Early Life Adversities and Borderline Intellectual Functioning Negatively Impact Limbic System Connectivity in Childhood: A Connectomics-Based Study

Development and Testing of SPIDER-NET: An Interactive Tool for Brain Connectogram Visualization, Sub-Network Exploration and Graph Metrics Quantification

Brain connectomics consists in the modeling of human brain as networks, mathematically represented as numerical connectivity matrices. However, this representation may result in difficult interpretation of the data. To overcome this limitation, graphical representation by connectograms is currently used via open-source tools, which, however, lack user-friendly interfaces and options to explore specific sub-networks. In this context, we developed SPIDER-NET (Software Package Ideal for Deriving Enhanced Representations of brain NETworks), an easy-to-use, flexible, and interactive tool for connectograms generation and sub-network exploration. This study aims to present SPIDER-NET and to test its potential impact on pilot cases. As a working example, structural connectivity (SC) was investigated with SPIDER-NET in a group of 17 healthy controls (HCs) and in two subjects with stroke injury (Case 1 and Case 2, both with a focal lesion affecting part of the right frontal lobe, insular cortex and subcortical structures). 165 parcels were determined from individual structural magnetic resonance imaging data by using the Destrieux atlas, and defined as nodes. SC matrices were derived with Diffusion Tensor Imaging tractography. SC matrices of HCs were averaged to obtain a single group matrix. SC matrices were then used as input for SPIDER-NET. First, SPIDER-NET was used to derive the connectogram of the right hemisphere of Case 1 and Case 2. Then, a sub-network of interest (i.e., including gray matter regions affected by the stroke lesions) was interactively selected and the associated connectograms were derived for Case 1, Case 2 and HCs. Finally, graph-based metrics were derived for whole-brain SC matrices of Case 1, Case 2 and HCs. The software resulted effective in representing the expected (dis) connectivity pattern in the hemisphere affected by the stroke lesion in Cases 1 and 2. Furthermore, SPIDER-NET allowed to test an a priori hypothesis by interactively extracting a sub-network of interest: Case 1 showed a sub-network connectivity pattern different from Case 2, reflecting the different clinical severity. Global and local graph-based metrics derived with SPIDER-NET were different between cases with stroke injury and HCs. The tool proved to be accessible, intuitive, and interactive in brain connectivity investigation and provided both qualitative and quantitative evidence.

Isolated CHDs and neurodevelopmental follow-up using the Bayley Scales of Infant and Toddler Development and the Ages and Stages Questionnaire at 18 and 36 months

OBJECTIVES

To compare early neurocognitive development in children born with and without isolated CHD using the Bayley Scales of Infant and Toddler Development (3rd edition) and the Ages and Stages Questionnaire (3rd edition).

METHODS

Recruitment took place before birth. Women expecting fetuses with and without CHD causing disturbances in the flow of oxygenated blood to the fetal brain were included in a prospective cohort study comprising fetal MRI (previously published) and neurodevelopmental follow-up. We now present the 18- and 36-month neurodevelopmental follow-up using the Bayley Scales according to age and the 6-month-above-age Ages and Stages Questionnaire in 15 children with and 27 children without CHD.

RESULTS

Children with CHD had, compared with the children without CHD, an increased risk of scoring ≤ 100 in the Bayley Scales cognition category at 18 and 36 -months; relative risk 1.7 (95% confidence interval (CI): 1.0-2.8) and 3.1 (CI: 1.2-7.5), respectively. They also achieved lower scores in the 6-month-above-age Ages and Stages Questionnaires (24 and 42 months) communication; mean z-score difference -0.72 (CI: -1.4; -0.1) and -1.06 (CI: -1.8; -0.3) and gross motor; mean z-score difference: -0.87 (CI: -1.7; -0.1) and -1.22 (CI: -2.4; -0.02) categories.

CONCLUSIONS

The children with CHD achieved lower scores in the Bayley Scales cognition category and the Ages and Stages Questionnaire communication and gross motor categories possibly indicative of early neurodevelopmental deficiencies. We recommend early screening and monitoring for neurodevelopmental delays in children with CHD in order to improve further neurodevelopment and educational achievements.

SNAP-25 Single Nucleotide Polymorphisms, Brain Morphology and Intelligence in Children With Borderline Intellectual Functioning: A Mediation Analysis

Borderline intellectual functioning (BIF) is a multifactorial condition in which both genetic and environmental factors are likely to contribute to the clinical outcome. Abnormal cortical development and lower IQ scores were shown to be correlated in BIF children, but the genetic components of this condition and their possible connection with intelligence and brain morphology have never been investigated in BIF. The synaptosomal-associated protein of 25 kD (SNAP-25) is involved in synaptic plasticity, neural maturation, and neurotransmission, affecting intellectual functioning. We investigated SNAP-25 polymorphisms in BIF and correlated such polymorphisms with intelligence and cortical thickness, using socioeconomic status and environmental stress as covariates as a good proxy of the variables that determine intellectual abilities. Thirty-three children with a diagnosis of BIF were enrolled in the study. SNAP-25 polymorphisms rs363050, rs363039, rs363043, rs3746544, and rs1051312 were analyzed by genotyping; cortical thickness was studied by MRI; intelligence was measured using the WISC-III/IV subscales; environmental stressors playing a role in neuropsychiatric development were considered as covariate factors. Results showed that BIF children carrying the rs363043(T) minor allele represented by (CT + TT) genotypes were characterized by lower performance Perceptual Reasoning Index and lower full-scale IQ scores (p = 0.04) compared to those carrying the (CC) genotype. This association was correlated with a reduced thickness of the left inferior parietal cortex (direct effect = 0.44) and of the left supramarginal gyrus (direct effect = 0.56). These results suggest a link between SNAP-25 polymorphism and intelligence with the mediation role of brain morphological features in children with BIF.

A New Perspective on the Role of Self-Confidence and Confidence in the Evaluation and Rehabilitation of Children With Adverse Life Experience and Borderline Intellectual Functioning: A Preliminary Study

The borderline intellectual functioning (BIF) is a neurodevelopmental condition characterized by a borderline intelligence quotient (range 70-85) with difficulties in cognitive and social domains. Children with BIF often live in adverse conditions and show academic and behavioral difficulties. Rehabilitation programs for these children focus mainly on cognitive aspects, sometimes with the aid of new technologies that are able to engage and motivate. In this framework, the affective development of children with BIF and its possible role both in the difficulties they manifest and in the rehabilitation is still poorly investigated. In this work, we investigate the characteristics of the internal working models of these children by applying the separation anxiety test, using both the classical and a new coding system to identify the specific features of the attachment representation. Results delineate a profile characterized by low self-confidence and high separation anxiety, with a tendency to somatization. In the light of these results, we suggest that this attachment profile has an impact on the therapeutic relationships and on the efficacy in the use of technological devices. We propose a new perspective in which the interpersonal relationship with the psychologist and the support of the self-confidence of children are crucial to treating cognitive and behavioral difficulties in children with BIF. Only in this case, the use of new technologies and tools may be effective in promoting the greatest possible benefit from therapeutic interventions.

Rehabilitation and Disability Spectrum From Adverse Childhood Experience: The Impact of the Movement Cognition and Narration of Emotions Treatment (MCNT) Version 2.0

Adverse Childhood Experiences (ACE) are associated with an increased risk of cerebral, behavioral, and cognitive outcomes, and vulnerability to develop a Borderline Intellectual Functioning (BIF). BIF is characterized by an intelligence quotient (IQ) in the range 70-85, poor executive functioning, difficulties in emotion processing, and motor competencies. All these difficulties can lead to mental and/or neurodevelopmental disorders that require long-term care. Accordingly, we developed an intensive and multidomain rehabilitation program for children with ACE and BIF, termed the Movement Cognition and Narration of emotions Treatment (MCNT1.0). The efficacy of MCNT1.0 on cognitive and social functioning was demonstrated with a previously reported randomized controlled trial (RCT). To extend the impact of the treatment also to the motor domain a new version, called MCNT2.0, was implemented. The present study aims to verify the feasibility of MCNT2.0 and its effects on the motor domain. A quasi-experimental approach was used in which a group of 18 children with ACE and BIF were consecutively recruited and participated in the MCNT 2.0 program. Participants were compared with the MCNT1.0 group as an active comparator, using the dataset of the RCT. The two groups received a full evaluation comprising: the Wechsler Intelligent Scale for Children-IV (WISC-IV), the Movement-ABC (M-ABC), the Test of Gross Motor Development (TGMD), the Social Skills from Vineland Adaptive Behavioral Scale-II (VABS-II) and the Child Behavior Check List 6-18 (CBCL). An ANCOVA was carried out on changes in the scale scores from baseline with age and baseline score as covariates. Results showed a mean adherence to treatment of 0.85 (sd = 0.07), with no differences between groups in IQ, and Social Skills changes, while greater improvements for motor abilities were shown in the MCNT 2.0 group: M-ABC (p = 0.002), and TGMD (p = 0.002). Finally, greater improvement in the CBCL scale was observed in the MCNT 1.0 group (p = 0.002). Results indicate that due to its positive effects on cognitive, social participation and motor domains, MCNT2.0 may represent a protective factor against maladaptive outcomes of children with ACE and BIF.