1
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Bonke EM, Bonfert MV, Hillmann SM, Seitz-Holland J, Gaubert M, Wiegand TLT, De Luca A, Cho KIK, Sandmo SB, Yhang E, Tripodis Y, Seer C, Kaufmann D, Kaufmann E, Muehlmann M, Gooijers J, Lin AP, Leemans A, Swinnen SP, Bahr R, Shenton ME, Pasternak O, Tacke U, Heinen F, Koerte IK. Neurological soft signs in adolescents are associated with brain structure. Cereb Cortex 2022; 33:5547-5556. [PMID: 36424865 DOI: 10.1093/cercor/bhac441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
Abstract
Neurological soft signs (NSS) are minor deviations in motor performance. During childhood and adolescence, NSS are examined for functional motor phenotyping to describe development, to screen for comorbidities, and to identify developmental vulnerabilities. Here, we investigate underlying brain structure alterations in association with NSS in physically trained adolescents. Male adolescent athletes (n = 136, 13–16 years) underwent a standardized neurological examination including 28 tests grouped into 6 functional clusters. Non-optimal performance in at least 1 cluster was rated as NSS (NSS+ group). Participants underwent T1- and diffusion-weighted magnetic resonance imaging. Cortical volume, thickness, and local gyrification were calculated using Freesurfer. Measures of white matter microstructure (Free-water (FW), FW-corrected fractional anisotropy (FAt), axial and radial diffusivity (ADt, RDt)) were calculated using tract-based spatial statistics. General linear models with age and handedness as covariates were applied to assess differences between NSS+ and NSS− group. We found higher gyrification in a large cluster spanning the left superior frontal and parietal areas, and widespread lower FAt and higher RDt compared with the NSS− group. This study shows that NSS in adolescents are associated with brain structure alterations. Underlying mechanisms may include alterations in synaptic pruning and axon myelination, which are hallmark processes of brain maturation.
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Affiliation(s)
- Elena M Bonke
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Graduate School of Systemic Neurosciences , Ludwig-Maximilians-Universität, Munich , Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich, Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Michaela V Bonfert
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Stefan M Hillmann
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Johanna Seitz-Holland
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Malo Gaubert
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- CHU Rennes Radiology Department, , Rennes, France
- University of Rennes Inria, CNRS, Inserm, IRISA UMR 6074, Empenn ERL, , Rennes, France
| | - Tim L T Wiegand
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich, Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
| | - Alberto De Luca
- University Medical Center Utrecht Image Sciences Institute, , Utrecht, the Netherlands
- University Medical Center Utrecht Department of Neurology, , Utrecht, the Netherlands
| | - Kang Ik K Cho
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
| | - Stian B Sandmo
- Norwegian School of Sport Sciences Oslo Sports Trauma Research Center, Department of Sports Medicine, , Oslo, Norway
- Oslo University Hospital Division of Mental Health and Addiction, , Oslo, Norway
| | - Eukyung Yhang
- Boston University School of Public Health Department of Biostatistics, , Boston, MA , United States
| | - Yorghos Tripodis
- Boston University School of Public Health Department of Biostatistics, , Boston, MA , United States
- Boston University School of Medicine Alzheimer’s Disease and CTE Centers, , Boston, MA , United States
| | - Caroline Seer
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - David Kaufmann
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- University Hospital Augsburg Department of Diagnostic and Interventional Radiology and Neuroradiology, , Augsburg, Germany
| | - Elisabeth Kaufmann
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Ludwig-Maximilians-Universität Department of Neurology, , Munich, Germany
| | - Marc Muehlmann
- University Hospital Department of Clinical Radiology, , Ludwig-Maximilians-Universität, Munich, Germany
| | - Jolien Gooijers
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - Alexander P Lin
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
- Harvard Medical School Center for Clinical Spectroscopy, Brigham and Women’s Hospital, , Boston, MA, United States
| | - Alexander Leemans
- University Medical Center Utrecht Image Sciences Institute, , Utrecht, the Netherlands
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven , Leuven, Belgium
| | - Roald Bahr
- Norwegian School of Sport Sciences Oslo Sports Trauma Research Center, Department of Sports Medicine, , Oslo, Norway
| | - Martha E Shenton
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
| | - Ofer Pasternak
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA, United States
- Harvard Medical School Department of Radiology, Brigham and Women's Hospital, , Boston, MA, United States
| | - Uta Tacke
- University Children's Hospital (UKBB) , Basel, Switzerland
| | - Florian Heinen
- University Hospital Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
- Ludwig-Maximilians-Universität Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics at Dr. von Hauner Children's Hospital, , , Munich, Germany
| | - Inga K Koerte
- University Hospital, Ludwig-Maximilians-Universität cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , Munich, Germany
- Graduate School of Systemic Neurosciences , Ludwig-Maximilians-Universität, Munich, Germany
- NeuroImaging Core Unit Munich (NICUM), University Hospital, Ludwig-Maximilians-Universität , Munich , Germany
- Harvard Medical School Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, , Boston, MA , United States
- Harvard Medical School Department of Psychiatry, Massachusetts General Hospital, , Boston, MA , United States
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2
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Cayupe B, Troncoso B, Morgan C, Sáez-Briones P, Sotomayor-Zárate R, Constandil L, Hernández A, Morselli E, Barra R. The Role of the Paraventricular-Coerulear Network on the Programming of Hypertension by Prenatal Undernutrition. Int J Mol Sci 2022; 23:ijms231911965. [PMID: 36233268 PMCID: PMC9569920 DOI: 10.3390/ijms231911965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
A crucial etiological component in fetal programming is early nutrition. Indeed, early undernutrition may cause a chronic increase in blood pressure and cardiovascular diseases, including stroke and heart failure. In this regard, current evidence has sustained several pathological mechanisms involving changes in central and peripheral targets. In the present review, we summarize the neuroendocrine and neuroplastic modifications that underlie maladaptive mechanisms related to chronic hypertension programming after early undernutrition. First, we analyzed the role of glucocorticoids on the mechanism of long-term programming of hypertension. Secondly, we discussed the pathological plastic changes at the paraventricular nucleus of the hypothalamus that contribute to the development of chronic hypertension in animal models of prenatal undernutrition, dissecting the neural network that reciprocally communicates this nucleus with the locus coeruleus. Finally, we propose an integrated and updated view of the main neuroendocrine and central circuital alterations that support the occurrence of chronic increases of blood pressure in prenatally undernourished animals.
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Affiliation(s)
- Bernardita Cayupe
- Centro de Investigación Biomédica y Aplicada (CIBAP), Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 9170020, Chile
| | - Blanca Troncoso
- Escuela de Enfermería, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 9170020, Chile
| | - Carlos Morgan
- Laboratorio de Neurofarmacología y Comportamiento, Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 9170020, Chile
| | - Patricio Sáez-Briones
- Laboratorio de Neurofarmacología y Comportamiento, Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 9170020, Chile
| | - Ramón Sotomayor-Zárate
- Laboratorio de Neuroquímica y Neurofarmacología, Centro de Neurobiología y Fisiopatología Integrativa, Instituto de Fisiología, Facultad de Ciencias, Universidad de Valparaíso, Valparaíso 2360102, Chile
| | - Luis Constandil
- Laboratorio de Neurobiología, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago 9170020, Chile
| | - Alejandro Hernández
- Laboratorio de Neurobiología, Departamento de Biología, Facultad de Química y Biología, Universidad de Santiago de Chile, Santiago 9170020, Chile
| | - Eugenia Morselli
- Department of Basic Sciences, Faculty of Medicine and Sciences, Universidad San Sebastián, Santiago 7510157, Chile
| | - Rafael Barra
- Centro de Investigación Biomédica y Aplicada (CIBAP), Escuela de Medicina, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 9170020, Chile
- Correspondence: ; Tel.: +56-983831083
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3
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Chang MC, Liu HY, Huang ST, Chen HL. Study of Orofacial Function in Preschool Children Born Prematurely. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030360. [PMID: 35327731 PMCID: PMC8947379 DOI: 10.3390/children9030360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022]
Abstract
Children born prematurely often exhibit orofacial dysfunction. We conducted Nordic Orofacial Test Screening and analyzed chewing and swallowing functions of 243 children aged 3−5 years, consisting of 142 and 101 children born full-term and preterm, respectively, to evaluate the orofacial function of preschool premature children. Categorical variables were analyzed using chi-square test for a comparison. The univariate analysis of variance was used to analyze the effects of birth weight, gestational age, intubation at birth, use of nasal continuous positive airway pressure support after birth, and use of nasogastric tube on the chewing and swallowing functions of children born prematurely. In this survey, term-born children had a higher incidence of bad oral habits, grinding teeth while sleeping, and abnormal gulping compared to preterm-born children. Preterm-born children had a higher incidence of choking, decreased mouth opening (<30 mm), abnormal dental arch form, abnormal palatal vault, and dysarthria compared to term-born children.
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Affiliation(s)
- Mei-Chen Chang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan;
| | - Hsiu-Yueh Liu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung City 807378, Taiwan; (H.-Y.L.); (S.-T.H.)
| | - Shun-Te Huang
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung City 807378, Taiwan; (H.-Y.L.); (S.-T.H.)
- Division of Pediatric Dentistry and Special Care Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung City 807378, Taiwan
| | - Hsiu-Lin Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung City 807378, Taiwan
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807378, Taiwan
- Correspondence: ; Tel.: +886-7312-1101 (ext. 6529)
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4
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Barra R, Morgan C, Sáez-Briones P, Reyes-Parada M, Burgos H, Morales B, Hernández A. Facts and hypotheses about the programming of neuroplastic deficits by prenatal malnutrition. Nutr Rev 2020; 77:65-80. [PMID: 30445479 DOI: 10.1093/nutrit/nuy047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Studies in rats have shown that a decrease in either protein content or total dietary calories results in molecular, structural, and functional changes in the cerebral cortex and hippocampus, among other brain regions, which lead to behavioral disturbances, including learning and memory deficits. The neurobiological bases underlying those effects depend at least in part on fetal programming of the developing brain, which in turn relies on epigenetic regulation of specific genes via stable and heritable modifications of chromatin. Prenatal malnutrition also leads to epigenetic programming of obesity, and obesity on its own can lead to poor cognitive performance in humans and experimental animals, complicating understanding of the factors involved in the fetal programming of neuroplasticity deficits. This review focuses on the role of epigenetic mechanisms involved in prenatal malnutrition-induced brain disturbances, which are apparent at a later postnatal age, through either a direct effect of fetal programming on brain plasticity or an indirect effect on the brain mediated by the postnatal development of obesity.
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Affiliation(s)
- Rafael Barra
- School of Medicine, Faculty of Medical Sciences, University of Santiago de Chile, Santiago, Chile
| | - Carlos Morgan
- Laboratory of Nutrition and Metabolic Regulation, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Patricio Sáez-Briones
- School of Medicine, Faculty of Medical Sciences, University of Santiago de Chile, Santiago, Chile
| | - Miguel Reyes-Parada
- School of Medicine, Faculty of Medical Sciences, University of Santiago de Chile, Santiago, Chile.,Facultad de Ciencias de la Salud Universidad Autónoma de Chile, Talca, Chile
| | - Héctor Burgos
- Núcleo Disciplinar Psicología, Facultad de Ciencias, Universidad Mayor, Santiago, Chile.,Center of Innovation on Information Technologies for Social Applications (CITIAPS), University of Santiago de Chile, Santiago, Chile
| | - Bernardo Morales
- Department of Biology, Faculty of Chemistry and Biology, University of Santiago de Chile, Santiago, Chile
| | - Alejandro Hernández
- Department of Biology, Faculty of Chemistry and Biology, University of Santiago de Chile, Santiago, Chile
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5
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Waclawik K, Jones AA, Barbic SP, Gicas KM, O'Connor TA, Smith GN, Leonova O, Mathias S, Barr AM, Procyshyn RM, Lang DJ, Woodward ML, MacEwan GW, Panenka WJ, Yamamoto A, Honer WG, Thornton AE. Cognitive Impairment in Marginally Housed Youth: Prevalence and Risk Factors. Front Public Health 2019; 7:270. [PMID: 31649909 PMCID: PMC6792471 DOI: 10.3389/fpubh.2019.00270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: Homeless and marginally housed youth are particularly vulnerable members of society, and are known to experience numerous health problems, including psychiatric illness, substance use, and viral infection. Despite the presence of these risk factors for cognitive compromise, there is limited research on the cognitive functioning of homeless and marginally housed youth. The present study examines the degree and pattern of cognitive impairment and associations with key risk factors in a sample of marginally housed young adults. Method: Participants (N = 101) aged 20-29 years old were recruited from single-room occupancy hotels, and underwent cognitive, psychiatric, neurological, and serological assessments. Results: Forty percent of participants were identified as mildly cognitively impaired across multiple domains, and 16% were moderately-severely impaired. Deficits in memory and attention were most prevalent, while impairments in inhibitory control/processing speed and cognitive flexibility were also present but tended to be less severe. Developmental and historical factors (premorbid intellectual functioning, neurological soft signs, earlier exposure to and longer duration of homelessness or marginal housing), as well as current health risks (stimulant dependence and hepatitis C exposure), were associated with cognitive impairment. Conclusions: The strikingly high rate of cognitive impairment in marginally housed young adults represents a major public health concern and is likely to pose a significant barrier to treatment and rehabilitation. These results suggest that the pathway to cognitive impairment involves both developmental vulnerability and modifiable risk factors. This study highlights the need for early interventions that address cognitive impairment and risk factors in marginalized young people.
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Affiliation(s)
- Kristina Waclawik
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Skye P. Barbic
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
- Providence Health Care and Foundry, Vancouver, BC, Canada
| | - Kristina M. Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Geoffrey N. Smith
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Steve Mathias
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
- Providence Health Care and Foundry, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Donna J. Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L. Woodward
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - G. William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
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6
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Kodric J, Sustersic B, Paro-Panjan D. Psychosocial functioning in adolescents: results according to Amiel-Tison neurological assessment in a group of preterm infants. Dev Neurorehabil 2019; 22:47-52. [PMID: 29400610 DOI: 10.1080/17518423.2018.1434699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This prospective study investigated the relationship between Amiel-Tison neurological assessment (ATNA) in preterm children and their psychosocial functioning in adolescence. METHODS From the initial group of 45 children regularly assessed by the ATNA from term until the age of 2 years, 27 participated in the follow-up at 13 years. RESULTS Of the three groups categorized by neurological signs as normal, intermediate or abnormal, parents of adolescents with normal ATNA reported the lowest number of executive function problems (p = 0.019) and behavioral symptoms (p = 0.011), while the adolescents themselves reported the lowest number of behavioral symptoms (p = 0.005) and the highest quality of life (p = 0.012). The number of problems reported increased with the number of abnormal neurological signs. CONCLUSION Standardized neurological assessment may be a helpful clinical tool for the identification of children at risk for later psychosocial problems who could benefit from prevention and early intervention programs.
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Affiliation(s)
- Jana Kodric
- a University Medical Center Ljubljana , Division of Pediatrics , Ljubljana , Slovenia
| | - Breda Sustersic
- b Developmental Department , Health Center Domzale , Domzale , Slovenia
| | - Darja Paro-Panjan
- a University Medical Center Ljubljana , Division of Pediatrics , Ljubljana , Slovenia
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7
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Gould JF, Hunt E, Roberts RM, Louise J, Collins CT, Makrides M. Can the Bayley Scales of Infant Development at 18 months predict child behaviour at 7 years? J Paediatr Child Health 2019; 55:74-81. [PMID: 30101998 DOI: 10.1111/jpc.14163] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 03/30/2018] [Accepted: 06/07/2018] [Indexed: 11/29/2022]
Abstract
AIM Infants born preterm (<37 weeks' gestation) are at risk of poor neurodevelopmental outcomes; hence, many neonatal centres routinely follow up infants using the Bayley Scales of Infant Development (BSID), although the predictive validity of the BSID for children born preterm is questionable. Our objective is to evaluate the predictive capacity of the BSID for behavioural functioning at school age of children born preterm. METHODS Children (n = 657 children born <33 weeks' gestation) were enrolled at birth from five neonatal centres around Australia. A psychologist assessed child development at 18 months using the BSID-II. When children were 7 years (corrected age) of age, parents completed the Strengths and Difficulties Questionnaire, the Behavior Rating Inventory of Executive Function and the Conners 3rd Edition Attention Deficit Hyperactivity Disorder Index. We explored associations between BSID-II at 18 months and behaviour scores at 7 years and examined the interaction effect of the use of an allied health service between the BSID-II and behaviour assessments. RESULTS For every one-point increase on the BSID-II Mental Development Index, behaviour scores decreased by 0.07 points for the Strengths and Difficulties Questionnaire Total Difficulties (95% confidence interval (CI) -0.10, -0.03), 0.12 points for the Behavior Rating Inventory of Executive Function Global Executive Composite (95% CI -0.21, -0.04) and 0.16 points for the Conners 3rd Edition Attention Deficit Hyperactivity Disorder Index (95% CI -0.26, -0.05). CONCLUSION The BSID-II at 18 months was weakly associated with parent-reported behaviour at 7 years in children born preterm.
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Affiliation(s)
- Jacqueline F Gould
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Emily Hunt
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel M Roberts
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Jennie Louise
- Data Management and Analysis Centre, University of Adelaide, Adelaide, South Australia, Australia
| | - Carmel T Collins
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Discipline of Paediatrics, University of Adelaide, Adelaide, South Australia, Australia
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8
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Alamiri B, Nelson C, Fitzmaurice GM, Murphy JM, Gilman SE. Neurological soft signs and cognitive performance in early childhood. Dev Psychol 2018; 54:2043-2052. [PMID: 30265034 DOI: 10.1037/dev0000566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Neurological soft signs (NSSs), minor neurological abnormalities, have been implicated as risk factors for poor cognitive performance in small-scale studies. Here we investigate the associations between NSSs and multiple domains of cognitive performance in a large, population-based cohort and evaluate sex differences in these associations. We analyzed data from 35,710 seven-year-old children in the Collaborative Perinatal Project to study the association between the number of NSSs and cognitive test scores using multiple linear regression models adjusting for risk factors for brain injury and aberrant neurodevelopment. NSSs were associated with lower scores on all domains of cognitive performance. Each additional soft sign was associated with lower full-scale IQ (b = -4.83, 95% CI [-5.06, -4.60]), performance IQ (b = -4.28, 95% CI [-4.54, -4.02]), and verbal IQ scores (b = -4.53, 95% CI [-4.76, -4.30]), as well as arithmetic (b = -4.06, 95% CI [-4.26, -3.85]), spelling (b = -3.53, 95% CI [-3.75, -3.30]), and reading (b = -4.00, 95% CI [-4.26, -3.75]) scores on the Wide Range Achievement Test (WRAT). Only one sex difference was observed: The association between NSS and the WRAT spelling test was somewhat stronger in girls (b = -4.01, 95% CI [-4.26, -3.36]) than in boys (b = -3.53, 95% CI [-3.75, -3.30]). There is an association between NSSs and poor cognitive performance that is not attributable to established risk factors for brain injury and aberrant neurodevelopment. Further research is needed to investigate the mechanisms underlying this association and to determine if interventions targeting NSS in children might have beneficial effects on neurocognitive development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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9
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The Association of Intrapair Birth-Weight Differences With Internalizing and Externalizing Behavior Problems. Twin Res Hum Genet 2018; 21:253-262. [PMID: 29642972 DOI: 10.1017/thg.2018.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Problem behaviors are of increasing public health concern. Twin studies have revealed substantial genetic and environmental influences on children's behavior, and examining birth-weight difference could allow the identification of the specific contribution of multiple non-shared prenatal environmental factors. The Twins and Multiple Births Association Heritability Study, a UK, volunteer-based study, recruited mothers of twins aged 18 months to 5 years; 960 twins (480 pairs) were included in the analysis. Twins' mothers answered questions relative to their pregnancy and their twins' characteristics, and completed the Child Behavior Checklist (CBCL) 1½-5. The association between the absolute birth-weight difference and each CBCL scale's score difference was analyzed by means of multiple linear regressions. Expected mean CBCL score differences were calculated. In monozygotic (MZ) twins, statistically and clinically significant associations were found between intrapair birth-weight difference and difference in total problems, internalizing problems, and emotional reactiveness. No significant results were observed neither in dizygotic (DZ) twins when analyzed as a separate group nor in MZ and DZ twins combined. The results of the present study suggest that with increasing the absolute birth-weight difference, the intrapair difference in total problems, internalizing behaviors and emotionality increases, with smaller twins being at major risk for later behavior problems. Moreover, these results suggest a causal association between birth weight and behavior development.
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10
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Tapancı Z, Yıldırım A, Boysan M. Neurological soft signs, dissociation and alexithymia in patients with obsessive-compulsive disorder (OCD) and healthy subjects. Psychiatry Res 2018; 260:90-97. [PMID: 29175504 DOI: 10.1016/j.psychres.2017.11.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 11/09/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
A body of evidence has supported that patients with obsessive-compulsive disorder (OCD) have increased rates of various neurological soft signs (NSS) compared to controls. Various lines of research has documented robust relationships between OCD and dissociative symptomatology. The study aimed to examine the associations between obsessive-compulsive symptoms, dissociative experiences alexithymia, and NSS. The study included thirty OCD patients and thirty healthy controls, matched for age, marital status, education, and income. The Neurological Evaluation Scale (NES), Padua Inventory-Revised (PI-R), Dissociative Experiences Scale (DES) and Toronto Alexithymia Scale (TAS-20) were administered. In comparison to healthy controls, patients with OCD had difficulty sequencing for complex motor acts and greater absorption/ imaginative involvement. Using latent class analysis, the study sample was classified into two homogenous subsets as mild NSS (n = 45) and severe NSS (n = 15). Majority of the participants who were grouped into severe NSS latent class were OCD patient (n = 14, 93.3%). Furthermore, those with severe NSS reported greater levels of alexithymia and more severe obsessive-compulsive symptoms, particularly precision. We concluded that relationships between OCD severity and NSS appear to be of crucial importance. Our data along with accumulated evidence suggest that OCD associated with pronounced NSS may represent a specific subtype of the disorder.
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Affiliation(s)
- Zafer Tapancı
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey.
| | - Abdullah Yıldırım
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey.
| | - Murat Boysan
- Department of Psychology, Yüzüncü Yıl University Faculty of Social Sciences, Van, Turkey.
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Talati A, Wickramaratne PJ, Wesselhoeft R, Weissman MM. Prenatal tobacco exposure, birthweight, and offspring psychopathology. Psychiatry Res 2017; 252:346-352. [PMID: 28327448 PMCID: PMC5438886 DOI: 10.1016/j.psychres.2017.03.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/06/2017] [Accepted: 03/07/2017] [Indexed: 02/04/2023]
Abstract
Although prenatal tobacco exposure (PTE) is associated with several adverse offspring mental health outcomes, mechanisms remain unclear. We test whether associations between PTE and offspring psychopathology are explained by birthweight, one of the earliest-occurring outcomes of PTE. The analysis focuses on 238 offspring from a family study of depression with (1) collected prenatal histories and (2) at least one clinical interview in adulthood to assess psychiatric problems. Exposure was categorized by maternal smoking of ≥10 cigarettes daily/nearly daily; diagnostic outcomes were confirmed by clinicians using the best-estimate procedure, blind to exposure. After adjusting for potential confounders, PTE was associated with 0.7lb(9%) lower birthweight (p=0.0002), increased rates of disruptive behavior disorders [males: OR=2.66(1.15,6.16), and (trend) substance use disorders [females: OR=2.23(0.98,5.09)], and decreased rates of mood disorders (males: OR=0.42(0.17,0.98)]. Birthweight was not independently associated with diagnoses and did not mediate the association between exposure and psychopathology. Maternal smoking has long-term adverse consequences for offspring. Although birthweight cannot be manipulated, smoking is a modifiable risk factor. Thus, cessation efforts focused on pregnant women may not only improve maternal wellbeing, but also mitigate adverse proximal (e.g., birthweight) and long-term (psychopathology) outcomes in offspring.
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Affiliation(s)
- Ardesheer Talati
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA; Sackler Institute for Developmental Psychobiology, Columbia University, New York, NY, USA.
| | - Priya J Wickramaratne
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA; Biostatistics, Mailman School of Public Health of Columbia University, New York, NY, USA.
| | | | - Myrna M Weissman
- Department of Psychiatry, Columbia University College of Physicians & Surgeons, New York, NY, USA; Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA; Departments of Epidemiology and Biostatistics, Mailman School of Public Health of Columbia University, New York, NY, USA; Sackler Institute for Developmental Psychobiology, Columbia University, New York, NY, USA.
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Malhotra DS, Borade DPB, Sharma DP, Satija DY, Dr Gunjan. A qualititative study of neurological soft signs in obsessive compulsive disorder and effect of comorbid psychotic spectrum disorders and familiality on its expression in Indian population. Asian J Psychiatr 2017; 25:6-12. [PMID: 28262175 DOI: 10.1016/j.ajp.2016.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/02/2016] [Accepted: 06/19/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Obsessive Compulsive Disorder (OCD) is one of the most common psychiatric disorders, with lifetime prevalence of 2%-3% and is known to lie on a spectrum continuous with Schizophrenia and other affective psychosis. Neurological Soft Signs (NSS) have been reported to be higher in both Schizophrenia and affective psychosis, like bipolar disorder, and their first degree relatives but in OCD, the results have been inconsistent. It remains unclear if NSS occur at even higher rates in individuals who have a co-morbidity for OCD and either schizophrenia or bipolar disorder, as it might be expected if a broader neurodevelopmental hit underlies the pathophysiology of both OCD and these disorders. AIMS AND OBJECTIVES To assess and compare NSS in patients of OCD, OCD with Psychotic spectrum disorders (OCD-PSD), first degree relatives of OCD (FDR of OCD) and healthy controls. METHODOLOGY 90 subjects each were recruited in four groups- OCD, OCD-PSD, FDR of OCD and healthy controls, as per the pre-defined inclusion and exclusion criteria for each group. Diagnosis was made as per ICD-10 criteria and Cambridge Neurological Inventory, Part-2 was applied. RESULTS AND CONCLUSION This study found statistically significant difference between the severity of NSS among these groups. There was also a significant difference in presence of NSS in OCD with PSD group and OCD group. A greater abnormality of NSS in FDR of OCD compared to healthy controls was found. This difference in proportions and severity of NSS between groups points towards an underlying common neurobiological and etiopathological underpinning between OCD with and without comorbid PSDs and their first degree relatives.
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Affiliation(s)
| | | | | | | | - Dr Gunjan
- Department of Psychiatry, S.M.S. Medical College, Jaipur, India
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Kong L, Herold CJ, Lässer MM, Schmid LA, Hirjak D, Thomann PA, Essig M, Schröder J. Association of cortical thickness and neurological soft signs in patients with chronic schizophrenia and healthy controls. Neuropsychobiology 2016; 71:225-33. [PMID: 26277883 DOI: 10.1159/000382020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 03/30/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neurological soft signs (NSS), i.e. subtle neurological abnormalities, have been frequently found in schizophrenia. Neuroimaging studies in schizophrenia have shown abnormal cortical thickness changes across the cortical mantle. However, few studies have examined relationships between NSS and cortical thickness abnormalities in schizophrenia. METHOD A sample of 18 patients with chronic schizophrenia and 20 age-matched healthy controls were included. Cortical thickness was assessed on high-resolution 3-tesla magnetic resonance imaging by using FreeSurfer software and NSS were rated on the Heidelberg Scale. RESULTS Significant negative correlations between NSS and cortical thickness were found in the prefrontal, inferior temporal, superior parietal, postcentral, and supramarginal cortices in the schizophrenia patients. In the controls, however, this negative correlation was found in the anterior cingulate, pericalcarine and superior/middle temporal regions. CONCLUSION Our results not only confirmed the association between NSS and cortical thickness in chronic schizophrenia but also indicated that patients and controls have different anatomical substrates of NSS.
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Affiliation(s)
- Li Kong
- College of Education, Shanghai Normal University, Shanghai, China
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Rimol LM, Bjuland KJ, Løhaugen GC, Martinussen M, Evensen KAI, Indredavik MS, Brubakk AM, Eikenes L, Håberg AK, Skranes J. Cortical trajectories during adolescence in preterm born teenagers with very low birthweight. Cortex 2016; 75:120-131. [DOI: 10.1016/j.cortex.2015.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/19/2015] [Accepted: 12/07/2015] [Indexed: 01/01/2023]
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Lester BM, Marsit CJ, Giarraputo J, Hawes K, LaGasse LL, Padbury JF. Neurobehavior related to epigenetic differences in preterm infants. Epigenomics 2015; 7:1123-36. [PMID: 26585459 PMCID: PMC5551936 DOI: 10.2217/epi.15.63] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED Preterm birth is associated with medical problems affecting the neuroendocrine system, altering cortisol levels resulting in negative effects on newborn neurobehavior. Newborn neurobehavior is regulated by DNA methylation of NR3C1 and HSD11B2. AIM Determine if methylation of HSD11B2 and NR3C1 is associated with neurobehavioral profiles in preterm infants. PATIENTS & METHODS Neurobehavior was measured before discharge from the hospital in 67 preterm infants. Cheek swabs were collected for DNA extraction. RESULTS Infants with the high-risk neurobehavioral profile showed more methylation than infants with the low-risk neurobehavioral profile at CpG3 for NR3C1 and less methylation of CpG3 for HSD11B2. Infants with these profiles were more likely to have increased methylation of NR3C1 and decreased methylation of HSD11B2 at these CpG sites. CONCLUSION Preterm birth is associated with epigenetic differences in genes that regulate cortisol levels related to high-risk neurobehavioral profiles.
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Affiliation(s)
- Barry M Lester
- Brown Center for the Study of Children at Risk, Providence, RI, USA
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Carmen J Marsit
- Departments of Pharmacology & Toxicology & Community & Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - James Giarraputo
- Brown Center for the Study of Children at Risk, Providence, RI, USA
- Department of Neuroscience, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Katheleen Hawes
- Brown Center for the Study of Children at Risk, Providence, RI, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - Linda L LaGasse
- Brown Center for the Study of Children at Risk, Providence, RI, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA
| | - James F Padbury
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, Providence, RI, USA
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Nuccini F, Paterlini M, Gargano G, Landini A. The attachment of prematurely born children at school age: A pilot study. Clin Child Psychol Psychiatry 2015; 20:381-94. [PMID: 26160978 DOI: 10.1177/1359104515589640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This prospective longitudinal study compared the psychological development and patterns of attachment of 20 prematurely born children and 20 full-term children at 7 years of age. The School-age Assessment of Attachment (SAA) was used, and hypotheses and interpretation of the findings were drawn from the Dynamic-Maturational Model of Attachment and Adaptation (DMM). Significant differences between prematurely born and full-term children were found: 10% versus 0% at "high" risk, 55% versus 25% at "moderate" risk, and 35% versus 75% at "low" risk. There were no differences in the percentage of psychological trauma between samples, but there was a difference in the types of experiences leading to trauma. For prematurely born children, it was most often illness, whereas for full-term children, it was family problems. We discuss the implications for clinicians.
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Affiliation(s)
- Francesca Nuccini
- Neonatal Intensive Care Unit, Obstetric, Gynecology and Pediatric Department, Hospital Arcispedale Santa Maria Nuova-Istituto di Ricovero e Cura a Carattere Scientifico, Italy
| | - Marcella Paterlini
- Department of Gynecology and Pediatric Department, Hospital Arcispedale Santa Maria Nuova-Istituto di Ricovero e Cura a Carattere Scientifico, Italy
| | - Giancarlo Gargano
- Neonatal Intensive Care Unit, Obstetric, Gynecology and Pediatric Department, Hospital Arcispedale Santa Maria Nuova-Istituto di Ricovero e Cura a Carattere Scientifico, Italy
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Rosenthal DG, Weitzman M. Examining the Effects of Intrauterine and Postnatal Exposure to Tobacco Smoke on Childhood Cognitive and Behavioral Development. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411400103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Physical, behavioral, and cognitive effects of prenatal tobacco and postnatal secondhand smoke exposure. Curr Probl Pediatr Adolesc Health Care 2014; 44:219-41. [PMID: 25106748 PMCID: PMC6876620 DOI: 10.1016/j.cppeds.2014.03.007] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/03/2014] [Accepted: 03/04/2014] [Indexed: 01/19/2023]
Abstract
The purpose of this review is to examine the rapidly expanding literature regarding the effects of prenatal tobacco and postnatal secondhand smoke (SHS) exposure on child health and development. Mechanisms of SHS exposure are reviewed, including critical periods during which exposure to tobacco products appears to be particularly harmful to the developing fetus and child. The biological, biochemical, and neurologic effects of the small fraction of identified components of SHS are described. Research describing these adverse effects of both in utero and childhood exposure is reviewed, including findings from both animal models and humans. The following adverse physical outcomes are discussed: sudden infant death syndrome, low birth weight, decreased head circumference, respiratory infections, otitis media, asthma, childhood cancer, hearing loss, dental caries, and the metabolic syndrome. In addition, the association between the following adverse cognitive and behavioral outcomes and such exposures is described: conduct disorder, attention-deficit/hyperactivity disorder, poor academic achievement, and cognitive impairment. The evidence supporting the adverse effects of SHS exposure is extensive yet rapidly expanding due to improving technology and increased awareness of this profound public health problem. The growing use of alternative tobacco products, such as hookahs (a.k.a. waterpipes), and the scant literature on possible effects from prenatal and secondhand smoke exposure from these products are also discussed. A review of the current knowledge of this important subject has implications for future research as well as public policy and clinical practice.
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Abstract
Long-term follow-up of infants born prematurely is necessary to determine neurodevelopmental outcomes, particularly with the expansion of interest from major disabilities to high prevalence/low severity dysfunctions. Models of pathogenesis include changes due to developmental disruptions and to injury, the magnitude and type of change influenced by the infant's age, and central nervous system recovery and reorganization. Alterations in neurogenesis, migration, myelination, cell death, and synaptogenesis occur even in the absence of insult. Despite increased knowledge regarding these processes, the functional significance of brain abnormalities is unclear. Because of methodologic problems in follow-up studies, it is difficult to characterize outcome definitively. Nonetheless, an acceptable degree of agreement across studies is found with regard to specific neurodevelopmental outcomes: motor/neurologic function, visuomotor integrative skills, IQ, academic achievement, language, executive function, and attention-deficit hyperactivity disorder/behavioral issues. In general, children born prematurely have more problems in these areas than do their normal birth weight counterparts. Suggestions for improved analyses and clarification of outcomes include use of cluster analysis, structural equation modeling, growth curve analysis, developmental epidemiologic approaches, and better control of background variables using risk indexes and factor scores. Better assessment techniques measuring functions documented to be at higher risk of problems are discussed.
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Hatch B, Healey DM, Halperin JM. Associations between birth weight and attention-deficit/hyperactivity disorder symptom severity: indirect effects via primary neuropsychological functions. J Child Psychol Psychiatry 2014; 55:384-92. [PMID: 24795955 PMCID: PMC4010942 DOI: 10.1111/jcpp.12168] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) has a range of aetiological origins which are associated with a number of disruptions in neuropsychological functioning. This study aimed to examine how low birth weight, a proxy measure for a range of environmental complications during gestation, predicted ADHD symptom severity in preschool-aged children indirectly via neuropsychological functioning. METHODS A total of 197 preschool-aged children were recruited as part of a larger longitudinal study. Two neuropsychological factors were derived from NEPSY domain scores. One, referred to as ‘Primary Neuropsychological Function,’ was loaded highly with Sensorimotor and Visuospatial scores. The other, termed ‘Higher-Order Function’ was loaded highly with Language and Memory domain scores. Executive functioning split evenly across the two. Analyses examined whether these neuropsychological factors allowed for an indirect association between birth weight and ADHD symptom severity. RESULTS As both factors were associated with symptom severity, only the Primary Neuropsychological Factor was associated with birth weight. Furthermore, birth weight was indirectly associated to symptom severity via this factor. CONCLUSIONS These data indicate that birth weight is indirectly associated with ADHD severity via disruption of neuropsychological functions that are more primary in function as opposed to functions that play a higher-order role in utilising and integrating the primary functions.
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Affiliation(s)
- Burt Hatch
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Dione M. Healey
- Department of Psychology, University of Otago, Dunedin, New Zealand
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Parfrey K, Gibbons SGT, Drinkwater EJ, Behm DG. Effect of head and limb orientation on trunk muscle activation during abdominal hollowing in chronic low back pain. BMC Musculoskelet Disord 2014; 15:52. [PMID: 24558971 PMCID: PMC3936867 DOI: 10.1186/1471-2474-15-52] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 02/12/2014] [Indexed: 11/29/2022] Open
Abstract
Background Individuals with chronic low back pain (CLBP) have altered activations patterns of the anterior trunk musculature when performing the abdominal hollowing manœuvre (attempt to pull umbilicus inward and upward towards the spine). There is a subgroup of individuals with CLBP who have high neurocognitive and sensory motor deficits with associated primitive reflexes (PR). The objective of the study was to determine if orienting the head and extremities to positions, which mimic PR patterns would alter anterior trunk musculature activation during the hollowing manoeuvre. Methods This study compared surface electromyography (EMG) of bilateral rectus abdominis (RA), external oblique (EO), and internal obliques (IO) of 11 individuals with CLBP and evident PR to 9 healthy controls during the hollowing manoeuvre in seven positions of the upper quarter. Results Using magnitude based inferences it was likely (>75%) that controls had a higher ratio of left IO:RA activation with supine (cervical neutral), asymmetrical tonic neck reflex (ATNR) left and right, right cervical rotation and cervical extension positions. A higher ratio of right IO:RA was detected in the cervical neutral and ATNR left position for the control group. The CLBP group were more likely to show higher activation of the left RA in the cervical neutral, ATNR left and right, right cervical rotation and cervical flexion positions as well as in the cervical neutral and cervical flexion position for the right RA. Conclusions Individuals with CLBP and PR manifested altered activation patterns during the hollowing maneuver compared to healthy controls and that altering cervical and upper extremity position can diminish the group differences. Altered cervical and limb positions can change the activation levels of the IO and EO in both groups.
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Affiliation(s)
| | | | | | - David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St, John's, Newfoundland, Canada.
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Creanga AA, Berg CJ, Ko JY, Farr SL, Tong VT, Bruce FC, Callaghan WM. Maternal mortality and morbidity in the United States: where are we now? J Womens Health (Larchmt) 2014; 23:3-9. [PMID: 24383493 PMCID: PMC3880915 DOI: 10.1089/jwh.2013.4617] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This article provides a brief overview of the work conducted by the Division of Reproductive Health at the Centers for Disease Control and Prevention on severe maternal morbidity and mortality in the United States. The article presents the latest data and trends in maternal mortality and severe maternal morbidity, as well as on maternal substance abuse and mental health disorders during pregnancy, two relatively recent topics of interest in the Division, and includes future directions of work in all these areas.
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Affiliation(s)
- Andreea A Creanga
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia
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El-Mazahi MM, El-Mahdi MAEF, El-Khaleeg HAEH, Abou Gomaa GH. Cognitive and Behavioural Outcome of Preterm Versus Full Term Infants, at School Entry Age. TRENDS IN MEDICAL RESEARCH 2014; 9:44-52. [DOI: 10.3923/tmr.2014.44.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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de la Espriella RA, Hernández JF, Espejo LM. [Cortical Release Signs in Patients with Schizophrenia, Depressive Disorders, and Bipolar Affective Disorder]. REVISTA COLOMBIANA DE PSIQUIATRIA 2013; 42:311-319. [PMID: 26573115 DOI: 10.1016/s0034-7450(13)70027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/28/2013] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Determining the presence of cortical release signs associated with white matter damage, is a clinically easy method to perform. The objective of this study is to determine the presence of cortical release signs in patients with mental illnesses and cerebrovascular disease, as well as its clinical usefulness, given that it indicates cortical damage. MATERIAL AND METHODS A review was made of cortical release signs in patients hospitalized in clinical psychiatry and general hospitals with bipolar affective disorder (40), depression (37), schizophrenia (33), cardiovascular disease (33) and dementia (37). RESULTS The signs of cortical release do not have the same importance as cortical damage. For example, the glabellar reflex was found in all the groups, that of paratonia, particularly in the group with schizophrenia, and others signs in the group of patients with dementia. CONCLUSIONS It is suggested that these signs imply subcortical white matter damage. The appearance of these signs shows the need for a follow up of patients diagnosed with bipolar affective disorder, depression and schizophrenia.
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Affiliation(s)
- Ricardo Andrés de la Espriella
- Médico especialista en Psiquiatría, terapeuta sistémico, magíster en epidemiología clínica; Docente en Departamento de Psiquiatría, Universidad Pontificia Javeriana; Gestor de Docencia e Investigación, Clínica Nuestra Señora de La Paz, Bogotá, Colombia.
| | | | - Lina María Espejo
- Médico especialista en Psiquiatría, Clínica Nuestra Señora de La Paz, Bogotá, Colombia
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Abstract
The connection between housing and health is well established. Physical, chemical, and biological aspects of the child's home, such as cleanliness, moisture, pests, noise, accessibility, injury risks, and other forms of housing environmental quality, all have the potential to influence multiple aspects of the health and development of children. Basic sanitation, reduced household crowding, other improvements in housing and expanded, and improved housing regulations have led to advances in children's health. For example, lead poisoning prevention policies have profoundly reduced childhood lead exposure in the United States. This and many other successes highlight the health benefits for families, particularly children, by targeting interventions that reduce or eliminate harmful exposures in the home. Additionally, parental mental health problems, food insecurity, domestic violence, and the presence of guns in children's homes all are largely experienced by children in their homes, which are not as yet considered part of the Healthy Homes agenda. There is a large movement and now a regulatory structure being put in place for healthy housing, which is becoming closely wedded with environmental health, public health, and the practice of pediatrics. The importance of homes in children's lives, history of healthy homes, asthma, and exposures to lead, carbon monoxide, secondhand/thirdhand smoke, radon, allergy triggers is discussed, as well as how changes in ambient temperature, increased humidity, poor ventilation, water quality, infectious diseases, housing structure, guns, electronic media, family structure, and domestic violence all affect children's health.
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Taylor MJ. Structure and function: how to connect? Neuroradiology 2013; 55 Suppl 2:55-64. [PMID: 23929311 DOI: 10.1007/s00234-013-1246-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 07/11/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The majority, but not all, of very preterm-born infants have difficulties with a variety of cognitive functions as children. It is critical to be able to predict as early as possible those who will have difficulties, to be able to direct appropriate interventions. METHODS We are conducting multimodal structural and functional MRI studies in very preterm-born infants and following them with behavioural and neuroimaging assessments until 4 years of age. We are also completing structural and more complex functional imaging in school-aged very preterm-born children. RESULTS A number of MRI measures between preterm and term age correlate with outcome at 2 years of age. Functional and structural differences are also seen at school age; examples from these various studies are presented. CONCLUSION Structural and functional studies in preterm-born versus term-born infants and children, particularly if completed longitudinally, provide important information on the evolution of brain-behaviour correlates and can help predict outcome in this high-risk population.
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Affiliation(s)
- Margot J Taylor
- Diagnostic Imaging, Neurosciences and Mental Health Programme, Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada.
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Revisiting the effect of maternal smoking during pregnancy on offspring birthweight: a quasi-experimental sibling analysis in Sweden. PLoS One 2013; 8:e61734. [PMID: 23616908 PMCID: PMC3629140 DOI: 10.1371/journal.pone.0061734] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/15/2013] [Indexed: 02/07/2023] Open
Abstract
Maternal smoking during pregnancy (SDP) seems associated with reduced birthweight in the offspring. This observation, however, is based on conventional epidemiological analyses, and it might be confounded by unobserved maternal characteristics related to both smoking habits and offspring birth weight. Therefore, we apply a quasi-experimental sibling analysis to revisit previous findings. Using the Swedish Medical Birth Register, we identified 677,922 singletons born between 2002 and 2010 from native Swedish mothers. From this population, we isolated 62,941 siblings from 28,768 mothers with discrepant habits of SDP. We applied conventional and mother-specific multilevel linear regression models to investigate the association between maternal SDP and offspring birthweight. Depending on the mother was light or heavy smoker and the timing of exposition during pregnancy (i.e., first or third trimester), the effect of smoking on birthweight reduction was between 6 and 78 g less marked in the sibling analysis than in the conventional analysis. Sibling analysis showed that continuous smoking reduces birthweight by 162 grams for mothers who were light smokers (1 to 9 cigarettes per day) and 226 g on average for those who were heavy smokers throughout the pregnancy in comparison to non-smoker mothers. Quitting smoking during pregnancy partly counteracted the smoking-related birthweight reduction by 1 to 29 g, and a subsequent smoking relapse during pregnancy reduced birthweight by 77 to 83 g. The sibling analysis provides strong evidence that maternal SDP reduces offspring birthweight, though this reduction was not as great as that observed in the conventional analysis. Our findings support public health interventions aimed to prevent SDP and to persuade those who already smoke to quit and not relapse throughout the pregnancy. Besides, further analyses are needed in order to explain the mechanisms through which smoking reduces birthweight and to identify other maternal characteristics that are common causes of both birthweight reduction and maternal smoking.
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Cognitive impairment and neurological soft signs in an Egyptian sample of schizophrenia patients. MIDDLE EAST CURRENT PSYCHIATRY 2013. [DOI: 10.1097/01.xme.0000422971.41913.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bersani G, Clemente R, Gherardelli S, Bersani FS, Manuali G. Obstetric complications and neurological soft signs in male patients with schizophrenia. Acta Neuropsychiatr 2012; 24:344-8. [PMID: 25287176 DOI: 10.1111/j.1601-5215.2011.00636.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bersani G, Clemente R, Gherardelli S, Bersani FS, Manuali G. Obstetric complications and neurological soft signs in male patients with schizophrenia.Objective: The study investigated the relationship between neurological soft signs (NSS) and obstetric complications (OCs) in patients with schizophrenia.Methods: Sixty-three male patients with schizophrenia were divided into two subgroups, based on the OCs presence or absence, which were compared in relation to NSS prevalence. After that, a Person's correlation test was performed to explore the correlation between NSS and OCs severity.Results: The subgroup with OCs showed more NSS, but there were not significant correlations between NSS and OCs severity.Conclusions: It seems that any OC, without distinction in typology and severity, could unspecifically impair the neurodevelopment and inducing NSS expression. Our findings confirm the hypothesis that neurodevelopment alterations, such as those probably induced by OCs, can contribute to a premorbid brain dysfunctional state expressed by NSS.
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Affiliation(s)
- Giuseppe Bersani
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Roberta Clemente
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Simona Gherardelli
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Francesco Saverio Bersani
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Giorgiana Manuali
- Department of Medical - Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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Martins IP, Lauterbach M, Luís H, Amaral H, Rosenbaum G, Slade PD, Townes BD. Neurological subtle signs and cognitive development: a study in late childhood and adolescence. Child Neuropsychol 2012; 19:466-78. [PMID: 22694740 DOI: 10.1080/09297049.2012.693911] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND AIM Neurological subtle signs (NSS) are often observed during the neurological examination of children and tend to disappear with age. Their persistence into late adolescence or young adulthood has been related to psychiatric and neurocognitive disorders. To provide a better understanding of their functional basis, a longitudinal correlational study with neurocognitive measurements was performed. METHOD We conducted multiple regression and correlation analyses of NSS with demographic and cognitive measures on a subset of 341 healthy children (56% males), taking part in a longitudinal dental study. Participants, whose ages ranged between 11-15 years, at first evaluation, undertook yearly, during 5 years, a 6-item NSS exam (producing a total score ranging between 0-18) and a comprehensive battery of neurocognitive tests. Effects of age, gender, IQ, and 7 neurocognitive factors on NSS were analyzed. RESULTS Over the years, NSS scores correlated consistently with selective attention (Stroop test), motor speed (finger tapping), and visuomotor speed (pegboard speed). DISCUSSION These results suggest that the disappearance of NSS in late childhood and adolescence occurs primarily in parallel with the development of motor and visuomotor functions and secondarily in relation to higher order functions such as selective attention (Stroop) and executive control (B-A Trails difference).
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Affiliation(s)
- Isabel Pavão Martins
- Instituto de Medicina Molecular (IMM), Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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Neuroanatomical consequences of very preterm birth in middle childhood. Brain Struct Funct 2012; 218:575-85. [PMID: 22572806 DOI: 10.1007/s00429-012-0417-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 04/07/2012] [Indexed: 01/08/2023]
Abstract
Individuals born preterm can demonstrate reductions in brain volume, cortical surface area and thickness. However, the extent of these neuroanatomical deficits and the relation among these measures in middle childhood, a critical developmental period, have not been determined. We assessed differences in brain structure by acquiring high-resolution T(1)-weighted scans in 25 children born very preterm (<32 weeks gestational age) without significant post-natal neurological sequelae and 32 age-matched term-born children (7-10 years). Children born very preterm had decreased brain volume, surface area and cortical thickness compared to term-born children. Furthermore, children born preterm did not display the robust relation between total brain volume and basal ganglia and thalamic volume apparent in the term-born children. Cortical thickness analyses revealed that the cortex was thinner for children born preterm than term-born children in the anterior cingulate cortex/supplementary motor area, isthmus of the cingulate gyrus, right superior temporal sulcus, right anterior insula, postcentral gyrus and precuneus. Follow-up analyses revealed that right precuneus thickness was correlated with gestational age. Thus, even without significant postnatal medical sequelae, very preterm-born children showed atypical brain structure and developmental patterns in areas related to higher cognitive function. Disruptions of the typical neurodevelopmental trajectory in the third trimester of pregnancy likely underlie these differences persisting into middle childhood.
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Frederick MJ. Birth Weight Predicts Scores on the ADHD Self-Report Scale and Attitudes towards Casual Sex in College Men: A Short-Term Life History Strategy? EVOLUTIONARY PSYCHOLOGY 2012; 10:342-351. [PMCID: PMC10480879 DOI: 10.1177/147470491201000212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 04/03/2012] [Indexed: 03/03/2024] Open
Abstract
Early development can have long-term effects on physiology and behavior. While severe disturbances predictably lead to dysfunction, recent work in humans and animals has led to a growing appreciation for the more subtle ways in which early conditions can modulate behavioral tendencies later in life. Life history theory predicts that early cues signaling a stressful or suboptimal environment might lead an organism to adopt a strategy favoring short-term gains and early reproduction. Fifty college men reported their birth weight, completed the Attention-Deficit/Hyperactivity Disorder (ADHD) Self-Report Scale, and answered a series of questions about their sexual history and attitudes towards short-term sexual encounters. Lower birth weights were associated with higher scores on the ADHD scale (r = −.352; p ≤ .05) and more favorable attitudes towards casual sex (r = −.456; p ≤ 0.001). There was a significant interaction between birth weight and casual sex favorability in predicting number of sexual partners (F 1,46 = 4.994; p ≤ .05). This suggests that, although men who are smaller at birth may otherwise be at a disadvantage in reproductive terms, they may offset their reduced fitness by being more willing to engage in casual sex.
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Crombie R, Clark C, Stansfeld SA. Environmental noise exposure, early biological risk and mental health in nine to ten year old children: a cross-sectional field study. Environ Health 2011; 10:39. [PMID: 21569605 PMCID: PMC3117762 DOI: 10.1186/1476-069x-10-39] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 05/14/2011] [Indexed: 05/28/2023]
Abstract
BACKGROUND Previous research suggests that children born prematurely or with a low birth weight are more vulnerable to the mental health effects of ambient neighbourhood noise; predominantly road and rail noise, at home. This study used data from the Road Traffic and Aircraft Noise Exposure and Children's Cognition and Health (RANCH) study to see if this finding extends to aircraft and road traffic noise at school. METHODS Children and their parents from schools around three European airports were selected to represent a range of aircraft and road traffic noise exposure levels. Birth weight and gestation period were merged to create a dichotomous variable assessing 'early biological risk'. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ). Complete data were available for 1900 primary school children. RESULTS Children who were 'at risk' (i.e. low birth weight or premature birth) were rated as having more conduct problems and emotional symptoms and poorer overall mental health than children not at risk. However, there was no interaction between aircraft or road traffic noise exposure at school and early biological risk. CONCLUSIONS Data from the RANCH study suggests that children with early biological risk are not more vulnerable to the effects of aircraft or road traffic noise at school on mental health than children without this risk; however they are more likely to have mental ill-health.
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Affiliation(s)
- Rosanna Crombie
- Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, Wolfson Institute of Preventive Medicine, Centre for Psychiatry, Room 103, Old Anatomy Building, Charterhouse Square, EC1M 6BQ, London
| | - Charlotte Clark
- Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, Wolfson Institute of Preventive Medicine, Centre for Psychiatry, Room 103, Old Anatomy Building, Charterhouse Square, EC1M 6BQ, London
| | - Stephen A Stansfeld
- Queen Mary, University of London, Barts and the London School of Medicine and Dentistry, Wolfson Institute of Preventive Medicine, Centre for Psychiatry, Room 103, Old Anatomy Building, Charterhouse Square, EC1M 6BQ, London
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Zelkowitz P, Na S, Wang T, Bardin C, Papageorgiou A. Early maternal anxiety predicts cognitive and behavioural outcomes of VLBW children at 24 months corrected age. Acta Paediatr 2011; 100:700-4. [PMID: 21214883 DOI: 10.1111/j.1651-2227.2010.02128.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The present study examined the effects of maternal anxiety during infant hospitalization in the Neonatal Intensive Care Unit (NICU) on the child's cognitive and behavioural development at 24 months corrected age. Parental anxiety following the birth of a very low birthweight (VLBW, <1500 g) infant may impede their capacity to be sensitive to the infant's cues and adversely affect infant developmental outcomes. METHODS A sample of 88 mothers and their VLBW infants were recruited in the NICU; 57 were followed at 24 months corrected age. During the infant's hospitalization, mothers completed a self-report measure of trait anxiety. When the infants were 24 months corrected age, mother-child interaction was videotaped during free play at home. These videotaped observations were coded using Emotional Availability Scales. Child cognitive and behavioural outcomes were evaluated using the Bayley Scales of Infant Development (II) and the Child Behavior Checklist for Ages 1.5-5. RESULTS Maternal anxiety in the NICU was found to be a significant and independent predictor of child cognitive development and internalizing behaviour problems, controlling for maternal education and neonatal morbidity. CONCLUSION These results suggest that early intervention programmes targeting anxious mothers of VLBW infants are indicated, to promote optimal developmental outcomes.
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Affiliation(s)
- Phyllis Zelkowitz
- Department of Psychiatry, Jewish General Hospital, Montreal, Canada.
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Chang SM, Walker SP, Grantham-McGregor S, Powell CA. Early childhood stunting and later fine motor abilities. Dev Med Child Neurol 2010; 52:831-6. [PMID: 20345956 DOI: 10.1111/j.1469-8749.2010.03640.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to determine the effects of early childhood stunting (height for age 2SD or more below reference values) and interventions on fine motor abilities at 11 to 12 years, and the relationship between fine motor abilities and school achievement and intelligence. METHOD A cohort of stunted children who had participated in a randomized trial of psychosocial stimulation and/or nutritional supplementation in early childhood was compared with a group of non-stunted children. Fine motor abilities were assessed in 116 stunted (67 males, 49 females) and 80 non-stunted children (43 males, 37 females) at a mean age of 11 years 8 months (SD 4.3 mo) and 11 years 9 months (SD 3.8 mo) respectively. Testers were blind to the children's group assignment. RESULTS Two fine motor factors were derived: rapid sequential continuous movements (RSCM) and dexterity. No effect of the early intervention was found. RSCM scores were lower in the stunted group than in the non-stunted group (p=0.01), but differences in dexterity were not significant (p=0.18) after adjusting for social background. Among stunted children, the RSCM score was significantly associated with IQ (p=0.04) and school achievement (all p<0.05). INTERPRETATION Stunting in early childhood is associated with poor scores on tests of rapid sequential continuous hand movements in later childhood. Children with poorer scores are at greater risk for low IQs and low levels of school achievement.
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Affiliation(s)
- Susan M Chang
- Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Jamaica.
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Simard MN, Lambert J, Lachance C, Audibert F, Gosselin J. Stability of neurocranial signs in the first two years of life in infants at risk. Early Hum Dev 2010; 86:473-8. [PMID: 20619977 DOI: 10.1016/j.earlhumdev.2010.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 05/27/2010] [Accepted: 06/16/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Acknowledgement of low-severity/high-prevalence disabilities in infants born preterm singles out the need to identify early markers of brain impairments which could predict these late emergent disabilities. The neurological status as assessed by the Amiel-Tison Neurological Assessments (ATNA) has been proposed as one such potential marker. However, the stability of the ATNA has never been formally assessed. AIM This study aimed to assess the stability of the ATNA. STUDY DESIGN A total of 89 infants born preterm with a gestational age ranging from 29 0/7 to 37 0/7 weeks inclusively and a birth weight below 2500 g were followed during their first two years of life (term age, 4, 8, 12 and 24 months corrected age) in a clinical context. RESULTS Of these, 62 children (69.7%) were classified in the same category on the five assessments while 14 (15.7%) had only one divergent result and 13 (14.6%) had two divergent results over the follow-up. The neurological status throughout the assessments remains stable according to Cochran's Q. CONCLUSION As the neurological status identified by the ATNA remained stable throughout repeated measurements in a regular clinical context and has been shown to correlate with later developmental performances, it should be included as a criterion to target children at risk and used during follow-up.
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Affiliation(s)
- Marie-Noëlle Simard
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montréal, Québec, Canada
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Andiman SE, Haynes RL, Trachtenberg FL, Billiards SS, Folkerth RD, Volpe JJ, Kinney HC. The cerebral cortex overlying periventricular leukomalacia: analysis of pyramidal neurons. Brain Pathol 2010; 20:803-14. [PMID: 20331617 DOI: 10.1111/j.1750-3639.2010.00380.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The role of the cerebral cortex in the cognitive deficits in preterm survivors is poorly understood. Periventricular leukomalacia (PVL), the key feature of encephalopathy of prematurity, is characterized by periventricular necrotic foci and diffuse gliosis in the surrounding cerebral white matter. Here, we tested the hypothesis that reductions in the density of layer I neurons and/or pyramidal neurons in layers III and/or V are associated with PVL, indicating cortical pathology potentially associated with cognitive deficits in long-term survivors. In controls (23 gestational weeks to 18 postnatal months) (n = 15), a lack of significant differences in pyramidal density among incipient Brodmann areas suggested that cytoarchitectonic differences across functional areas are not fully mature in the fetal and infant periods. There was a marked reduction (38%) in the density of layer V neurons in all areas sampled in the PVL cases (n = 17) compared to controls (n = 12) adjusted for postconceptional age at or greater than 30 weeks, when the six-layer cortex is visually distinct (P < 0.024). This may reflect a dying-back loss of somata complicating transection of layer V axons projecting through the necrosis in the underlying white matter. This study underscores the potential role of secondary cortical injury in the encephalopathy of prematurity.
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Affiliation(s)
- Sarah E Andiman
- Department of Pathology, Children's Hospital Boston and Harvard Medical School, Boston, Mass, USA
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Alati R, Najman JM, O’Callaghan M, Bor W, Williams GM, Clavarino A. Fetal growth and behaviour problems in early adolescence: findings from the Mater University Study of Pregnancy. Int J Epidemiol 2009; 38:1390-400. [DOI: 10.1093/ije/dyp252] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Advances in antenatal medicine and neonatal intensive care have successfully resulted in improved survival rates of preterm infants. These improvements have been most dramatic in infants born extremely low birth weight (ELBW, <or=1000 g) and at the limits of viability (22 to 25 weeks). But improvements in survival have not been accompanied by proportional reductions in the incidence of disability in this population. Thus, survival is not an adequate measure of success in these infants who remain at high risk for neurodevelopmental and behavioral morbidities. There is now increasing evidence of sustained adverse outcomes into school age and adolescence, not only for ELBW infants but for infants born late preterm.
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Kollins SH, Garrett ME, McClernon FJ, Lachiewicz AM, Morrissey-Kane E, FitzGerald D, Collins AL, Anastopoulos AD, Ashley-Koch AE. Effects of postnatal parental smoking on parent and teacher ratings of ADHD and oppositional symptoms. J Nerv Ment Dis 2009; 197:442-9. [PMID: 19525745 PMCID: PMC3678953 DOI: 10.1097/nmd.0b013e3181a61d9e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To assess the effects of postnatal parental smoking on subsequent parent and teacher ratings of DSM-IV attention deficit hyperactivity disorder (ADHD) symptoms and oppositional behaviors in children diagnosed with ADHD and their siblings. Children between 5 and 12 years of age with ADHD and their siblings were included. DSM-IV ADHD symptom subscales (Inattentive and hyperactive-impulsive), and oppositionality subscale scores from Conners' Rating Scales were predicted on the basis of parental smoking status in the first 7 years after birth using Generalized Estimating Equations controlling for a range of relevant covariates. Postnatal parental smoking was associated with both parent and teacher ratings of ADHD symptoms and oppositional behavior. After controlling for a number of covariates, several of these relationships were still significant. The risk of maternal smoking for the development of ADHD symptoms does not end during pregnancy. Research on the mechanisms underlying the observed associations is needed.
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Affiliation(s)
- Scott H. Kollins
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina
| | - Melanie E. Garrett
- Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - F. Joseph McClernon
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina
| | - Ave M. Lachiewicz
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Erin Morrissey-Kane
- Department of Psychology, University of North Carolina Greensboro, Greensboro, North Carolina
| | - David FitzGerald
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina
| | - Ann L. Collins
- Center for Human Genetics, Duke University Medical Center, Durham, North Carolina
| | - Arthur D. Anastopoulos
- Department of Psychology, University of North Carolina Greensboro, Greensboro, North Carolina
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Korkman M, Mikkola K, Ritari N, Tommiska V, Salokorpi T, Haataja L, Tammela O, Pääkkönen L, Olsén P, Fellman V. Neurocognitive test profiles of extremely low birth weight five-year-old children differ according to neuromotor status. Dev Neuropsychol 2009; 33:637-55. [PMID: 18788015 DOI: 10.1080/87565640802254471] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The neurocognitive outcome of children born with extremely low birth weight (ELBW) is highly variable due to the complexity of morbidity. So far, no study has compared comprehensive neuropsychological test profiles in groups with different neuromotor status. In a national cohort of ELBW children neuropsychological test profiles were assessed in 4 groups defined according to a neurological examination at 5 years of age: normal neuromotor status (N = 56), motor coordination problems (N = 32), multiple subtle neuromotor signs including both motor coordination problems and deviant reflexes (N = 20), and spastic diplegia (N = 12). The neurocognitive assessment included a test of intelligence, the Wechsler Primary and Preschool Scale of Intelligence-Revised (WPPSI-R) and 14 subtests of attention and executive functions, verbal functions, manual motor functions, visuoconstructional functions and verbal learning (NEPSY). The children with normal neuromotor status performed within the average range; children with motor coordination problems had widespread impairment; and children with spastic diplegia and children with multiple minor neuromotor signs had uneven test profiles with stronger verbal results but weaknesses in attention and executive functions, and in manual motor and visuoconstructional tasks. In conclusion, very preterm children with neuromotor signs, including motor coordination problems, are at risk for neurocognitive impairment, in spite of average intelligence. More impaired children have more irregular test profiles. Follow-up and neuropsychological assessment of very preterm children with minor neuromotor signs are therefore indicated.
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Affiliation(s)
- Marit Korkman
- Department of Psychology, University of Helsinki, Helsinki, Finland.
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Giles LL, DelBello MP, Gilbert DL, Stanford KE, Shear PK, Strakowski SM. Cerebellar ataxia in youths at risk for bipolar disorder. Bipolar Disord 2008; 10:733-7. [PMID: 18837868 DOI: 10.1111/j.1399-5618.2007.00574.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Structural, biochemical, and functional cerebellar abnormalities occur in individuals with or at-risk for developing bipolar disorder (BD), but the clinical implications of these abnormalities are unknown. The present study examined cerebellar function in youths who were at familial risk for BD by comparing ataxia battery scores of youths with a bipolar parent to those of healthy youths. METHODS Trained raters administered an ataxia battery, consisting of three tasks, to children (aged 8-12 years) with at least one parent with BD type I (BDI) who themselves did not have BDI (at-risk or AR group, n = 21) and healthy comparison children (aged 8-12 years) with parents free of DSM-IV Axis I psychopathology (HC group, n = 23). RESULTS AR youths performed worse than HC youths on the Sharpened Romberg test (subjects standing heel-to-toe) and standing on one foot with eyes open (p < 0.02). CONCLUSIONS The results indicate that youths at familial risk for BD have more difficulty performing a Sharpened Romberg test than a HC group, suggesting that midline cerebellar dysfunction may be a biomarker for the future development of BD. Further studies examining the relationships among youths at risk for BD, coordination abnormalities, and cerebellar dysfunction are needed.
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Affiliation(s)
- Lisa L Giles
- Division of Bipolar Disorders Research, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA
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Martins I, Lauterbach M, Slade P, Luís H, DeRouen T, Martin M, Caldas A, Leitão J, Rosenbaum G, Townes B. A longitudinal study of neurological soft signs from late childhood into early adulthood. Dev Med Child Neurol 2008; 50:602-7. [PMID: 18754898 DOI: 10.1111/j.1469-8749.2008.03043.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neurological examination of children includes the screening for soft neurological signs (NSS). There is little knowledge about their evolution during adolescence, except that their lasting presence has been associated with developmental, psychological, and cognitive disorders. We report the results of a NSS exam (assessing gross and fine motor function and the presence of hyperactivity and motor impersistence) over a 5-year period, among a group of healthy children who were followed annually as part of a dental study. Their ages ranged from 11 to 15 years at onset to 14 to 18 years at the end. Participants were divided into four groups by age (younger and older) and sex. At the first evaluation there were 191 males and 150 females. NSS score diminished both with increasing age and follow-up time in both groups, but at different rates in males and females. Females reached the lowest scores two years before the younger subgroup of males. These results show that NSS change rapidly in adolescence and at different rates in males and females, which must be taken into account in clinical contexts. The evolution of NSS suggests that they are a signature of neural development.
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Affiliation(s)
- Isabel Martins
- Language Research Laboratory, Neurology, University of Lisbon, Lisbon, Portugal
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Co-occurrence of motor problems and autistic symptoms in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2008; 47:662-672. [PMID: 18434922 DOI: 10.1097/chi.0b013e31816bff88] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the relation between parent reports of motor problems and clinically significant autistic symptoms in children with and without attention-deficit/hyperactivity disorder (ADHD). METHOD Subjects were male (n = 521) and female (n = 330) twins from an epidemiological study of ADHD, ages 7 to 19 years at assessment using the Child Behavior Checklist and semistructured psychiatric diagnostic interviews. Parent-rated Social Responsiveness Scale questionnaires were returned for 62% of 1,647 individuals who participated in interviews. After exclusion of subjects with incomplete data or evidence of mental retardation, 851 subjects (52%) were available for the present study analysis. Each subject was classified by DSM-IV ADHD subtype and assigned to one of seven population-defined ADHD subtypes based on latent class analysis of DSM-IV ADHD symptoms. Within each ADHD subtype, we examined the relation between Child Behavior Checklist motor problem endorsement and elevated autistic symptoms on the Social Responsiveness Scale. RESULTS Motor problems and high levels of autistic traits were most common in individuals with combined-type ADHD. Within each of the clinically relevant DSM-IV and latent class ADHD subtypes, individuals with the combination of motor problems and ADHD were more likely to have high levels of autistic traits than those with ADHD alone. CONCLUSIONS Children with the combination of ADHD and parent-reported motor coordination deficits have elevated levels of autistic symptoms. Targeted treatment and prevention interventions may be warranted. The exclusion criteria for DSM-IV ADHD should be revised to reflect these population-based findings.
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Herrmann M, King K, Weitzman M. Prenatal tobacco smoke and postnatal secondhand smoke exposure and child neurodevelopment. Curr Opin Pediatr 2008; 20:184-90. [PMID: 18332716 DOI: 10.1097/mop.0b013e3282f56165] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To review the recent scientific literature examining the association of prenatal tobacco and postnatal secondhand smoke exposure and child neurodevelopment. RECENT FINDINGS Low birth weight and decreased in-utero brain growth are two of multiple potential etiologic pathways proposed as mediating the effects of prenatal tobacco smoke exposure on child neurodevelopment. These negative effects of prenatal exposure have been consistently demonstrated in animal models, and in humans have been found as early as the newborn period. The literature on both prenatal and postnatal exposure is remarkably consistent in showing associations with increased rates of behavior problems, including irritability, oppositional defiant behavior, conduct disorders and attention deficit hyperactivity disorder. A more rudimentary literature also suggests deficits in intelligence quotient. Recent studies have focused on elucidating the complex interaction among tobacco exposure, genetics and environmental factors. Questions still remain about the relative roles of prenatal vs. postnatal exposure and the potential role of genetic and social confounders, limiting the ability to infer a causal nature to these associations at this time. The consistency of findings across studies is, however, highly suggestive of a causal relationship between environmental tobacco exposure and adverse behavioral and cognitive outcomes in children. SUMMARY Prenatal tobacco and postnatal secondhand smoke exposure is consistently associated with problems in multiple domains of children's neurodevelopment and behavior.
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Affiliation(s)
- Melissa Herrmann
- Department of Pediatrics, New York University School of Medicine, New York, New York 10016-6497, USA
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Neurological outcomes in children with and without amalgam-related mercury exposure: seven years of longitudinal observations in a randomized trial. J Am Dent Assoc 2008; 139:138-45. [PMID: 18245680 DOI: 10.14219/jada.archive.2008.0128] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although large-scale, randomized trials involving children have been completed and their results demonstrate an absence of neurobehavioral effects from clinical exposure to mercury amalgam, neurological findings from such studies have not been reported. METHODS The authors conducted a randomized, prospective trial examining the safety of dental amalgam in which 507 children aged 8 through 12 years were assigned to treatment with either amalgam or resin-based composite. During seven years of follow-up, the authors performed annual clinical neurological examinations, including an evaluation of neurological hard signs (NHSs), presence of tremor and neurological soft signs (NSSs). RESULTS The authors found no significant differences between treatment groups in any of the neurological measures. Groups did not differ with respect to the presence or absence of NHSs or tremor, nor the presence or absence or severity of NSSs at any point. As expected, NSS severity scores diminished with increasing age. CONCLUSIONS Even at the levels of amalgam exposure in this study (a mean of 7.7-10.7 amalgam surfaces per subject across the seven years of follow-up), the authors conclude that exposure to mercury from dental amalgam does not adversely affect neurological status. CLINICAL IMPLICATIONS The current evidence is that potential neurobehavioral or neurological effects from dental amalgam mercury exposure in children are inconsequential.
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Unaltered development of the archi- and neocortex in prematurely born infants: genetic control dominates in proliferation, differentiation and maturation of cortical neurons. PROGRESS IN BRAIN RESEARCH 2008. [PMID: 17920423 DOI: 10.1016/s0079-6123(07)64001-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
The development of cerebral cortex includes highly organized, elaborate and long-lasting series of events, which do not come to an end by the time of birth. Indeed, many developmental events continue after the 40th postconceptual week resulting in a long morphological, behavioral and cognitive development of children. Premature birth causes an untimely dramatic change in the environment of the human fetus and often results in serious threats for life. Cognitive abilities of prematurely born children vary, but a correlation between cognitive impairment and the time of birth is evident. In this study we review the morphological evidence of cortical maturation in preterm and full-term infants. Various aspects of postnatal cortical development including cell proliferation and maturation of neurons in the temporal archi- and neocortex are discussed and compared in preterm infants and age-matched full-term controls. Our results suggest that cell proliferation and maturation are not influenced by the preterm delivery. In contrast, the perinatal decrease of the number of Cajal-Retzius cells might be regulated by a mechanism that is affected by preterm birth. We demonstrate that cognitive deficiencies of the prematurely born infants cannot be explained with light microscopically observed alteration of proliferation and maturation of neurons.
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Espy KA, Senn TE, Charak DA, Tyler J, Wiebe SA. Perinatal pH and neuropsychological outcomes at age 3 years in children born preterm: an exploratory study. Dev Neuropsychol 2007; 32:669-82. [PMID: 17931124 DOI: 10.1080/87565640701376003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The impact of extreme prematurity and related hypoxic-ischemic events on brain development recently has begun to be characterized with modern neuroimaging methods, although comparatively less is known about the neuropathology in those born at heavier birth weights. Even subclinical levels of perinatal hypoxia-ischemia, as indexed by perinatal blood pH, are related to intelligence in school-aged children born preterm. Given the impact of hypoxia-ischemia on white matter and the emerging evidence of specific executive and mathematic deficits in children born preterm, the impact of perinatal hypoxia-ischemia on these outcomes was explored in children at relatively low-risk for sequelae. In a sample of 22 preschool children born preterm, arterial blood pH values obtained within the first 3 h of life were abstracted from review of hospital medical charts, and then related to specific cognitive task performance at age 3 years. Mean initial pH was in the normal to subclinical range. Initial pH appears to be a strong predictor of specific mathematics and controlled attention abilities, and is not limited to general verbal ability alone. However, initial pH was not related to performance on measures of motor impulsivity or working memory. As a screening index of subtle hypoxia-ischemia, these findings suggest that perinatal arterial blood pH warrants further study as a potential marker of subtle hypoxic-ischemic injury that likely affects cognitive outcome throughout childhood in those at risk due to preterm birth.
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Affiliation(s)
- Kimberly Andrews Espy
- Office of Research and Department of Psychology, University of Nebraska, Lincoln, NE 68588-0433, USA.
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Schothorst PF, Swaab-Barneveld H, van Engeland H. Psychiatric disorders and MND in non-handicapped preterm children. Prevalence and stability from school age into adolescence. Eur Child Adolesc Psychiatry 2007; 16:439-48. [PMID: 17896123 PMCID: PMC2493532 DOI: 10.1007/s00787-007-0617-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2007] [Indexed: 11/20/2022]
Abstract
In preterm children (N = 66) without major physical and/or mental handicaps the prevalence of psychiatric disorders and minor neurological dysfunction (MND) was assessed at school age (8-10 years). In adolescence (15-17 years) 43 children were reassessed. The study sample was drawn from a cohort of non-handicapped preterm children (N = 218) hospitalised in a Neonatal Intensive Care Unit because of serious neonatal complications. The findings in the preterm group were compared with two control groups (N = 20 and N = 20) matched for age and sex ratio. The association between psychiatric disorders on the one hand and group status (preterm versus control), MND, IQ and family adversity on the other was explored. At both ages the preterm children exhibited more psychiatric disorders and MND than controls. The very preterm and/or very low birth weight children contributed to the differential psychopathological findings between the preterm and control groups. Besides preterm birth, the prevalence of psychiatric disorders was positively associated with MND and negatively associated with VIQ and family adversity. In the preterm group there was a shift from school age into adolescence into a predominance of anxious and depressive disorders. No significant changes with age were found with respect to the prevalence of MND and psychiatric disorders. Thus, very preterm and/or very low birth weight children are at increased risk of persistent psychiatric disorders, especially anxious and depressive disorders. In preterm children the development of psychopathology seems to be mediated by MND, decreased verbal abilities and family adversity.
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Affiliation(s)
- P F Schothorst
- Department of Child and Adolescent Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, the Netherlands.
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