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Effects of Correcting for Prematurity on Executive Function Scores of Children Born Very Preterm at School Age. J Pediatr 2021; 238:145-152.e2. [PMID: 34217768 DOI: 10.1016/j.jpeds.2021.06.070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/02/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate whether correction for prematurity affects executive function scores in school-aged children born very preterm. STUDY DESIGN Executive functions were assessed with standardized neuropsychological tests in 142 children born very preterm (born at ≤32 weeks of gestational age or with a birth weight of ≤1500 g) and 391 control children, aged 7-13 years. Four-month age bands were established from the data of control children. Differences between uncorrected and corrected scores were compared against zero difference and between very preterm children born before and after 28 weeks of gestation. Regression models were used to compare the uncorrected and corrected scores of children born very preterm with control children. RESULTS For all executive functions, significant, larger-than-zero differences between uncorrected and corrected scores were apparent in children born very preterm. Mean differences ranged from 0.04 to 0.18 SDs. Weak evidence was found that the effect of age correction is more pronounced in very preterm children born before 28 weeks of gestation than in those born after 28 weeks. Differences in executive function scores between children born very preterm and control children were attenuated if scores were corrected for prematurity. CONCLUSIONS Test scores based on corrected rather than uncorrected age may more accurately determine the developmental stage of very preterm children's executive functions at school age. Potential consequences for clinical and research practice need to be discussed in the future.
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Abstract
OBJECTIVE To determine whether correction for prematurity is appropriate for cognitive, language, and motor function at varying degrees of prematurity and at different baseline functional levels. METHODS The newly published Bayley-4 normative data on 1700 normal children were used. Raw scores for baseline levels of function (-2 SD, -1 SD, and M) were identified at 6, 12, 24, and 36 months for receptive communication, expressive communication, fine motor, and gross motor scaled scores and cognitive, language, and motor composite scores. Differences between the baseline and uncorrected scores at 4, 3, 2, and 1 months of prematurity were evaluated at each age. RESULTS Using a cutoff of 3 points (1/5 SD), correction is needed for cognitive composite scores at all gestational ages for the first 2 years and in those born 4 months premature at 3 years of age; language and motor composite scores should be corrected to 3 years at all degrees of prematurity. CONCLUSION Not correcting for prematurity in cognitive, language, and motor function at 3 years and younger places preterm infants at a distinct disadvantage when compared to peers with few exceptions, suggesting that such correction should be routine.
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George JM, Pagnozzi AM, Bora S, Boyd RN, Colditz PB, Rose SE, Ware RS, Pannek K, Bursle JE, Fripp J, Barlow K, Iyer K, Leishman SJ, Jendra RL. Prediction of childhood brain outcomes in infants born preterm using neonatal MRI and concurrent clinical biomarkers (PREBO-6): study protocol for a prospective cohort study. BMJ Open 2020; 10:e036480. [PMID: 32404396 PMCID: PMC7228524 DOI: 10.1136/bmjopen-2019-036480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Infants born very preterm are at risk of adverse neurodevelopmental outcomes, including cognitive deficits, motor impairments and cerebral palsy. Earlier identification enables targeted early interventions to be implemented with the aim of improving outcomes. METHODS AND ANALYSIS Protocol for 6-year follow-up of two cohorts of infants born <31 weeks gestational age (PPREMO: Prediction of Preterm Motor Outcomes; PREBO: Prediction of Preterm Brain Outcomes) and a small term-born reference sample in Brisbane, Australia. Both preterm cohorts underwent very early MRI and concurrent clinical assessment at 32 and 40 weeks postmenstrual age (PMA) and were followed up at 3, 12 and 24 months corrected age (CA). This study will perform MRI and electroencephalography (EEG). Primary outcomes include the Movement Assessment Battery for Children second edition and Full-Scale IQ score from the Wechsler Intelligence Scale for Children fifth edition (WISC-V). Secondary outcomes include the Gross Motor Function Classification System for children with cerebral palsy; executive function (Behavior Rating Inventory of Executive Function second edition, WISC-V Digit Span and Picture Span, Wisconsin Card Sorting Test 64 Card Version); attention (Test of Everyday Attention for Children second edition); language (Clinical Evaluation of Language Fundamentals fifth edition), academic achievement (Woodcock Johnson IV Tests of Achievement); mental health and quality of life (Development and Well-Being Assessment, Autism Spectrum Quotient-10 Items Child version and Child Health Utility-9D). AIMS Examine the ability of early neonatal MRI, EEG and concurrent clinical measures at 32 weeks PMA to predict motor, cognitive, language, academic achievement and mental health outcomes at 6 years CA.Determine if early brain abnormalities persist and are evident on brain MRI at 6 years CA and the relationship to EEG and concurrent motor, cognitive, language, academic achievement and mental health outcomes. ETHICS AND DISSEMINATION Ethical approval has been obtained from Human Research Ethics Committees at Children's Health Queensland (HREC/19/QCHQ/49800) and The University of Queensland (2019000426). Study findings will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12619000155190p. WEB ADDRESS OF TRIAL: http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619000155190p.
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Affiliation(s)
- Joanne M George
- Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Alex M Pagnozzi
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Queensland, Australia
| | - Samudragupta Bora
- Mothers, Babies and Women's Health Program, Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul B Colditz
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Stephen E Rose
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Kerstin Pannek
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Queensland, Australia
| | - Jane E Bursle
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jurgen Fripp
- The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Queensland, Australia
| | - Karen Barlow
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Kartik Iyer
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Shaneen J Leishman
- Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Veldhuizen S, Rivard L, Cairney J. Relative age effects in the Movement Assessment Battery for Children-2: age banding and scoring errors. Child Care Health Dev 2017; 43:752-757. [PMID: 28295480 DOI: 10.1111/cch.12459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 02/26/2017] [Indexed: 11/28/2022]
Abstract
AIM The Movement Assessment Battery for Children-2 (MABC-2) uses age-grouped scoring, which will result in relative motor functioning being overestimated for some children and underestimated for others. In this paper, we measure these errors and discuss their consequences. METHOD We pool data from two validation studies to obtain a sample of 278 children assessed with the MABC-2 (mean (SD) age: 5 years, 0 months (9.6 months); 142 female). We used regression to measure the association between standard score and relative age, and used these results to estimate misclassification rates at the MABC-2's recommended thresholds. RESULTS Movement Assessment Battery for Children-2 scores were distributed as expected (mean (SD) = 10.4 (2.8)). We estimated that the standard score varied by 2.76 units (0.92 SDs) per year of relative age. Depending on threshold and age bandwidth, this implies overall misclassification rates from 9% to 23%. INTERPRETATION Relative age differences in MABC-2 scores led to substantial systematic error for young children. These errors can affect MABC-2 validity, longitudinal stability and agreement with other tools, which may reduce the appropriateness of care offered to children. Scoring approaches that may reduce or eliminate these errors are outlined.
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Affiliation(s)
- S Veldhuizen
- Infant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - L Rivard
- CanChild Centre for Studies in Childhood Disability, McMaster University, Hamilton, Canada
| | - J Cairney
- Infant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Canada
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Veldhuizen S, Bedard C, Rodriguez C, Cairney J. Psychological distress and parent reporting on child health: The case of developmental delay. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 63:11-17. [PMID: 28242393 DOI: 10.1016/j.ridd.2017.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Caregiver-completed screening questionnaires are a common first step in the identification of developmental delay. A caregiver's mood and anxiety level, however, may affect how he or she perceives and reports possible problems. AIMS In this article, we consider the association between caregiver distress and the accuracy of the Ages and Stages Questionnaire (ASQ), a widely-used screen. METHODS AND PROCEDURES Our sample includes 857 parent-child dyads drawn from the Psychometric Assessment of the NDDS Study (PANS) and the NDDS Alternate Responses Study (NARS). Parents completed the ASQ and the K6, a brief measure of generalized distress. Children were assessed using the Bayley Scales of Infant and Child Development (BSID). We divided children on BSID result and used logistic regression to examine how distress influenced the ASQ's accuracy in each group. RESULTS Of our 857 children, 9% had at least one domain below -2 standard deviations on the BSID, and 17.3% had positive ASQ results. Caregiver distress predicted a positive ASQ substantially and significantly more strongly among BSID-positive children than among others. This translates into slightly reduced ASQ specificity but greatly improved sensitivity among caregivers with higher distress. CONCLUSIONS At low to moderate levels of distress, greater distress is associated with greater ASQ accuracy.
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Affiliation(s)
- Scott Veldhuizen
- INfant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Chloe Bedard
- INfant and Child Health (INCH) Lab, Department of Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Christine Rodriguez
- INfant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - John Cairney
- INfant and Child Health (INCH) Lab, Department of Family Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
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Parental Concerns, Developmental Temperature Taking, and the Necessary Conditions for Developmental Surveillance and Screening. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0095-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Systematic Screening for Developmental Delay in Early Childhood: Problems and Possible Solutions. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0090-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Do We Need to Correct Age for Prematurity When Assessing Children? J Pediatr 2016; 173:11-2. [PMID: 27059914 DOI: 10.1016/j.jpeds.2016.03.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 03/15/2016] [Indexed: 11/24/2022]
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Thompson LM, Peñaloza RA, Stormfields K, Kooistra R, Valencia-Moscoso G, Muslima H, Khan NZ. Validation and adaptation of rapid neurodevelopmental assessment instrument for infants in Guatemala. Child Care Health Dev 2015; 41:1131-9. [PMID: 26250756 PMCID: PMC4715612 DOI: 10.1111/cch.12279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 06/08/2015] [Accepted: 06/28/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Timely detection of neurodevelopmental impairments in children can prompt referral for critical services that may prevent permanent disability. However, screening of impairments is a significant challenge in low-resource countries. We adapted and validated the rapid neurodevelopmental assessment (RNDA) instrument developed in Bangladesh to assess impairment in nine domains: primitive reflexes, gross and fine motor development, vision, hearing, speech, cognition, behaviour and seizures. METHODS We conducted a cross-sectional study of 77 infants (0-12 months) in rural Guatemala in July 2012 and July 2013. We assessed inter-rater reliability and predictive validity between the 27-item RNDA and the 325-item Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and concurrent validity based on chronic malnutrition, a condition associated with neurodevelopmental impairments. For both RNDA and BSID-III, standardized scores below 80 were defined as borderline impairment. RESULTS Children came from rural households (92%), were born to indigenous women of Mayan descent (73%) and had moderate or severe growth stunting (43%). Inter-rater reliability for eight RNDA domains was of moderate to high reliability (weighted κ coefficients, 0.49-0.99). Children screened positive for impairment in fine motor (17%) and gross motor (14%) domains using the RNDA. The RNDA had good concurrent ability; infants who were growth stunted had higher mean levels of impairment in gross motor, speech and cognition domains (all p < 0.001). The RNDA took 20-30 min to complete compared with 45-60 min for BSID-III. CONCLUSIONS Wide-scale implementation of a simple, valid and reliable screening tool like the RNDA by community health workers would facilitate early screening and referral of infants at-risk for neurodevelopmental impairment.
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Affiliation(s)
- Lisa M. Thompson
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco
| | - Reneé Asteria Peñaloza
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco
| | - Kate Stormfields
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco
| | - Rebecca Kooistra
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco
| | | | - Humaira Muslima
- Department of Pediatric Neuroscience, Dhaka Shishu (Children’s) Hospital, Dhaka, Bangladesh
| | - Naila Zaman Khan
- Department of Pediatric Neuroscience, Dhaka Shishu (Children’s) Hospital, Dhaka, Bangladesh
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Veldhuizen S, Clinton J, Rodriguez C, Wade TJ, Cairney J. Concurrent validity of the Ages And Stages Questionnaires and Bayley Developmental Scales in a general population sample. Acad Pediatr 2015; 15:231-7. [PMID: 25224137 DOI: 10.1016/j.acap.2014.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/30/2014] [Accepted: 08/04/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Developmental delay is relatively common and produces serious impairment. Efforts to screen for delay often include parent-completed instruments. We evaluated the agreement between the most popular such instrument, the Ages and Stages Questionnaires (ASQ) and the third edition of the Bayley Scales of Infant Development (BSID-III). METHODS We analyzed a community sample of 587 children aged 1 month to 36 months who received both the ASQ and the BSID-III. We calculate sensitivity, specificity, and positive and negative predictive values. Because published BSID-III norms produced unexpectedly low prevalences, we also derived a set of distribution-based thresholds using quantile regression, and we repeated the validation analysis using these results. RESULTS BSID-III prevalence was 2.9% (95% confidence interval [CI] 1.7-4.6) with published norms and 7.7% (95% CI 5.6-10.1) with distribution-based thresholds, while 18.2% (95% CI 15.2-21.6) of children were positive on the ASQ. For published BSID-III norms, sensitivity was 41% (95% CI 18-67) and specificity 82% (95% CI 79-85). Results with distribution-based thresholds were essentially identical. Performance was somewhat better among children over 1 year (sensitivity 50%, specificity 87%). For subscales, sensitivities were generally lower (range 0-50%) and specificities higher (range 92-96%). CONCLUSIONS Agreement between the ASQ and BSID-III was relatively poor. Previous studies have reported somewhat better agreement. There are numerous possible explanations for differences, including the age ranges used, the risk profile of children, and differences in the ASQ administration. Results raise concerns about the performance of this instrument in primary care and community settings.
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Affiliation(s)
- Scott Veldhuizen
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; Health Services and Health Equity Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Jean Clinton
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada; Departments of Psychiatry and Behavioral Neurosciences and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Christine Rodriguez
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Terrance J Wade
- Department of Community Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - John Cairney
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada; Departments of Psychiatry and Behavioral Neurosciences and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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