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Jaekel J, Heuser KM, Zapf A, Roll C, Nuñez FB, Bartmann P, Wolke D, Felderhoff-Mueser U, Huening B. Preterm children's long-term academic performance after adaptive computerized training: an efficacy and process analysis of a randomized controlled trial. Pediatr Res 2021; 89:1492-1499. [PMID: 32919388 PMCID: PMC7588952 DOI: 10.1038/s41390-020-01114-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/04/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adaptive computerized interventions may help improve preterm children's academic success, but randomized trials are rare. We tested whether a math training (XtraMath®) versus an active control condition (Cogmed®; working memory) improved school performance. Training feasibility was also evaluated. METHODS Preterm born first graders, N = 65 (28-35 + 6 weeks gestation) were recruited into a prospective randomized controlled multicenter trial and received one of two computerized trainings at home for 5 weeks. Teachers rated academic performance in math, reading/writing, and attention compared to classmates before (baseline), directly after (post), and 12 months after the intervention (follow-up). Total academic performance growth was calculated as change from baseline (hierarchically ordered-post test first, follow-up second). RESULTS Bootstrapped linear regressions showed that academic growth to post test was significantly higher in the math intervention group (B = 0.25 [95% confidence interval: 0.04-0.50], p = 0.039), but this difference was not sustained at the 12-month follow-up (B = 0.00 [-0.31 to 0.34], p = 0.996). Parents in the XtraMath group reported higher acceptance compared with the Cogmed group (mean difference: -0.49, [-0.90 to -0.08], p = 0.037). CONCLUSIONS Our findings do not show a sustained difference in efficacy between both trainings. Studies of math intervention effectiveness for preterm school-aged children are warranted. IMPACT Adaptive computerized math training may help improve preterm children's short-term school performance. Computerized math training provides a novel avenue towards intervention after preterm birth. Well-powered randomized controlled studies of math intervention effectiveness for preterm school-aged children are warranted.
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Affiliation(s)
- Julia Jaekel
- Child and Family Studies
- Psychology, University of Tennessee Knoxville, Knoxville, TN, USA. .,Psychology, University of Warwick, Coventry, UK.
| | - Katharina M. Heuser
- grid.410718.b0000 0001 0262 7331Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, Essen, Germany ,grid.5570.70000 0004 0490 981XPsychology, Ruhr-University Bochum, Bochum, Germany
| | - Antonia Zapf
- grid.13648.380000 0001 2180 3484Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Roll
- grid.412581.b0000 0000 9024 6397Vest Children’s Hospital Datteln, University Witten-Herdecke, Datteln, Germany
| | | | - Peter Bartmann
- grid.15090.3d0000 0000 8786 803XChildren’s Hospital, University Hospital Bonn, Bonn, Germany
| | - Dieter Wolke
- grid.7372.10000 0000 8809 1613Psychology, University of Warwick, Coventry, UK
| | - Ursula Felderhoff-Mueser
- grid.410718.b0000 0001 0262 7331Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, Essen, Germany
| | - Britta Huening
- grid.410718.b0000 0001 0262 7331Pediatrics I, Neonatology, Pediatric Intensive Care, Pediatric Neurology, University Hospital Essen, Essen, Germany
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Pérez-Pereira M, Martínez-López Z, Maneiro L. Longitudinal Relationships Between Reading Abilities, Phonological Awareness, Language Abilities and Executive Functions: Comparison of Low Risk Preterm and Full-Term Children. Front Psychol 2020; 11:468. [PMID: 32256436 PMCID: PMC7090025 DOI: 10.3389/fpsyg.2020.00468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
Different investigations have found that very or extremely (high risk) preterm children show global or specific difficulties in phonological awareness (PA) and reading abilities. Do low risk preterm children, however, exhibit this pattern? Phonological awareness has been considered an important predictor of literacy. Certain executive functions (EFs), and language abilities in turn, have been found to predict PA. The aims of this study are (1) to compare reading abilities of low risk preterm children of different gestational age (GA) groups to those of full-term children, (2) to compare the performance of low risk preterm children of different GA groups to that of full-term children in different EFs, language measures and PA, and (3) to perform a path analysis in order to test a longitudinal model of the relationships between EFs, language abilities, PA and reading. The participants were 108 low risk 4- year-old preterm children, classified into 3 groups of different GAs, and 34 full-term children. The children’s EFs (rapid automatized naming task (RAN), working memory, and inhibition) were assessed at 4 and 5 years of age. Vocabulary comprehension, morphosyntactic production and grammar reception were assessed when the children were 5 years of age, as well as phonemic awareness and syllabic awareness. Finally, reading abilities were assessed when the children were 9 years old. No significant difference between gestational age groups was found on any of the measures taken on EFs, language abilities, phonological awareness, or reading abilities. The path analysis model demonstrates the direct effect of working memory, certain linguistic skills governed by rules (grammar, morphology) and phonological awareness on reading abilities at 9 years of age. The model also shows the mediating role that PA has on the relationship between EFs and language abilities with reading abilities.
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Affiliation(s)
- Miguel Pérez-Pereira
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Zeltia Martínez-López
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Lorena Maneiro
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Learning disabilities among extremely preterm children without neurosensory impairment: Comorbidity, neuropsychological profiles and scholastic outcomes. Early Hum Dev 2016; 103:69-75. [PMID: 27517525 DOI: 10.1016/j.earlhumdev.2016.07.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/07/2016] [Accepted: 07/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Children born extremely preterm are at high risk for intellectual disability, learning disabilities, executive dysfunction and special educational needs, but little is understood about the comorbidity of intellectual and learning disabilities in this population. AIMS This study explored comorbidity in intellectual disability (ID) and learning disabilities (LD) in children born extremely preterm (EP; <26+0weeks' gestation). SUBJECTS AND STUDY DESIGN A UK national cohort of 161 EP children and 153 term-born controls without neurosensory impairments was assessed at 11years of age (the EPICure Study). OUTCOME MEASURES IQ, mathematics and reading attainment, executive function, visuospatial processing and sensorimotor skills were assessed using standardised tests, and curriculum-based attainment and special educational needs (SEN) using teacher reports. RESULTS Overall, 75 (47%) EP children and 7 (4.6%) controls had ID or LD (RR 10.12; 95% CI 4.81, 21.27). Comorbidity in ID/LD was more common among EP children than controls (24% vs. 0%). EP children with comorbid ID/LD had significantly poorer neuropsychological abilities and curriculum-based attainment than EP children with an isolated disability or no disabilities. LD were associated with a 3 times increased risk for SEN. However, EP children with ID alone had poorer neuropsychological abilities and curriculum-based attainment than children with no disabilities, yet there was no increase in SEN provision among this group. CONCLUSIONS EP children are at high risk for comorbid intellectual and learning disabilities. Education professionals should be aware of the complex nature of EP children's difficulties and the need for multi-domain assessments to guide intervention.
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Doyle LW, Anderson PJ, Battin M, Bowen JR, Brown N, Callanan C, Campbell C, Chandler S, Cheong J, Darlow B, Davis PG, DePaoli T, French N, McPhee A, Morris S, O’Callaghan M, Rieger I, Roberts G, Spittle AJ, Wolke D, Woodward LJ. Long term follow up of high risk children: who, why and how? BMC Pediatr 2014; 14:279. [PMID: 25399544 PMCID: PMC4289257 DOI: 10.1186/1471-2431-14-279] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/15/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Most babies are born healthy and grow and develop normally through childhood. There are, however, clearly identifiable high-risk groups of survivors, such as those born preterm or with ill-health, who are destined to have higher than expected rates of health or developmental problems, and for whom more structured and specialised follow-up programs are warranted. DISCUSSION This paper presents the results of a two-day workshop held in Melbourne, Australia, to discuss neonatal populations in need of more structured follow-up and why, in addition to how, such a follow-up programme might be structured. Issues discussed included the ages of follow-up, and the personnel and assessment tools that might be required. Challenges for translating results into both clinical practice and research were identified. Further issues covered included information sharing, best practice for families and research gaps. SUMMARY A substantial minority of high-risk children has long-term medical, developmental and psychological adverse outcomes and will consume extensive health and education services as they grow older. Early intervention to prevent adverse outcomes and the effective integration of services once problems are identified may reduce the prevalence and severity of certain outcomes, and will contribute to an efficient and effective use of health resources. The shared long-term goal for families and professionals is to work toward ensuring that high risk children maximise their potential and become productive and valued members of society.
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Affiliation(s)
- Lex W Doyle
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Peter J Anderson
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Malcolm Battin
- />National Women’s Hospital, Auckland City Hospital, Auckland, New Zealand
| | - Jennifer R Bowen
- />Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales Australia
| | - Nisha Brown
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Newborn Services, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Catherine Callanan
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Catherine Campbell
- />Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Australia
| | - Samantha Chandler
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Jeanie Cheong
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Brian Darlow
- />Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Peter G Davis
- />Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria Australia
- />Premature Infant Follow-up Program, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Tony DePaoli
- />Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania Australia
| | - Noel French
- />Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia Australia
| | - Andy McPhee
- />Neonatal Services, Women’s and Children’s Health Network, North Adelaide, South Australia Australia
| | - Shusannah Morris
- />Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, 20 Flemington Road, Parkville, Victoria 3052 Australia
| | - Michael O’Callaghan
- />Paediatrics and Child Health, Mater Clinical School, University of Queensland, Brisbane, Queensland Australia
| | - Ingrid Rieger
- />Department of Neonatal Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales Australia
- />Faculty of Medicine, University of Sydney, Sydney, New South Wales Australia
| | - Gehan Roberts
- />Department of Paediatrics, The University of Melbourne, Melbourne, Victoria Australia
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Community Child Health, The Royal Children’s Hospital, Parkville, Victoria Australia
| | - Alicia J Spittle
- />Victorian Infant Brain Studies, Clinical Sciences, Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Department of Physiotherapy, The University of Melbourne, Parkville, Victoria Australia
| | - Dieter Wolke
- />Department of Psychology, The University of Warwick, Coventry, UK
| | - Lianne J Woodward
- />Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
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Simms V, Gilmore C, Cragg L, Marlow N, Wolke D, Johnson S. Mathematics difficulties in extremely preterm children: evidence of a specific deficit in basic mathematics processing. Pediatr Res 2013; 73:236-44. [PMID: 23165451 DOI: 10.1038/pr.2012.157] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Extremely preterm (EP, <26 wk gestation) children have been observed to have poor academic achievement in comparison to their term-born peers, especially in mathematics. This study investigated potential underlying causes of this difficulty. METHODS A total of 219 EP participants were compared with 153 term-born control children at 11 y of age. All children were assessed by a psychologist on a battery of standardized cognitive tests and a number estimation test assessing children's numerical representations. RESULTS EP children underperformed in all tests in comparison with the term controls (the majority of Ps < 0.001). Different underlying relationships between performance on the number estimation test and mathematical achievement were found in EP as compared with control children. That is, even after controlling for cognitive ability, a relationship between number representations and mathematical performance persisted for EP children only (EP: r = 0.346, n = 186, P < 0.001; control: r = 0.095, n = 146, P = 0.256). CONCLUSION Interventions for EP children may target improving children's numerical representations in order to subsequently remediate their mathematical skills.
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Affiliation(s)
- Victoria Simms
- Department of Health Sciences, University of Leicester, Leicester, UK
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Allegaert K. Clinical pharmacological studies in children: From exploratory towards confirmation driven methodology. World J Clin Pediatr 2012; 1:3-7. [PMID: 25254160 PMCID: PMC4145636 DOI: 10.5409/wjcp.v1.i2.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 07/31/2012] [Accepted: 08/05/2012] [Indexed: 02/06/2023] Open
Abstract
Just like children are not small adults, pediatric studies are not just subgroup-adult studies. Clinical pharmacology aims to predict these effects based on drug, population and/or patient-specific pharmacokinetics (concentration-time profiles) and -dynamics (concentration-effect profile). The most essential characteristics of childhood are growth and maturation. Both phenomena are most prominent during infancy making the claim that “an infant is not just a small child” as relevant compared to the paradigm that “a child is not just a small adult”. From a clinical pharmacology perspective, the consequence of such a dynamic setting is extensive variability throughout childhood in both the pharmacokinetics and pharmacodynamics. Trial design probably has impact on recruitment to an even greater extent compared to adult studies. In general, if a study is designed well, with a clear clinical question with which parents and children can identify, they are likely to consider participation. Open communication with all stakeholders involved will most likely result in ethically correct, practically feasible, scientifically sound, and economical reasonable studies to provide children with the appropriate treatment. From an academic perspective, feasibility, relevance, applicability and costs of clinical pharmacological studies in children can be significantly improved by new sampling concepts (e.g., saliva, urine, dried spot blood) and the systematic introduction of already known information into the trial design through model based pediatric drug development, that mainly affect feasibility of pharmacokinetic studies. In contrast, for the pharmacodynamic part of pediatric studies, development and validation of population specific biomarkers or robust outcome variables is urgently needed.
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Affiliation(s)
- Karel Allegaert
- Karel Allegaert, Division of Woman and Child, Neonatal Intensive Care Unit, University Hospital, 3000 Leuven, Belgium
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