Irene Bircow Elgen

Prediction of Neurodevelopmental and Sensory Outcome at 5 Years in Norwegian Children Born Extremely Preterm

OBJECTIVE: To examine the prevalence of neurodevelopmental disability and the predictive value of pre-, peri-, and postnatal data on neurologic, sensory, cognitive, and motor function in children born extremely preterm. METHODS: This was a prospective observational study of all infants born in Norway between 1999 and 2000 with gestational ages between 22 and 27 weeks or birth weights between 500 and 999 g. Cognitive function was assessed with the Wechsler Preschool and Primary Scale of Intelligence–Revised, motor function with the Movement Assessment Battery for Children, and severity of cerebral palsy with the Gross Motor Function Classification for Cerebral Palsy. Disabilities were described as mild, moderate, or severe. RESULTS: Of 371 eligible children, 306 (82%) were examined at a mean (SD) age of 5 years and 10 (4) months. For gestational age less than 28 weeks (n = 239), 26 (11%) children had cerebral palsy alone (n = 21) or in combination with blindness (n = 3) or deafness (n = 2); 1 was blind and 1 was deaf. Of the remaining children, the mean full-scale IQ was 94 ± 15, and significant predictors were (values given as the difference in IQ points [95% confidence intervals]) high maternal education (9.6 [5.7–13.4]), preeclampsia (−7.7 [−12.7 to −2.7]), and retinopathy of prematurity higher than grade 2 (−17.5 [−27.1 to −8.0]). Movement Assessment Battery for Children scores were positively associated with gestational age and prenatal steroids and negatively associated with being small for gestational age, male gender, and having retinopathy of prematurity. Moderate to severe neurodevelopmental disability was more common for gestational ages 25 weeks or less (28 of 87 children) than for 26 to 27 weeks (12 of 152 children; P < .001) and 28 weeks or more (7 of 67 children; P = .001). CONCLUSIONS: The outcome was poorer for children with gestational ages of 25 weeks or less compared with those with gestational ages between 26 and 27 weeks. For those without cerebral palsy, blindness, or deafness, however, gestational age had a limited association with cognitive and motor function.

Emotional and behavioural problems in subgroups of children with chronic illness: results from a large-scale population study.

BACKGROUNDnChildren with chronic illness are known to have an increased risk of emotional and behavioural problems. In the present population-based study children with asthma, neurological disorders and other chronic illnesses were compared with children without chronic illnesses to assess differences in psychological presentation across illness groups.nnnMETHODSnA total of 537 children with parent-reported chronic illness in the Bergen Child Study were categorized into three groups: asthma, neurological disorders and other chronic illnesses. Emotional and behavioural problems were assessed by the Strengths and Difficulties Questionnaire.nnnRESULTSnAll three illness groups had an increased rate of emotional and behavioural problems, as well as increased probability of a psychiatric disorder compared with children without a chronic illness. Most children with asthma and other chronic illnesses did not have emotional and behavioural problems, and effect sizes were small in both groups. In children with neurological disorders the effect sizes ranged from moderate to large, with emotional problems, inattention hyperactivity and peer problems being the most frequent problems.nnnCONCLUSIONSnThe increased rate of emotional and behavioural problems in children with chronic illness, especially neurological disorders, emphasizes the importance of early detection of mental health problems in these children.

Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports

BackgroundA randomized and controlled clinical study was performed to evaluate the use of neurofeedback (NF) to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents.MethodsThe ADHD population was selected from an outpatient clinic for Child and Adolescent Mental Health in Norway. Ninety-one of the 275 children and adolescents ranging in age from 6 to 18u2009years (10.5u2009years) participated in 30 sessions of an intensive NF program. The reinforcement contingency was based on the subjects’ production of cortical beta1 activity (15–18u2009Hz). The ADHD participants were randomized into three groups, with 30 in the NF group, 31 controls in a group that was given methylphenidate, and 30 in a group that received NF and methylphenidate. ADHD core symptoms were reported by parents using the parent form of the Clinician’s Manual for Assessment by Russell A. Barkley.ResultsNinety-one children and adolescents were effectively randomized by age, sex, intelligence and distribution of ADHD core symptoms. The parents reported significant effects of the treatments, but no significant differences between the treatment groups were observed.ConclusionsNF was as effective as methylphenidate at treating the attentional and hyperactivity symptoms of ADHD, based on parental reports.Trial registrationCurrent Controlled Trials NCT01252446

Teacher ratings of mental health among school children in Kinshasa, Democratic Republic of Congo

AimIn Africa, little is known about child mental health. This study piloted the Strengths and Difficulties Questionnaire (SDQ) in Kinshasa, investigated mental health problems and the association between these problems and school performance, demographic factors, illness and nutrition.MethodsAn epidemiological survey was conducted with 1,187 children, 7–9 years old, recruited from randomly selected schools. Mental health problems were assessed with the SDQ (a behavioural screening tool) administered to teachers. Stability of the factor structure was examined using principal component factor analysis of the SDQ items. The reliability was evaluated using measures of internal consistency of the SDQ scales.ResultsFactor analysis yielded five factors, similar to the published SDQ scales. The internal consistency was satisfactory on all of the SDQ scales. Using the 90th percentile, the cut-off scores were somewhat higher than the published cut-off scores in this younger sample. Poor nutrition, low socioeconomic status and illness were found to increase the risk for mental health problems and low school performance.ConclusionSDQ may be considered useful to describe mental health problems among urban African children in Kinshasa. An association between mental health, school performance, demographic factors, illness and nutrition was found.

Cognitive performance in a low birth weight cohort at 5 and 11 years of age

The objective of this study was to evaluate cognitive functions, changes over time, and prenatal, perinatal, and neonatal predictors in low birth weight children. A cohort of 130 low birth weight children was compared with 131 control children. A neuropsychologic test battery including subtests from the Wechsler Intelligence Scale for Children-Revised and the Illinois Test of Psycholinguistic Abilities, Knox Cube Test, Grooved Pegboard Test, Finger, and Foot Tapping was used. School performance was assessed using the Child Behavior Check List. Low birth weight children were comparable with control children in areas of verbal and visuo-spatial function, distractibility, and motor tempo, when parental factors were controlled for. An apparent association between breast milk feeding and child intelligence quotient was rendered insignificant when confounding parental factors were controlled for. None of the other identifiable prenatal, perinatal, or neonatal predictors were significantly related to cognitive outcome or school problems at 11 years of age. No differences were found in cognitive functions between those weighing less than 1500 g and 1500-2000 g. Motor problems and low verbal intelligence quotient at 5 years of age in the low birth weight children (previously published data) each doubled the risk of presenting a school problem at 11 years of age. Our findings are encouraging for low birth weight children regarding testable cognitive consequences and less encouraging regarding ability of cognitive test to identify school problems.

Sleep in Children with Chronic Illness, and the Relation to Emotional and Behavioral Problems—A Population-Based Study

OBJECTIVEnTo examine sleep and sleep problems in children with chronic illness, and the potential effect of emotional and behavioral problems.nnnMETHODSnThe Bergen Child Study is a total population study. Based on data from the second wave, information about sleep was given by 5,781 children and their parents, of which 496 children (8.6%) had a chronic illness.nnnRESULTSnThere were no differences in time in bed between children with a chronic illness and their healthy peers. However, the chronic illness group reported more problems falling asleep and had more nighttime awakenings. The increased risk for sleep problems was reduced to a nonsignificant level when adjusting for emotional and behavioral problems.nnnCONCLUSIONSnThe elevated rate of sleep problems and association with emotional and behavioral problems in children with chronic illness underline the importance of early detection and intervention in this group.

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

BACKGROUNDnExtreme prematurity carries a high risk of neurosensory disability.nnnAIMSnExamine which information obtained pre-, peri- and postnatally may be predictive of neurosensory disabilities at 2 years of age.nnnSTUDY DESIGNnProspective 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.nnnOUTCOME MEASURESnIncidence of neurosensory disabilities.nnnRESULTSnOf 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 (> or = 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.nnnCONCLUSIONnNICU morbidities, rather than GA or intrauterine growth are the significant predictors of major neurosensory disabilities among extreme prematurity surviving to discharge from the NICU.

Psychiatric Disorders among Children with Cerebral Palsy at School Starting Age.

The aim of the present population study was to estimate the prevalence of psychiatric disorders in children with cerebral palsy (CP), as well as the impact of comorbid conditions. A cohort of children with CP born 2001-2003, and living in the Western Health Region of Norway were evaluated at school starting age. Parents were interviewed with the diagnostic instrument Kiddie-SADS, to find the prevalence of psychiatric disorders. Sixty-seven children participated, 43 boys, with mean age 88 months (SD 6,8 months). Most children had spastic CP, Gross Motor Function Classification System (GMFCS) levels I and II were found in 2/3 of the group. We found the diagnostic instrument appropriate for GMFCS levels I-IV. Child psychiatric disorders were found in 57% of the children, including 28 children meeting criteria for an attention deficit disorder, which was the most common. Communication problem was significantly associated with having a psychiatric disorder, whereas intellectual disability, type of CP and functional level did not account for significant differences. Subthreshold symptoms were found in 33 children, and 42 children (75%) met criteria for either psychiatric disorder, or mental health symptoms. One in four (14 children) were considered well-functioning from a mental health point of view. We conclude with a recommendation for early psychiatric evaluation of all children with CP.

Aspects of inattention in low birth weight children

The objective of this study was to explore the nature of impaired attention in low birth weight children. A population-based sample (n = 129) of 11-year-old low birth weight children was compared with a randomized group of normal birth weight children (n = 128). Continuous Performance Test, a Cue-Target Task, and a Stroop Color-Word test were used to assess the following dimensions of attentional function: inattention, impulsivity, vigilance, selected attention, and alternating attention. The attention subscale from the Child Behavior Check List questionnaire was included to assess maternal report of inattention. Low birth weight children had generally slower reaction time than normal birth weight children and manifested impaired vigilance, but this could be attributed to group differences in confounding parental factors. Impairment was not a function of birth weight within the low birth weight group, but low birth weight boys manifested impaired vigilance compared with normal birth weight boys. Every fourth low birth weight child was reported with inattention, but small differences were found between the inattentive and attentive low birth weight children. No specific attentional dysfunction was observed in the low birth weight study group. The nature of reported impaired attention among low birth weight children is still uncertain.

Low birthweight children: coping in school?

Aim. To describe and compare school performance and IQ at 11 y of age in a population of 130 children weighing less than 2000 g at birth without any major handicaps (low birthweight) and a random control sample of 131 children born at term weighing over 3000 g (normal birthweight); and to evaluate the relative strength of parental factors versus child birthweight in predicting IQ. Methods. The mothers and teachers completed validated questionnaires addressing school performance and the childs IQ was evaluated by WISC‐R, prorated. In addition, socioeconomic status was investigated using different questionnaires. Results. According to maternal reports, twice as many low birthweight children had school problems and three times as many of these children were referred to the School Psychological Service. Mean prorated IQ was 5 points lower in the low birthweight group. No statistically significant difference was found for mean IQ between the groups with birthweights of less than 1500 g vs 1500–2000 g. In a multivariate linear regression analysis, parental factors accounted for 13% of the variance in child IQ compared with only 3% accounted for by child birthweight.