BREV, une batterie d'évaluation des fonctions cognitives : validation dans les troubles des apprentissages

[The private pediatrician in the clinical care pathway for children affected by specific learning disorders in France]

The clinical care pathway for children presenting specific learning disorders, including language, motor coordination, and attention disorders is based on different levels of assessment by the professionals involved. In France, a first step of organization was established in 2002 by founding of a network of structures devoted to clinical assessment of complex cases, research, and teaching for the professionals involved. Although this organization proved to contribute an essential service, the demand largely exceeded the availability of access. A three-level organization was therefore suggested in 2013 including a first-level devoted to clinical analysis of simple cases, together with the professionals involved in rehabilitation (i.e., speech therapists, occupational therapists, psychologists), a second-level in charge of analyzing complex situations, involving comorbidities and failure of first-level care, together with the already structured third level of assessment devoted to genetic disorders, severe situations, and association with neurological conditions. To plan the practical application of these different levels, we assessed the situation of ambulatory pediatricians working in private practice, because this network appeared to be the most available in France to play these roles. A survey was therefore conducted among the main representative association of pediatricians (Association française de pédiatrie ambulatoire), including 1565 members of the 2700 in activity in France, on their level of knowledge and clinical expertise, and the drawbacks encountered in their practice in this field. Of the 481 respondents (36%), 25% were not yet in 2016 self-confident in assuming a first-level role, while 56% were ready to participate in a first-level response and 18% in a second-level response. In the 5 upcoming years, the vast majority of pediatricians intended to progress in their involvement, which should provide all regions in France with a network of professionals able to respond to the specific needs of children (48% in the first-level and 43.5% in the second-level of expertise). Specific obstacles have already been encountered by professionals who wish to play a full role in this domain: insufficient funding for medical evaluations and lack of access to specialized evaluations. This survey emphasizes the need for obtaining access to both practical and theoretical professional development programs (77.5%), funding of clinical assessment time (76%), all of which need to be answered by the French health authorities. To date, very few nationwide programs of clinical care pathways in these fields have been developed, but examples are available in France on Alzheimer disease and elderly populations, providing a model for children affected by specific development and learning difficulties. Setting up a clinical care pathway by the French Ministry of Health (Haute Autorité de santé) assumes that the needs expressed by ambulatory pediatricians will be taken into account, including the design and implementation of Medical Education programs according to the level of expertise, together with the adequate funding of diagnosis, follow-up, and care pathway coordination time.

Quality of life of early school-age French children born preterm: a cohort study

OBJECTIVES

To describe the health-related quality of life (HRQL) of a cohort of children aged 6-10 years who were born preterm; and to determine whether sociodemographic factors, neonatal features and neurocognitive status were affecting their HRQL.

STUDY DESIGN

All singleton infants born between 24 and 32 weeks of gestation between January 1997 and December 2001 at the study hospital, who were still alive in 2007 (age 6-10 years), and who had undergone complete clinical paediatric follow-up were included in the study. Maternal and perinatal data were obtained by chart review and regular clinical examination. The 'Battery for Rapid Evaluation of Cognitive Functions' (BREV) was used for cognitive evaluation when children were aged 4-8 years. HRQL data were collected in 2007 using the 'Vécu et Santé Perçue de l'Adolescent et de l'Enfant' (VSP-A) questionnaire (parent version). The HRQL of the preterm children was compared with that of a French reference population.

RESULTS

Of 202 children who fulfilled the inclusion criteria, 82 children participated in the study. Their mean age was 7.9 years [standard deviation (SD) 1.4], mean birth weight was 1130.0 g (SD 361.4), 23 children were born before 28 weeks of gestation, 46 were female and 11 had major neurocognitive disorders. These data were not significantly different for the non-respondents (n=120). Parents of preterm children reported a significantly lower perception of HRQL of their child compared with parents of children in the reference population, as reflected by VSP-A global index scores and scores for the 'body image', 'vitality', 'psychological well-being' and 'school performance' dimensions. In multivariate analyses, three factors were found to be significantly associated with at least one dimension in the VSP-A scale in the preterm children: presence of major neurocognitive disorders, negatively correlated with 'vitality', 'relationships with friends', 'physical well-being' and 'school performance' dimensions; maternal parity, positively correlated with the 'psychological well-being' dimension; and socio-economic status of family, positively correlated with the 'relationships with friends' dimension. The maximum R(2) was 15%.

CONCLUSION

In addition to neurocognitive disorders, other variables such as socio-economic status of the family have a significant impact on the HRQL of preterm children at 6-10 years of age. Given the low proportion of variability in HRQL explained by the models, there is a need to explore other factors (e.g. environmental).

[Dyslexia: clinical characteristics]

Dyslexia is characterized by a severe, persistent reading disorder occurring in an intelligent child. In the large field of learning disabilities, dyslexia is related to a cerebral dysfunction well described with Imagery and genetic studies. Nevertheless the diagnosis of dyslexia cannot be done by another way than clinical symptoms. Optimizing the management of children with dyslexia is a critical issue and is now possible, thanks to the improvement of neurosciences data and the mobilization of the key stakeholders. The knowledge of the precise symptoms is essential in order to lead the child's doctor able to improve coordination and harmonization of teaching and care and guidance of parents.

Evaluation of a tool to screen at preschool age for minor cognitive disorders liable to affect schooling among children born premature

PURPOSE

To evaluate a detection tool designed to help paediatricians identify, at preschool age, minor neurocognitive disorders that interfere with normal schooling.

METHODS

One hundred-and-fourteen preterm singletons born between 1997 and 2001 at less than 32 weeks of amenorrhoea, in a tertiary perinatal care center, were invited to visit us for a medical examination and a rapid neurocognitive assessment (BREV) when they were aged between 4 and 8 years and were re-contacted at 6-10 years of age to evaluate their current schooling situation. Results of BREV and schooling parameters were compared.

RESULTS

Mean gestational age was 29 weeks and mean birth weight was 1,164 g. Fifteen children (13.2%) showed abnormal results on BREV testing and had unusual schooling histories. Among the 68 children with normal BREV, 65 (95.6%) had achieved normal schooling. The sensitivity of the BREV test in this population for detection of minor disorders interfering with schooling was thus 83.3% (95% CI = 57.7-95.6) and the predictive value of a negative test was 95.6% (95% CI = 86.8-98.9). For the 57 children (50%) assessed before the age of 5 years, the sensitivity and the predictive value of a negative test were both 100%.

CONCLUSION

Our survey shows that the BREV test can, in a population of preschool children who were born premature, screen for minor neurocognitive disorders that impact schooling parameters. BREV assessment, used in the setting of follow-up of premature infants, would identify children in need of early remedial education before schooling under-attainment or failure developed.

Poor reading in French elementary school: the interplay of cognitive, behavioral, and socioeconomic factors

BACKGROUND

: Reading impairment is the major learning disability in childhood. Most previous studies were done on English-speaking populations. Yet, it has been argued that the English writing system exacerbates phonological deficits because of its exceptionally high inconsistency between spelling and sound. Thus, cross-language studies are needed to explore the universal versus language-specific factors underlying reading impairment. The goal of the present research was to study biological, socioeconomic, cognitive, and behavioral factors underlying poor reading in French-speaking second grade children.

METHODS

: A total of 1062 children from 20 different schools in the city of Paris participated in the study. After an initial test phase, children with a suspected impairment in reading acquisition were assessed individually. Subsequently, 100 poor readers and 50 controls were matched for sex, age, school, and neighborhood socioeconomic status (SES). They underwent comprehensive medical, cognitive, and behavioral assessment complemented by individual socioeconomic data.

RESULTS

: The average prevalence of reading impairment was around 12% in our sample. It was highly influenced by neighborhood SES, varying from 3.3% in high SES to 24.2% in low SES areas. Among the individual SES variables, low maternal education significantly distinguished poor from typical readers. Multiple regression analyses showed that reading outcome was best predicted by phonological awareness skills and attention deficits.

CONCLUSION

: The majority of poor readers come from low SES areas. As in the English literature, the most robust predictor for reading impairment is phonological awareness. In addition, behavioral problems, such as attention deficits, seem to aggravate reading deficits for children with weak phonological awareness skills.

[Deficits in reading acquisition in primary school: cognitive, social and behavioral factors studied in a sample of 1062 children]

BACKGROUND

Reading impairment is the major learning disability in children. While research on illiteracy has mainly been conducted from a sociological perspective, research on dyslexia has typically been studied from a cognitive-linguistic perspective. Studies that jointly investigate sociological, behavioral and cognitive factors in predicting reading outcome are rare and limited to English-speaking populations. The goal of the present study was to screen second grade children with reading impairment in French urban elementary schools and to pin down the factors that explain the various facets of reading failure and success.

METHODS

A total of 1062 children from 20 different schools in the city of Paris participated in the study. Different aspects of reading were assessed individually for children with a suspected impairment in reading acquisition. Subsequently, 131 poor readers and 50 typically developing readers were matched for sex, age, and school. For these children, medical, cognitive, behavioral and individual socioeconomic data were obtained. Group differences were examined and multiple regression analyses were conducted to examine how much variance in reading was explained by the various variables.

RESULTS

The prevalence of poor reading skills in grade 2 was highly influenced by neighborhood socioeconomic status (SES) (ranging from 3.3% in high SES to 20.5% in low SES areas). Among the SES variables, employment of the father was a significant predictor of poor reading. Among the cognitive variables, phonological awareness and rapid naming were the most significant factors, much more than verbal or nonverbal intelligence. Among the behavioral variables, attention was an important factor but not externalized symptoms. Multiple regression analyses showed that reading outcome was best predicted by phonological awareness skills and attention deficits.

CONCLUSION

The majority of children with reading disability come from low SES areas. As in the English literature, the most robust predictor for reading impairment is phonological awareness, even when SES is taken into account. In addition, attention deficits seemed to aggravate reading impairments for children with weak phonological awareness skills. Successful early prevention should focus on reinforcing phonological awareness, recoding and attention skills.

Preterm birth affects dorsal-stream functioning even after age 6

With increasing numbers of preterm infants surviving, the impact of preterm birth on later cognitive development presents a major interest. This study investigates the impact of preterm birth on later dorsal- and ventral-stream functioning. An atypical pattern of performance was found for preterm children relative to full-term controls, but in the dorsal-drawing task only. These findings suggest that the number of gestational weeks does affect dorsal-stream functioning, even after more than 6 years of favorable environmental conditions in healthy preterm children.

Neuropsychological screening of a group of preterm twins: comparison with singletons

OBJECTS

Perform neuropsychological screening of a group of preterm twins without major brain pathology and compare it with a control group of similarly preterm children born as singletons.

MATERIALS AND METHODS

Twenty-three preterm twins born at fewer than 32 weeks of gestation were tested for rapid evaluation of cognitive functions at the age of 4 years. The tests evaluated language, non-verbal performances, learning and attention deficit disorders. Cognitive profiles were established. Links between perinatal factors, clinical follow-up and cognitive outcome were investigated. Their cognitive outcome was then compared with the cognitive outcome of 31 preterm singletons with the same gestational periods.

CONCLUSION

The twins' neuropsychological outcome was not more marked than that of the singletons. Birth weight discordance and chorionicity were the only predictive perinatal factors with worse outcome in the twin population.