Validity and internal consistency of the Ages and Stages Questionnaire 60-month version and the effect of three scoring methods

Background

The Ages and Stages Questionnaire (ASQ) is currently the most used parent-completed developmental screener consisting of different age-specific questionnaires. Psychometric evaluation of the ASQ 60-month version (ASQ-60) is limited. Furthermore, it is unclear which of the available scoring methods of the ASQ is most useful in the identification of children with potential developmental problems.

Aim

To evaluate the internal consistency and construct validity of the ASQ-60 with a large sample size, and to assess the effects of three scoring-methods on this validity.

Study design

Parents of 394 term-born and 1063 preterm-born children from the prospective cohort-study Lollipop completed the ASQ-60 and a general questionnaire on school-problems.

Outcome measures

Internal consistency and construct validity of the ASQ-60 were determined using the ASQ total score. Construct validity was also determined using two other types of scoring-methods based on low domain-scores (‘ASQ domain score’) and parental concerns (‘ASQ total score with parental concerns’).

Results

Cronbach's alpha for total score was 0.86, confirming internal consistency. Male gender, prematurity, low paternal education, low family income and small-for-gestational-age were associated with low ‘ASQ total scores,’ confirming construct validity. Regarding construct validity with special education as criterion, sensitivity was best using the ‘ASQ domain score’ or the ‘ASQ total score’ with parental concerns (both 0.96). However, the specificity was best (0.93) using the ASQ total score.

Conclusion

The ASQ-60 has a good internal consistency and validity to screen for developmental problems in the general population. The ‘ASQ total score’ has the best performance, the ‘ASQ domain score’ is recommended in case of preferred high sensitivity.     

Minor neurological dysfunction and cognition in 9-year-olds born at term

Background

In children with developmental disorders, motor problems often co-occur with cognitive difficulties. Associations between specific cognitive deficits underlying learning problems and minor neurological dysfunction (MND) are still unknown.

Aims

To assess associations between specific types of MND as clinical markers of non-optimal brain function and performance in specific cognitive domains.

Study design

Part of a randomized controlled trial.

Subjects

Three hundred and forty one 9-year-old children born at term (177 boys, 164 girls).

Outcome measures

Children were neurologically assessed to detect eight types of MND: mild dysfunction in posture and muscle tone, reflexes, coordination, fine manipulative ability, sensory function, cranial nerve function, choreiform dyskinesia and excessive associated movements. Cognitive function in the domains of attention, memory and language was evaluated using the Test of Everyday Attention for Children (TEA-Ch), a developmental neuropsychological assessment (NEPSY) and the Children's Memory Scale.

Results

Fine manipulative disability and coordination problems were associated with lower scores on attention, memory and learning and language, other types of MND were not. Girls with coordination problems performed significantly worse on attention/executive function than those without this dysfunction; however, in boys, such association was absent.

Conclusion

Particularly, fine manipulative disability and coordination problems were associated with worse cognitive function in the domains of attention, learning and memory and language. Previous and present data suggest a minor sex difference in neurocognitive associations: in girls dysfunction of the cerebello-thalamo-cortical pathways may be associated with cognitive deficits, while in boys cognitive impairment may be associated with dysfunction of cortico-striato-thalamo-cortical pathways.     

Developmental effects of micronutrient supplementation and malaria in Zanzibari children

Background

Children's development is affected by the interplay of internal and external factors and changes in one factor can precipitate changes in multiple developmental domains.

Aims

The aim of this study was to test a theoretical model of children's development using structural equation modeling.

Study design

This was designed as a substudy of a randomized, placebo-controlled, 2 × 2 factorial trial of the effects of daily supplementation with iron (12.5 mg) + folic acid (50 μg) (FeFA) with or without zinc (10 mg) (Zn) on child mortality.

Subjects

Zanzibari children aged 5–9 mo (n = 106) and 10–14 mo (n = 141) at baseline were included in this sub study.

Outcome measures

Longitudinal data on children's hemoglobin, growth, malaria infection, motor development, motor activity, and language development and caregiver behavior were used to test the fit of the theoretical model for two age groups and to examine the direct and indirect relationships among the variables in the model.

Results

The theoretical models were a good fit to the data for both age groups and revealed that FeFA with or without Zn had positive effects on motor development. FeFA alone had negative effects on language development in both age groups and Zn alone had negative effects on language development in children aged 10–14 mo. The incidence of malaria had negative effects on the majority of health and development outcomes in children aged 5–9 mo, and on motor development and hemoglobin in children aged 10–14 mo.

Conclusions

These findings illustrate how nutrition and health factors can affect different domains of development and how these changes can precipitate changes in other domains. More work is needed to better understand the multiple impacts of internal and external factors on children's development and how changes in developmental domains interact with each other over time to determine children's overall developmental trajectory. The randomized, placebo-controlled study was registered as an International Standard Randomized Controlled Trial, number ISRCTN59549825.     

Characterizing early detection of language difficulties in children born preterm

Background

The optimal age for assessing language difficulties in premature children remains unclear.

Aims

To determine the most predictive and earliest screening tool for later language difficulties on children born preterm.

Study design

A prospective population-based study in the Loire Infant Follow-up Team LIFT

Subjects

All children born < 35 weeks of gestation between 2003 and 2005 were assessed at corrected ages by four screening tools: the Ages & Stages Questionnaire (ASQ) communication scale at 18 and 24 months, the language items of Brunet Lezine test at 24 months, and the “Epreuves de Repérage des Troubles du Langage” (ERTL) at 4 years.

Outcome measures

After 5 years, the kindergarten teacher evaluated the vocabulary, grammar and pronunciation capacities of the child in comparison with the classroom performances.

Results

Among 1957 infants enrolled at discharge, 947 were assessed by their teacher with 12.2% (n = 116) of language difficulties. Full data at all time points were available for 426 infants. The area under curve of the receiver operator characteristic curve obtained for the ASQ communication scale at 18 months was significantly lower (0.65 ± 0.09) than that obtained at 24 months (0.77 ± 0.08) and the languages items of Brunet Lezine test at 24 months (0.77 ± 0.08), and the ERTL at 4 years (0.76 ± 0.09). The optimal cut-off value for ASQ communication at 24 months is ≤ 45 [sensitivity of 0.79 (95%CI: 0.70–0.86); specificity of 0.63 (95%CI: 0.59–0.66)].

Conclusions

The Ages & Stages Questionnaire communication scale at 24 corrected months appears as an acceptable test at an early time point to identify preterm children at risk of later language difficulties.     

The effects of maternal stress and child language ability on behavioral outcomes of children with congenital hearing loss at 18-24months

Background

Prior studies have shown that children with congenital hearing loss have increased rates of behavior disorders. Child hearing loss has also been reported to be associated with increased maternal stress. Little is known about the behavior or the predictors of behavioral outcomes of children with hearing loss identified early and receiving Early Intervention services.

Aim

The objective of this study was to identify the behavioral outcomes in early identified children with hearing loss and control hearing children at 18-24 months of age and to examine the impact of stress on early behavior development. It was hypothesized that children with hearing loss will have more behavior problems, and maternal stress will be associated with child behavior problems.

Study design

Prospective observational.

Subjects

Children with and without congenital hearing loss and their mothers.

Outcome measures

The Parenting Stress Index and the Child Behavior Checklist.

Results

Children with hearing loss had increased scores for withdrawn and internalizing behavior. In multivariate analyses after adjusting for hearing loss, Neonatal Intensive Care Unit stay, and socioeconomic status, maternal stress independently contributed to higher scores for internalizing behavior, externalizing behavior, and total behavior problems.

Conclusion

Maternal stress is an important correlate of behavior problems for children with hearing loss and should be considered by Early Intervention providers.     

Language outcomes and service provision of preschool children with congenital hearing loss

Background

Children with congenital hearing loss (HL) are at increased risk of speech and language delays and require increased resource needs.

Methods

Assessments of language, adaptive behavior, and resource needs at mean age of 60 ± 5 months. Effects of age of enrollment in Early Intervention (EI) and degree of HL were evaluated.

Results

Children with HL had lower Reynell verbal comprehension scores (77.6 ± 18 versus 94.8 ± 15; p = 0.0001) and expressive language scores (85.9 ± 19 versus 97.4 ± 15; p = 0.0051) than hearing children. Children with HL enrolled in EI ≤ 3 months versus > 3 months had higher verbal comprehension (86.6 ± 21 versus 70.3 ± 12; p = 0.0143) and expressive language scores (92.1 ± 12 versus 80.5 ± 21; p = 0.0601), respectively. Children with bilateral moderate to profound HL and children with unilateral or bilateral mild HL were more likely to have low verbal comprehension scores versus children with hearing (75.8 ± 17 and 81.0 ± 22 versus 94.8 ± 15; p = 0.001), and receive more special educational services (100% and 100% versus 42%) respectively. After adjusting for degree of HL and Vineland adaptive scores < 70, entry to EI ≤ 3 months was associated with a 13.8 point higher verbal comprehension score (p = 0.047) for children with HL. The model accounted for 26% of variance.

Conclusions

Persistent beneficial effects of early age of entry to EI on verbal comprehension scores are observed for children with congenital HL at preschool age. Children with HL continue to need comprehensive education services.     

Executive function is associated with social competence in preschool-aged children born preterm or full term

Background

Executive function (EF), defined as higher-order cognitive processes used in planning and organizing actions and emotions, is often impaired in children born preterm. Few studies have assessed social competence, the processes and resources required to meet social demands and achieve social goals, in children born preterm. The relations between EF and social competence in preterm and full term preschoolers have not been well characterized.

Aims

To characterize social competence and assess the relationship between EF and social competence in preschool-aged children born preterm or full term.

Study design

Cross-sectional study.

Subjects

Study subjects had a history of preterm birth (≤ 34 weeks of gestation) and birth weight < 2500 g (n = 70). Controls were born full term (≥ 37 weeks) (n = 79).

Outcome measures

Children completed a battery of EF tasks; a mean age-adjusted z-score for the battery was generated for each child. Parents rated child EF on one scale and child social competence on two standardized scales.

Results

Compared to full term children, preterm children showed a lower mean EF battery z-score, poorer parent-rated EF, and poorer scores on the two social competence scales. In hierarchical multiple regression models, EF battery z-score and parent-rated EF made independent contributions to both measures of social competence. Preterm birth explained additional variance for one measure of social competence.

Conclusions

Standard assessment of EF skills and social competence in young preschool children, including children born preterm, may identify at-risk children for long-term social difficulties and may also provide targets for intervention.     

Intérêts de la psychothérapie à médiation sensorielle dans le cadre de la prise en charge des troubles de la relation et de la communication chez des enfants autistes sévèrement déficitaires II : illustration clinique

Background

Sensory and emotional disorders are typical in autism spectrum and were analyzed by psychological, neuropsychological and psychodynamic models of interpretation. Our theoretical analysis revealed that sensory-based solicitation of the autistic patients with intellectual disabilities could allow the revival of the intersubjectivity development. Therefore, the emergence of a relational and communicative dynamic. We conceptualized an approach of psychotherapy with sensory mediation intended to formulate therapeutic proposals for remediation of relationship and communication disorders.

Objectives

In this study, we aim: to present our care devices and method and their application within the framework of a developmental, clinical and experimental research program; to report the main results obtained with five patients as a clinical illustration.

Method

During 18 months, we exposed five patients to individual weekly sessions of psychotherapy with sensory mediation. Our experimental group, constituted of three children presenting severe intellectual disability associated with autistic disorders. It was compared to a control group with two children showing the similar level of intellectual deficiency but without autistic disorders. Quantitative (i.e. statistical) and qualitative analyses of the therapeutic effects were performed in the following domains: sensory integration, social interaction, communication, stereotypies, “positive” behaviors and “negative” behaviors.

Results

The specificity of the sensory profile of children with autistic disorders was shown. Moreover, we calculated a Sensory Integration Index allowing observation of the improvement of the autistic children's sensory integration capacity along the continuous care. Both groups increased significantly their investment of the plurimodal stimulations (i.e. associated proximal and distal stimulations). In parallel, the psychotherapy sessions allowed an increased level of social interaction and communicative skills for both groups. Furthermore, the number of stereotypies decreased for the autistic children in the course of care.     

Validity and Reliability Determination of Denver Developmental Screening Test-II in 0-6 Year–Olds in Tehran

Objective

This research was designed to identify the validity and reliability of the Persian version of Denver Developmental Screening Test II (DDST-II) in Iranian children, in order to provide an appropriate developmental screening tool for Iranian child health workers.

Methods

At first a precise translation of test was done by three specialists in English literature and then it was revised by three pediatricians familiar with developmental domains. Then, DDST-II was performed on 221 children ranging from 0 to 6 years, in four Child Health Clinics, in north, south, east and west regions of Tehran city. In order to determine the agreement coefficient, these children were also evaluated by ASQ test. Because ASQ is designed to use for 4–60 month- old children, children who were out of this rang were evaluated by developmental pediatricians. Available sampling was used. Obtained data was analyzed by SPSS software.

Findings

Developmental disorders were observed in 34% of children who were examined by DDST-II, and in 12% of children who were examined by ASQ test. The estimated consistency coefficient between DDST-II and ASQ was 0.21, which is weak, and between DDST-II and the physicians’ examination was 0.44. The content validity of DDST-II was verified by reviewing books and journals, and by specialists’ opinions. All of the questions in DDST-II had appropriate content validity, and there was no need to change them. Test-retest and Inter-rater methods were used in order to determine reliability of the test, by Cronbach''s α and Kauder-Richardson coefficients. Kauder-Richardson coefficient for different developmental domains was between 61% and 74%, which is good. Cronbach''s α coefficient and Kappa measure of agreement for test-retest were 92% and 87% and for Inter-rater 90% and 76%, respectively.

Conclusion

This research showed that Persian version of DDST-II has a good validity and reliability, and can be used as a screening tool for developmental screening of children in Tehran city.     

Social–emotional delays at 2 years in extremely low gestational age survivors: Correlates of impaired orientation/engagement and emotional regulation

Background

Premature infants are less socially and emotionally competent at school age than infants born at term.

Aims

To evaluate the correlates of social and emotional delays at 2 years of age among prematurely born children.

Study design

This is a prospective cohort study.

Subjects

904 children born at < 28 weeks gestation during 2002–2004 and enrolled in the ELGAN study who survived until age 2 years and returned for a developmental assessment.

Outcome measures

The Bayley Behavior Rating Scale (BRS), a neurological examination, and the Bayley Scales of Infant Development II (BSID-II).

Results

Fully 31% of children had a non-optimal (14%) or questionable (17%) (NO/Q) BRS score for Emotional Regulation (ER), and 27% had a non-optimal (13%) or questionable (14%) score for Orientation/Engagement (O/E). Children with NO/Q scores on ER and O/E were more likely than others to have MDI and PDI scores < 70 and be unable to walk. Antecedents of NO/Q OE scores included multi-fetal pregnancy, while antecedents of NO/Q scores for both ER and O/E included indicators of socioeconomic disadvantage, and male sex.

Conclusions

Over 25% of children born extremely premature exhibit socio-emotional delays during developmental assessment at age 2 years. Antecedents of these delays include sociodemographic characteristics, as well as those common antecedents of other impairments commonly observed among extremely preterm infants.     

Assessment of motor behaviour in high-risk-infants at 3 months predicts motor and cognitive outcomes in 10 years old children

Background

The general movement assessment has mainly been used to identify children with cerebral palsy (CP). A detailed assessment of quality of infant motor repertoire using parts of the “Assessment of Motor Repertoire — 3 to 5 Months” which is based on Prechtl's general movement assessment can possibly identify later motor and cognitive problems in children without CP.

Aims

This study aims to determine whether analysis of quality of infant motor repertoire has predictive value for motor and cognitive outcomes at age 10 in children at risk for later neurological impairment.

Study design

A longitudinal study design was used.

Subjects

Video-recordings of 40 “neurologically high-risk” infants at 14 weeks post-term age were analysed with respect to motor repertoire.

Outcome measures

Fidgety movements were classified as present or absent. Quality of concurrent motor repertoire was classified as normal if smooth and fluent and abnormal if jerky, monotonous or stiff. Poor motor outcome was defined as a score ≤ 5th centile on the Movement-Assessment-Battery-2, while poor cognitive outcome as total IQ < 85 on Wechsler Intelligence Scale-III.

Results

Among the high-risk children with presence of fidgety movements, poor motor and/or cognitive outcome at 10 years was identified by abnormal concurrent motor repertoire at 14 weeks post-term age in 86% (95% CI: 0.60–0.96) of the children. On the other hand, 71% (95% CI: 0.47–0.87) of those with normal motor and cognitive outcomes were identified by presence of fidgety movements and normal motor repertoire.

Conclusions

Assessment of quality of infant motor repertoire may be a valuable early clinical marker for later impaired motor and cognitive outcomes in high-risk children who do not develop CP.     

Differential associations between maternal scaffolding and toddler emotion regulation in toddlers born preterm and full term

Background

Parental “scaffolding” behavior has been associated with developmental outcomes in at-risk children.

Aims

Because there are limited empirical data regarding how scaffolding is associated with emotion-based developmental skills, the purpose of this study was to compare associations between maternal verbal scaffolding and toddler emotion regulation, including fewer displays of negative affect and increased contentment and enjoyment during play, in toddlers born preterm and full term.

Study design

This study was a cross-sectional cohort design. Maternal and toddler behavior was assessed during 5 min of videotaped free play with standardized toys.

Subjects

131 toddlers (18–22 months) and their mothers were included (77 born preterm; 54 born full term).

Outcome measures

Toddler emotion regulation, negative affect, and dyadic mutual enjoyment were coded from videotaped play.

Results

The association between maternal scaffolding and emotion regulation was different for dyads with a toddler born preterm versus full term, wherein the association was positive for toddlers born preterm and non-significant for toddlers born full term. Similarly, the association between maternal scaffolding and negative affect was different for the two groups: negative for toddlers born preterm and non-significant for toddlers born full term. Finally, the association between maternal scaffolding and mutual enjoyment was positive for toddlers born preterm and non-significant for toddlers born full term.

Conclusions

Our findings highlight early differences in mother-child interactive style correlates of children born preterm compared to those born full term. Maternal scaffolding behavior may be uniquely associated with emotion regulation and a positive dyadic encounter for toddlers born preterm.     

Motor skills at 23 years of age in young adults born preterm with very low birth weight

Background

Motor skills have previously not been reported in young adults born with very low birth weight (VLBW), although they are commonly reported in children and adolescents.

Aim

To compare fine and gross motor skills in VLBW young adults with matched term-born controls, and to study longitudinal changes in the VLBW group.

Study design

A geographically based follow-up study of a VLBW group and a control group.

Subjects

Thirty-six VLBW (birth weight ≤ 1500 g) young adults, including four participants with cerebral palsy (CP), and 37 matched controls (birth weight ≥ 10th centile) were examined at 14 and 23 years of age.

Outcome measures

Fine and gross motor skills were assessed using Grooved Pegboard test (GP), Trail Making Test-5 (TMT-5), Movement Assessment Battery for Children-2 (Movement ABC-2) and High-level Mobility Assessment Tool (HiMAT).

Results

VLBW young adults were slower than controls on GP (p = 0.026) and TMT-5 (p < 0.001). Mean total Movement ABC-2 score was 69.7 ± 20.2 in the VLBW group compared with 74.1 ± 14.4 in the control group (p = 0.017). Differences were also seen in manual dexterity and balance. Additionally, HiMAT showed reduced balance and speed in gross motor skills in the VLBW group. The proportion of participants with motor problems did not change between age 14 and 23. After exclusion of participants with CP, scores were essentially the same.

Conclusion

VLBW young adults had overall poorer fine and gross motor skills compared with controls. Reduced speed seemed to be an underlying problem. Longitudinal findings indicate that VLBW children have not outgrown their motor problems when entering adulthood.     

Predicting neurosensory disabilities at two years of age in a national cohort of extremely premature infants

Background

Extreme prematurity carries a high risk of neurosensory disability.

Aims

Examine which information obtained pre-, peri- and postnatally may be predictive of neurosensory disabilities at 2 years of age.

Study design

Prospective observational study of all infants born in Norway in 1999 and 2000 with gestational age (GA) 22-27 completed weeks or birth weight (BW) of 500-999 g.

Outcome measures

Incidence of neurosensory disabilities.

Results

Of 373 surviving children, 30 (8%) had major neurosensory disabilities (26 CP, 6 blind, 3 deaf), and a further 46 (12%) had minor visual or hearing disabilities. The rate of major neurosensory disabilities was 19 of 99 (19%) for children with GA 23-25 vs. 8 of 189 (4%) for GA 26-27 weeks (p < 0.001). In a multivariable model, only morbidities detected in the neonatal intensive care unit (NICU) were associated with major neurosensory disabilities; adjusted odds ratios (95% confidence intervals) were 68.6 (18.7, 252.2) for major abnormalities on cerebral ultrasound, 6.8 (1.7, 27.4) for retinopathy of prematurity (ROP) grade > 2, 3.2 (1.0, 9.7) for ROP grade 1-2, 6.5 (1.9, 22.3) for prolonged use (≥ 21 days) of steroid treatment for lung disease and 3.1 (1.0, 9.4) for clinical chorioamnionitis. The visual outcome was strongly related to the degree of ROP (p < 0.001), and all who had a normal hearing screen in the NICU had normal hearing at 2 years.

Conclusion

NICU morbidities, rather than GA or intrauterine growth are the significant predictors of major neurosensory disabilities among extreme prematurity surviving to discharge from the NICU.     

Development of the Preverbal Visual Assessment (PreViAs) questionnaire

Background

Visual cognitive functions of preverbal infants are evaluated by means of a behavioral assessment. Parents or primary caregivers may be appropriate to certify the acquisition of certain abilities.

Aims

To develop the PreViAs (Preverbal Visual Assessment) questionnaire to assess visual behavior of infants under 24 months of age and to assess the normative outcomes for each item at each age.

Study design

The process was divided into three phases: scale development (items and domains generation), pilot testing, and exploratory analysis.

Results

The final version of the PreViAs questionnaire consisted of 30 items, each related to one or more of four domains (visual attention, visual communication, visual–motor coordination, and visual processing). For the exploratory analysis, 298 children (159 boys and 139 girls) were recruited. Their ages ranged from 0.1 to 24 months (mean, 11.2 months). Internal consistency of the questionnaire was high for all domains (Cronbach's α coefficients of 0.85–0.94).

Conclusions

The PreViAs questionnaire is a useful scale for assessing visual cognitive abilities of infants under 24 months of age. It is easy and feasible to complete by primary caregivers.     

The relation of infant attachment to attachment and cognitive and behavioural outcomes in early childhood

Background

In China, research on the relation of mother–infant attachment to children's development is scarce.

Aims

This study sought to investigate the relation of mother–infant attachment to attachment, cognitive and behavioural development in young children.

Study design

This study used a longitudinal study design.

Subjects

The subjects included healthy infants (n = 160) aged 12 to 18 months.

Outcome measures

Ainsworth's “Strange Situation Procedure” was used to evaluate mother–infant attachment types. The attachment Q-set (AQS) was used to evaluate the attachment between young children and their mothers. The Bayley scale of infant development-second edition (BSID-II) was used to evaluate cognitive developmental level in early childhood. Achenbach's child behaviour checklist (CBCL) for 2- to 3-year-olds was used to investigate behavioural problems.

Results

In total, 118 young children (73.8%) completed the follow-up; 89.7% of infants with secure attachment and 85.0% of infants with insecure attachment still demonstrated this type of attachment in early childhood (κ = 0.738, p < 0.05). Infants with insecure attachment collectively exhibited a significantly lower mental development index (MDI) in early childhood than did infants with secure attachment, especially the resistant type. In addition, resistant infants were reported to have greater social withdrawal, sleep problems and aggressive behaviour in early childhood.

Conclusion

There is a high consistency in attachment development from infancy to early childhood. Secure mother–infant attachment predicts a better cognitive and behavioural outcome; whereas insecure attachment, especially the resistant attachment, may lead to a lower cognitive level and greater behavioural problems in early childhood.     

Association between neonatal iron overload and early human brain development in premature infants

Background

Emerging evidence suggests that excess iron may be detrimental for brain development. However, little is known regarding the association between neonatal iron overload and subsequent neurodevelopment during infancy in vulnerable premature infants.

Aims

To evaluate the association between neonatal iron overload and neurodevelopment in premature infants.

Study design

Prospective cohort study.

Subjects

24–32 weeks gestational age infants who had serum ferritin (SF) measured at 34–35 weeks post-menstrual age (PMA) and did not meet exclusion criteria: SF < 76 ng/ml, toxoplasmosis, syphilis, rubella, cytomegalovirus, herpes infections, chromosomal disorders, or craniofacial anomalies were eligible. In addition, infants with sepsis or elevated C-reactive protein within 10 days before their SF measurement were excluded.

Outcome measures

Infants were evaluated for neurodevelopmental outcome at 8–12 months of age and were deemed to have neurodevelopmental impairment if they had one or more of the following: mental developmental index < 70, abnormal neurological examination, bilateral blindness, bilateral deafness, or required occupational, physical, or speech therapy.

Results

95 infants were studied. 70 had normal iron status (SF 76–400 ng/ml) while 25 were deemed to have iron overload (SF > 400 ng/ml) at 34–35 weeks PMA. There was a marginal increase in neurodevelopmental impairment among infants with iron overload compared to infants with normal iron status (64% vs. 41%, p = 0.05). However, after controlling for confounders, iron overload was not associated with neurodevelopmental impairment (Adjusted OR 0.71, 95% CI, 0.21–2.5).

Conclusion

Modest neonatal iron overload is not associated with neurodevelopmental impairment during infancy in premature infants.     

Is There any Difference in Health Related Quality of Life,Self Care and Social Function in Children with Different Disabilities Living in Turkey?

Objective

The aim of this study was to examine the differences in the health related quality of life and the self care and social function in daily life of children with different disabilities.

Methods

One hundred and two children with physical, emotional and cognitive disabilities (cerebral palsy, mental retardation, and hearing loss) and 28 children age matched as a control group were included in this study for the comparison. The Pediatric Evaluation of Disability Inventory (PEDI) was used to evaluate the independence and participation of children in daily life activities. The Turkish version of the Child Health Questionnaire-Parent form (CHQ - PF50) was used to evaluate the health related quality of life.

Findings

All 3 groups were different from the control group in terms of self-care and the social domains according to the PEDI results (P<0.05). Children with cerebral palsy (CP) were more dependent in the areas of self-care and mobility activities (P<0.05). The main difference was found in global general health (GGH), physical functioning (PF), the emotional impact on the parent (PE) subsections of the CHQ-PF50 between the CP and the hearing loss groups; the role of the physical (RP) and emotional behavior (BE) subsections between the mental retardation (MR) and the CP groups, and the BE and mental health (MH) subsections between the MR and the hearing loss (HL) groups (P<0.05).

Conclusion

All the children with disabilities were different from the control group in their quality of life, self care and social function. However the status of the children with MR and HL were parallel between each other in their health related quality of life, self care and social function. On the other hand, the most affected and dependent group was children with CP. The results will provide guidelines for healthcare professionals in implementing effective rehabilitation programs, especially to those with cerebral palsy, to reduce the level of strain and increase the health related quality of life, self care and social function of children with different disabilities.     

Follow-up at age 10 years in ELBW children — Functional outcome,brain morphology and results from motor assessments in infancy

Background

Extremely-low-birth-weight (ELBW) children without severe brain injury or CP are at high risk of developing deficits within cognition, attention, behavior and motor function. Assessing the quality of an infant's spontaneous motor-repertoire included in Prechtl's General-Movement-Assessment (GMA) has been shown to relate to later motor and cognitive functioning in preterm children without CP.

Aims

To investigate functional outcome and cerebral MRI morphometry at 10 years in ELBW children without CP compared to healthy controls and to examine any relationship with the quality of infant-motor-repertoire included in the GMA.

Study design

A cohort-study-design.

Subjects

31 ELBW children (mean birth-weight: 773 g, SD 146, mean gestational age 26.1 weeks, SD 1.8) and 33 term-born, age-matched controls.

Outcome measures

GMA was performed in ELBW children at 3 months corrected age. At 10 years the children underwent comprehensive motor, cognitive, behavioral assessments and cerebral MRI.

Results

The non-CP ELBW children had similar full-IQ but poorer working memory, poorer motor skills, and more attentional and behavioral problems compared to controls. On cerebral MRI reduced volumes of globus pallidus, cerebellar white matter and posterior corpus callosum were found. Cortical surface-area was reduced in temporal, parietal and anterior-medial-frontal areas. Poorer test-results and reduced brain volumes were mainly found in ELBW children with fidgety movements combined with abnormal motor-repertoire in infancy.

Conclusion

Non-CP ELBW children have poorer functional outcomes, reduced brain volumes and cortical surface-area compared with term-born controls at 10 years. ELBW children with abnormal infant motor-repertoire seem to be at increased risk of later functional deficits and brain pathology.     

Prematurity and school readiness in a nationally representative sample of Australian children: Does typically occurring preschool moderate the relationship?

Objective

This study aims to examine the relationship between indicators of prematurity and children's cognitive and behavioral school readiness in a nationally representative sample and to investigate whether typically occurring preschool enrollment moderates this relationship, particularly for children from disadvantaged families in Australia.

Methods

The Longitudinal Study of Australian Children is a nationally representative prospective sample of two cohorts of children with sequentially obtained indicators of child health and developmental outcomes. We analyzed information on 8060 children aged 4–5 years who had complete data on birth weight, gestational age, prenatal risks, social factors, and cognitive and behavioral outcomes of school readiness. Multivariate regressions were used to relate three indicators of prematurity (low birth weight, preterm birth, and small for gestational age) to cognitive and behavioral school readiness.

Results

Children born preterm, small for gestational age, or with low birth weight have significantly lower cognitive school readiness after controlling for social factors and prenatal risks. None of the premature indicators were associated with behavioral school readiness. All children benefited from attending preschool. Yet, preschool enrollment did not moderate the relationship between prematurity and school readiness. The only exception is for small for gestational age survivors with low educated mothers. Preschool enrollment was associated with an increase in cognitive school readiness skills.

Conclusions

Prematurity was associated with lower cognitive school readiness skills. Typical occurring preschool did not eliminate this association. Findings suggest that simply expanding the preschool enrollment is inadequate to address the developmental needs of premature children from disadvantaged backgrounds.