Phillipa R. Butcher

Support for the global feasibility of the Ages and Stages Questionnaire as developmental screener

OBJECTIVE To investigate the psychometric properties of the Dutch version of the 48 months Ages and Stages Questionnaire (D_ASQ_48). DESIGN Prospective cohort study of a community-based sample of children born in 2002 and 2003 whose parents filled out the D_ASQ_48 and a questionnaire on school status at 60 months. The ASQ was translated into Dutch and back-translated into English by three independent translators. SETTING Well Child Centers covering 25% of the Netherlands. PARTICIPANTS Parents of 1510 preterm and 562 term children born in 2002-2003 attending routine Well Child visits at age 45-50 months. MAIN OUTCOME MEASURES Reliability, validity and mean population scores for D_ASQ_48 compared to other countries. RESULTS Mean population scores for the D_ASQ_48 were mostly similar to those in the USA, Norway and Korea. Exceptions (effect sizes of difference >0.5) were problem solving (USA) and fine motor (Korea). Reliability was good for the total score (Cronbach alpha 0.79) and acceptable for all domains (0.61-0.74). As expected, infants born at gestational age <32 weeks, children from low income families, of low educated mothers, and boys were more likely to fail on several domains (odds ratios, OR ranging from 1.5 to 4.9). The only unexpected association concerned children from one-parent families. Sensitivity to predict special education at five years of age was 89% and specificity 80%. CONCLUSIONS The good psychometric properties of the Dutch ASQ_48 and the small differences when compared to other countries support its usefulness in the early detection of developmental problems amongst children worldwide.

The quality of the early motor repertoire in preterm infants predicts minor neurologic dysfunction at school age.

OBJECTIVE The quality of a childs motor repertoire at age 3 to 4 months postterm is predictive of later cerebral palsy (CP). Its predictive power for minor neurologic dysfunction (MND) is unclear. This study aimed to investigate the predictive value of the quality of the early motor repertoire for the development of MND at school age. STUDY DESIGN We assessed the motor repertoire from video recordings made at 6 to 24 weeks postterm in 82 preterm infants (mean gestational age, 29.7 +/- 1.9 weeks; mean birth weight, 1183 +/- 302 g). At age 7 to 11 years, Touwens neurologic examination was performed, and the children were classified as normal (n = 49; 60%), MND (n = 18; 22%), or CP (n = 15; 18%). RESULTS Multiple logistic regression analysis showed that the quality of fidgety movements (FMs) and the quality of the concurrent motor repertoire had independent prognostic value for MND at school age. Abnormal FMs evolved into MND in 64% of the children. Nine of the 28 children with normal FMs and an abnormal concurrent motor repertoire developed abnormally (32%). Only 1 child of the 21 children with normal FMs and a normal concurrent motor repertoire developed MND (5%). CONCLUSIONS Assessment of the quality of the early motor repertoire can accurately identify individual infants at high and low risk for MND at school age.

Infants' shifts of gaze from a central to a peripheral stimulus : a longitudinal study of development between 6 and 26 weeks

Abstract This article reports the results of an intensive, longitudinal investigation of the development of infants’ ability to shift gaze from a central to a peripheral stimulus. Sixteen infants were followed at 2-week intervals from 6 to 26 weeks of age. A high degree of discontinuity was found in the development of both frequency and latency of shifts of gaze, with rapid improvement between 9 and 16 weeks, followed by more gradual improvement between 16 and 26 weeks. Individual developmental trajectories for frequency were highly similar to the group trajectory. Trajectories for latency cost differed more across infants. Inter-infant differences had not become stable for either measure at 26 weeks. The findings are consistent with explanations of the development of gaze shifting in terms of changes in the relative strength of processes which maintain the focus of attention and gaze, and processes which interrupt and shift it.

Functioning of 7-Year-Old Children Born at 32 to 35 Weeks’ Gestational Age

OBJECTIVE: To compare neuropsychological functions in moderately preterm (32–35 weeks’ gestation) and full-term children at the age of 7 years and identify gender differences. METHODS: Community-based prospective cohort study of 248 moderately preterm children (138 boys) and 130 full-term children (58 boys). Neuropsychological tests included IQ, memory, attention, visual perception, motor skills, visuomotor skills, and parental report of executive functioning. RESULTS: The moderately preterm group performed significantly worse on total and performance IQ, visuospatial reasoning, attention control, inhibition, and executive functioning. No differences were found in verbal IQ, verbal memory, and visuomotor and motor skills. Preterm children were at higher risk for scores <10th percentile on intelligence, visuospatial reasoning (relative risk ratio both: 1.69 [95% confidence interval: 1.29–2.28]), and executive functioning problems (relative risk: 1.94 [95% confidence interval: 1.51–2.57]). Using gender-specific norms, preterm boys performed significantly worse than full-term boys on visuospatial reasoning (P < .01); preterm girls performed significantly worse than full-term girls on visuospatial reasoning, intelligence, attention, and executive functioning (P < .05). CONCLUSIONS: Moderately preterm birth is associated with lower intelligence and poorer neuropsychological functioning at early school age. No differences in motor skills and verbal memory were found. Using gender-specific norms, our data suggest that moderately preterm boys catch up, whereas moderately preterm girls lag behind their peers on various neuropsychological functions by the age of 7 years.

A longitudinal study of the development of shifts of gaze to a peripheral stimulus in preterm infants with transient periventricular echogenicity

Shifts of gaze to peripheral targets were studied longitudinally, between 6 and 26 weeks corrected age, in full-term and very preterm infants with transient periventricular echogenicity (PVE). Before 10 weeks, simple shifts of gaze were faster and more frequent in preterms with PVE<14 days than in full-terms, suggesting these preterms profited from additional early visual experience. After 16 weeks, there were subtle differences between full- and preterm infants in the development of shifts of gaze requiring disengagement. The differences suggest that, after disengagement had become established, its fine-tuning occurred more slowly in the preterms. Slower fine-tuning of disengagement was not associated with duration of PVE, since it was more marked in preterms with PVE<14 days than in preterms with PVE> or =14 days. The differences in performance between full- and preterm infants were small. However, even small differences may affect the efficiency of visually guided behaviors.

Less efficient elementary visuomotor processes in 7- to 10-year-old preterm-born children without cerebral palsy: An indication of impaired dorsal stream processes

Follow-up studies of preterm children without serious neurological complications have consistently found deficits in visuomotor skills. To determine whether these deficits may be related to impaired elementary visuomotor processes, we investigated movement programming and execution of simple pointing movements in 7- to 10-year-old preterm (<34 weeks g.a. and/or b.w. <1800 g) and full-term children. Such detailed analysis of simple pointing movements provides information on the extent to which processes associated with dorsal and/or cerebellar functions are impaired. Multi-level analysis showed that movement programming and execution were slowed in the 7-, 9-, and 10-year-old preterm groups. This indicates impaired dorsal visual stream functioning in preterm children, but do not rule out impaired cerebellar functioning. At 8 years of age, there were no differences between the two groups in movement execution time. This could have reflected a transition in the development of movement control in the control group, which has been associated in typically developing children with a decrease in motor speed. Interestingly, a similar decrease was not found in the preterm group at 8 years of age.

Inhibition of return in very young infants: a longitudinal study

Inhibition of return (IOR) was measured at 2-week intervals from 6 weeks to 6 months of age in 16 infants. IOR refers to the tendency not to return attention to a recently attended location. A spatial cueing task adapted to the attentional and oculomotor skills of the youngest infants was used. At 6 weeks, infants looked more frequently and faster to cued targets. Looks to uncued targets were more frequent than looks to cued targets from 16 weeks, and faster than looks to cued targets from 18 weeks. Infants differed in the tempo of development and the level of performance on both indices of IOR in the final session. Individual preferences for uncued targets fluctuated from session to session. Unstable looking biases were observed in all infants. They explained a significant part of the intra-individual differences in preference. Latency to look to uncued targets was stable from the 18-week session.

Difference rather than delay in development of elementary visuomotor processes in children born preterm without cerebral palsy: a quasi-longitudinal study.

Follow-up studies of preterm children without serious neonatal medical complications have consistently found poor visuomotor and visuospatial skills. In the first round of current follow-up study, we found a deficit in elementary visuomotor processes in preterm children without Cerebral Palsy (CP). To determine whether the development of these processes was delayed or different, we carried out a quasi-longitudinal study in which kinematic characteristics of pointing movements in 7- to 11-year-old preterm born children without CP and in an age-matched full-term group were analyzed. Multi-level analysis suggested a difference rather than a delay in the preterm born group: we found a regression around 8 years of age in the control but not in the preterm group. To our knowledge, this study is the first to provide longitudinal data confirming this regression in the development of movement control in typically developing children. Our results are also consistent in suggesting that elementary visuomotor processes are less efficient in preterm born children without CP: their movements were either slower or less accurate. While these differences were subtle, they persisted until 11 years of age.

The Link between Peer Relations, Prosocial Behavior, and ODD/ADHD Symptoms in 7–9-Year-Old Children

Oppositional defiant disorder (ODD) and attention-deficit/hyperactivity disorder (ADHD) are characterized by symptoms that hinder successful positive interaction with peers. The main goal of this study was to examine if the presence of symptoms of ODD and ADHD affects the relationship between positive social behavior and peer status found in 7–9-year-old children who show symptoms typical of ADHD and/or ODD. Furthermore, the possible interaction with sex was investigated. We used data collected in the first wave of The Bergen Child Study of mental health (BCS), a prospective longitudinal total population study of childrens developmental and mental health. The target population consisted of children in the second to the fourth, in all public, private, and special schools in Bergen, Norway, in the fall of 2002 (N = 9430). All 79 primary schools in Bergen participated in the study. Both teacher (8809 complete cases) and parent (6253 complete cases) report were used in the analyses. ADHD and ODD scores were estimated using the Swanson Noland and Pelham rating scale version IV (SNAP-IV), and peer problems and prosocial behavior were assessed using the Strengths and Difficulties Questionnaire (SDQ). We replicated the relationship between peer problems and prosocial behavior found previously in typically developing children. Our results showed that the relationship between peer problems and prosocial behavior became weaker as the ODD symptoms increased in number and severity. For ADHD this effect was only found in the teacher report of the children. A sex effect for ODD symptoms was found only using the parent report: boys with ODD symptoms showed less prosocial behavior than girls with similar levels of ODD symptoms. Since this effect was not found using the teacher data, it may imply a situational effect (school/home) for girls with high levels of ODD. The moderator effect of ODD/ADHD was comparable for boys and girls. Our findings suggest that even if children with ADHD/ODD symptoms have the opportunity to practice their social skills in peer relationships, this is not necessarily accompanied by an increase in prosocial behavior.

Visuospatial perception in children born preterm with no major neurological disorders.

OBJECTIVE Many investigations have found deficits in visuospatial perception in children born preterm, however, it is not clear whether the deficits are specific to visuospatial perception or the consequences of deficits in other functional areas, which often accompany preterm birth. This study investigated whether children born preterm show a specific deficit in visuospatial perception. METHOD Fifty-six 7- to 11-year-old preterm born children (gestational age <34 weeks) without cerebral palsy and 51 age-matched, full-term children completed four computerized tasks tapping different levels and types of visuospatial perception. Accuracy and speed of responses were recorded. Task formats were designed to reduce demands on attentional deployment. Measures of intelligence and parental education were included in the analysis. RESULTS Children born preterm performed less accurately and/or less rapidly on all tasks. Their poorer performance did not reflect differences in speed-accuracy trade-off. Parental education and IQ, both significantly lower in the preterm children, contributed positively to performance on all tasks. IQ mediated the association between preterm birth and visuospatial performance on the most cognitively demanding task. CONCLUSION Children born preterm performed more poorly than full-term controls on four visuospatial perceptual tasks. Although intelligence and parental education were also associated with performance, preterm birth contributed independently of these factors on three of four tasks. Many children born preterm are thus multiply disadvantaged on visuospatial tasks: the lower IQ scores and parental educational levels frequently found in this group increase the deficit associated with preterm birth.