Marian J. Jongmans

Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review

Neonatal encephalopathy (NE) following perinatal asphyxia (PA) is considered an important cause of later neurodevelopmental impairment in infants born at term. This review discusses long-term consequences for general cognitive functioning, educational achievement, neuropsychological functioning and behavior. In all areas reviewed, the outcome of children with mild NE is consistently positive and the outcome of children with severe NE consistently negative. However, children with moderate NE form a more heterogeneous group with respect to outcome. On average, intelligence scores are below those of children with mild NE and age-matched peers, but within the normal range. With respect to educational achievement, difficulties have been found in the domains reading, spelling and arithmetic/mathematics. So far, studies of neuropsychological functioning have yielded ambiguous results in children with moderate NE. A few studies suggest elevated rates of hyperactivity in children with moderate NE and autism in children with moderate and severe NE. Conclusion: Behavioral monitoring is required for all children with NE. In addition, systematic, detailed neuropsychological examination is needed especially for children with moderate NE.

Attention development in infants and preschool children born preterm: a review.

A potential mechanism that can explain preterm childrens heightened risk for the development of later cognitive and behavioral problems is attention. Attention is the ability of an infant or child to orient to, to shift between and to maintain focus on events, objects, tasks, and problems in the external world, processes which are all dependent on the functioning of attentional networks in the brain. The aim of this paper is to provide a review of the literature on attention development in children born preterm during the first 4 years of life. First, research examining the differences between preterm and full-term children indicates that early attention development in infants born preterm is less optimal and that these differences increase when infants grow into toddlers. Second, studies investigating individual differences within preterm populations reveal the influence of both biological factors and environmental factors. Third, individual differences in early orienting and sustained attention have been shown to be predictive of later attentional, cognitive and behavioral functioning in children born preterm. The importance of long-term follow-up studies, with a focus on individual developmental trajectories in orienting, sustained and executive attention, is emphasized.

Minor neurological signs and perceptual-motor difficulties in prematurely born children

AIM To examine the spectrum of neurological dysfunction and perceptual-motor difficulties at school age in a cohort of prematurely born children, and the relation of these measures to neonatal brain lesions, intelligence quotient, and behavioural adjustment. METHOD One hundred and eighty three children were tested at the age of 6 years using Touwen’s Examination of the Child with Minor Neurological Dysfunction, the Movement Assessment Battery for Children (Movement ABC), the Developmental Test of Visual-Motor Integration (VMI), British Ability Scales, and Rutter Scales. RESULTS Twenty six children had definite cerebral palsy and one was blind. Of the remaining 156, the proportions falling below the 15th centile point were 31% on Touwen’s Examination, 44% on the Movement ABC, and 17% on the VMI. Forty two passed all three tests. No child with a normal ultrasound scan developed cerebral palsy, whereas nearly all those with major lesions did. Minor lesions, however, were not generally predictive of later outcome. Correlations between the tests were generally low. CONCLUSIONS These findings stress the need to assess neurological and perceptual motor functioning separately at school age and to monitor relationships with other aspects of development.

Long-term outcome after neonatal hypoxic-ischaemic encephalopathy

Outcome of full-term infants with neonatal encephalopathy of hypoxic-ischemic origin is often assessed in infancy or early childhood and data on outcome in childhood and adolescence is limited. MRI performed in the neonatal period has made a huge contribution to recognition of different patterns of injury. These different patterns of injury are related to the severity of later motor and cognitive disabilities. Long-term follow-up shows that cognitive and memory difficulties may follow even in children without motor deficits. It is therefore recommended to perform follow-up assessment into childhood in children with and without adverse neurological outcome in early infancy.

Building child trauma theory from longitudinal studies: a meta-analysis.

Many children are exposed to traumatic events, with potentially serious psychological and developmental consequences. Therefore, understanding development of long-term posttraumatic stress in children is essential. We aimed to contribute to child trauma theory by focusing on theory use and theory validation in longitudinal studies. Forty studies measuring short-term predictors and long-term posttraumatic stress symptoms were identified and coded for theoretical grounding, sample characteristics, and correlational effect sizes. Explicit theoretical frameworks were present in a minority of the studies. Important predictors of long-term posttraumatic stress were symptoms of acute and short-term posttraumatic stress, depression, anxiety, and parental posttraumatic stress. Female gender, injury severity, duration of hospitalization, and elevated heart rate shortly after hospitalization yielded small effect sizes. Age, minority status, and socioeconomic status were not significantly related to long-term posttraumatic stress reactions. Since many other variables were not studied frequently enough to compute effect sizes, existing theoretical frameworks could only be partially confirmed or falsified. Child trauma theory-building can be facilitated by development of encouraging journal policies, the use of comparable methods, and more intense collaboration.

Effectiveness of a Computerised Working Memory Training in Adolescents with Mild to Borderline Intellectual Disabilities

BACKGROUND The goal of this study is to evaluate the effectiveness of a computerised working memory (WM) training on memory, response inhibition, fluid intelligence, scholastic abilities and the recall of stories in adolescents with mild to borderline intellectual disabilities attending special education. METHOD A total of 95 adolescents with mild to borderline intellectual disabilities were randomly assigned to either a training adaptive to each childs progress in WM, a non-adaptive WM training, or to a control group. RESULTS Verbal short-term memory (STM) improved significantly from pre- to post-testing in the group who received the adaptive training compared with the control group. The beneficial effect on verbal STM was maintained at follow-up and other effects became clear at that time as well. Both the adaptive and non-adaptive WM training led to higher scores at follow-up than at post-intervention on visual STM, arithmetic and story recall compared with the control condition. In addition, the non-adaptive training group showed a significant increase in visuo-spatial WM capacity. CONCLUSION The current study provides the first demonstration that WM can be effectively trained in adolescents with mild to borderline intellectual disabilities.

Decreasing Incidence and Severity of Cerebral Palsy in Prematurely Born Children

OBJECTIVE To examine incidence and severity of cerebral palsy (CP), and associated factors among preterm survivors (gestational age <34 weeks), admitted to a neonatal intensive care unit from 1990-2005. STUDY DESIGN Eighteen antenatal, perinatal and postnatal factors were analyzed. The cohort was divided in four birth periods: 1990-1993 (n=661), 1994-1997 (n=726), 1998-2001 (n=723), and 2002-2005 (n=850). The Gross Motor Function Classification System was used as primary outcome measure (mean age: 32.9 ± 5.3 months). Logistic regression analyses were used. RESULTS CP incidence decreased from 6.5% in period I, to 2.6%, 2.9% and 2.2% (P<.001) in period II-IV, respectively. Simultaneously, cystic periventricular leukomalacia (c-PVL) decreased from 3.3% in period I to 1.3% in period IV (P=.004). Within the total cohort (n=3287), c-PVL grade III decreased from 2.3% in period I to 0.2% in period IV (P=.003). The number of children with Gross Motor Function Classification System levels III-V decreased from period I to IV (P=.035). Independent risk factors for CP were c-PVL and severe intraventricular hemorrhage, whereas antenatal antibiotics, presence of an arterial line, Caesarean section, and gestational age were independent protective factors. CONCLUSION CP incidence and severity decreased from 1990-1993 onward, which could be attributed to a reduction of 93% in severe c-PVL.

Consequences of Comorbidity of Developmental Coordination Disorders and Learning Disabilities for Severity and Pattern of Perceptual—Motor Dysfunction

Children with developmental coordination disorder (DCD) have difficulty learning and performing age-appropriate perceptual—motor skills in the absence of diagnosable neurological disorders. Descriptive studies have shown that comorbidity of DCD exists with attentiondeficit/hyperactivity disorder (ADHD) and learning disabilities (LD). This study examined the consequences of the comorbidity of DCD and LD for the severity and pattern of perceptual—motor dysfunction. Compared to children with DCD without LD, children with co-morbid DCD and LD performed lower on a standardized assessment of perceptual—motor ability. Furthermore, it appeared that children with combined DCD and LD have particular difficulty performing manual dexterity and balance tasks but not ball-skill tasks. Implications for understanding the relationship between LD and perceptual—motor problems are discussed. We conclude that the comorbidity of DCD and LD not only affects the severity of perceptual—motor dysfunction but also is associated with a distinctive pattern of perceptual—motor dysfunction.

The Association Between Developmental Coordination Disorder and Other Developmental Traits

OBJECTIVE: To explore associations between developmental coordination disorder (DCD) and attention, language, social skills, and academic ability in a population-based cohort. METHODS: We analyzed data (N = 6902) from the Avon Longitudinal Study of Parents and Children (ALSPAC). Probable DCD was defined as children below the 15th centile of the ALSPAC Coordination Test aged 7 years with functional impairment in activities of daily living or handwriting, excluding children with neurologic difficulties or an IQ of <70. Four developmental domains were assessed by using standardized tests between the ages of 7.5 and 9 years: attention; language skills (expressive language, comprehension, short-term memory); social skills (nonverbal skills and social communication); and academic ability (reading and spelling). The worst 5% of each trait was used to define impairment. We used multiple logistic regression models to assess the association between probable DCD and each trait. Our final model controlled for IQ, socioeconomic factors, and other developmental traits not in the domain assessed. RESULTS: A total of 346 (5.0%) children met criteria for probable DCD. Probable DCD was associated with difficulties in attention (odds ratio [OR]: 1.94 [95% confidence interval (CI): 1.17–3.24]), nonword repetition (OR: 1.83 [95% CI: 1.26–2.66]), social communication (OR: 1.87 [95% CI: 1.15–3.04]), reading (OR: 3.35 [95% CI: 2.36–4.77]), and spelling (OR: 2.81 [95% CI: 2.03–3.90]). CONCLUSIONS: Children with probable DCD had an increased risk of difficulties in attention, social skills, reading, and spelling. These additional difficulties need to be screened for during assessment and considered when formulating interventions.

Mental Health Difficulties in Children With Developmental Coordination Disorder

OBJECTIVE: To explore the associations between probable developmental coordination disorder (DCD) defined at age 7 years and mental health difficulties at age 9 to 10 years. METHODS: We analyzed of prospectively collected data (N = 6902) from the Avon Longitudinal Study of Parents and Children. “Probable” DCD was defined by using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria as those children below the 15th centile of the Avon Longitudinal Study of Parents and Children Coordination Test, with functional limitations in activities of daily living or handwriting, excluding children with neurologic difficulties or an IQ <70. Mental health was measured by using the child-reported Short Moods and Feelings Questionnaire and the parent-reported Strengths and Difficulties Questionnaire. Multiple logistic regression models, with the use of multiple imputation to account for missing data, assessed the associations between probable DCD and mental health difficulties. Adjustments were made for environmental confounding factors, and potential mediating factors such as verbal IQ, associated developmental traits, bullying, self-esteem, and friendships. RESULTS: Children with probable DCD (N = 346) had an increased odds of self-reported depression, odds ratio: 2.08 (95% confidence interval: 1.36–3.19) and parent-reported mental health difficulties odds ratio: 4.23 (95% confidence interval: 3.10–5.77). The odds of mental health difficulties significantly decreased after accounting for verbal IQ, social communication, bullying, and self-esteem. CONCLUSIONS: Children with probable DCD had an increased risk of mental health difficulties that, in part, were mediated through associated developmental difficulties, low verbal IQ, poor self-esteem, and bullying. Prevention and treatment of mental health difficulties should be a key element of intervention for children with DCD.