Stephen R. Hooper

Cumulative risk and early cognitive development: a comparison of statistical risk models.

Although it is generally accepted that social risk factors predict delays in early cognitive and language development, there is less agreement about how to represent such associations statistically. Using data collected prospectively on 87 African American children during their first 4 years, this study examined 3 analytic methods for describing a childs level of social risk: (a) individual risk variables, (b) factor scores derived from those risk variables, and (c) a risk index computed by tallying the number of risk conditions present. Comparisons indicated that the individual-risk-variables approach provides better overall prediction of developmental outcomes at a particular age but is less useful in predicting developmental patterns. The risk-factor approach provides good prediction of developmental trajectories when sample sizes are moderate to large. Finally, the risk-index approach is useful for relating social risk to developmental patterns when a large number of risk variables are assessed with a small sample or when other constructs are of primary interest.

Neuropsychological Findings in Childhood Neglect and their Relationships to Pediatric PTSD

Although child neglect is the most prevalent form of child maltreatment, the neurocognitive effects of neglect are understudied. We examined IQ, reading, mathematics, and neurocognitive domains of fine-motor skills, language, visual-spatial, memory/learning, and attention/executive functions in two groups of nonsexually abused medically healthy neglected children, one with DSM-IV posttraumatic stress disorder (PTSD) and one without, and a demographically similar healthy nonmaltreated control group. Significantly lower IQ, reading, mathematics, and selected differences in complex visual attention, visual memory, language, verbal memory and learning, planning, problem solving, and speeded naming were seen in Neglect Groups. The Neglect with PTSD Group performed worse than controls on NEPSY Design Copying, NEPSY Tower, and Mathematics; and performed worse than controls and Neglect without PTSD on NEPSY Memory for Faces-Delayed. Negative correlations were seen between PTSD symptoms, PTSD severity, and maltreatment variables, and IQ, Academic Achievement, and neurocognitive domains. Neglected children demonstrated significantly lower neurocognitive outcomes and academic achievement than controls. Lower IQ, neurocognitive functions, and achievement may be associated with more PTSD symptoms (particularly re-experiencing symptoms), greater PTSD severity, and a greater number of maltreatment experiences. Trauma experiences may additionally contribute to subsequent neurodevelopmental risk in neglected children. (JINS, 2009, 15, 868-878.).

Double-blind, placebo-controlled study of amantadine hydrochloride in the treatment of children with autistic disorder

OBJECTIVE To test the hypothesis that amantadine hydrochloride is a safe and effective treatment for behavioral disturbances--for example, hyperactivity and irritability--in children with autism. METHOD Thirty-nine subjects (intent to treat; 5-19 years old; IQ > 35) had autism diagnosed according to DSM-IV and ICD-10 criteria using the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule-Generic. The Aberrant Behavior Checklist-Community Version (ABC-CV) and Clinical Global Impressions (CGI) scale were used as outcome variables. After a 1-week, single-blind placebo run-in, patients received a single daily dose of amantadine (2.5 mg/kg per day) or placebo for the next week, and then bid dosing (5.0 mg/kg per day) for the subsequent 3 weeks. RESULTS When assessed on the basis of parent-rated ABC-CV ratings of irritability and hyperactivity, the mean placebo response rate was 37% versus amantadine at 47% (not significant). However, in the amantadine-treated group there were statistically significant improvements in absolute changes in clinician-rated ABC-CVs for hyperactivity (amantadine -6.4 versus placebo -2.1; p = .046) and inappropriate speech (-1.9 versus 0.4; p = .008). CGI scale ratings were higher in the amantadine group: 53% improved versus 25% (p = .076). Amantadine was well tolerated. CONCLUSIONS Parents did not report statistically significant behavioral change with amantadine. However, clinician-rated improvements in behavioral ratings following treatment with amantadine suggest that further studies with this or other drugs acting on the glutamatergic system are warranted. The design of these and similar drug trials in children with autistic disorder must take into account the possibility of a large placebo response.

Social Risk and Protective Child, Parenting, and Child Care Factors in Early Elementary School Years

Objective. African American children exposed to multiple social risk factors during early childhood often experience academic difficulties, so identification of protective factors is important. Design. Academic and school behavior trajectories from kindergarten through third grade were studied among 75 African American children who have been followed prospectively since infancy to test hypothesized protective factors: quality of home and child care environments during early childhood, child language and social skills at entry to kindergarten, and school characteristics. Results. Children exposed to multiple risks in early childhood showed lower levels of academic and social-emotional skills from kindergarten through third grade. Parenting mediated the association with risk. Childrens language skills, parenting, and child care quality serve as protective factors in acquisition of mathematics skills and reduction in problem behaviors during the first 4 years of primary school for African American children facing multiple risks. Attending a school with a higher proportion of children from low-income families might predict increasing numbers of problem behaviors over time. Conclusions. Exposure to social risk in early childhood negatively predicted academic achievement and adjustment during early elementary school for African American children, in part through associations between exposure to social risk and less responsive and stimulating parenting. Furthermore, the negative associations between risk and academic outcomes were substantially weaker when children had more responsive and sensitive parents or child care providers or entered school with stronger language skills.

Research on the preschool prediction of later academic achievement: A review

Abstract This review provides a comprehensive examination of the longitudinal research on the preschool prediction of later academic achievement. A total of 74 studies published from 1973 to 1986 are considered with respect to both their methodological features and their substantive findings. Effective predictors were found to span cognitive, verbal, and perceptual/perceptual-motor areas of functioning in the preschool child, as well as behavioral and demographic factors. Predictive relationships varied according to the specific area of criterion performance assessed and the grade level when evaluated, and also in terms of when the initial testing was obtained. Overall, the research has succeeded in identifying a general set of preschool measures that should allow a gross discrimination of children who are likely to fall at the extremes of academic ability in early elementary school grades. More attention must be given to selected methodological issues if better discrimination is to be achieved. These are outlined, and the incorporation of a theoretical framework based on neurodevelopmental concepts is discussed.

Executive Functions in Elementary School Children With and Without Problems in Written Expression

This study examined the executive functioning of 55 elementary school children with and without problems in written expression. Two groups reflecting children with and without significant writing problems were defined by an average primary trait rating across two separate narratives. The groups did not differ in terms of chronological age, ethnicity, gender, socioeconomic status, special education status, or presence of attention problems or receptive vocabulary capabilities; however, they did differ in reading decoding ability, and this variable was controlled for in all analyses. Dependent measures included tasks tapping an array of executive functions grouped conceptually in accordance with a model of executive functioning reflecting the following domains: initiate, sustain, set shifting, and inhibition/stopping. Analysis of covariance (ANCOVA) procedures revealed statistically significant group differences on the initiation and set shift domains, with the sustaining domain approaching significance. Children with writing problems performed more poorly in each of these domains, although the effect sizes were small. A multiple regression that employed these four factors and the reading decoding variable to predict the primary trait score from the written narratives revealed a statistically significant regression function; however, reading decoding contributed most of the unique variance to the writing outcome. These findings point out the importance of executive functions in the written language process for elementary school students, but highlight the need to examine other variables when studying elementary school-age children with written expression problems.

ADHD symptoms in children with FXS.

Parent‐ and teacher‐report of attention‐deficit/hyperactivity disorder (ADHD) symptoms were examined using problem behavior and DSM‐IV symptom inventory questionnaires for 63 children with full mutation fragile X syndrome (FXS) and 56 children without disabilities matched on mental age (MA). Prevalence rates of ADHD symptoms varied depending on type of measure (problem behavior or DSM‐IV criteria), subscale (ADHD‐inattentive or ADHD‐hyperactive), scoring method (continuous T‐scores or categorical scores based on DSM‐IV algorithm), and rater (parent or teacher). Overall, 54–59% of boys with FXS met diagnostic behavioral criteria for either ADHD‐inattentive type only, ADHD‐hyperactive type only, or ADHD‐combined type based on parent or teacher report. Boys with FXS were rated as having clinically high scores or met diagnostic criteria at higher rates than expected for the general population and had higher raw scores than their MA‐matched peers. Parent ratings of boys with FXS resulted in higher ADHD‐inattentive type and ADHD‐hyperactive type T‐scores than teachers. Boys who were rated as meeting DSM‐IV criteria were more likely to be taking psychotropic medication and to have younger mental ages. Parents were substantially more likely than teachers to rate boys as meeting DSM‐IV criteria for ADHD‐inattentive type, while teachers were only slightly more likely than parents to rate boys as meeting DSM‐IV criteria for ADHD‐hyperactive type. Teachers were more likely than parents to rate boys as meeting DSM‐IV criteria for ADHD when boys had lower levels of FMRP.

Health-Related Quality of Life of Children With Mild to Moderate Chronic Kidney Disease

OBJECTIVE: To compare the health-related quality of life (HRQoL) of children with chronic kidney disease (CKD) with healthy children; to evaluate the association between CKD severity and HRQoL; and to identity demographic, socioeconomic, and health-status variables that are associated with impairment in HRQoL in children with mild to moderate CKD. METHODS: This was a cross-sectional assessment of HRQoL in children who were aged 2 to 16 and had mild to moderate CKD using the Pediatric Inventory of Quality of Life Core Scales (PedsQL). Overall HRQoL and PedsQL domain means for parents and youth were compared with previously published norms by using independent sample t tests. Study participants were categorized by kidney disease stage (measured by iohexol-based glomerular filtration rate [iGFR]), and group differences in HRQoL were evaluated by using analysis of variance and Cuzick trend tests. The association between hypothesized predictors of HRQoL and PedsQL scores was evaluated with linear and logistic regression analyses. RESULTS: The study sample comprised 402 participants (mean age: 11 years, 60% male, 70% white, median iGFR: 42.5 mL/min per 1.73 m2, median CKD duration: 7 years). Youth with CKD had significantly lower physical, school, emotional, and social domain scores than healthy youth. iGFR was not associated with HRQoL. Longer disease duration and older age were associated with higher PedsQL scores in the domains of physical, emotional, and social functioning. Older age was associated with lower school domain scores. Maternal education ≥16 years was associated with higher PedsQL scores in the domains of physical, school, and social functioning. Short stature was associated with lower scores in the physical functioning domain. CONCLUSIONS: Children with mild to moderate CKD, in comparison with healthy children, reported poorer overall HRQoL and poorer physical, school, emotional, and social functioning. Early intervention to improve linear growth and to address school functioning difficulties is recommended.

Diffusion Tensor Measures of the Corpus Callosum in Adolescents With Adolescent Onset Alcohol Use Disorders

BACKGROUND In adults, myelination injury is associated with alcoholism. Maturation of the corpus callosum is prominent during adolescence. We hypothesized that subjects with adolescent-onset alcohol use disorders (AUD; defined as Diagnostic and Statistical Manual of Mental Disorders-IV alcohol dependence or abuse) would have myelination microstructural differences compared to controls. METHODS Adolescent subjects (25 males, 7 females) with an AUD (16.9 +/- 1.2 years), who were recruited from substance abuse treatment programs and had co-morbid mental disorders, and 28 sociodemographically similar healthy controls (17 males, 11 females; 15.9 +/- 1.1 years) underwent a 3.0 T MRI diffusion tensor imaging scan. RESULTS Measures of rostral body fractional anisotropy (FA) were higher in the AUD group than in the control group. Compared to controls, mean diffusivity (MD) was lower, while FA was higher, in the AUD group in the isthmus region. Anterior corpus callosum microstructural development differed in adolescents with AUD, as age was positively (not negatively) associated with rostrum MD and age was negatively (not positively) associated with rostrum FA. There were sex by group interactions in that control females had higher posterior midbody FA when compared to female adolescents with AUD. CONCLUSIONS Lower MD and higher FA values in the AUD group suggest pre-morbid vulnerability for accelerated prefrontal and temporo-parietal myelin maturation that may enhance the risk for adolescent AUD. Significant (and opposite to developmentally expected) correlations were seen between anterior corpus callosum MD and FA measures and age in the AUD group, suggesting neurotoxic effects of alcohol on adolescent corpus callosum microstructure. As seen in adults, female adolescents with AUD may be especially vulnerable to corpus callosum microstructural injury. Further diffusion tensor imaging studies of corpus callosum maturation in children at familial risk for alcoholism, and in those with AUD, need to be done to elucidate these mechanisms.

Executive functions in young males with fragile X syndrome in comparison to mental age-matched controls: baseline findings from a longitudinal study.

The performance of 54 boys with fragile X syndrome (FXS), ages 7 to 13 years, was compared to that of a group of typically developing boys who were matched on mental age (MA) and ethnicity across multiple measures of executive function (EF). Boys with FXS varied in their ability to complete EF measures, with only 25.9% being able to complete a set-shifting task and 94.4% being able to complete a memory for word span task. When compared to the control group, and controlling for MA and maternal education, boys with FXS showed significant deficits in inhibition, working memory, cognitive flexibility/set-shifting, and planning. No group differences were observed in processing speed. Mental age significantly impacted performance on working memory, set-shifting, planning, and processing speed tasks for both groups. In boys with FXS, MA significantly predicted performance on working memory and set-shifting tasks. Our findings suggest that deficits in EF in boys with FXS are not solely attributable to developmental delays but, rather, present as a true array of neurocognitive deficits.