Maryline Monnier

Emotional and effortful control abilities in 42-month-old very preterm and full-term children

BACKGROUND Very preterm (VP) infants are at greater risk for cognitive difficulties that may persist during school-age, adolescence and adulthood. Behavioral assessments report either effortful control (part of executive functions) or emotional reactivity/regulation impairments. AIMS The aim of this study is to examine whether emotional recognition, reactivity, and regulation, as well as effortful control abilities are impaired in very preterm children at 42 months of age, compared with their full-term peers, and to what extent emotional and effortful control difficulties are linked. STUDY DESIGN Children born very preterm (VP; < 29 weeks gestational age, n=41) and full-term (FT) aged-matched children (n=47) participated in a series of specific neuropsychological tests assessing their level of emotional understanding, reactivity and regulation, as well as their attentional and effortful control abilities. RESULTS VP children exhibited higher scores of frustration and fear, and were less accurate in naming facial expressions of emotions than their aged-matched peers. However, VP children and FT children equally performed when asked to choose emotional facial expression in social context, and when we assessed their selective attention skills. VP performed significantly lower than full terms on two tasks of inhibition when correcting for verbal skills. Moreover, significant correlations between cognitive capacities (effortful control) and emotional abilities were evidenced. CONCLUSIONS Compared to their FT peers, 42 month-olds who were born very preterm are at higher risk of exhibiting specific emotional and effortful control difficulties. The results suggest that these difficulties are linked. Ongoing behavioral and emotional impairments starting at an early age in preterms highlight the need for early interventions based on a better understanding of the relationship between emotional and cognitive difficulties.

Brain network characterization of high-risk preterm-born school-age children.

Higher risk for long-term cognitive and behavioral impairments is one of the hallmarks of extreme prematurity (EP) and pregnancy-associated fetal adverse conditions such as intrauterine growth restriction (IUGR). While neurodevelopmental delay and abnormal brain function occur in the absence of overt brain lesions, these conditions have been recently associated with changes in microstructural brain development. Recent imaging studies indicate changes in brain connectivity, in particular involving the white matter fibers belonging to the cortico-basal ganglia-thalamic loop. Furthermore, EP and IUGR have been related to altered brain network architecture in childhood, with reduced network global capacity, global efficiency and average nodal strength. In this study, we used a connectome analysis to characterize the structural brain networks of these children, with a special focus on their topological organization. On one hand, we confirm the reduced averaged network node degree and strength due to EP and IUGR. On the other, the decomposition of the brain networks in an optimal set of clusters remained substantially different among groups, talking in favor of a different network community structure. However, and despite the different community structure, the brain networks of these high-risk school-age children maintained the typical small-world, rich-club and modularity characteristics in all cases. Thus, our results suggest that brain reorganizes after EP and IUGR, prioritizing a tight modular structure, to maintain the small-world, rich-club and modularity characteristics. By themselves, both extreme prematurity and IUGR bear a similar risk for neurocognitive and behavioral impairment, and the here defined modular network alterations confirm similar structural changes both by IUGR and EP at school age compared to control. Interestingly, the combination of both conditions (IUGR + EP) does not result in a worse outcome. In such cases, the alteration in network topology appears mainly driven by the effect of extreme prematurity, suggesting that these brain network alterations present at school age have their origin in a common critical period, both for intrauterine and extrauterine adverse conditions.

Gestational age and gender influence on executive control and its related neural structures in preterm-born children at 6 years of age

Within preterm-born children, being born male and at a lower gestational age (GA) have both been associated with a heightened risk for developmental difficulties. However, in this population little is known about the combined effect and the influence of these risk factors on cortical structures and executive control. In the present study, 58 preterm-born children (GA ranging from 24.0 to 35.1 weeks) were administered the computerized Child Attention Network Task at 6 years of age. Brain magnetic resonance imaging was performed and analyzed using Voxel-Based Morphometry (VBM) in all children. At a behavioral level, boys born <28 weeks of GA had significantly less executive control than preterm-born girls <28 weeks (p = .001) and preterm-born boys ≥28 (p = .003). The reduced executive control in preterm-born boys <28 weeks gestation was related to lower cortical densities in the inferior frontal gyrus (IFG) and dorsolateral prefrontal cortex (DLPFC). The current study links the higher incidence of reduced executive control in preterm-born boys to a higher degree of prematurity (low GA) and identifies brain structural abnormalities in the prefrontal cortex related to these deficits. The implications of these results are discussed.

Response inhibition difficulties in preterm children aged 9–12 years: Relations with emotion and behavior

Previous studies with children have demonstrated inhibition difficulties associated with prematurity, but the question of potentially catching up with a delay in inhibition processes before adolescence still remains. Moreover, preterm adolescents are more at risk than their term-born peers for presenting behavioral problems such as emotional difficulties and attention deficit/hyperactivity disorder. In addition to examining response inhibition, this study addressed, for the first time, the impact of an emotional context on response inhibition abilities and its relation to behavioral problems in late school-aged preterm children. Fifty-eight preterm children aged 9–12 years were compared with 61 controls on two versions of a stop-signal task, the Delay Frustration Task, and the Strengths and Difficulties Questionnaire. Results showed general difficulties in inhibiting a response, rather than a specific impact of emotional context in preterm children. Compared with controls, these children exhibited more and longer button presses in a delay situation, as well as faster go reaction times associated with lower probability of inhibition in the stop-signal tasks. These difficulties reflected impulsivity and were associated with higher hyperactivity/inattention and conduct problems. Additionally, intrauterine growth restriction was found to be an additional perinatal risk factor for hyperactivity/inattention symptoms. These findings suggest that remaining inhibition difficulties in the preterm population at preadolescence could reveal increasing behavioral issues.

Suivi neurodéveloppemental à 5 ans des extrêmes prématurés et détection des difficultés sur le plan des fonctions exécutives

INTRODUCTION A significant proportion of prematurely born children encounter behavioral difficulties, such as attention deficit or hyperactivity, which could be due to executive function disorders. AIMS To examine whether the standard neurodevelopmental assessment offered to premature children in Switzerland recognizes executive function disorders. METHODS The study population consisted of 49 children born before 29 weeks of gestation who were examined between 5 and 6 years of age with a standard assessment, with additional items to assess executive functioning. Children with severe neurodevelopmental impairment were excluded (mental retardation, cerebral palsy, autism). Standard assessment consisted in the Kaufman Assessment Battery for Children (K-ABC), which comprises three subscales: sequential processes (analysis of sequential information), simultaneous processes (global analysis of visual information), and composite mental processes (CMP) (result of the other two scales), as well as a behavioral evaluation using the standardized Strengths and Difficulties Questionnaire (SDQ). Executive functioning was assessed with tasks evaluating visual attention, divided attention, and digit memory as well as with a specialized questionnaire, the Behavior Rating Index of Executive Functions (BRIEF), which evaluates several aspects of executive function (regulation, attention, flexibility, working memory, etc). RESULTS Children were divided according to their results on the three K-ABC scales (< or >85), and the different neuropsychological tasks assessing executive function were compared between the groups. The CMP did not differentiate children with executive difficulties, whereas a score < 85 on the sequential processes was significantly associated with worse visual and divided attention. There was a strong correlation between the SDQ and the BRIEF questionnaires. For both questionnaires, children receiving psychotherapy had significantly higher results. Children who presented behavioral problems assessed with the SDQ presented significantly higher scores on the BRIEF. CONCLUSION A detailed analysis of the standard neurodevelopmental assessment allows the identification of executive function disorders in premature children. Children who performed below 85 on the sequential processes of the K-ABC had significantly more attentional difficulties on the neuropsychological tasks and therefore have to be recognized and carefully followed. Emotional regulation had a strong correlation with behavioral difficulties, which were suitably assessed with the SDQ, recognized by the families, and treated.

ATTACHMENT IN INFANTS WITH CLEFT LIP AND/OR PALATE: MARGINAL SECURITY AND ITS CHANGES OVER TIME: Marginal Security in Infants With Cleft

This study examines the attachment quality and how this changed over time among infants who had cleft lip and palate (CLP), by conducting a prospective longitudinal study addressing the effects of this type of perinatal event on the parent-infant relationship and the emotional development of the infants. At 12 months of age, the Strange Situation Paradigm (SSP; M. Ainsworth, M.C. Blehar, E. Waters, & T. Wall, 1978) was administered to a sample of 38 CLP infants (born between 2003 and 2010) and 17 healthy controls. At 4 years of age, the Attachment Story Completion Task (ASCT; I. Bretherton, D. Ridgeway, & J. Cassidy, 1990) was administered to 32 individuals from the CLP sample and 14 from the control group. As reported in the literature, CLP infants display secure attachment behaviors as frequently as do control infants (55%). However, a more detailed analysis of the attachment scales revealed that CLP infants show more avoidance and less proximity seeking. In addition, a closer examination of the subcategories of attachment styles revealed that most CLP infants (71%) displayed distal attachment strategies such as the B1/B2 or A1/A2 subcategories. At 4 years old, CLP infants clearly displayed more deactivation and less security than did the control sample. Moreover, when detailing the evolution of attachment individually, almost 60% of the CLP children showing distal strategies at 12 months became deactivated or disorganized when they reached 4 years. Indeed, subtle differences in attachment behaviors at 12 months old-which can be considered marginally secure at that age-may reveal attachment vulnerabilities, which seem to be more apparent over the course of development.

Normal neurodevelopmental outcome despite severe and early extensive encephalomalacia: plasticity, repair or magic?

A male born at 26 weeks’ gestation was seen for neurodevelopmental assessment at 4 years. His neonatal history was marked by the diagnosis of large subcortical cysts located in the left frontal and bilateral parietal regions, which was thought to carry a bad prognosis (Fig. 1a–c). Charts were carefully reviewed, specifically looking for hypocapnia, hypotension, and hypoglycaemia. Despite extensive investigations, no aetiology for this severe and atypical encephalomalacia was found. He was born after a Caesarian section for chorioamnionitis with a birthweight of 815 grammes and APGAR scores were 1/3/4. The infant was treated for respiratory distress syndrome, extubated on day 6, reintubated on day 11 for severe bradycardia/apnea, and then on mechanical ventilation until day 25 because of a symptomatic ductus arteriosus, surgically ligated on day 14. He stayed on nasal continuous positive airway pressure until day 93. Because of histological chorioamnionitis and despite negative cultures, antibiotics were given for 13 days. Cranial ultrasounds showed right-sided grade II hemorrhage according to Papile et al. on day 4, followed by moderate ventricular dilatation since day 14. Cysts became visible after day 35, 3 weeks after uneventful patent ductus arteriosus closure, in an atypical distribution, not commu-

1211 Psychomotor and Emotional Development at 12 Months of Very Preterm Infants with Bronchopulmonary Dysplasia

Cognitive, behavioral and emotional problems have been extensively reported for preterm children. BPD has been outlined in many studies as having an additional deleterious effect on early development. Our aim was to examine neurodevelopment and emotional regulation (ER) in preterm infants with BPD within the first year of life. 38 preterm infants (GA: 27.3 ± 1.01.wks) were seen at 12 months corrected age, of which 19 have had BPD. Four components of the Laboratory Temperament Assessment Battery (Lab TAB) were administered in addition to the Bayley scales (MDI/ PDI). ER was derived from scores on the two trials of the anger evaluation of the Lab TAB. By age of 12 months, mean PDI were lower in BPDgroup (p< 0.05) compared to non- BPD-group. No significant difference between groups was found for the MDI. Correlation analysis revealed a significant negative correlation between ER on the first anger trial and BW (p < 0.01) as well as with GA (p< 0.05), only for the BPD- group. These findings were no longer significant in the second trial. However, a trend indicated an improvement of ER over the two trials in the non-BPD group but not in the BPDgroup. These results indicate that in children born preterm with BPD a higher BW as well as GA are protective factors allowing for better ER. These results add to the breadth of the literature indicating not only motor and intellectual development to be influenced by BPD at a young age but also the capacity to regulate emotions.