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Schembri E, Jouve E, Poinso F, Encely L, Viellard M, Fernandez A, Guivarch J. Evaluation of a medically coordinated care program in the management of autism. L'ENCEPHALE 2024:S0013-7006(24)00115-5. [PMID: 38971647 DOI: 10.1016/j.encep.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 07/08/2024]
Abstract
Autism spectrum disorders (ASD) are neurodevelopmental disorders of varying intensity and disability. The reference health strategy in France for the care of young children with autism is day care hospital (DCH). As the number of places in DCH is insufficient, medically coordinated care programs by the mental health consultation centers (MHCC) are being developed in response. OBJECTIVES Our objective is to evaluate the effectiveness of a medically coordinated care program in a MHCC versus the care in DCH of child psychiatry. METHODS Non-inferiority retrospective study comparing the evolution after one year of care of 20 ASD children divided into two groups DCH and MHCC. In the DCH ASD group, the child is taken care of two half-days a week in a day hospital with individual educational care. In the MHCC ASD group, the child benefits from a medically coordinated care program. The medical care is reinforced by more frequent and longer consultations with guidance offered to parents. In both groups, the child receives speech therapy and psychomotor therapy in private practice at the same rate. Comparison is made using a composite criterion associating CARS-2 and VABS-II. Non-inferiority of the medically coordinated care program in autism in reference to DCH was tested on the difference between the changes (DCH group variation - MHCC group variation) with a non-inferiority threshold of 10% of the initial value of each score. RESULTS We observed a reduction in autism severity at the CARS-2 and a moderate improvement in socio-adaptive behavior at the VABS-II in both groups. This trend was even more pronounced in the MHCC group than in the DCH group, but only the greater reduction in CARS-2 severity in the MHCC was statistically significant. CONCLUSIONS As it is necessary to integrate the two scales into the composite criterion, it is not possible to retain the non-inferiority of the MHCC with care program. However, both those children followed in DCH and those in the MHCC care program progress. This shows the relevance of the care offered at the MHCC for children suffering from ASD, in the context of a growing lack of space in DCH. The continuation of this research work through multicenter studies with larger numbers could demonstrate the non-inferiority of coordinated care programs in the MHCC versus DCH. It would also allow subgroups to be set up, taking into account the initial characteristics of the children in order to have more precise indications concerning the relevance of each treatment.
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Affiliation(s)
- Elodie Schembri
- Faculty of Medicine, Aix-Marseille University, Marseille, France; Department of Child Psychiatry, AP-HM, Marseille, France
| | - Elisabeth Jouve
- Aix-Marseille University, Marseille, France; Service Évaluation Médicale, AP-HM, Marseille, France
| | - François Poinso
- Faculty of Medicine, Aix-Marseille University, Marseille, France; Department of Child Psychiatry, AP-HM, Marseille, France; Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille University, Marseille, France
| | - Laure Encely
- Department of Child Psychiatry, AP-HM, Marseille, France
| | | | - Arnaud Fernandez
- Pediatric Hospitals of Nice, CHU-Lenval (HPNCL), Nice, France; University Department of Child and Adolescent Psychiatry (SUPEA), Nice, France; EA CoBTek, University Côte d'Azur (UCA), Nice, France; Adolescent full-time hospitalization (UHCD), Nice, France; Competence Center for Rare Diseases with Psychiatric Expression (CC MREP), Nice, France; Expert Center for Pediatric Psychotrauma (CE2P), Nice, France
| | - Jokthan Guivarch
- Faculty of Medicine, Aix-Marseille University, Marseille, France; Department of Child Psychiatry, AP-HM, Marseille, France; Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix-Marseille University, Marseille, France.
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Afsharnejad B, Black MH, Falkmer M, Bölte S, Girdler S. The Methodological Quality and Intervention Fidelity of Randomised Controlled Trials Evaluating Social Skills Group Programs in Autistic Adolescents: A Systematic Review and Meta-analysis. J Autism Dev Disord 2024; 54:1281-1316. [PMID: 36681732 PMCID: PMC10981608 DOI: 10.1007/s10803-023-05893-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/22/2023]
Abstract
A systematic review and meta-analysis were utilised to explore the methodological quality, program fidelity, and efficacy of social skills group programs (SSGPs) aiming to support autistic adolescents in navigating their everyday social worlds. The study evaluated the methodological quality and theoretical fidelity of studies, with a random effect meta-analysis conducted to summarise the overall efficacy of SSGP and its effect on social communication and interaction, behavioural/emotional challenges, adaptive functioning, and autism characteristics. Although findings from the 18 identified studies indicated an adjusted medium overall effect with these programs successfully supporting autistic adolescents' socialisation needs (g = 0. 60, p < 0.001), most studies demonstrated medium to low program fidelity despite their good methodological quality. Given the significant heterogeneity of SSGPs and variations in the design and measurement frameworks of efficacy studies, understanding the generalisability of the findings of this research is unclear.
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Affiliation(s)
- Bahareh Afsharnejad
- School of Allied Health, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia.
- Curtin Autism Research Group (CARG), Curtin University, Perth, WA, Australia.
| | - Melissa H Black
- School of Allied Health, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia
- Curtin Autism Research Group (CARG), Curtin University, Perth, WA, Australia
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Marita Falkmer
- School of Education and Communication, CHILD, Swedish Institute for Disability Research, Jönköping University, Jönköping, Sweden
| | - Sven Bölte
- School of Allied Health, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia
- Curtin Autism Research Group (CARG), Curtin University, Perth, WA, Australia
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Sonya Girdler
- School of Allied Health, Curtin University, Kent Street, Bentley, Perth, WA, 6102, Australia
- Curtin Autism Research Group (CARG), Curtin University, Perth, WA, Australia
- Division of Neuropsychiatry, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- School of Allied Health, University of Western Australia, Perth, WA, Australia
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3
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Gates JA, McNair ML, Richards JK, Lerner MD. Social Knowledge & Performance in Autism: A Critical Review & Recommendations. Clin Child Fam Psychol Rev 2023; 26:665-689. [PMID: 37544969 PMCID: PMC10613329 DOI: 10.1007/s10567-023-00449-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
Autistic social challenges have long been assumed to arise from a lack of social knowledge ("not knowing what to do"), which has undergirded theory and practice in assessment, treatment, and education. However, emerging evidence suggests these differences may be better accounted for by difficulties with social performance ("doing what they may know"). This distinction has important implications for research, practice, policy, and community support of autistic people. This review examines the theoretical and clinical implications and empirical status of the knowledge-performance distinction in autism. Current evidence suggests that social knowledge deficits are neither definitional nor reliably related to outcomes in autism. Prioritizing social knowledge, then, may produce unanticipated, problematic consequences in terms of accuracy of assessment, intervention effectiveness, and promotion of stigma. It may also yield unrealistic expectations around the value of knowledge for autistic people and their families, yielding important ethical considerations. Conversely, recent evidence highlights performance-related factors as being especially promising for better modeling and addressing social challenges in autism. Prioritizing performance, then, may offer new directions for assessment, substantially different intervention opportunities, and novel methods of inclusion and affirmation. This review touches upon each of these domains and implications, integrates these developments with broader models of social competence in youth, and provides direction for future research and practice regarding social competence in autism.
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Affiliation(s)
| | | | | | - Matthew D Lerner
- Stony Brook University, Stony Brook, USA.
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
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Gates JA, Gerber AH, Miller CE, Lerner MD. Quantifying social skill deficits and strengths profiles in autistic youth. Child Dev 2023; 94:659-673. [PMID: 36573397 PMCID: PMC10658759 DOI: 10.1111/cdev.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
While social difficulties in autism are well-established, questions remain regarding whether these represent challenges in acquiring or performing such skills, reduced social strengths, or a unique distribution across these domains (i.e., social profile). This study empirically derived social profiles of 211 autistic and non-autistic youth (Mage = 13.50; Autistic N = 150; Male N = 151; 85.3% White). Assessments occurred between 2016 and 2020. Results showed that autistic youth exhibit significantly more social acquisition and performance deficits and fewer strengths than nonautistic youth (ds = -.44 to .65). Performance deficits were most-and acquisition deficits least-prominent within autistic profiles, potentially implicating longstanding theoretical models of social difficulties in autism, and supporting new, idiographic approaches for conceptualizing, assessing, and treating social challenges.
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Parsons N, D’Aprano F, Parish A, Hughes ME, Outsikas A. Use of video self-modelling to teach combined vocational and social skills to an adult with autism spectrum disorder. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Autistic adults have difficulty in learning vocational and social skills, which often translates into low employment rates. Video self-modelling (VSM) is an effective educational technique for high-support-needs autistic adults, with the ability to teach challenging vocational skills as well as basic social skills. OBJECTIVE: The present study examined the use of video self-modelling to teach vocational and social skills to a 22-year-old autistic adult. Target behaviours categories included (1) reading order forms, (2) transporting goods, and (3) engaging with customers. METHODS: A multiple baseline design was used to evaluate the effectiveness of the videos in teaching these target behaviours. The dependent variables were the percentage of tasks completed correctly, and quantitative prompt dependency, using a least-to-most prompting strategy. RESULTS: Results showed that VSM modestly improved reading order forms and transporting goods, and moderately improved engagement with customers. CONCLUSION: This intervention resulted in the successful employment of an autistic adult in a job that he desired, whilst teaching him skills he specifically struggled with. As such, VSM should be considered for others wanting to learn combined social and vocational skills.
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Affiliation(s)
- Nicholas Parsons
- Cognitive Neuroscience Unit, Deakin University, Melbourne, VIC, Australia
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Fiore D’Aprano
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Annie Parish
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Matthew E. Hughes
- Australian National Imaging Facility, Swinburne University, Melbourne, VIC, Australia
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Guivarch J, Jouve E, Avenel E, Poinso F, Conforti-Roussel L. Effect of physical therapy on 7- to 10-year-old children with autism spectrum disorder: A retrospective study in a university day hospital. Bull Menninger Clin 2021; 85:385-404. [PMID: 34851684 DOI: 10.1521/bumc.2021.85.4.385] [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: 11/20/2022]
Abstract
More than half of children who have autism spectrum disorder (ASD) suffer from motor impairment. In a retrospective study, the authors investigated the effect of a body-mediated workshop with dance movement therapy (DMT) on the motor skills and social skills of children with ASD by comparing 10 autistic children aged 7 to 10 years who benefited from DMT with 10 autistic children in a control group. Scores on the Movement Assessment Battery for Children and the Vineland Adaptive Behavior Scale were compared. The body-mediated workshop had significant benefits for motricity, especially manual dexterity, and for relational skills. A body-mediated workshop may have a multimodal effect and requires transmodal training. Regarding the mechanisms that explain the benefits and the cascading effect, the roles of imitation and multimodal connections are important.
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Affiliation(s)
- Jokthan Guivarch
- Faculty of Medicine, Aix-Marseille University, Marseille, France.,Department of Child Psychiatry, APHM, Marseille, France.,Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix Marseille University, Marseille, France
| | - Elisabeth Jouve
- Aix Marseille University, Marseille, France.,Service Evaluation Medicale, APHM, Marseille, France
| | - Elodie Avenel
- Department of Child Psychiatry, APHM, Marseille, France
| | - François Poinso
- Faculty of Medicine, Aix-Marseille University, Marseille, France.,Department of Child Psychiatry, APHM, Marseille, France.,Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix Marseille University, Marseille, France
| | - Laura Conforti-Roussel
- Unit of Child and Adolescent Psychiatry, Montpellier-Saint Eloi Hospital, Montpellier, France.,Department of Child Psychiatry, Bezier Hospital, Bezier, France
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Implicit and Explicit Memory in Youths with High-Functioning Autism Spectrum Disorder: A Case-Control Study. J Clin Med 2021; 10:jcm10184283. [PMID: 34575393 PMCID: PMC8464918 DOI: 10.3390/jcm10184283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 11/17/2022] Open
Abstract
Individuals with autism spectrum disorder (ASD) usually manifest heterogeneous impairments in their higher cognitive functions, including their implicit memory (IM) and explicit memory (EM). However, the findings on IM and EM in youths with ASD remain debated. The aim of this study was to clarify such conflicting results by examining IM and EM using two comparable versions of the Serial Reaction Time Task (SRTT) in the same group of children and adolescents with ASD. Twenty-five youths with high-functioning ASD and 29 age-matched and IQ-matched typically developing youths undertook both tasks. The ability to implicitly learn the temporal sequence of events across the blocks in the SRTT was intact in the youths with ASD. When they were tested for EM, the participants with ASD did not experience a significant reduction in their reaction times during the blocks with the previously learned sequence, suggesting an impairment in EM. Moreover, the participants with ASD were less accurate and made more omissions than the controls in the EM task. The implications of these findings for the establishment of tailored educational programs for children with high-functioning ASD are discussed.
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Popovic SC, Starr EM, Koegel LK. Teaching Initiated Question Asking to Children with Autism Spectrum Disorder Through a Short-Term Parent-Mediated Program. J Autism Dev Disord 2020; 50:3728-3738. [PMID: 32112233 DOI: 10.1007/s10803-020-04426-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study investigated whether a brief parent-mediated intervention would increase the frequency of question asking in children with ASD. Mothers participated in a 3-week training consisting of 2-h sessions twice weekly. Data were collected in the context of concurrent multiple baseline design. Results demonstrate all three children increased frequency of question asking with two children maintaining gains. All three children demonstrated generalization of question asking to novel items, family members, and/or settings. Affect improved for two of the three children. Overall, mothers were able to reach Fidelity of Implementation during most sessions and rated the intervention as highly acceptable. Results are discussed in regard to the feasibility of providing a short-term parent-implemented intervention to increase social initiations through question asking.
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Affiliation(s)
- Svetlana C Popovic
- Faculty of Education, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada.
| | - Elizabeth M Starr
- Faculty of Education, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Lynn K Koegel
- Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry and Child Development, Stanford University, 410 Quarry Road, Stanford, CA, 94305, USA
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Keifer CM, Mikami AY, Morris JP, Libsack EJ, Lerner MD. Prediction of social behavior in autism spectrum disorders: Explicit versus implicit social cognition. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1758-1772. [PMID: 32484000 DOI: 10.1177/1362361320922058] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
LAY ABSTRACT Difficulties with social communication and interaction are a hallmark feature of autism spectrum disorder. These difficulties may be the result of problems with explicit social cognition (effortful and largely conscious processes) such as learning and recalling social norms or rules. Alternatively, social deficits may stem from problems with implicit social cognition (rapid and largely unconscious processes) such as the efficient integration of social information. The goal of this study was to determine how problems in explicit and implicit social cognition relate to social behavior in 34 youth with autism spectrum disorder. We measured aspects of implicit and explicit social cognition abilities in the laboratory using behavioral, cognitive, and brain (electrophysiological) measures. We then used those measures to predict "real-world" social behavior as reported by parents, clinicians, and independent observers. Results showed that overall better aspects of implicit and explicit social cognition predicted more competent social behavior. In addition, the ability to fluidly integrate social information (implicit social cognition) was more frequently related to competent social behavior that merely knowing what to do in social situations (explicit social cognition). These findings may help with the development of interventions focusing on improving social deficits.
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Affiliation(s)
| | - Amori Yee Mikami
- The University of British Columbia, Canada.,University of Virginia, USA
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Marro BM, Kang E, Hauschild KM, Normansell KM, Abu-Ramadan TM, Lerner MD. Social performance–based interventions promote gains in social knowledge in the absence of explicit training for youth with autism spectrum disorder. Bull Menninger Clin 2019; 83:301-325. [DOI: 10.1521/bumc.2019.83.3.301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Youth with autism spectrum disorder (ASD) experience deficits in social knowledge. It has long been theorized that these youth must learn these skills explicitly, and social skills interventions (SSIs) have followed suit. Recently, performance-based SSIs have emerged, which promote in vivo opportunities for social engagement without explicit instruction. Effects of performance-based SSIs on social knowledge have not been examined. This study employs two discrete samples (one lab-based, one community-based) of youth with ASD to examine the effects of performance-based interventions on social knowledge. Results largely support the efficacy and effectiveness of improving social knowledge by performance-based interventions without explicit teaching. This indicates that youth with ASD may be able to learn these aspects of social cognition implicitly, rather than exclusively explicitly. The results of the current study also suggest that SSI content, dosage, and intensity may relate to these outcomes, which are important considerations in clinical practice and future studies.
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Korzeniewski SJ, Allred EN, Joseph RM, Heeren T, Kuban KC, O’Shea TM, Leviton A. Neurodevelopment at Age 10 Years of Children Born <28 Weeks With Fetal Growth Restriction. Pediatrics 2017; 140:peds.2017-0697. [PMID: 29030525 PMCID: PMC5654396 DOI: 10.1542/peds.2017-0697] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to evaluate the relationships between fetal growth restriction (FGR) (both severe and less severe) and assessments of cognitive, academic, and adaptive behavior brain function at age 10 years. METHODS At age 10 years, the Extremely Low Gestational Age Newborns Cohort Study assessed the cognitive function, academic achievement, social-communicative function, psychiatric symptoms, and overall quality of life of 889 children born before 28 weeks' gestation. A pediatric epileptologist also interviewed parents as part of a seizure evaluation. The 52 children whose birth weight z scores were <-2 were classified as having severe FGR, and the 113 whose birth weight z scores were between -2 and -1 were considered to have less severe FGR. RESULTS The more severe the growth restriction in utero, the lower the level of function on multiple cognitive and academic achievement assessments performed at age 10 years. Growth-restricted children were also more likely than their extremely preterm peers to have social awareness impairments, autistic mannerisms, autism spectrum diagnoses, difficulty with semantics and speech coherence, and diminished social and psychosocial functioning. They also more frequently had phobias, obsessions, and compulsions (according to teacher, but not parent, report). CONCLUSIONS Among children born extremely preterm, those with severe FGR appear to be at increased risk of multiple cognitive and behavioral dysfunctions at age 10 years, raising the possibility that whatever adversely affected their intrauterine growth also adversely affected multiple domains of cognitive and neurobehavioral development.
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Affiliation(s)
- Steven J. Korzeniewski
- Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, Michigan;,Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
| | - Elizabeth N. Allred
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Tim Heeren
- Department of Biostatistics, School of Public Health
| | - Karl C.K. Kuban
- Boston University, Boston, Massachusetts;,Departments of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
| | - T. Michael O’Shea
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina
| | - Alan Leviton
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Neurology, Harvard Medical School, Harvard University, Boston, Massachusetts
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