Effortful control,positive emotional expression,and behavior problems in children born preterm

The present study focused on the role of high effortful control in the expression of positive emotion and development of behavior problems in children born preterm (mean gestational age = 31.4 weeks). Using data from a prospective longitudinal study, the present study assessed effortful control and behavior problems at 24 and 36 months and positive emotional expression at 24 months in a sample of 173 children born preterm. Less positive emotional expression was associated with higher effortful control for boys but not girls. Higher effortful control was associated with fewer total behavior problems, but this relation was attenuated when socioeconomic assets were included in the model. More socioeconomic assets were associated with fewer behavior problems for both boys and girls and higher effortful control for girls. Socioeconomic assets appear to be an important factor in the development of effortful control and behavior problems in children born preterm regardless of gender, whereas positive emotional expression was important for boys. Future intervention research should examine fostering adaptive levels of effortful control in high-risk populations as a means to facilitate resilience processes.     

A multimodal treatment strategy for behavior problems in toddlers

The article focuses on a multimodal strategy for the treatment of behavior problems commonly associated with toddlers. These problem behaviors, which include temper tantrums, bedtime and sleep difficulties, aggressiveness, not listening, and eating problems, are among the most often presented to mental health professionals who deal with this age group. The treatment approach, which combines clinically pertinent aspects of dynamic, behavioral, and family approaches, includes the following components: data collection (problem clarification, family-of-origin interviews, interactional sessions), formulation of hypotheses, introduction of a behaviorally oriented management program, tracking of problems inherent in the implementation and successful management of the behavioral program, and booster sessions. The treatment strategy is illustrated by a clinical case. Each component of the treatment, along with its inherent clinical problems/difficulties, is discussed.     

The relationship between sleep problems and working memory in children born very preterm

In two studies, the relationship between sleep and working memory performance was investigated in children born very preterm (i.e., gestation less than 32 weeks) and the possible mechanisms underlying this relationship. In Study 1, parent-reported measures of snoring, night-time sleep quality, and daytime sleepiness were collected on 89 children born very preterm aged 6 to 7 years. The children completed a verbal working memory task, as well as measures of processing speed and verbal storage capacity. Night-time sleep quality was found to be associated with verbal working memory performance over and above the variance associated with individual differences in processing speed and storage capacity, suggesting that poor sleep may have an impact on the executive component of working memory. Snoring and daytime sleepiness were not found to be associated with working memory performance. Study 2 introduced a direct measure of executive functioning and examined whether sleep problems would differentially impact the executive functioning of children born very preterm relative to children born to term. Parent-reported sleep problems were collected on 43 children born very preterm and 48 children born to term (aged 6 to 9 years). Problematic sleep was found to adversely impact executive functioning in the very preterm group, while no effect of sleep was found in the control group. These findings implicate executive dysfunction as a possible mechanism by which problematic sleep adversely impacts upon cognition in children born very preterm, and suggest that sleep problems can increase the cognitive vulnerability already experienced by many of these children.     

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.     

Developmental and medical factors associated with parenting stress in mothers of toddlers born very preterm in a neonatal follow-up clinic

The purpose of this exploratory, cross-sectional study was to identify child-related factors associated with maternal parenting stress in toddlers born very preterm and followed in a neonatal follow-up (NFU) clinic. The study aimed to describe the associations of current medical complications and presence of developmental delays with total parenting stress. Participants were 53 mother–child dyads presenting in a NFU clinic. Mothers completed the Parenting Stress Index-Short Form (PSI-SF), and children were administered the Brigance Early Head Start Screen II. Medical variables were also collected from the child's medical record. Approximately 24% of mothers had at least one elevated subscale score on the PSI-SF. Regression analyses indicated that receipt of early intervention services was associated with increased parenting stress among mothers of toddlers born very preterm, though number of current medical complications was not. Parents of children born very preterm are at increased risk for parenting stress that extends beyond discharge from the neonatal intensive care unit . Clinicians working in NFU clinics are positioned to monitor for increased parenting stress, particularly among families of children with emerging signs of developmental delay.     

Knowledge of self,mother, and father in preterm and full-term toddlers

Full-term and preterm toddler's featural knowledge of self, mother, and father was assessed in relation to individual differences in age, attachment status, and cognitive ability. No relation was found between infants' knowledge of self and the predictor variables at 13 months. Different factors, however, were related to infants' knowledge of mothers' and fathers' features. Hierarchical regressions revealed that at 20 months, after controlling for the relation between complexity of knowledge and MDI Bayley scores, full-term infants who were securely attached to their mothers demonstrated more complex knowledge of her than insecurely attached infants or premature Infants' knowledge of self at 20 months and father at both 13 and 20 months was significantly related to attachment status but not term status. These data are discussed in the context of possible differential influences of term status on infant-mother and infant-father interactions.     

Prenatal cortisol, prematurity and low birthweight

Three hundred depressed pregnant women were recruited at approximately 20 weeks gestation. They were then divided by a median split into high and low urinary cortisol level groups. The high cortisol group had higher CES-D depression scores and higher inhibition (BIS) scores prenatally. Their fetuses had smaller head circumference, abdominal circumference, biparietal diameter and fetal weight. The high cortisol group neonates were shorter gestational age and lower birthweight and they had lower Brazelton habituation and higher Brazelton reflex scores. Discriminant function analyses suggested that cortisol levels more accurately classified short gestation and low birthweight groups than CES-D depression scores.     

Maternal sociodemographic factors differentially affect the risk of behavioral problems in Brazilian and Italian preterm toddlers

The main aim of the present study was to examine differences in behavioral problems in toddlers born very preterm in Brazil and Italy. The sample comprised 154 toddlers (18–24 months of age) born very preterm, including 76 toddlers from Brazil and 78 toddlers from Italy. The Child Behavior Checklist was used to assess behavioral problems. Specific sociodemographic factors (i.e., maternal age at childbirth and maternal education) and neonatal factors (i.e., gestational age, sex, and length of hospitalization) were tested as potential mediators of country-related differences in behavioral problems. Brazilian toddlers presented more internalizing, externalizing, and total behavioral problems compared with their Italian counterparts. The effect of country on the toddlers’ internalizing and total behavioral problems was mediated by maternal age at childbirth and education. Independent effects of country, maternal age at childbirth, and maternal education emerged for externalizing behavioral problems. No significant effect emerged for neonatal variables. These findings suggest that sociodemographic factors, in addition to country-related differences, should be considered when assessing the risk of behavioral problems in preterm toddlers.     

Peer rejection in childhood: effects on maternal depression and behavior problems in toddlers.

The aim of this study was to develop a conceptual model that would clarify how a woman's recollections of peer and parent rejection in childhood influence her emotional well-being and, resultantly, her own child's behavior problems. Given current interest in peer versus parent influences, the authors used a design and analysis to reveal the unique contributions of peer and parent rejection. The participants were a community sample of 88 mothers and their 2 1/2-year-old children. The study found that mothers' recollections of peer rejection in childhood were significantly associated with depressive symptomatology, but recollections of parental rejection in childhood were unrelated to current depressive symptoms. Recollections of peer rejection during childhood, internal representation of self, and depressive symptoms made significant, unique contributions to the variance in behavior problems in their children. Together, these variables significantly explained 27% of the variance in the final model.     

Exploring predictors of change in behavioral problems over a 1-year period in preterm born preschoolers

ObjectiveAlthough predictors of the prevalence of behavioral problems in preterm-born children have been frequently studied, predictors of behavioral change in these children remain unknown. Therefore, in this study we explore predictors of short-term changes in problem behavior in preterm-born preschoolers, an age period characterized by rapid behavioral change.MethodTwo- to 5-year-old children born with a gestational age <32 weeks and/or birth weight <1500 g were eligible, because of their high risk for behavioral problems. Following screening, 59 children with a t-score ≥60 on either the internal, external or total problem scale of the Child Behavior Checklist were included in the study. Linear mixed modeling was used to investigate predictors of change in behavior over a 1-year period.ResultsHigher levels of parenting stress, parent perceived child vulnerability, and parental hostility towards the child and lower educational levels of the mother significantly predicted increases in externalizing behavior. The higher the age of the child, the more internalizing problems decreased.ConclusionsParenting stress, parent perceived child vulnerability and parental hostility towards the child were the only modifiable predictors of increases in externalizing behavior, whilst no modifiable predictors of internalizing behavior were found. There may be a reciprocal interaction between stress in parents and child externalizing problems. Furthermore, stress and worries may directly influence parents’ reports on behavioral measures, because it could cause them to be concerned by behavior otherwise perceived as normal. Therefore, future interventions for parents of preterm-born children should primarily address parental stress and concerns regarding their child.     

Representational momentum in children born preterm and at term

The term representational momentum (RM) refers to the idea that our memory representations for moving objects incorporate information about movement – a fact that can lead us to make errors when judging an object’s location (the RM effect). In this study, we explored the RM effect in a sample of children born very prematurely and a sample born at term. Because preterm children are known to be at risk for problems with motion perception, we anticipated that they would show a weaker or absent RM effect. This prediction was confirmed. In addition, we found that, in both samples of children, 5–6 year olds showed a reduced RM effect compared to 7–9 year olds. These results demonstrate that the ability to represent motion information in memory shows continued development over this age range, and may help to elucidate factors contributing to problems with fine and gross motor planning and execution that have been observed in the preterm population. We propose that problems affecting the formation, maintenance, or use of predictive models, or motion extrapolation skills, may have cascading effects on the development of other abilities.     

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.     

Visual search in typically developing toddlers and toddlers with Fragile X or Williams syndrome

Visual selective attention is the ability to attend to relevant visual information and ignore irrelevant stimuli. Little is known about its typical and atypical development in early childhood Experiment 1 investigates typically developing toddlers' visual search for multiple targets on a touch-screen. Time to hit a target, distance between successively touched items, accuracy and error types revealed changes in 2- and 3-year-olds' vulnerability to manipulations of the search display. Experiment 2 examined search performance by toddlers with Fragile X syndrome (FXS) or Williams syndrome (WS). Both of these groups produced equivalent mean time and distance per touch as typically developing toddlers matched by chronological or mental age; but both produced a larger number of errors. Toddlers with WS confused distractors with targets more than the other groups; while toddlers with FXS perseverated on previously found targets. These findings provide information on how visual search typically develops in toddlers, and reveal distinct search deficits for atypically developing toddlers.     

Mathematics ability and related skills in preschoolers born very preterm

Children born very preterm (VPT) are at risk for academic, behavioral, and/or emotional problems. Mathematics is a particular weakness and better understanding of the relationship between preterm birth and early mathematics ability is needed, particularly as early as possible to aid in early intervention. Preschoolers born VPT (n = 58) and those born full term (FT; n = 29) were administered a large battery of measures within 6 months of beginning kindergarten. A multiple-mediation model was utilized to characterize the difference in skills underlying mathematics ability between groups. Children born VPT performed significantly worse than FT-born children on a measure of mathematics ability as well as full-scale IQ, verbal skills, visual–motor integration, phonological awareness, phonological working memory, motor skills, and executive functioning. Mathematics was significantly correlated with verbal skills, visual–motor integration, phonological processing, and motor skills across both groups. When entered into the mediation model, verbal skills, visual–motor integration, and phonological awareness were significant mediators of the group differences. This analysis provides insights into the pre-academic skills that are weak in preschoolers born VPT and their relationship to mathematics. It is important to identify children who will have difficulties as early as possible, particularly for VPT children who are at higher risk for academic difficulties. Therefore, this model may be used in evaluating VPT children for emerging difficulties as well as an indicator that if other weaknesses are found, an assessment of mathematics should be conducted.     

Information processing in toddlers: Continuity from infancy and persistence of preterm deficits

The present report assesses information processing in the toddler years (24 and 36 months), using a cohort of preterms (< 1750 g) and full-terms initially seen in infancy. The children received a battery of tasks tapping 11 specific abilities from four domains — memory, processing speed, attention, and representational competence. The same battery had been used earlier — at 7 and 12 months. There were four main findings. (1) Preterms showed no ‘catch-up,’ but rather persistent deficits in immediate recognition, recall, encoding speed, and attention. (2) There was significant continuity from infancy through the toddler years for most aspects of information processing. (3) These specific abilities combined additively to account for global cognitive ability, consistent with the componential theory of intelligence. (4) Toddler information processing abilities completely mediated the relative deficits of preterms in general cognitive ability. Thus, although the toddler years have often been characterized as a period of discontinuity and transformation, these results indicate that continuity prevails for information processing abilities over the first three years of life.     

Perinatal infection, fetal inflammatory response, white matter damage, and cognitive limitations in children born preterm

Only sparse information is available about a possible association between antenatal infection outside the brain and subsequent cognitive limitations among preterm infants. Based on published studies, we provide a theoretical schema that links them via the fetal inflammatory response and neonatal white matter damage. We conclude that the relationship between antenatal infection and cognitive limitations deserves much further attention by researchers interested in the prevention of this undesirable outcome of prematurity.     

A longitudinal model of executive function development from birth through adolescence in children born very or extremely preterm

Executive function deficits are often reported as a specific weakness in preterm children. Yet, executive function development is still not fully understood. In a prospective longitudinal study, 115 preterm born children, ≤31 weeks of gestation, were recruited at birth and subject to neuropsychological assessments at ages 5.5 and 18 years. By applying Miyake and colleagues’ integrative framework of executive function to our data, two core components of executive function, working memory and cognitive flexibility, were identified through confirmatory factor analysis. Developmental stability was investigated in a serial multiple mediator structural equation model. Biological, medical, and social factors as well as mental development at 10 months were entered as predictors. Both components of executive function were highly stable from 5.5 to 18 years. Gestational age, intrauterine growth, lack of perinatal medical complications, and female sex were positively related to mental development at 10 months, which together with parental education influenced both core executive functions at 5.5 years. Working memory at 5.5 years mediated outcome in working memory at 18 years. In addition to the mediation of cognitive flexibility at 5.5 years, perinatal medical complications and restricted intrauterine growth had a continued direct negative impact on cognitive flexibility at 18 years. The application of a theoretical framework added to our understanding of executive function development in preterm born children. The study supports early identification of executive deficits among children born preterm, as deficits are unlikely to diminish with maturation.