Kristie L. Poole

Motor coordination and mental health in extremely low birth weight survivors during the first four decades of life.

The co-morbidity of motor coordination and mental health problems is an increasing concern. While links between poor motor coordination and mental health have been examined extensively in individuals born at normal birth weight (NBW; >2500g), relatively little research has examined these associations in special populations, particularly those born at extremely low birth weight (ELBW; <1000g). In this study, we examined whether birth weight status (ELBW vs. NBW) moderated associations between motor coordination problems and levels of mental health problems from childhood into the fourth decade of life. The present study utilized the oldest known prospectively followed, population-based cohort of ELBW survivors (n=151). This group was born between 1977 and 1982 in Ontario, Canada and was compared to a matched group of NBW controls (n=145). Mental health problems were measured at age 8 using parent and teacher reports, and at age 22-26 and 29-36 using self-reports. Childhood motor coordination was retrospectively reported at age 29-36. In both ELBW and NBW groups, childhood coordination problems were associated with elevated levels of inattention and symptoms of anxiety and depression. However, we observed stronger associations between childhood motor coordination problems and mental health problems in NBW controls at 22-26 and 29-36 years of age than in ELBW survivors. Our findings highlight the importance of recognizing and screening for motor coordination problems not only in vulnerable, at-risk children, but in all children, as motor difficulties appear to be associated with mental health problems well into adult life.

Childhood motor coordination and adult psychopathology in extremely low birth weight survivors

OBJECTIVE To determine if childhood motor coordination is associated with lifetime major depressive disorder (MDD), current generalized anxiety disorder (GAD), and attention-deficit/hyperactivity disorder (ADHD) in adulthood, and to examine if extremely low birth weight (ELBW; <1000 g) status moderates the strength of these associations. METHOD Prospective study of a cohort of normal birth weight (NBW) controls and ELBW survivors. Participants completed the short form Bruininks-Oseretsky Test of Motor Proficiency (BOTMP-SF) at age 8. At age 29-36, participants completed the Mini International Neuropsychiatric Interview to diagnose the psychiatric disorders of interest. RESULTS Birth weight status significantly influenced the strength and direction of associations between childhood motor coordination and adult psychiatric outcomes such that the odds of MDD (Pinteraction=.02) and GAD (Pinteraction=.01) increased with worsening motor scores in NBW adults but not ELBW survivors. Stratified analyses indicated that in NBW adults, for each one-point decrease in BOTMP-SF score, the odds of lifetime MDD increased by 10% (OR=1.10, 95% CI: 1.01-1.20). LIMITATIONS Participant attrition reduced sample size and that may have limited our ability to detect statistically significant results for some of our analyses. CONCLUSION Poorer motor coordination in early life has a negative long-term impact on the development of MDD and GAD of individuals born at NBW. The long-term mental health risks of childhood motor coordination problems are significant and highlight the importance of recognizing motor deficits in all children, so that associated psychological difficulties can be identified and treated at an early age.

Motor Coordination Difficulties in Extremely Low Birth Weight Survivors Across Four Decades.

Objective: To compare levels of motor coordination difficulties in a cohort of extremely low birth weight (ELBW; <1000 g) survivors and normal birth weight (NBW) controls from childhood until age 36. The stability of motor coordination in ELBW and NBW adults from their 20s to their 30s was also assessed. Methods: This study uses a prospectively followed population-based birth cohort of ELBW survivors born between 1977 and 1982 in Ontario, Canada, to compare motor coordination at age 8, age 22 to 26, and age 29 to 36 in ELBW survivors relative to a matched group of NBW controls across a number of different measures. Results: After adjusting for neurosensory impairment, ELBW survivors had significantly higher levels of motor coordination difficulties than their NBW counterparts at age 8, 22 to 26, and 29 to 36. Self-reported motor coordination remained relatively stable from age 22 to 26 to age 29 to 36 in both groups. Conclusions: ELBW survivors display higher levels of motor coordination difficulties than NBW controls in childhood through their mid 30s. Motor coordination seems to be stable from age 22 to 36 in both groups, suggesting that the presence of motor problems in ELBW survivors can have important implications for functional outcomes in adulthood.

Trajectories of frontal brain activity and socio-emotional development in children

Asymmetric frontal brain activity is thought to reflect individual differences in approach- and avoidance-oriented motivation and emotional experience. Using a prospective longitudinal design, the authors investigated whether trajectories of frontal electroencephalogram (EEG) asymmetry in children (Mage  = 6.39 years at enrollment) predicted subjective, behavioral, and autonomic indices of socioemotional processes. Resting frontal EEG activity was measured across four separate repeated assessments spanning approximately 2 years. Childrens EEG asymmetry across assessments was best characterized by two trajectories: a stable right frontal asymmetry class (48.65%), and a stable left frontal asymmetry class (51.35%). At visit 4, children in the stable right frontal asymmetry displayed more avoidance-related tendencies and children in the stable left frontal asymmetry class exhibited more approach-related tendencies across social, emotional, and autonomic measures. These findings suggest that developmental patterns of resting frontal brain activity across the early school years may underlie approach- and avoidance-related motivation and predict socio-emotional processes in some children.

The Temperamentally Shy Child as the Social Adult: An Exemplar of Multifinality

Does child temperament predict adult personality and social behavior? We argue that the antecedent and foundation of temperamental shyness observed in childhood and adulthood is rooted in temperamental inhibition first observed in early infancy, particularly inhibition to social novelty, which has a strong biological basis. With development, we believe the temperamental shyness phenotype becomes more intricate with the emergence of self-concept and the person now positioned within multiple contexts, each of which exerts different influences on shaping personality development. In this chapter, we review the developmental course and socioemotional outcomes of temperamental shyness. We first propose a developmental model of temperamental shyness that we have been developing over the last two decades.

Shyness and sociability among extremely low birth weight survivors in the third and fourth decades of life: Associations with relationship status

OBJECTIVE We examined differences between the oldest known longitudinally followed cohort of extremely low birth weight survivors (ELBW; < 1,000 grams) and normal birth weight (NBW; > 2,500 grams) control participants on shyness and sociability, as well as conflicted shyness in adulthood across nearly a decade from their 20s to 30s. METHOD 100 ELBW survivors and 88 NBW control participants self-reported on shyness and sociability using the Cheek and Buss (1981; Cheek, 1983) shyness and sociability scale. Participants also self-reported on their relationship status. A composite measure of conflicted shyness was also computed (i.e., the product of shyness and sociability). RESULTS We found that, in their 30s, ELBW survivors reported higher shyness, but similar levels of sociability and conflicted shyness compared to controls. However, the ELBW group exhibited a greater decrease in conflicted shyness than NBW controls from their 20s to their 30s. Greater decreases in conflicted shyness in both groups were associated with being male, as well as with changes in relationship status such as finding a partner or getting married. CONCLUSIONS Relatively higher shyness among ELBW survivors in adulthood suggests that stressful pre- and early postnatal environments may have lasting effects on personality development. However, later social influences such as relationship status may attenuate some types of shyness in adulthood.

Childhood language skills and adolescent self-esteem in preterm survivors

Fifty-seven percent of children with poor language skills are affected by socio-emotional problems. Despite the importance of language skills to interpersonal functioning and school performance, relatively little is known about how they affect self-esteem in adolescence. Data on youth at high risk for language problems (e.g. those born extremely low birth weight (ELBW; <1000 grams)) are even more scarce. This prospective study examined associations between language skills at age 8 and self-esteem during adolescence (12–16 years) in individuals born at ELBW (N = 138) or normal birth weight (NBW; >2500 grams) (N = 111). Participants’ language skills were assessed using the Verbal Scale of the Wechsler Intelligence Scale for Children-Revised and the Token Test at age 8. In adolescence, participants completed the Harter Self-Perception Profile for Adolescents. Birth weight status was found to moderate associations between childhood language and adolescent global self-esteem (Token Test (p = .006), Verbal Intelligence Quotient (p = .033)) such that better language skills were associated with higher self-esteem in adolescent ELBW survivors, but not in NBW participants. Language skills may play a protective role in the development and maintenance of self-esteem in ELBW youth and could be an important target for optimizing their functioning, particularly before transitioning to the critical adolescent period.

Trajectories of self-esteem in extremely low birth weight survivors through adulthood

Although the developmental course of self-esteem has been examined in general population samples, there is a lack of research examining the trajectory of self-esteem in populations who experience unique developmental challenges. We compared the trajectory of self-esteem in extremely low birth weight (ELBW; <1000 grams) survivors and normal birth weight (NBW) controls from mid-adolescence through their early 30s. Self-esteem was reported during three follow-up periods (age 12-16, age 22-26, age 30-35). Adjusting for sex, chronic health problems, socioeconomic status, and social support, no difference was noted in self-esteem in the two groups in adolescence, but birth weight status predicted rate of change of self-esteem from adolescence to adulthood. The NBW controls showed the expected, normative increases in self-esteem from mid-adolescence to young adulthood, while ELBW individuals displayed stable, low levels of self-esteem into young adulthood. Our findings highlight that ELBW survivors may not experience the normative trajectory of self-esteem into young adulthood.

Early developmental influences on self-esteem trajectories from adolescence through adulthood: Impact of birth weight and motor skills

While the trajectory of self-esteem from adolescence to adulthood varies from person to person, little research has examined how differences in early developmental processes might affect these pathways. This study examined how early motor skill development interacted with preterm birth status to predict self-esteem from adolescence through the early 30s. We addressed this using the oldest known, prospectively followed cohort of extremely low birth weight (<1000 g) survivors (N = 179) and normal birth weight controls (N = 145) in the world, born between 1977 and 1982. Motor skills were measured using a performance-based assessment at age 8 and a retrospective self-report, and self-esteem was reported during three follow-up periods (age 12-16, age 22-26, and age 29-36). We found that birth weight status moderated the association between early motor skills and self-esteem. Stable over three decades, the self-esteem of normal birth weight participants was sensitive to early motor skills such that those with poorer motor functioning manifested lower self-esteem, while those with better motor skills manifested higher self-esteem. Conversely, differences in motor skill development did not affect the self-esteem from adolescence to adulthood in individuals born at extremely low birth weight. Early motor skill development may exert differential effects on self-esteem, depending on whether one is born at term or prematurely.

Association of external cephalic version before term with late preterm birth

While evidence suggests that beginning an external cephalic version (ECV) before term (340/7 to 366/7 weeks) compared with after term may be associated with an increase in late preterm birth (340/7 to 366/7 weeks), it remains unknown what might account for this risk. The objective of the present study is to further investigate the association between ECV before term and late preterm birth.