Visual configural processing in adults born at extremely low birth weight

Being born at extremely low birth weight (ELBW; ≤1,000 g) is associated with enduring visual impairments. We tested for long‐term, higher order visual processing problems in the oldest known prospectively followed cohort of ELBW survivors. Configural processing (spacing among features of an object) was examined in 62 adults born at ELBW (M_age = 31.9 years) and 82 adults born at normal birth weight (NBW; ≥2,500 g: M_age = 32.5 years). Pairs of human faces, monkey faces, or houses were presented in a delayed match‐to‐sample task, where non‐matching stimuli differed only in the spacing of their features. Discrimination accuracy for each stimulus type was compared between birth weight groups, adjusting for neurosensory impairment, visual acuity, binocular fusion ability, IQ, and sex. Both groups were better able to discriminate human faces than monkey faces (p < .001). However, the ELBW group discriminated between human faces (p < .001), between monkey faces (p < .001), and to some degree, between houses (p < .06), more poorly than NBW control participants, suggesting a general deficit in perceptual processing. Human face discrimination was related to performance IQ (PIQ) across groups, but especially among ELBW survivors. Coding (a PIQ subtest) also predicted human face discrimination in ELBW survivors, consistent with previously reported links between visuo‐perceptive difficulties and regional slowing of cortical activity in individuals born preterm. Correlations with Coding suggested ELBW survivors may have used a feature‐matching approach to processing human faces. Future studies could examine brain‐based anatomical and functional evidence for altered face processing, as well as the social and memory consequences of face‐processing deficits in ELBW survivors.     

Still cautious: Personality characteristics of extremely low birth weight adults in their early 30s

Extremely low birth weight survivors (ELBW; <1000 g) display a personality style characterized by cautiousness, shyness, and risk aversion in their 20s. We examined whether non-impaired ELBW survivors were still more cautious than their normal birth weight (NBW) peers at ages 30–35 and assessed the stability of this personality characteristic across approximately a decade in the oldest known cohort of ELBW survivors. Of the 154 participants tested at ages 22–26, 111 (i.e., 72%) of them returned approximately 10 years later [i.e., 69% (49/71) ELBW and 75% (62/83) NBW], and once again they completed the Eysenck Personality Questionnaire-Revised (EPQ-R). We created the same theoretically and empirically derived composite measure of cautiousness at each visit by summing the EPQ-R psychoticism scale (reverse scored) and the EPQ-R lie scale. We found that ELBW adults reported higher cautiousness than their NBW counterparts at ages 30–35. We also found that levels of cautiousness remained stable over approximately 10 years in both groups. Our findings suggest that individuals born at ELBW were more cautious than NBW peers and that this personality characteristic remained stable into their early 30s. The present study appears to be the first empirical demonstration of personality stability among adult ELBW survivors.     

The contribution of visual processing to academic achievement in adolescents born extremely preterm or extremely low birth weight

Children born extremely preterm (EP, <28 weeks) and/or extremely low birth weight (ELBW, <1000 g) have more academic deficiencies than their term-born peers, which may be due to problems with visual processing. The aim of this study is to determine (1) if visual processing is related to poor academic outcomes in EP/ELBW adolescents, and (2) how much of the variance in academic achievement in EP/ELBW adolescents is explained by visual processing ability after controlling for perinatal risk factors and other known contributors to academic performance, particularly attention and working memory. A geographically determined cohort of 228 surviving EP/ELBW adolescents (mean age 17 years) was studied. The relationships between measures of visual processing (visual acuity, binocular stereopsis, eye convergence, and visual perception) and academic achievement were explored within the EP/ELBW group. Analyses were repeated controlling for perinatal and social risk, and measures of attention and working memory. It was found that visual acuity, convergence and visual perception are related to scores for academic achievement on univariable regression analyses. After controlling for potential confounds (perinatal and social risk, working memory and attention), visual acuity, convergence and visual perception remained associated with reading and math computation, but only convergence and visual perception are related to spelling. The additional variance explained by visual processing is up to 6.6% for reading, 2.7% for spelling, and 2.2% for math computation. None of the visual processing variables or visual motor integration are associated with handwriting on multivariable analysis. Working memory is generally a stronger predictor of reading, spelling, and math computation than visual processing. It was concluded that visual processing difficulties are significantly related to academic outcomes in EP/ELBW adolescents; therefore, specific attention should be paid to academic remediation strategies incorporating the management of working memory and visual processing in EP/ELBW children.     

Early interactive behaviours in preterm infants and their mothers: Influences of maternal depressive symptomatology and neonatal birth weight

The study evaluated the quality of preterm infant–mother interactions, considering severity of birth weight (ELBW and VLBW) and maternal depression, compared to full term babies. 69 preterm infants (29 ELBW and 40 VLBW) and 80 full-term (FT) infants and their mothers were recruited. At 3 months of corrected age, the quality of mother–infant interaction was evaluated through Global Rating Scales; moreover, infant level of development and maternal depression were assessed through Griffith Development Mental Scales and Edinburgh Postnatal Depression Scale. Results showed adequate sensitivity in preterm infants’ mothers and higher involvement with their infants, compared to full term mothers, but ELBW ones exhibited an intrusive interactive pattern and a higher prevalence of depressive symptoms. The study underlined the relevance of paying special attention to both ELBW infants and their mothers, in order to support the parenting role and the co-construction of early interactions.     

Neurodevelopmental impairment: Predictors of its impact on the families of extremely low birth weight infants at 18 months

Effects on a family of a child with chronic illness have been described. The Impact on Family Scale (IOF) was developed to measure these effects. The impact of extremely low birth weight (ELBW) infants with neurodevelopmental impairment on families is unknown. This study determined IOF scores for families of ELBW infants with increasing degree of impairment at 18 months and identified factors that increase vulnerability to impact. A total of 3,849 ELBW infant survivors born at the 16 centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 1993 and February 2001 were assessed at 18 to 22 months. Infants were divided into four groups by degree of impairment. IOF scores were analyzed by impairment group. Multivariate analyses assessed effects of impairment, social/demographic factors, unmet service needs, and resource utilization on the IOF. A total of 1,624 (42.2%) infants had moderate/severe impairment. Increasing severity of impairment was associated with higher IOF scores. Severity of impairment contributed 6% of variance to the IOF scores. Twenty‐one percent of variance was contributed by additional medical needs, low socioeconomic status (SES), and lack of social support. Although increasing severity of impairment impacts families of ELBW infants, significantly more impact is contributed by additional medical needs, low SES, and lack of social support.     

Sources of variability in sequelae of very low birth weight.

Few investigations have examined the specificity of sequelae of very low birth weight (VLBW, <1500 g) or sources of variability in outcome. To better understand the nature and determinants of outcome, we assessed neuropsychological and achievement skills at mean age 11 years in 62 children with <750 g birth weight, 54 with 750-1499 g birth weight, and 66 term-born controls. Distinct cognitive constructs were identified by factor analysis, and the three birthweight groups were compared on these constructs and on composite measures of achievement. Although the group with <750 g birth weight performed less well on all tests than term-born controls, group differences in a perceptual planning factor and in mathematics remained even when IQ was controlled, and deficits were more pronounced in mathematics than in reading. Results from structural equation modeling were consistent with the hypothesis that neuropsychological skills mediated the relationship between birth weight and achievement. The findings confirm the differential deficit hypothesis, support the need to consider multiple sources of variability in VLBW outcomes, and highlight the importance of neuropsychological constructs in developing an explanatory framework.     

Verbal memory deficits in children with less than 750 g birth weight.

Numerous studies have documented memory deficits in very low birthweight (VLBW, < 1500 g) children, yet we know little about the nature of these memory problems. To clarify memory sequelae and examine memory deficits in relation to the degree of low birth weight, we administered the California Verbal Learning Test-Children's Version (CVLT-C) to a regional sample of 57 < 750 g birthweight children and to groups of 53 750-1499 g birthweight children and 49 term-born controls. Group comparisons revealed significant differences between the < 750 g birthweight group and term-born children on measures of list learning, delayed recall, and inaccurate recall. In addition, the percentage improvement in correct recognitions relative to long-term delayed recall was greater in the < 750 g group than in the term-born controls. Similar differences were observed between VLBW children with and without abnormal neonatal cerebral ultrasounds (high- and low-risk groups). Differences in learning rate between the VLBW and term-born groups, and between high- and low-risk VLBW children, were evident even when vocabulary skill was covaried or when children with neurosensory deficits or IQ < 80 were excluded from analysis. The findings document deficits in verbal memory in the subset of VLBW children at greatest biological risk, and suggest that acquisition processes are selectively impaired.     

Assessment of parental sensitivity towards pre-school children born with very low birth weight

The article introduces the Parental Sensitivity Assessment Scale (PSAS) and examines the influence of the PSAS score and other factors on the general cognitive level in pre-school children born with very low birth weight (VLBW). McCarthy general cognitive index (GCI) was obtained for 102 VLBW and 92 normal birth weight (NBW) control children in Denmark in the mid-1980s. The mean ages of the two groups were 52.4 vs. 53.1 months. Parental sensitivity was assessed using PSAS. There was no significant difference in the mean PSAS score between the two birth weight groups (p > 0.3). Birth weight group (p < 0.001) and mother's schooling (p= 0.026) significantly correlated with GCI in the children. The PSAS score was highly significantly correlated to the variance of the GCI (p < 0.001), which was not explained by VLBW and mother's schooling. We found no interactional effect between parental sensitivity and birth weight group (p > 0.5) - the prematurely born children were not more affected by low parental sensitivity than were the control children.     

Test of visuospatial construction: Validity evidence in extremely low birth weight and late preterm children at early school age

The Test of Visuospatial Construction (TVSC), a measure of visuoconstruction that does not rely on upper extremity motor response or written production, was administered to extremely low birth weight (ELBW), late preterm (LPT), and term participants at preschool (n = 355) and kindergarten (n = 265) ages. TVSC showed statistically significant weak-to-moderate positive correlations (age 3: r = .118–.303; age 6: r = .138–.348) with Developmental VMI, Differential Ability Scales-II Copying, Matrices, and Pattern Construction subtests, Baron-Hopkins Board Test, and the Purdue Pegboard. One-way ANOVA indicated ELBW performed worse than Term (p = .044) on visuospatial construction at age 3 with a small-to-medium effect size (d = ?0.43). No other statistically significant differences were found at age 3 on the TVSC (ELBW/LPT: p = .608, d = ?0.17; LPT/Term: p = .116, d = ?0.31). At age 6, ELBW participants performed worse than LPT participants (p = .027) and Term participants (p = .012); LPT participants did not differ from Term participants. Small effect sizes at age 3 (ELBW < LPT, d = ?0.17; ELBW < Term, d = ?0.43) were notably larger at age 6 (ELBW < LPT, d = ?0.42; ELBW < Term, d = ?0.53). Important practical differences showing LPT participants performed below Term participants (d = ?0.31) at age 3 were no longer evident at age 6 (d = ?0.097). These findings provide preliminary evidence of TVSC validity supporting its use to detect neuropsychological impairment and to recommend appropriate interventions in young preterm children.     

Executive functions in extremely low birth weight and late-preterm preschoolers: Effects on working memory and response inhibition

Executive function (EF) refers to fundamental capacities that underlie more complex cognition and have ecological relevance across the individual's lifespan. However, emerging executive functions have rarely been studied in young preterm children (age 3) whose critical final stages of fetal development are interrupted by their early birth. We administered four novel touch-screen computerized measures of working memory and inhibition to 369 participants born between 2004 and 2006 (52 Extremely Low Birth Weight [ELBW]; 196 late preterm; 121 term-born). ELBW performed worse than term-born on simple and complex working memory and inhibition tasks and had the highest percentage of incomplete performance on a continuous performance test. The latter finding indicates developmental immaturity and the ELBW group's most at-risk preterm status. Additionally, late-preterm participants performed worse compared with term-born on measures of complex working memory but did not differ from those term-born on response inhibition measures. These results are consistent with a recent literature that identifies often subtle but detectable neurocognitive deficits in late-preterm children. Our results support the development and standardization of computerized touch-screen measures to assess EF subcomponent abilities during the formative preschool period. Such measures may be useful to monitor the developmental trajectory of critical executive function abilities in preterm children, and their use is necessary for timely recognition of deficit and application of appropriate interventional strategies.     

Developmental change in the neuropsychological functioning of very low birth weight infants

Research on very low birth weight (VLBW) infants has not carefully evaluated developmental patterns of neurological and neuropsychological functioning across time. This study reports on a broad range of developmental outcomes for VLBW infants of low (LR, n = 116) and high (HR, n = 84) medical risk compared to full term infants (FT, n = 120) across 6, 12, and 24 months of age. While low risk infants showed initial delays in most areas, faster rates of change in motor and neurological development resulted in catch-up by 2 years of age as compared to the FT infants. The lack of acceleration in development of mental skills demonstrates a persistent lag in this area. In contrast, HR infants showed initial delays in all areas as compared to both LR and FT infants with slower rates of change in mental and expressive language skills. Although faster rates of change were evident for HR infants in motor, neurological, and receptive language skills, scores in these areas remain lower than those for the LR and FT infants. The absence of accelerated rates of development for certain VLBW infants has implications for prognosis and patient access to early intervention services.     

Cognitive control deficits in adolescents born with very low birth weight (≤ 1500 g): Evidence from dichotic listening

The objective of the paper is to explore bottom‐up auditory and top‐down cognitive processing abilities as part of long‐term outcome assessment of preterm birth. Fifty‐five adolescents (age 13–15) born with very low birth weight (VLBW) were compared to 80 matched controls born to term, using three consonant‐vowel dichotic listening (DL) instruction conditions (non‐forced, forced‐right and forced‐left). DL scores were correlated with cortical gray matter thickness derived from T1‐weighted structural MRI volumes using FreeSurfer to examine group differences also in the neural correlates of higher cognitive processes. While showing normal bottom‐up processing, VLBW adolescents displayed impaired top‐down controlled conflict processing related to significant cortical thickness differences in left superior temporal gryus and anterior cingulate cortex. Preterm birth with VLBW induces fundamental changes in brain function and structure posing a risk for long‐term neurocognitive impairments. Deficits emerge in situations of increasing cognitive conflict and can be related to measures of executive functions as well as morphology.     

Selective deficit in spatial location memory in extremely low birth weight children at age six: The PETIT Study

Spatial location memory has rarely been assessed in young children due to a scarcity of developmentally appropriate tests. This study sought to compare nonverbal learning and recall in children born extremely low birth weight (ELBW; <1000 g) and less than 33 gestational weeks (GW) with term-born children at early school age using a recently developed and adapted test. We administered a modification of the Hopkins Board to 210 children at age six; 84 born ELBW (35 born < 26 GW; 49 born 26–33 GW) and 126 term-born. Six measures were obtained: naming, trials-to-criterion, errors-to-criterion, delayed item recall, delayed location recall, and percent retention. After age correction, ELBW children had worse general cognition, item naming, delayed item recall, delayed location recall, and percent retention than term-born children. Delayed item recall and percent retention performances of ELBW children remained worse after correction for general cognition. ELBW groups (< 26 GW and 26–33 GW) groups performed worse than term-born children in naming and delayed item recall with chronological age as covariate. Those born before 26 GW, but not 26–33 GW, performed worse than term-born children in delayed location recall and percent retention. Differences remained significant after controlling for gender, maternal education, and delivery type. All three groups' performance declined from final learning trial to delayed location recall, with a decline greater for less than 26 GW than term-born children. Extreme prematurity (< 26 GW) and ELBW are significant risk factors for spatial location memory deficit. The modified Hopkins Board discriminated high-risk preterm and term-born children at early school age and appears to be a useful test to measure this rarely studied cognitive capacity.     

Formula: see text]Executive functions in extremely low birth weight and late-preterm preschoolers: Effects on working memory and response inhibition

Executive function (EF) refers to fundamental capacities that underlie more complex cognition and have ecological relevance across the individual's lifespan. However, emerging executive functions have rarely been studied in young preterm children (age 3) whose critical final stages of fetal development are interrupted by their early birth. We administered four novel touch-screen computerized measures of working memory and inhibition to 369 participants born between 2004 and 2006 (52 Extremely Low Birth Weight [ELBW]; 196 late preterm; 121 term-born). ELBW performed worse than term-born on simple and complex working memory and inhibition tasks and had the highest percentage of incomplete performance on a continuous performance test. The latter finding indicates developmental immaturity and the ELBW group's most at-risk preterm status. Additionally, late-preterm participants performed worse compared with term-born on measures of complex working memory but did not differ from those term-born on response inhibition measures. These results are consistent with a recent literature that identifies often subtle but detectable neurocognitive deficits in late-preterm children. Our results support the development and standardization of computerized touch-screen measures to assess EF subcomponent abilities during the formative preschool period. Such measures may be useful to monitor the developmental trajectory of critical executive function abilities in preterm children, and their use is necessary for timely recognition of deficit and application of appropriate interventional strategies.     

Birth weight and stuttering: Evidence from three birth cohorts

PurposePrevious studies have produced conflicting results with regard to the association between birth weight and developmental stuttering. This study sought to determine whether birth weight was associated with childhood and/or adolescent stuttering in three British birth cohort samples.MethodsLogistic regression analyses were carried out on data from the Millenium Cohort Study (MCS), British Cohort Study (BCS70) and National Child Development Study (NCDS), whose initial cohorts comprised over 56,000 individuals. The outcome variables were parent-reported stuttering in childhood or in adolescence; the predictors, based on prior research, were birth weight, sex, multiple birth status, vocabulary score and mother's level of education. Birth weight was analysed both as a categorical variable (low birth weight, <2500 g; normal range; high birth weight, ≥4000 g) and as a continuous variable. Separate analyses were carried out to determine the impact of birth weight and the other predictors on stuttering during childhood (age 3, 5 and 7 and MCS, BCS70 and NCDS, respectively) or at age 16, when developmental stuttering is likely to be persistent.ResultsNone of the multivariate analyses revealed an association between birth weight and parent-reported stuttering. Sex was a significant predictor of stuttering in all the analyses, with males 1.6–3.6 times more likely than females to stutter.ConclusionOur results suggest that birth weight is not a clinically useful predictor of childhood or persistent stuttering.     

Corrected and uncorrected Bayley scores: Longitudinal developmental patterns in low and high birth weight preterm infants

In this study, we longitudinally investigated developmental changes in very low birth weight (VLBW, less than 1500 gms), in higher birth weight (HBW, 1500–2000 gms) preterm, and in full-term (FT) infants. We also investigated changes in their caretaking home environment. The subjects were 20 VLBW, 39 HBW, and 24 FT infants who participated in an intervention study. Blind independent assessments were performed at 4, 8, 12, and 16 months corrected age using the Bayley mental and motor scales, both corrected for prematurity and uncorrected, the Infant and Toddler temperament questionnaires, and the Caldwell Home Observation for Measurement of the Environment inventory (HOME). The VLBW infants obtained the lowest mental (77) and motor (77) uncorrected scores, which were significantly different from the mental and motor scores of the HBW (94 and 89, respectively) and of the FT (115 and 109, respectively) infants. Mental and motor uncorrected scores were significantly lower at 4 months than at 8, 12, and 16 months. By 12 months, the uncorrected scores of the HBW infants no longer differed from the FT ones, and by 16 months only the difference between the FT and the VLBW was significant. The corrected mental and motor scores yielded no significant group or age differences. Post hoc analysis of an interaction in the motor scores yielded significantly higher scores for the FT than for the VLBW group at the last assessment. Overall, the VLBW infants were more passive and less intense than were either HBW or FT infants. In general, the home environment of the VLBW infants was significantly less stimulating and responsive than was the home environment of the FT and HBW infants. These results are discussed in terms of vulnerability of the VLBW preterm infants to developmental deficits and the difficulties their parents experience in their caretaking role.     

Impaired prospective memory but intact episodic memory in intellectually average 7- to 9-year-olds born very preterm and/or very low birth weight

Relatively little is known about episodic memory (EM: memory for personally-experienced events) and prospective memory (PM: memory for intended actions) in children born very preterm (VP) or with very low birth weight (VLBW). This study evaluates EM and PM in mainstream-schooled 7- to 9-year-olds born VP (≤ 32 weeks) and/or VLBW (< 1500 g) and matches full-term children for comparison (n = 35 and n = 37, respectively). Additionally, participants were assessed for verbal and non-verbal ability, executive function (EF), and theory of mind (ToM). The results show that the VP/VLBW children were outperformed by the full-term children on the memory tests overall, with a significant univariate group difference in PM. Moreover, within the VP/VLBW group, the measures of PM, verbal ability and working memory all displayed reliable negative correlations with severity of neonatal illness. PM was found to be independent of EM and cognitive functioning, suggesting that this form of memory might constitute a domain of specific vulnerability for VP/VLBW children.     

Interpretation of the personality inventory for children-revised (PIC-R): Influence of cognitive impairment

The Personality Inventory for Children-Revised (PIC-R) is a parent-report measure of social-emotional adjustment for children 3 to 16 years of age. The present study examined the clinical value of the PIC-R by exploring the impact of age and developmental status on PIC-R profiles, particularly on the Psychosis (PSY) scale, within a sample of preschool and school-age children referred for assessment of suspected cognitive impairment and learning problems. Compared to school-age children, significantly more preschoolers obtained elevated scores on the Psychosis scale; those preschoolers with cognitive impairments were even more likely to obtain significantly elevated Psychosis scale scores, despite the absence of diagnosed childhood psychosis. No significant relationship was found between Psychosis scale elevations and cognitive impairment in the school-age group. The PIC-R was moderately accurate in identifying cognitively impaired preschoolers but only minimally accurate in identifying cognitively impaired school-age children.     

The role of maternal responsiveness in predicting infant affect during the still face paradigm with infants born very low birth weight

There is limited empirical literature addressing infants' response to a standardized stressor with infants born very low birth weight (VLBW). The purpose of this study was to assess the relative strength of maternal responsiveness in predicting infant affect in response to the Still Face (SF) paradigm in a cross‐sectional cohort of ethnically diverse infants born VLBW and their mothers (N = 50; infants 6–8 months old). Infant affect and maternal responsiveness were coded in 1‐s intervals while dyads participated in the SF. In addition, perinatal medical status, developmental status, and infant temperament were assessed. Findings revealed that positive infant affect during and after the SF stressor were strongly associated with baseline infant positive affect and maternal responsiveness at the reunion episode, respectively. In contrast, when predicting negative infant affect during and after the SF stressor, prior infant negative affect was strongly and uniquely significant. Infant positive affect, negative affect, and maternal responsiveness were not significantly associated with gender, infant perinatal medical history, developmental status, or temperament. Future research is warranted to determine how these findings relate to infants' stress reactions in naturalistic settings and if relationship‐focused interventions may reverse infant negative emotionality, enhance positive emotionality, and thereby improve self‐regulation and longer term social and cognitive developmental outcomes in medically at‐risk infants.     

Does Childhood Executive Function Predict Adolescent Functional Outcomes in Girls with ADHD?

We prospectively followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD (n = 140) and matched comparison girls (n = 88) over a period of 5 years, from middle childhood through early/mid-adolescence. Our aim was to examine the ability of measures of childhood executive function (EF) to predict functional outcomes in adolescence. Measures of neuropsychological functioning comprised the childhood predictors, with academic, social, and global functioning serving as adolescent criterion measures. Results indicated that childhood EF predicted (a) academic achievement and social functioning across our entire sample (independent of diagnostic group status) and (b) global functioning only in girls with ADHD (independent of IQ). These results highlight the non-specificity of EF deficits and suggest the importance of assessing and developing interventions that target EF impairments, particularly in those at high-risk for negative outcomes, in order to prevent long-term difficulties across a range of important functional domains.