Helle Wessel Andersson

Cognitive development of term small for gestational age children at five years of age

AIM To assess the relative significance for cognitive development of small for gestational age, parental demographic factors, and factors related to the child rearing environment. METHODS IQ of a population based cohort of 338 term infants who were small for gestational age (SGA) and without major handicap, and a random control sample of 335 appropriate for gestational age (AGA) infants were compared at 5 years of age. RESULTS The mean non-verbal IQ was four points lower, while the mean verbal IQ was three points lower for the children in the SGA group. The results were not confounded by parental demographic or child rearing factors. However, parental factors, including maternal non-verbal problem solving abilities, and child rearing style, accounted for 20% of the variance in non-verbal IQ, while SGA versus AGA status accounted for only 2%. The comparable numbers for verbal IQ were 30 and 1%. Furthermore, we found no evidence that the cognitive development of SGA children was more sensitive to a non-optimal child rearing environment than that of AGA children. Maternal smoking at conception was associated with a reduction in mean IQ comparable to that found for SGA status, and this effect was the same for SGA and AGA children. The cognitive function of asymmetric SGA was comparable to that of symmetric SGA children. CONCLUSIONS Our findings indicate that child cognitive development is strongly associated with parental factors, but only marginally associated with intrauterine growth retardation.

Neuropsychologic and motor function in small-for-gestation preschoolers.

The aim of this study was to evaluate neuropsychologic and motor performance in term small-for-gestation preschool children. A patient-based sample of 311 5-year-old children with birth weights less than the fifteenth percentile for gestation was compared with a random sample of 321 appropriate-for-gestation control subjects. The main assessment tools were subscales from the Wechsler Preschool and Primary Scale of Intelligence Revised, subscales from the Illinois Test of Psycholinguistic Abilities, tests of manual dexterity and figure copying, and the Peabody Developmental Motor Scales. The small-for-gestation children had mean scores on tests of visuospatial and visuomotor abilities that were one fourth standard deviation lower than appropriate-for-gestation control subjects and slightly lower scores on manual dexterity. The small-for-gestation children were comparable to appropriate-for-gestation children regarding motor performance. We therefore conclude that the neuropsychologic and neuromotor performance in preschool years of term small-for-gestation children is reassuring.

Can cerebral MRI at age 1 year predict motor and intellectual outcomes in very‐low‐birth weight children?

This follow‐up study reports on cerebral MRI findings in 20 very‐low‐birthweight (VLBW) infants without disabilities at age 1 year in relation to motor, intellectual, and perceptual function at age 6 years. MRI findings, anthropometrics, and Bayley Scales of Infant Development scores at age 1 year as predictors of psychomotor status at age 6 years are also evaluated and compared. Outcome parameters were the Peabody Developmental Motor Scales and the Wechsler Preschool and Primary Scale of Intelligence. The results show that infants with myelin hyperintensities including the centrum semiovale or with occipital hyperintensities with associated ventricular dilatation at age 1 scored lower on the Peabody Gross Motor Locomotion Scale at age 6 than infants with normal myelination or with isolated occipital hyperintensities. This may indicate damage to motor fibers caused by perinatal periventricular leukomalacia. No relation was found between abnormal MRI findings at age 1 and later fine motor, intellectual, and perceptual function.

Maternal child-rearing attitudes, IQ, and socioeconomic status as related to cognitive abilities of five-year-old children.

The effects of maternal child-rearing attitudes, as measured by the Child Rearing Practices Report, on 5-yr.-old childrens Verbal IQ and Performance IQ were investigated in a Scandinavian sample of 108 boys and 126 girls. The maternal child-rearing attitude of Restrictiveness, as defined by scores on the Report, showed negative relations to the cognitive measures. However, the significant negative relation between Restrictiveness and Verbal IQ, obtained for both sexes, disappeared when the effects of maternal IQ and socioeconomic status were controlled. The maternal child-rearing attitude of Nurturance, as defined by scores on the Report, was significantly related to Verbal IQ and Performance IQ for boys only. Significant relationships between scores on Nurturance and cognitive abilities of boys remained when the effects of maternal IQ and socioeconomic status were controlled.

Behavior in term, small for gestational age preschoolers

AIMS To evaluate whether being born small for gestational age (SGA) was associated with an increased frequency of preschool behavioral problems. STUDY DESIGN Follow-up study at 5 years of age. SUBJECTS A population based cohort of 318 term infants who were SGA, defined as having a birthweight less than the 15th percentile for gestational age, and without major handicap such as cerebral palsy or mental retardation, and a random control sample of 307 appropriate for gestational age (AGA) infants. OUTCOME MEASURES The Personality Inventory for Children and the Yale Childrens Inventory (completed by the mothers), and child behavior during psychometric testing. RESULTS Behavior problems was not more common among the SGA children. The results were not confounded by a wide range of parental demographic and child rearing factors, including maternal non-verbal problem solving abilities, child rearing style, and maternal psychological distress. However, the parental factors explained 13% of the variance in a summary score of child behavior compared to 1% explained by SGA vs. AGA status. The SGA children were not more sensitive to the negative impacts of parental risk factors than AGA controls. The study does not address the outcome of severely growth-retarded SGA infants. CONCLUSION Being born moderately SGA is not a significant risk factor for preschool behavior problems.

User satisfaction with child and adolescent mental health services: impact of the service unit level.

BackgroundChild and adolescent mental health service units (CAMHS) play an important role in the supply of services to children and adolescents with mental illness. The purpose of this study was to examine the service unit effect on parent satisfaction with outpatient treatment.MethodThe study was undertaken in 49 of 72 Norwegian outpatient CAMHS in 2004. A total of 2253 of the parents who were asked to participate (87%) responded. Parent satisfaction was measured using two summated scales: clinician interaction/information and treatment outcome. Multilevel analyses were used to assess the contribution of the service units to satisfaction and to investigate patient level predictors of parent satisfaction.ResultsAbout 96−98% of the parent satisfaction variance could be attributed to factors within CAMHS, leaving only 2–4% of the variance attributable to the CAMHS level. Parents of patients aged 0–6 years were more satisfied than older patients’ parents. Longer treatment episodes were positively associated with satisfaction. Parents whose children had been referred with externalizing symptoms were less satisfied with treatment outcome than those referred for internalizing symptoms. Waiting time was negatively associated with treatment outcome satisfaction. Adjustments for patient characteristics did not substantially change the relative effect of CAMHS on satisfaction ratings.ConclusionThe results indicate that information from user satisfaction surveys has clear limitations as an indicator of CAMHS quality. From a quality improvement perspective, the factors affecting the variance within CAMHS are of dominating importance compared to factors affecting between CAMHS variance.

The Fagan Test of Infant Intelligence: Predictive Validity in a Random Sample:

The predictive validity of The Fagan Test of Infant Intelligence was investigated in a random sample of 100 boys and 96 girls from two Norwegian cities. Infants were assessed on the Fagan test between the ages of 7 to 9 months A follow-up at 5 years included the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI–R) and three subtests from the Illinois Test of Psycholinguistic Abilities (ITPA). Low internal consistency of the Fagan test was found, with alphas of .10 and .02 for the two study sites. Fagan test-score correlated significantly with WPPSI–Verbal IQ and with scores on ITPA Auditory Reception for both samples, but the mean correlation was as low as .22. The prediction was not significantly higher for infants tested before 8 months of age than for those tested later. The study raises questions about use of the Fagan test as a screening tool in a nonrisk population.

Gender Differences Among Children with Externalising Behaviour Disorders in a Clinic Population

The objective of this study was to compare the referral patterns for males and females with externalising disorders who were admitted for specialised psychiatric treatment. The study was based on the total population of children receiving specialised mental treatment in Norway in 2001. From the total patient population of 28,571 children and adolescents aged 0-17 years, a sample was drawn of boys and girls who were referred for externalising behaviour disorders. The sample comprised a total 9729 children, of whom 2218 were females and 7511 were males. Males and females were compared with regard to age at referral, referring agents, secondary reasons for referral as indicated by referring agency, and diagnostic status. The analyses revealed several gender differences in referral patterns. A statistically significant larger proportion of males than females were referred at ages between 6 and 12 years (67.3% and 57.1%, respectively; p < 0.001 ), whereas relatively more females than males were referred at ages above 12 years (32.4% and 21.7%, respectively; p < 0.001 ). Males were more frequently referred from the school sector than females (31.2% and 21.8%, respectively; p < 0.001 ), and exhibited more externalising symptoms than females as indicated by their secondary reason for referral (47.8% and 31.5%, respectively; p < 0.001 ). Co-occurring internalising symptoms were relatively more frequent in females than in males (21.9% and 16.9%, respectively; p < 0.001 ). Furthermore, results showed statistically significant differences in diagnostic status between males and females. Among males 37.7% was assigned an ICD-10 axis I diagnosis of hyperkinetic disorders or conduct disorders; the corresponding number for females was 24.0% ( p < 0.001 ). The results may reflect the true prevalence in the child and adolescent population, or alternatively indicate a gender-related bias in the referral process of children.

Factors associated with waiting time for access to mental health services for children and adolescents in Norway

The present study addresses the question of equality of access, as it relates to waiting time for specialised mental health treatment for children and adolescents. The aim was to investigate whether demographic, clinical factors and service‐related factors were associated with waiting time. Data was based on a documentation system in which all Norwegian children and adolescents receiving specialised mental health services were recorded. The analysis was based on a sample of 6497 children, who were referred for, and received, outpatient treatment in 2001, and for whom there was a complete data‐set on dates for referral and first appointment at the clinic. The following factors were included for analysis: age at referral, gender, reason for referral and referring agent, place of residence, as well two aspects related to the clinic providing services (i.e. mean number of consultations provided per patient per year, and mean number of consultations done by one therapist per year). Analysis of variance, Students t‐tests and logistic regression analysis were applied. Children aged 6‐12 years, and children with externalised behaviour disorders were statistically significantly more likely to wait longer for services as compared with children in the other age groups, and with other disorders. Furthermore, children referred from the school sector waited statistically significantly longer for treatment than those referred from other agencies. Results also suggest that the waiting time varies with how available resources and treatment capacity of the outpatient clinic is utilised. Waiting time for services is an important indicator of the accessibility of services, and should be included in evaluations of national mental health reforms. This study suggests unevenness in access to services, which is related both to clinical‐demographical characteristics as well as to service‐related aspects of individual clinics. Efforts should be made to break down barriers to care that are related to unequal access to mental health treatment for children and adolescents.

CEREBRAL MRI IN NON-DISABLED VLBW CHILDREN AT ONE AND SIX YEARS - RELATIONSHIP BETWEEN GLIOSIS AND MOTOR, PERCEPTUAL AND BEHAVIOR PROBLEMS. ▴ 1667

CEREBRAL MRI IN NON-DISABLED VLBW CHILDREN AT ONE AND SIX YEARS - RELATIONSHIP BETWEEN GLIOSIS AND MOTOR, PERCEPTUAL AND BEHAVIOR PROBLEMS. ▴ 1667