A Bayesian Probabilistic Framework for Identification of Individuals with Dyslexia

Purpose

Bayesian-based models for diagnosis are common in medicine but have not been incorporated into identification models for dyslexia. The purpose of the present study was to evaluate Bayesian identification models that included a broader set of predictors and that capitalized on recent developments in modeling the prevalence of dyslexia.

Method

Model-based meta-analysis was used to create a composite correlation matrix that included common predictors of dyslexia such as decoding, phonological awareness, oral language, but also included response to intervention (RTI) and family risk for dyslexia. Bayesian logistic regression models were used to predict poor reading comprehension, unexpectedly poor reading comprehension, poor decoding, and unexpectedly poor decoding, all at two levels of severity.

Results

Most predictors made independent and substantial contributions to prediction, supporting models of dyslexia that rely on multiple rather than single indicators. RTI was the strongest predictor of poor reading comprehension and unexpectedly poor reading comprehension. Phonological awareness was the strongest predictor of poor decoding and unexpectedly poor decoding, followed closely by family risk.

Conclusion

Bayesian-based models are a promising tool for implementing multiple-indicator models of identification. Ideas for improving prediction and implications for theory and practice are discussed.

Long-term functional alterations following prenatal GLP-1R activation

Evidence supporting the use of glucagon-like peptide-1 (GLP-1) analogues to pharmacologically treat disorders beyond type 2 diabetes and obesity is increasing. However, little is known about how activation of the GLP-1 receptor (GLP-1R) during pregnancy affects maternal and offspring outcomes. We treated female C57Bl/6 J mice prior to conception and throughout gestation with a long-lasting GLP-1R agonist, Exendin-4. While GLP-1R activation has significant effects on food and drug reward, depression, locomotor activity, and cognition in adults, we found few changes in these domains in exendin-4-exposed offspring. Repeated injections of Exendin-4 had minimal effects on the dams and may have enhanced maternal care. Offspring exposed to the drug weighed significantly more than their control counterparts during the preweaning period and demonstrated alterations in anxiety-like outcomes, which indicate a developmental role for GLP-1R modulation in the stress response that may be sex-specific.

Effects of Developmental Nicotine Exposure on Frontal Cortical GABA-to-Non-GABA Neuron Ratio and Novelty-Seeking Behavior

Cigarette smoking during pregnancy is a major public health concern, resulting in detrimental health effects in the mother and her offspring. The adverse behavioral consequences for children include increased risk for attention deficit hyperactivity disorder, working memory deficits, epilepsy, novelty-seeking, and risk-taking behaviors. Some of these behavioral conditions are consistent with an imbalance in frontal cortical excitatory (glutamate) and inhibitory (GABA) neurotransmitter signaling. We used a GAD67-GFP knock-in mouse model to examine if developmental nicotine exposure alters frontal cortical GABA neuron numbers, GABA-to-non-GABA neuron ratio and behavioral phenotypes. Female mice were exposed to nicotine (100 or 200 μg/mL) in drinking water beginning 3 weeks prior to breeding and until 3 weeks postpartum. Male and female offspring were examined beginning at 60 days of age. The nicotine exposure produced dose-dependent decreases in GABA-to-non-GABA neuron ratios in the prefrontal and medial prefrontal cortices without perturbing the intrinsic differences in cortical thickness and laminar distribution of GABA or non-GABA neurons between these regions. A significant increase in exploratory behavior and a shift toward "approach" in the approach-avoidance paradigm were also observed. Thus, developmental nicotine exposure shifts the cortical excitation-inhibition balance toward excitation and produces behavioral changes consistent with novelty-seeking behavior.

The practical utility of genetic screening in school settings

Can genetic screening be used to personalize education for students? Genome-wide association studies (GWAS) screen an individual's DNA for specific variations in their genome, and how said variations relate to specific traits. The variations can then be assigned a corresponding weight and summed to produce polygenic scores (PGS) for given traits. Though first developed for disease risk, PGS is now used to predict educational achievement. Using a novel simulation method, this paper examines if PGS could advance screening in schools, a goal of personalized education. Results show limited potential benefits for using PGS to personalize education for individual students. However, further analysis shows PGS can be effectively used alongside progress monitoring measures to screen for learning disability risk. Altogether, PGS is not useful in personalizing education for every child but has potential utility when used simultaneously with additional screening tools to help determine which children may struggle academically.

Data Envelopment Analysis (DEA) in the Educational Sciences

Many of the analytical models commonly used in educational research often aim to maximize explained variance and identify variable importance within models. These models are useful for understanding general ideas and trends, but give limited insight into the individuals within said models. Data envelopment analysis (DEA), is a method rooted in organizational management that makes such insights possible. Unlike models alluded to above, DEA does not explain variance. Instead, it explains how efficiently an individual utilizes their inputs to produce outputs, and identifies which input is not being utilized optimally. This paper provides a history and usages of DEA from fields outside of education, and describes the math and processes behind it. This paper then extends DEA's usage into the educational field using a study on child reading ability. Using students from the Project KIDS dataset (n=1987), DEA is demonstrated using a simple view of reading framework, identifying individual efficiency levels in using reading-based skills to achieve reading comprehension, determining which skills are being underutilized, and classifying new subsets of readers. New subsets of readers were identified using this method, with implications for more targeted interventions.

Measures of Early Social Communication and Vocabulary Production to Predict Language Outcomes at Two and Three Years in Late-Talking Toddlers

BACKGROUND

Late talkers are a heterogeneous group of toddlers and reliable predictors of persistent language delay have been elusive. The purpose of this study was to determine the extent to which early social communication and vocabulary production predicted variance in language outcomes at 2 and 3 years of age.

METHODS

Participants were 408 typically developing and late-talking toddlers who completed the Communication and Symbolic Behavior Scales Caregiver Questionnaire and Behavior Sample (CSBS CQ and CSBS BS) at a mean of 20 months, the Language Development Survey (LDS) at a mean of 24 months, and the Mullen Scales of Early Learning (MSEL) at a mean of 25 months. A subgroup of 198 children completed a second MSEL at 3 years of age. Associations among the LDS, CSBS CQ, CSBS BS, and MSEL were examined using correlational and hierarchical linear regression analyses. Logistic regression was used to examine each measure's contribution to predicting language delay at 2 and 3 years.

RESULTS

Moderate to large correlations were observed among all variables. The LDS, CSBS CQ, and CSBS BS added unique contributions to the prediction of 2- and 3-year expressive and receptive language outcomes. Measures of speech and vocabulary production were the strongest predictors of language outcomes at age 2. At age 3, social and symbolic communication played a more significant role in accounting for variance in expressive and receptive language outcome. A similar pattern emerged for the categorical prediction of language delay.

CONCLUSIONS

Measures of social communication between 18-21 months added important information to predicting language outcomes at 2 and 3 years, above and beyond parent-reported expressive vocabulary production measured at 24 months, with small effect sizes overall. Implications for identifying younger children who are at risk for continued language delay and recommendations for referral to early intervention programs are discussed.

Cluster randomized trial of the classroom SCERTS intervention for elementary students with autism spectrum disorder

OBJECTIVE

This cluster randomized trial (CRT) evaluated the efficacy of the Classroom Social, Communication, Emotional Regulation, and Transactional Support (SCERTS) Intervention (CSI) compared with usual school-based education with autism training modules (ATM).

METHOD

Sixty schools with 197 students with autism spectrum disorder (ASD) in 129 classrooms were randomly assigned to CSI or ATM. Mean student age was 6.79 years (SD 1.05) and 81.2% were male. CSI teachers were trained on the model and provided coaching throughout the school year to assist with implementation. A CRT, with students nested within general and special education classrooms nested within schools, was used to evaluate student outcomes.

RESULTS

The CSI group showed significantly better outcomes than the ATM group on observed measures of classroom active engagement with respect to social interaction. The CSI group also had significantly better outcomes on measures of adaptive communication, social skills, and executive functioning with Cohen's d effect sizes ranging from 0.31 to 0.45.

CONCLUSION

These findings support the preliminary efficacy of CSI, a classroom-based, teacher-implemented intervention for improving active engagement, adaptive communication, social skills, executive functioning, and problem behavior within a heterogeneous sample of students with ASD. This makes a significant contribution to the literature by demonstrating efficacy of a classroom-based teacher-implemented intervention with a heterogeneous group of students with ASD using both observed and reported measures. (PsycINFO Database Record

Combining Old and New for Better Understanding and Predicting Dyslexia

Despite decades of research, it has been difficult to achieve consensus on a definition of common learning disabilities such as dyslexia. This lack of consensus represents a fundamental problem for the field. Our approach to addressing this issue is to use model-based meta-analyses and Bayesian models with informative priors to combine the results of a large number of studies for the purpose of yielding a more stable and well-supported conceptualization of reading disability. A prerequisite to implementing these models is establishing informative priors for dyslexia. We illustrate a new approach for doing so based on the known distribution of the difference between correlated variables, and use this distribution to determine the proportion of poor readers whose poor reading is unexpected (i.e., likely to be due to dyslexia) as opposed to expected.

Predictors of Item Accuracy on the Test de Vocabulario en Imagenes Peabody for Spanish-English Speaking Children in the United States

This study examines the response patterns of 288 Spanish-English dual language learners on a standardized test of receptive Spanish vocabulary. Investigators analyzed responses to 54 items on the Test de Vocabulario en Imagenes (TVIP) (Dunn & Dunn, 2007) focusing on differential accuracy on items influenced by a) cross-linguistic overlap, b) context (home/school), and c) word frequency in Spanish. The response patterns showed cross-linguistic overlap in phonology was a significant predictor of accuracy at the item level. After accounting for item number (expected difficulty level), context of exposure was a significant predictor of the likelihood of obtaining a correct response. Spanish word frequency was not a significant predictor of accuracy. The current findings substantiate the influence of cross-linguistic overlap in phonology and context on Spanish vocabulary recognition by Spanish-English speaking children. Children were more likely to obtain correct responses on lexical items that were associated with the home context. Researchers and practitioners should consider phonological cross-linguistic overlap in addition to context of word exposure and word frequency when designing and utilizing vocabulary assessments for children from linguistic minority backgrounds.

Consequences of Misspecifying Levels of Variance in Cross-Classified Longitudinal Data Structures

The purpose of this study was to determine if modeling school and classroom effects was necessary in estimating passage reading growth across elementary grades. Longitudinal data from 8367 students in 2989 classrooms in 202 Reading First schools were used in this study and were obtained from the Progress Monitoring and Reporting Network maintained by the Florida Center for Reading Research. Oral reading fluency (ORF) was assessed four times per school year. Five growth models with varying levels of data (student, classroom, and school) were estimated in order to determine which structures were necessary to correctly partition variance and accurately estimate standard errors for growth parameters. Because the results illustrate that not modeling higher-level clustering inflated lower-level variance estimates and in some cases led to biased standard errors, the authors recommend the practice of including classroom cross-classification and school nesting when predicting longitudinal student outcomes.

Factor structure and aetiological architecture of the BRIEF: A twin study

Executive function is a broad construct that encompasses various processes involved in goal-directed behaviour in non-routine situations (Banich, 2009). The present study uses a sample of 560 5- to 16-year-old twin pairs (M = 11.14, SD = 2.53): 219 monozygotic twin pairs (114 female; 105 male) and 341 dizygotic twin pairs (136 female, 107 male; 98 opposite sex) to extend prior literature by providing information about the factor structure and the genetic and environmental architecture of the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000, Child Neuropsychol., 6, 235; Gioia et al., 2000, Behavior rating inventory of executive function, Lutz, FL: Psychological Assessment Resources), a multifaceted rating scale of everyday executive functions. Phenotypic results revealed a 9-scale, 3-factor model best represents the BRIEF structure within the current sample. Results of the genetically sensitive analyses indicated the presence of rater bias/contrast effects for the Initiate, Working Memory, and Task-Monitor scales. Additive genetic and non-shared environmental influences were present for the Initiate, Plan/Organize, Organization of Materials, Shift, and Monitor and Self-Monitor scales. Influences on Emotional Control were solely environmental. Interestingly, the aetiological architecture observed was similar to that of performance-based measures of executive function. This observed similarity provided additional evidence for the usefulness of the BRIEF as a measure of 'everyday' executive function.

Reading development in young children: genetic and environmental influences

The development of reading skills in typical students is commonly described as a rapid growth across early grades of active reading education, with a slowing down of growth as active instruction tapers. This study examined the extent to which genetics and environments influence these growth rates. Participants were 371 twin pairs, aged approximately 6 through 12, from the Western Reserve Reading Project. Development of word-level reading, reading comprehension, and rapid naming was examined using genetically sensitive latent quadratic growth curve modeling. Results confirmed the developmental trajectory described in the phenotypic literature. Furthermore, the same shared environmental influences were related to early reading skills and subsequent growth, but genetic influences on these factors were unique.

Reading development in young children: genetic and environmental influences

The development of reading skills in typical students is commonly described as a rapid growth across early grades of active reading education, with a slowing down of growth as active instruction tapers. This study examined the extent to which genetics and environments influence these growth rates. Participants were 371 twin pairs, aged approximately 6 through 12, from the Western Reserve Reading Project. Development of word-level reading, reading comprehension, and rapid naming was examined using genetically sensitive latent quadratic growth curve modeling. Results confirmed the developmental trajectory described in the phenotypic literature. Furthermore, the same shared environmental influences were related to early reading skills and subsequent growth, but genetic influences on these factors were unique.

Predicting individual differences in reading comprehension: a twin study

We examined the Simple View of reading from a behavioral genetic perspective. Two aspects of word decoding (phonological decoding and word recognition), two aspects of oral language skill (listening comprehension and vocabulary), and reading comprehension were assessed in a twin sample at age 9. Using latent factor models, we found that overlap among phonological decoding, word recognition, listening comprehension, vocabulary, and reading comprehension was primarily due to genetic influences. Shared environmental influences accounted for associations among word recognition, listening comprehension, vocabulary, and reading comprehension. Independent of phonological decoding and word recognition, there was a separate genetic link between listening comprehension, vocabulary, and reading comprehension and a specific shared environmental link between vocabulary and reading comprehension. There were no residual genetic or environmental influences on reading comprehension. The findings provide evidence for a genetic basis to the "Simple View" of reading.

Teacher quality moderates the genetic effects on early reading

Children's reading achievement is influenced by genetics as well as by family and school environments. The importance of teacher quality as a specific school environmental influence on reading achievement is unknown. We studied first- and second-grade students in Florida from schools representing diverse environments. Comparison of monozygotic and dizygotic twins, differentiating genetic similarities of 100% and 50%, provided an estimate of genetic variance in reading achievement. Teacher quality was measured by how much reading gain the non-twin classmates achieved. The magnitude of genetic variance associated with twins' oral reading fluency increased as the quality of their teacher increased. In circumstances where the teachers are all excellent, the variability in student reading achievement may appear to be largely due to genetics. However, poor teaching impedes the ability of children to reach their potential.

Conversational language use as a predictor of early reading development: language history as a moderating variable

PURPOSE

The present study examined the nature of concurrent and predictive associations between conversational language use and reading development during early school-age years.

METHOD

Language and reading data from 380 twins in the Western Reserve Reading Project were examined via phenotypic correlations and multilevel modeling on exploratory latent factors.

RESULTS

In the concurrent prediction of children's early reading abilities, a significant interaction emerged between children's conversational language abilities and their history of reported language difficulties. Specifically, conversational language concurrently predicted reading development above and beyond variance accounted for by formal vocabulary scores, but only in children with a history of reported language difficulties. A similar trend was noted in predicting reading skills 1 year later, but the interaction was not statistically significant.

CONCLUSIONS

Findings suggest a more nuanced view of the association between spoken language and early reading than is commonly proposed. One possibility is that children with and without a history of reported language difficulties rely on different skills, or the same skills to differing degrees, when completing early reading-related tasks. Future studies should examine the causal link between conversational language and early reading specifically in children with a history of reported language difficulties.

Conduct problems, IQ, and household chaos: a longitudinal multi-informant study

BACKGROUND

We tested the hypothesis that household chaos would be associated with lower child IQ and more child conduct problems concurrently and longitudinally over two years while controlling for housing conditions, parent education/IQ, literacy environment, parental warmth/negativity, and stressful events.

METHODS

The sample included 302 families with same-sex twins (58% female) in Kindergarten/1st grade at the first assessment. Parents' and observers' ratings were gathered, with some collected over a two-year period.

RESULTS

Chaos varied widely. There was substantial mother-father agreement and longitudinal stability. Chaos covaried with poorer housing conditions, lower parental education/IQ, poorer home literacy environment, higher stress, higher negativity and lower warmth. Chaos statistically predicted lower IQ and more conduct problems, beyond the effects of other home environment factors.

CONCLUSIONS

Even with other home environment factors controlled, higher levels of chaos were linked concurrently with lower child IQ, and concurrently and longitudinally with more child conduct problems. Parent self-reported chaos represents an important aspect of housing and family functioning, with respect to children's cognitive and behavioral functioning.

Environmental influences on the longitudinal covariance of expressive vocabulary: measuring the home literacy environment in a genetically sensitive design

BACKGROUND

Despite the well-replicated relationship between the home literacy environment and expressive vocabulary, few studies have examined the extent to which the home literacy environment is associated with the development of early vocabulary ability in the context of genetic influences. This study examined the influence of the home literacy environment on the longitudinal covariance of expressive vocabulary within a genetically sensitive design.

METHODS

Participants were drawn from the Western Reserve Reading Project, a longitudinal twin project of 314 twin pairs based in Ohio. Twins were assessed via three annual home visits during early elementary school; expressive vocabulary was measured via the Boston Naming Test (BNT), and the Home Literacy Environment (HLE) was assessed using mothers' report.

RESULTS

The heritability of the BNT was moderate and significant at each measurement occasion, h(2) = .29-.49, as were the estimates of the shared environment, c(2) = .27-.39. HLE accounted for between 6-10% of the total variance in each year of vocabulary assessment. Furthermore, 7-9% of the total variance of the stability over time in BNT was accounted for by covariance in the home literacy environment.

CONCLUSIONS

These results indicate that aspects of the home literacy environment, as reported by mothers, account for some of the shared environmental variance associated with expressive vocabulary in school aged children.

Reading First kindergarten classroom instruction and students' growth in phonological awareness and letter naming-decoding fluency

This study investigated the role of the amount, content, and implementation of reading instruction provided by 17 kindergarten teachers in eight Reading First elementary schools as it related to students' progress (n=286 students) on early reading assessments of phonological awareness and letter naming-decoding fluency. Children's phonological awareness and letter naming-decoding fluency grew significantly from fall to spring. On average, across the three 60 min observations, teachers provided over 30 min a day of phonological awareness and phonics instruction and 15 min a day of vocabulary and comprehension instruction. Global ratings of instructional quality revealed two implementation factors: explicit and individualized implementation and meaningful interactions around text. Hierarchical linear modeling revealed that the amounts of specific instructional content, as well as how this instruction was implemented, was related to students' letter knowledge and phonological awareness skill growth.

Longitudinal genetic analysis of early reading: The Western Reserve Reading Project

We examined the genetic and environmental contribution to the stability and instability of reading outcomes in early elementary school using a sample of 283 twin pairs drawn from the Western Reserve Reading Project. Twins were assessed across two measurement occasions. In Wave 1, children were either in kindergarten or first grade. Wave 2 assessments were conducted one year later. Results suggested substantial genetic stability across measurement occasions. Additionally, shared environmental influences also accounted for stability, particularly for variables more closely tied to direct instruction such as phonological awareness, letter knowledge, and word knowledge. There was also evidence for independent genetic and shared environmental effects, suggesting that new sources of variance may emerge as the demands of school change and children begin to acquire early reading skills.

Children's history of speech-language difficulties: genetic influences and associations with reading-related measures

PURPOSE

This study examined (a) the extent of genetic and environmental influences on children's articulation and language difficulties and (b) the phenotypic associations between such difficulties and direct assessments of reading-related skills during early school-age years.

METHOD

Behavioral genetic analyses focused on parent-report data regarding the speech-language skills of 248 twin pairs (M = 6.08 years) from the Western Reserve Reading Project. In addition, phenotypic associations between children's speech-language status and direct assessments of early reading-related abilities were examined through hierarchical linear modeling (HLM).

RESULTS

Probandwise concordance rates and intraclass tetrachoric correlations indicated high heritability for children's difficulties in expressive language and articulation, with estimates of .54 and .97 accordingly. HLM results indicated that children with histories of speech-language difficulties scored significantly lower than unaffected children on various measures of early reading-related abilities.

CONCLUSIONS

Results from the parent-report survey provided converging evidence of genetic effects on children's speech and language difficulties and suggest that children with a history of speech-language difficulties are at risk for lower performance on early reading-related measures. The extent of risk differed across measures and appeared greatest for children who demonstrated a history of difficulties across articulation, expressive language, and receptive language. Implications for future genetic research and clinical practice are discussed.

Perception of unmet basic needs as a predictor of physical functioning among community-dwelling older adults

OBJECTIVES

The present study examined the influence of participant's perception that their basic needs were not being met on their physical functioning problems. The association between lower social economic status (SES), typically indexed by income and education, and physical disability has been clearly established. Although income and education are not easily modifiable among older adults, perceptions of resource deficits may be more easily influenced through interventions.

METHOD

Among community-dwelling older adults (N = 4,162), the authors examined the influence of participants' perception that their basic needs were not being met on physical functioning problems during a 10-year period using growth curve analyses.

RESULTS

Baseline problems meeting basic needs influenced the growth in physical functioning problems, even after controlling for more objective indices of SES and for health problems and behaviors.

DISCUSSION

Interventions focused on providing older adults with resources for meeting basic needs may substantially reduce the subsequent level of disability.

Personality differences in children and adolescents with attention-deficit/hyperactivity disorder, conduct disorder, and controls

BACKGROUND

Differences in personality profiles were examined between children who differed in their co-morbidity of externalizing disorders: attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD).

METHODS

11- and 17-year-old male and female twins from a community sample were categorized as ADHD only, CD only, co-morbid CD-ADHD, and controls (no ADHD or CD) based on threshold and subthreshold CD and ADHD diagnoses assessed with structured interviews. Multivariate analyses were used to identify patterns of personality that differentiate these four diagnostic groups. It was hypothesized that significant differences would be found in the pattern of personality variables between participants in the co-morbid group, compared to the other three groups, and that these differences would hold across developmental periods.

RESULTS

As expected, the co-morbid group had a pattern of personality marked by higher Negative Emotionality and lower Constraint than the other diagnostic groups. This pattern was evidenced across gender and age cohort.

CONCLUSIONS

An extreme personality profile may represent a liability toward the occurrence of ADHD and CD with more extreme profiles contributing to the occurrence of both disorders among boys and girls. Implications for treatment planning and theoretical development are discussed.

Diagnosing agoraphobia in the context of panic disorder: examining the effect of DSM-IV criteria on diagnostic decision-making

A diagnostic and statistical manual (DSM)-IV diagnosis of agoraphobia in the context of panic disorder (PD) is based on three nosologically sufficient criteria: (1) avoidance, (2) use of companions, and (3) endurance of situations despite distress. Therefore, an agoraphobia diagnosis can be made across an extremely broad range of cases including when there are no avoidance behaviors (e.g., the patient endures the situation). It was hypothesized that clinicians do not weight these criteria equally and that the DSMs individual, sufficient criteria lead to poor inter-rater reliability. Clinicians (N=48) rated hypothetical patients with symptom profiles emphasizing each of these three criteria. Consistent with expectation, clinicians differentially weighted these criteria. Avoidance was relatively more apt to produce a diagnosis when only one criterion was emphasized in clinical vignettes. Inter-rater reliability was poor in instances when only one sufficient criterion was highlighted. Knowledge concerning DSM criteria resulted in a greater rate of agoraphobia endorsement, but knowledge did not account for the overall pattern of findings.

Longitudinal outcomes of Haemophilus influenzae meningitis in school-age children

The purpose of this study was to investigate long-term outcomes of Haemophilus influenzae Type b meningitis in a cohort of school-age survivors. Findings from an initial assessment at mean age 10 years revealed neuropsychological, achievement, and behavioral sequelae in the children with neurologic complications during the acute-phase illness (H. Taylor, C. Schatschneider, & D. Rich, 1992). Here, the cohort was reassessed 1 and 2 years after the initial evaluation to investigate age-related influences on disease sequelae. After excluding children with hearing loss, the sample was divided into 2 groups: an affected group of 39 children with acute-phase neurologic complications and an unaffected group of 73 children without these complications. Growth-curve modeling showed poorer outcomes at the final assessment and less rapid improvement at follow-up for the affected group. Later age at assessment and later age at illness were associated with larger group differences in some outcomes. Results suggest that children with diffuse early brain insults are at risk for later-emerging sequelae.

Utility of kindergarten teacher judgments in identifying early learning problems

Most existing research on early identification of learning difficulties has examined the validity of methods for predicting future academic problems. The present study focused instead on the sensitivity of kindergarten teachers to learning problems in their students and on the continuity of teacher-identified problems over time. To identify early learning problems, kindergarten teachers in a suburban school district rated student progress toward six academic objectives as satisfactory or unsatisfactory. Twenty percent of the district's 303 kindergarten children received unsatisfactory ratings in at least one area. Thirty-eight of these children (identified group) were matched to 34 children with satisfactory ratings in all areas (nonidentified group). Results of testing conducted during kindergarten revealed poorer academic achievement in identified children than in nonidentified children. Children from the identified group also performed more poorly than children from the nonidentified group on tests of phonological processing and working memory/executive function and were rated by teachers as having more behavior and attention problems and lower social competence. Follow-up of the sample to first grade documented continued learning problems in the identified group. These findings support the use of teacher judgements in early detection of learning problems and argue against reliance on discrepancy criteria.

Neurodevelopmental outcomes of Ugandan infants with HIV infection: an application of growth curve analysis

Neurodevelopmental outcomes of human immunodeficiency virus Type 1 (HIV-1)-infected infants of non-drug-using mothers were assessed in a controlled, prospective study from birth to 24 months with 3 groups: 61 infants of HIV-infected mothers, 234 uninfected infants of HIV-infected mothers (seroreverters), and 115 uninfected infants of uninfected mothers. Compared with seroreverters and uninfected infants, HIV-infected infants demonstrated lower mental and motor development on the Bayley Scales and greater deceleration in their rate of motor development. HIV-infected infants with abnormal neurologic exams had lower motor and mental test scores and lower rates of motor Bayley Scales scores than their HIV-infected counterparts with normal neurologic exams. Contrary to prediction, no group differences in mean performance or growth rates were found on visual information processing on the Fagan Test of Infant Intelligence.

Neurodevelopmental outcomes of Ugandan infants with HIV infection: an application of growth curve analysis

Neurodevelopmental outcomes of human immunodeficiency virus Type 1 (HIV-1)-infected infants of non-drug-using mothers were assessed in a controlled, prospective study from birth to 24 months with 3 groups: 61 infants of HIV-infected mothers, 234 uninfected infants of HIV-infected mothers (seroreverters), and 115 uninfected infants of uninfected mothers. Compared with seroreverters and uninfected infants, HIV-infected infants demonstrated lower mental and motor development on the Bayley Scales and greater deceleration in their rate of motor development. HIV-infected infants with abnormal neurologic exams had lower motor and mental test scores and lower rates of motor Bayley Scales scores than their HIV-infected counterparts with normal neurologic exams. Contrary to prediction, no group differences in mean performance or growth rates were found on visual information processing on the Fagan Test of Infant Intelligence.

Predictors of early school age outcomes in very low birth weight children

The purpose of this study was to examine predictors of outcome in very low birth weight (< 1500 g) children. The very low birth weight sample consisted of 68 children weighing less than 750 g at birth and 65 children weighing 750 to 1499 g at birth who had been matched to the less than 750 g birth weight children in terms of hospital of birth, age, sex, and race. Mean ages for these two groups were 6.7 and 6.9 years, respectively. Outcomes were measured in terms of tests of cognitive function, neuropsychological abilities, and academic achievement and parent and teacher ratings of child behavior and school performance. A weighted sum of the number of major neonatal medical complications (Neonatal Risk Index) provided a composite measure of biological risk. Social risks were also assessed. Results indicated that the Neonatal Risk Index was the most consistent predictor of outcomes. Even after taking social risks into account, neonatal risk predicted overall cognitive ability and other achievement, neuropsychological, and behavior outcomes. Individual neonatal complications that predicted outcomes included severe cerebral ultrasonographic abnormality, chronic lung disease, necrotizing enterocolitis, and apnea of prematurity. Research and therapy to prevent or reduce neonatal complications and amelioration of social risks are of critical importance in improving outcomes of very low birth weight.

Acute-phase neurologic complications of Haemophilus influenzae type b meningitis: association with developmental problems at school age

The purposes of this study were to describe the incidence of acute-phase neurologic complications in a sample of 126 children with Haemophilus influenzae type b meningitis, and to determine if these complications were associated with higher rates of learning and behavior problems at school age. Risks were assessed by comparing rates of adverse psychoeducational outcomes in the 53 children in the sample with complications to corresponding outcome rates in the 67 children who were free of neurologic complications and who did not have abnormal electroencephalograms (EEGs) or computed tomographic (CT) scans. Comparisons were made by means of logistic regression analysis. Twenty-nine children (23% of the sample) had seizures, 16 (13%) were comatose or obtunded, 15 (12%) had sensorineural hearing loss, 8 (6%) had hemiparesis, and 7 (6%) had cranial nerve deficits other than hearing loss. Relative to children without complications, those with complications had higher rates of grade repetition and substandard performance on neuropsychological and achievement testing. Adverse outcomes, however, consisted primarily of more subtle cognitive and learning problems; only two of the children in the sample obtained prorated IQ scores below 70. Sequelae were associated with persistent neurologic deficits and bilateral hearing loss, as well as with transient symptoms including seizures, coma, and hemiparesis. While study findings argue against adverse consequences for the vast majority of children treated for this disease, the results clarify learning and behavior outcomes and indicate which children are at greatest risk.

Preinjury family environment as a determinant of recovery from traumatic brain injuries in school-age children

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than environmental factors as predictors of recovery. We addressed this concern using data collected during a prospective study of children with either TBI or orthopedic injuries (OI) and their families. Participants included 53 children with severe TBI, 56 with moderate TBI, and 80 with OI, all from 6 to 12 years of age at the time of injury. Measures of the preinjury family environment were collected shortly after the injury (baseline). Child cognitive and behavioral outcomes were assessed at baseline and at 6- and 12-month follow-ups. Individual growth curve analyses showed that measures of the preinjury family environment consistently predicted both the level of cognitive and behavioral functioning at 12 months postinjury and the rate of intraindividual change during the 12-month follow-up period, even after taking into account group membership and injury severity. In some cases, the preinjury family environment was a significant moderator of the effect of TBI, buffering its impact in high-functioning families and exacerbating it in low-functioning families. Thus, preinjury environmental factors predict recovery following TBI in children, even after accounting for injury-related variables.

Achievement in children with birth weights less than 750 grams with normal cognitive abilities: evidence for specific learning disabilities

Examined achievement, behavior, and neuropsychological outcomes at early school age in a regional population of children < 750-g birth weight who were neurologically intact and who scored in the broad average range on a test of cognitive ability. Comparison groups included children of birth weight 750-1,499 g and children born at full-term. The children < 750 g performed more poorly than the higher birth weight groups on tests of math, even after adjusting for group differences in cognitive ability. Corresponding group differences were found in language, perceptual motor, and attentional skills, but not in behavior outcomes. Findings document specific weaknesses in achievement and neuropsychological skills in children < 750 g birth weight and support the need for early identification and special education interventions.

School-age outcomes in children with birth weights under 750 g

BACKGROUND

Since the mid-1980s, increasing numbers of children with birth weights under 750 g have survived to school age.

METHODS

We matched a regional cohort of 68 surviving children born from 1982 through 1986 with birth weights under 750 g (mean, 670 g; gestational age, 25.7 weeks) with 65 children weighting 750 to 1499 g at birth and 61 children born at term. Growth, neurosensory status, and functioning at school age in the three groups were compared. Associations of biologic and social risk factors with major developmental outcomes were examined by means of logistic-regression analyses.

RESULTS

Children with birth weights under 750 g were inferior to both comparison groups in cognitive ability, psychomotor skills, and academic achievement. They had poorer social skills and adaptive behavior and more behavioral and attention problems. The mean (+/- SD) Mental Processing Composite score for the cohort was 87 +/- 15, as compared with 93 +/- 14 for children with birth weights of 750 to 1499 g and 100 +/- 13 for children born at term (P < 0.001). The rates of mental retardation (IQ < 70) in the three groups were 21, 8, and 2 percent, respectively; the rates of cerebral palsy were 9, 6, and 0 percent; and the rates of severe visual disability were 25, 5, and 2 percent. Major cerebral ultrasonographic abnormalities were associated with mental retardation (odds ratio, 5.4; 95 percent confidence interval, 1.8 to 15.8) and cerebral palsy (odds ratio, 15.2; 95 percent confidence interval, 3.0 to 77.4). Oxygen dependence at 36 weeks was associated with mental retardation (odds ratio, 4.5; 95 percent confidence interval, 1.2 to 10.7) and severe visual disability (odds ratio, 4.3; 95 percent confidence interval, 1.3 to 14.2). Social disadvantage, though associated with several neuropsychological outcomes, was not associated with major developmental impairment.

CONCLUSIONS

Children with birth weights under 750 g who survive represent a subgroup of very-low-birth-weight children who are at high risk for neurobehavioral dysfunction and poor school performance.