collapse
Affiliation(s)
| | - Hua Fang
- Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | | | - Pauline A Filipek
- Department of Pediatrics, University of Texas Health Sciences Center at Houston
| | - Jenifer Juranek
- Department of Pediatrics, University of Texas Health Sciences Center at Houston
| | - Barbara Bangert
- Departments of Pediatrics and Radiology, Case Western Reserve University
| | - Maureen Hack
- Departments of Pediatrics and Radiology, Case Western Reserve University
| | - H Gerry Taylor
- Departments of Pediatrics and Radiology, Case Western Reserve University
| |
Collapse
|
53
|
Kumar P, Shankaran S, Ambalavanan N, Kendrick DE, Pappas A, Vohr BR, Poindexter BB, Das A, Higgins RD. Characteristics of extremely low-birth-weight infant survivors with unimpaired outcomes at 30 months of age. J Perinatol 2013; 33:800-5. [PMID: 23807719 PMCID: PMC3903461 DOI: 10.1038/jp.2013.71] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/05/2013] [Accepted: 05/23/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate characteristics of unimpaired outcome in extremely low-birth-weight (ELBW) survivors. STUDY DESIGN ELBW infants (n=714) with 30 months' assessments were analyzed. Logistic regression was used to develop a model for the binary outcome of unimpaired versus impaired outcome. RESULT Thirty-three percent of infants had an unimpaired outcome. Seventeen percent of ELBW survivors had a Bayley II Mental Developmental Index score of ≥ 101 and 2% had a score of ≥ 116. Female gender, use of antenatal steroids (ANS), maternal education ≥ high school and the absence of major neonatal morbidities were independent predictors of unimpaired outcome. The likelihood of an unimpaired outcome in the presence of major neonatal morbidities was higher in infants exposed to ANS. CONCLUSION The majority of unimpaired ELBW survivors had cognitive scores shifted toward the lower end of the normal distribution. Exposure to ANS was associated with higher likelihood of an unimpaired outcome in infants with major neonatal morbidities.
Collapse
Affiliation(s)
- Praveen Kumar
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL,Corresponding author: Praveen Kumar, MBBS, DCH, MD, Northwestern Memorial Hospital, 250 E. Superior Street, Room 05-2159, Chicago, IL, United States 60611, Phone: 312-472-4320, Fax: 312-472-4329,
| | | | | | - Douglas E. Kendrick
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC
| | - Athina Pappas
- Department of Pediatrics, Wayne State University, Detroit, MI
| | - Betty R. Vohr
- Department of Pediatrics, Brown University, Providence, RI
| | - Brenda B. Poindexter
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Abhik Das
- Statistics and Epidemiology Unit, RTI International, Rockville, MD
| | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | | |
Collapse
|
54
|
Simms V, Cragg L, Gilmore C, Marlow N, Johnson S. Mathematics difficulties in children born very preterm: current research and future directions. Arch Dis Child Fetal Neonatal Ed 2013; 98:F457-63. [PMID: 23759519 DOI: 10.1136/archdischild-2013-303777] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Children born very preterm have poorer attainment in all school subjects, and a markedly greater reliance on special educational support than their term-born peers. In particular, difficulties with mathematics are especially common and account for the vast majority of learning difficulties in this population. In this paper, we review research relating to the causes of mathematics learning difficulties in typically developing children, and the impact of very preterm birth on attainment in mathematics. Research is needed to understand the specific nature and origins of mathematics difficulties in very preterm children to target the development of effective intervention strategies.
Collapse
Affiliation(s)
- Victoria Simms
- Department of Health Sciences, University of Leicester, Leics, UK
| | | | | | | | | |
Collapse
|
55
|
Fan RG, Portuguez MW, Nunes ML. Cognition, behavior and social competence of preterm low birth weight children at school age. Clinics (Sao Paulo) 2013; 68:915-21. [PMID: 23917653 PMCID: PMC3714779 DOI: 10.6061/clinics/2013(07)05] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 03/07/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the cognitive and behavioral development of preterm and low birth weight newborns living in a disadvantageous socioeconomic environment at school age. METHODS This cross-sectional study included children aged 6-7 from a historical birth cohort of preterm (gestational age <37 weeks) and low birth weight (<2,500 g) infants. The Wechsler Intelligence Scale for Children III (WISC-III) was administered by a psychologist while the parents completed the Child Behavior Checklist. The results were compared to the test's reference. The perinatal information and follow-up data were collected from the hospital files. The demographic data were collected from the parents. The current performance was compared with the results from the Denver II and Bayley II tests, which were administered during the first years of life. RESULTS The total intelligence quotient varied from 70 to 140 (mean 98.7±15.8). The borderline intelligence quotient was observed in 9.3% of the children. The Child Behavior Checklist indicated a predominance of social competence problems (27.8%, CI 19.2 to 37.9) compared with behavioral problems (15.5%, CI 8.9 to 24.2). Both the Child Behavior Checklist domains, such as schooling, social and attention problems, and the cognitive scores were significantly associated with maternal education and family income. The results of the Denver and Bayley tests were associated with the cognitive performance (p<0.001) and the Child Behavior Checklist social profile, including aggressive and externalizing behavior (p<0.001). CONCLUSIONS Our data suggest that even low-risk preterm newborns are at risk for developing disturbances in early school age, such as mild cognitive deficits and behavioral disorders. This risk might increase under unfavorable socioeconomic conditions.
Collapse
Affiliation(s)
- Rachel Gick Fan
- Division of Neurology/Neuropsychology, Hospital São Lucas, Porto Alegre, RS, Brazil
| | | | | |
Collapse
|
56
|
Fávero ML, Higino TCM, Pires APB, Burke PR, Silva FLDCE, Tabith Júnior A. Pediatric phoniatry outpatient ward: clinical and epidemiological characteristics. Braz J Otorhinolaryngol 2013; 79:163-7. [PMID: 23670320 PMCID: PMC9443823 DOI: 10.5935/1808-8694.20130029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 12/14/2012] [Indexed: 11/28/2022] Open
Abstract
Children with language or learning impairment and normal hearing need phoniatric assessment to analyse various communication and development aspects targeting the differential diagnosis and therapeutic indications. Objective Characterize clinical and epidemiological features of a pediatric population treated in a phoniatric outpatient clinic. Method A cross-sectional historical cohort study (retrospective study) was performed involving 68 patients undergoing phoniatric consultation. Outcome measures were age, gender, source of referral for phoniatric consultation, phoniatric diagnosis, mean age at diagnosis, neonatal risks, family history of communication disorders and referrals. Results 70.58% were male and 29.42% female, mean age 6.85 ± 2.49 years. 63.23% from external services and 45.59% had no hearing diagnosis. 14 different diagnoses were performed: 50% had Cerebral Palsy, Specific Language Impairment and Pervasive Developmental Disorder. The difference between the average ages was statistically significant (F = 4.369 p = 0.00). 50% had a family history of communication disorders and 51.47% history of neonatal risk. 51.47% were referred for neurological consultation and 79.41% for therapies. Conclusion The population seen was predominantly male, with more complex language development deviations probably due to multiple etiologies. Many of them had no hearing diagnosis.
Collapse
Affiliation(s)
- Mariana Lopes Fávero
- Training programs in Phoniatry and Hearing Electrophysiology - DERDIC/PUCSP, Brazil.
| | | | | | | | | | | |
Collapse
|
57
|
Lobo MA, Galloway JC. Assessment and stability of early learning abilities in preterm and full-term infants across the first two years of life. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1721-1730. [PMID: 23500166 PMCID: PMC3628416 DOI: 10.1016/j.ridd.2013.02.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 06/01/2023]
Abstract
Infants born preterm have increased risk for learning disabilities yet we lack assessments to successfully detect these disabilities in early life. We followed 23 full-term and 29 preterm infants from birth through 24 months to assess for differences in and stability of learning abilities across time. Measures included the Bayley-III cognitive subscale, the mobile paradigm assessment, and a means-end learning assessment. Preterm infants had poorer performance on measures of cognition and learning across the first two years of life. Learning performance at 3-4 months was consistent with learning performance at 12-24 months of age. At 3-4 months, the mobile paradigm had better sensitivity and predictive values for predicting 24-month cognitive delays on the Bayley-III than did the Bayley-III itself. At 12-18 months, the means-end learning assessment had better sensitivity than the Bayley-III for identifying 24-month cognitive delays on the Bayley-III. The results suggest that: (1) infants born preterm may demonstrate learning differences as early as the first few months of life, (2) learning differences identified in the first months of life are likely to persist throughout the second year of life, and (3) learning assessments that measure how infants and toddlers use their typical behaviors to problem-solve to control external events may be more effective than traditional standardized assessment tools for detecting early learning delays.
Collapse
Affiliation(s)
- Michele A Lobo
- University of Delaware, Physical Therapy Department, Newark, DE 19716, USA.
| | | |
Collapse
|
58
|
Williams BL, Dunlop AL, Kramer M, Dever BV, Hogue C, Jain L. Perinatal origins of first-grade academic failure: role of prematurity and maternal factors. Pediatrics 2013; 131:693-700. [PMID: 23530177 DOI: 10.1542/peds.2012-1408] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We examined the relationships among gestational age at birth, maternal characteristics, and standardized test performance in Georgia first-grade students. METHODS Live births to Georgia-resident mothers aged 11 to 53 years from 1998 through 2003 were deterministically linked with standardized test results for first-grade attendees of Georgia public schools from 2005 through 2009. Logistic models were used to estimate the odds of failure of the 3 components of the first-grade Criterion-Referenced Competency Test (CRCT). RESULTS The strongest risk factor for failure of each of the 3 components of the first-grade CRCT was level of maternal education. Child race/ethnicity and maternal age at birth were also associated with first-grade CRCT failure irrespective of the severity of preterm birth, but these factors were more important among children born moderately preterm than for those born on the margins of the prematurity distribution. Adjusting for maternal and child characteristics, there was an increased odds of failure of each component of the CRCT for children born late preterm versus term, including for math (adjusted odds ratio [aOR]: 1.17, 95% confidence interval [CI]: 1.13-1.22), reading (aOR: 1.13, 95% CI: 1.08-1.18), and English/language arts, for which there was an important interaction with being born small for gestational age (aOR: 1.17, 95% CI: 1.07-1.29). CONCLUSIONS Preterm birth and low maternal education increase children's risk of failure of first-grade standardized tests. Promoting women's academic achievement and reduce rates of preterm birth may be important to achieving gains in elementary school performance.
Collapse
Affiliation(s)
- Bryan L Williams
- Nell Hodgson Woodruff School of Nursing, Rollins School of Public Health, Emory University, 1520 Clifton Rd NE, Atlanta, GA 30322, USA.
| | | | | | | | | | | |
Collapse
|
59
|
Sansavini A, Guarini A, Caselli MC. Preterm birth: neuropsychological profiles and atypical developmental pathways. ACTA ACUST UNITED AC 2013; 17:102-13. [PMID: 23362030 DOI: 10.1002/ddrr.1105] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 05/10/2012] [Indexed: 11/08/2022]
Abstract
Preterm birth is characterized by multiple interacting atypical constraints affecting different aspects of neuropsychological development. In the first years of life, perceptual, motor, and communicative-linguistic abilities, as well as attention, processing speed, and memory are affected by preterm birth resulting in cascading effects on later development. From school age to adolescence, a catch-up of simpler competencies (i.e., receptive lexicon) along with a more selective effect on more complex competencies (i.e., complex linguistic functions, math, motor, and executive functions) are observed, as well as a relevant incidence of behavioral outcomes. A wide heterogeneity in preterm children's neuropsychological profiles is described depending on the interaction among the degree of neonatal immaturity, medical complications, neurological damages/alterations, environmental and social factors. Severe neuromotor and sensory damages are not frequent, while low severity impairments are common among preterm children. It is argued that developmental pathways of preterm children are atypical, and not merely delayed, and are characterized by different developmental patterns and relationships among competencies.
Collapse
|
60
|
Carolan-Olah M, Frankowska D. High environmental temperature and preterm birth: a review of the evidence. Midwifery 2013; 30:50-9. [PMID: 23473912 DOI: 10.1016/j.midw.2013.01.011] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 01/04/2013] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE to examine the evidence in relation to preterm birth and high environmental temperature. BACKGROUND this review was conducted against a background of global warming and an escalation in the frequency and severity of hot weather together with a rising preterm birth rate. METHODS electronic health databases such as: SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for research articles, that examined preterm birth and high environmental temperature. Further searches were based on the reference lists of located articles. Keywords included a search term for preterm birth (preterm birth, preterm, premature, <37 weeks, gestation) and a search term for hot weather (heatwaves, heat-waves, global warming, climate change, extreme heat, hot weather, high temperature, ambient temperature). A total of 159 papers were retrieved in this way. Of these publications, eight met inclusion criteria. DATA EXTRACTION data were extracted and organised under the following headings: study design; dataset and sample; gestational age and effect of environmental heat on preterm birth. Critical Appraisal Skills Programme (CASP) guidelines were used to appraise study quality. FINDINGS in this review, the weight of evidence supported an association between high environmental temperature and preterm birth. However, the degree of association varied considerably, and it is not clear what factors influence this relationship. Differing definitions of preterm birth may also add to lack of clarity. KEY CONCLUSIONS preterm birth is an increasingly common and debilitating condition that affects a substantial portion of infants. Rates appear to be linked to high environmental temperature, and more especially heat stress, which may be experienced during extreme heat or following a sudden rise in temperature. When this happens, the body may be unable to adapt quickly to the change. As global warming continues, the incidence of high environmental temperature and dramatic temperature changes are also increasing. This situation makes it important that research effort is directed to understanding the degree of association and the mechanism by which high temperature and temperature increases impact on preterm birth. Research is also warranted into the development of more effective cooling practices to ameliorate the effects of heat stress. In the meantime, it is important that pregnant women are advised to take special precautions to avoid heat stress and to keep cool when there are sudden increases in temperature.
Collapse
Affiliation(s)
- Mary Carolan-Olah
- School of Nursing and Midwifery, St. Alban's Campus, Victoria University, PO Box 14228, Melbourne 8001, Australia.
| | | |
Collapse
|
61
|
Simms V, Gilmore C, Cragg L, Marlow N, Wolke D, Johnson S. Mathematics difficulties in extremely preterm children: evidence of a specific deficit in basic mathematics processing. Pediatr Res 2013; 73:236-44. [PMID: 23165451 DOI: 10.1038/pr.2012.157] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Extremely preterm (EP, <26 wk gestation) children have been observed to have poor academic achievement in comparison to their term-born peers, especially in mathematics. This study investigated potential underlying causes of this difficulty. METHODS A total of 219 EP participants were compared with 153 term-born control children at 11 y of age. All children were assessed by a psychologist on a battery of standardized cognitive tests and a number estimation test assessing children's numerical representations. RESULTS EP children underperformed in all tests in comparison with the term controls (the majority of Ps < 0.001). Different underlying relationships between performance on the number estimation test and mathematical achievement were found in EP as compared with control children. That is, even after controlling for cognitive ability, a relationship between number representations and mathematical performance persisted for EP children only (EP: r = 0.346, n = 186, P < 0.001; control: r = 0.095, n = 146, P = 0.256). CONCLUSION Interventions for EP children may target improving children's numerical representations in order to subsequently remediate their mathematical skills.
Collapse
Affiliation(s)
- Victoria Simms
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | | | | | | | | |
Collapse
|
62
|
Tannock R. Rethinking ADHD and LD in DSM-5: proposed changes in diagnostic criteria. JOURNAL OF LEARNING DISABILITIES 2013; 46:5-25. [PMID: 23144062 DOI: 10.1177/0022219412464341] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is currently undergoing revision that will lead to a fifth edition (DSM-5) in 2013. This article first provides a brief synopsis of the DSM-5 administrative structure, procedures, and guiding principles to enhance understanding of how changes are made in the DSM. The next two sections (on attention-deficit/hyperactivity disorder and learning disorders, respectively) highlight the major concerns and controversies surrounding the DSM-IV diagnostic criteria for these two disorders and provide a rationale for the proposed changes to the criteria, along with a commentary on the empirical evidence on which the proposed changes were based.
Collapse
|
63
|
Abstract
OBJECTIVE To examine the prevalence of behavior disorders in a 2001-2003 birth cohort of extremely preterm/extremely low birth weight (EPT/ELBW, <28 weeks gestational age or <1000 g) children in kindergarten. METHOD We compared 148 EPT/ELBW children with 111 term-born normal birth weight classmate controls on reports of psychiatric symptoms obtained from parent interview (Children's Interview for Psychiatric Syndromes-Parent Form [P-ChIPS]), parent and teacher ratings of behavior (Child Behavior Checklist, Teacher's Report Form, and Behavior Rating Inventory of Executive Function), and teacher ratings of social functioning (School Social Behavior Scales, second edition). Associations of behavior disorders with global cognitive ability and tests of executive function were also examined within the EPT/ELBW group. RESULTS Rates of attention-deficit/hyperactivity disorder combined on psychiatric interview were about twice as high for the EPT/ELBW group than for the normal birth weight group, odds ratio (95% confidence interval) = 2.50 (1.34, 4.68), p = .004. The EPT/ELBW group also had much higher rates of teacher-identified disorders in attention, behavior self-regulation, and social functioning, with odds ratios (95% confidence intervals) ranging from 3.35 (1.64, 6.83) to 18.03 (4.12, 78.94), all p values <.01. Attention-deficit/hyperactivity disorder and impaired behavior self-regulation were associated with deficits on tests of executive function but not with global cognitive impairment. CONCLUSIONS The findings document increased rates of disorders in attention, behavior self-regulation, and socialization in EPT/ELBW children and suggest that deficits on tests of executive function are associated with some of these disorders. Early identification and intervention for these disorders are needed to promote early adjustment to school and facilitate learning progress.
Collapse
|
64
|
Abstract
Our objectives were to examine cognitive outcomes for extremely preterm/extremely low birth weight (EPT/ELBW, gestational age <28 weeks and/or birth weight <1000 g) children in kindergarten and the associations of these outcomes with neonatal factors, early childhood neurodevelopmental impairment, and socioeconomic status (SES). The sample comprised a hospital-based 2001-2003 birth cohort of 148 EPT/ELBW children (mean birth weight 818 g; mean gestational age 26 weeks) and a comparison group of 111 term-born normal birth weight (NBW) classmate controls. Controlling for background factors, the EPT/ELBW group had pervasive deficits relative to the NBW group on a comprehensive test battery, with rates of cognitive deficits that were 3 to 6 times higher in the EPT/ELBW group. Deficits on a measure of response inhibition were found in 48% versus 10%, odds ratio (95% confidence interval) = 7.32 (3.32, 16.16), p < .001. Deficits on measures of executive function and motor and perceptual-motor abilities were found even when controlling for acquired verbal knowledge. Neonatal risk factors, early neurodevelopmental impairment, and lower SES were associated with higher rates of deficits within the EPT/ELBW group. The findings document both global and selective cognitive deficits in EPT/ELBW children at school entry and justify efforts at early identification and intervention.
Collapse
|