Child Cognitive Outcomes Research Articles

Cognitive outcomes in children and adolescents born very preterm: a meta‐analysis

To estimate the association between very preterm birth (<32wks' gestation) and intelligence, executive functioning, and processing speed throughout childhood and adolescence, and to examine the effects of gestational age, birthweight, and age at assessment. Studies were included if children were born at earlier than 32weeks' gestation, aged 4 to 17years, had an age-matched term control group, and if the studies used standardized measures, were published in an English-language peer-reviewed journal, and placed no restrictions on participants based on task performance. We evaluated 6163 children born very preterm and 5471 term-born controls from 60 studies. Children born very preterm scored 0.82 SDs (95% confidence interval [CI] 0.74-0.90; p<0.001) lower on intelligence tests, 0.51 SDs (95% CI 0.44-0.58; p<0.001) lower on measures of executive functioning, and 0.49 SDs (95% CI 0.39-0.60; p<0.001) lower on measures of processing speed than term-born controls. Gestational age and birthweight were associated with study effect size in intelligence and executive functioning of younger children only. Age at assessment was not associated with study effect size. Children born very preterm have medium to large deficits in these cognitive domains. This meta-analysis is centred on very preterm birth and three cognitive domains. The three critical cognitive domains are intelligence, executive functioning, and processing speed.

Targeted Estimation of the Relationship Between Childhood Adversity and Fluid Intelligence in a US Population Sample of Adolescents.

Many studies have shown inverse associations between childhood adversity and intelligence, although most are based on small clinical samples and fail to account for the effects of multiple co-occurring adversities. Using data from the 2001-2004 National Comorbidity Survey Adolescent Supplement, a cross-sectional US population study of adolescents aged 13-18 years (n = 10,073), we examined the associations between 11 childhood adversities and intelligence, using targeted maximum likelihood estimation. Targeted maximum likelihood estimation incorporates machine learning to identify the relationships between exposures and outcomes without overfitting, including interactions and nonlinearity. The nonverbal score from the Kaufman Brief Intelligence Test was used as a standardized measure of fluid reasoning. Childhood adversities were grouped into deprivation and threat types based on recent conceptual models. Adjusted marginal mean differences compared the mean intelligence score if all adolescents experienced each adversity to the mean in the absence of the adversity. The largest associations were observed for deprivation-type experiences, including poverty and low parental education, which were related to reduced intelligence. Although lower in magnitude, threat events related to intelligence included physical abuse and witnessing domestic violence. Violence prevention and poverty-reduction measures would likely improve childhood cognitive outcomes.

Early kindergarten, maternal labor supply and children's outcomes: Evidence from Italy

We analyze a reform that introduced early access to subsidized childcare for 2-year-old children in Italy, exploring the effects on several measures of maternal labor supply and on children's cognitive outcomes. Our identification strategy exploits discontinuities in the eligibility rules and the staggered implementation of the reform. We find that the policy increased mothers' participation in the labor market and lowered the reservation wage of the unemployed, thus increasing their likelihood of finding a job. At the same time, the newly introduced childcare arrangement did not affect children's cognitive development, irrespective of their family background.

Life-cycle and intergenerational effects of child care reforms

We investigate the importance of various mechanisms by which child care policies can affect life‐cycle patterns of employment and fertility among women, as well as long‐run cognitive outcomes among children. A dynamic structural model of employment, fertility, and child care use is estimated using Norwegian administrative data. The estimation exploits a large‐scale child care reform, which provided generous cash transfers to mothers who did not use formal child care facilities. We find that the reform generates sizable changes in employment and fertility decisions, especially among low‐education women. We then use the mothers' unobserved heterogeneity in the structural model as a control function to examine the effects of mothers' behavior on long‐run cognitive outcomes of children. The reform leads to lower reading scores among children, primarily as a result of mothers shifting to inferior forms of care. In counterfactual simulations, we compare the effects of an alternative child care subsidy, an expanded maternity leave program, and a tax deduction for mothers with children. Female labor supply child care reform fertility cognitive development of children discrete choice dynamic programming C35 J13 J22 H31 I28

Government Education Expenditures, Pre-Primary Education and School Performance: A Cross-Country Analysis

Using data from OECD’s PISA, Eurostat and World Bank’s WDI, we explore how child cognitive outcomes at the aggregate country level are related to macroeconomic conditions, specifically government education expenditures and early education experience. We find that both government expenditures in education and attendance to early child care are associated with better later school performance. We also consider different childcare characteristics such as duration and quality, which appear to have significant effects Our results may imply that policies encouraging childcare expansion should also take into account quality issues.

Government Education Expenditures, Pre-Primary Education and School Performance: A Cross-Country Analysis

Using data from OECD’s PISA, Eurostat and World Bank’s WDI, we explore how child cognitive outcomes at the aggregate country level are related to macroeconomic conditions, specifically government education expenditures and early education experience. We find that both government expenditures in education and attendance to early child care are associated with better later school performance. We also consider different childcare characteristics such as duration and quality, which appear to have significant effects Our results may imply that policies encouraging childcare expansion should also take into account quality issues.

Effect of Chronic Hypoxia in Cognition on Childhood : Review Article

Background: Hypoxia is defined as the reduction of the normal oxygen supply. The hypoxia is traditionally classified as acute and chronic. Chronic hypoxia was classified into three subgroups: diffusion-limited hypoxia, hypoxemic hypoxia, and hypoxia due to a compromised perfusion of leaky micro vessels. Serious hypoxic-ischemic events are known to have an adverse impact on cognitive function. Aim: to review the evidence concerning the effect of chronic hypoxia on childhood cognitive outcomes including development and academic achievement. Materials and Methods: We used scientific websites such as PubMed, Google Scholar, and Research Gate to get related articles about this subject. Results: There were 15 articles included in this review including both research and review articles. Conclusion: It has been suggested that cognitive function including knowledge, attention, memory and Oxygen supply to the brain tissue may be decreased under hypoxia. Thus, brain desaturation and resultant biological process may be responsible for the impairment of cognitive function although the underlying mechanisms are still unclear

Early nutrition influences developmental myelination and cognition in infants and young children

Throughout early neurodevelopment, myelination helps provide the foundation for brain connectivity and supports the emergence of cognitive and behavioral functioning. Early life nutrition is an important and modifiable factor that can shape myelination and, consequently, cognitive outcomes. Differences in the nutritional composition between human breast and formula milk may help explain the functional and cognitive disparity often observed between exclusively breast versus formula-fed children. However, past cognitive and brain imaging studies comparing breast and formula feeding are often: cross-sectional; performed in older children and adolescents relying on parental recall of infant feeding; and generally treat formula-fed children as a single group despite the variability between formula compositions. Here we address some of these weakness by examining longitudinal trajectories of brain and neurocognitive development in children who were exclusively breastfed versus formula-fed for at least 3 months. We further examine development between children who received different formula compositions. Results reveal significantly improved overall myelination in breastfed children accompanied by increased general, verbal, and non-verbal cognitive abilities compared to children who were exclusively formula-fed. These differences were found to persist into childhood even with groups matched for important socioeconomic and demographic factors. We also find significant developmental differences depending on formula composition received and that, in particular, long-chain fatty acids, iron, choline, sphingomyelin and folic acid are significantly associated with early myelination trajectories. These results add to the consensus that prolonged and exclusive breastfeeding plays an important role in early neurodevelopment and childhood cognitive outcomes.

Cognitive outcomes in children with mild obstructive sleep disordered breathing

Cognitive outcomes in children with mild obstructive sleep disordered breathing

Effects of Nutritional Interventions during Pregnancy on Infant and Child Cognitive Outcomes: A Systematic Review and Meta-Analysis.

Background: Epidemiological studies have demonstrated that folate, iodine and iron intake during pregnancy impacts on foetal brain development and cognitive function. However, in human studies, the relationship with other dietary nutrients is less clear. Objective: This systematic review aims to critically appraise the current literature and meta-analyses results from nutritional interventions during pregnancy that aimed to optimise infant and child cognitive outcomes. Design: Ten electronic databases were searched for articles published up to August 2017. The search was limited to articles published in English. Randomised controlled trials (RCTs) testing the impact of any nutritional intervention (dietary counselling, education, nutrient supplementation, fortified foods and/or foods) during pregnancy on cognitive outcomes of children (<10 years old). Two independent reviewers assessed study eligibility and quality using the American Dietetic Association quality criteria checklist for primary research. Standardised mean differences were used for nine cognitive domains to measure effects for meta-analyses. Results: A total of 34 RCTs were included (21 studies included children aged less than 35 months, 10 studies included children aged 36–60 months and 3 studies included children aged 61–119 months). The types of nutritional interventions included nutrient supplements, whole foods, fortified foods and nutrition education. The following nine cognition outcomes: attention, behaviour, crystallised intelligence, fluid intelligence, global cognition, memory, motor skills, visual processing, and problem solving were not significantly impacted by nutritional interventions, although 65% of studies conducted post-hoc data analyses and were likely to be underpowered. Although, long chain polyunsaturated fatty acids (LCPUFA) supplementation was associated with a marginal increase in crystallised intelligence (Effect size (ES): 0.25; 95% confidence interval (95% CI): −0.04, 0.53), the effect was not statistically significant (p = 0.09), with significant study heterogeneity (p = 0.00). Conclusions: LCPUFA supplementation may be associated with an improvement in child crystallised intelligence, however further research is warranted. The remaining eight cognition domains were not significantly impacted by maternal nutritional interventions.

Home literacy activities: Accounting for differences in early grade literacy outcomes in low-income families in Zambia

Inequalities on child cognitive outcomes exist as children enter the first grade. These differences are even wider for children in low-income families. This article aims to examine the extent to which home factors account for variation in early literacy outcomes in the first year of schooling. A total of 72 first graders and their parents from low-income families in Lusaka, Zambia, participated in the study. A self-reported home literacy questionnaire was used to collect home literacy data − parental education, home possessions, reading materials, language awareness, print experience, writing activities, reading activities and teaching letters. Children’s early literacy skills were assessed using four measures: orthography awareness, spelling, vocabulary and math tests. These tests were measured at two points: at the beginning and at the end of the first grade. Results showed that teaching letters was most predictive of literacy outcomes both at the beginning and end of the first year. The study concludes that formal teaching of letters at home is the parents’ greatest strength for supporting literacy in low-income families. Thus, energies for parental involvement should be directed in ways that are culturally practised and manageable by parents for better literacy outcomes.

Parental breakup and children’s development: the role of time and of post-separation conditions

In recent years, the relationship between parental separation and child outcomes has received massive attention. This extraordinary level of interest stems from the rise in divorce rates in almost all developed countries. The aim of the paper is to identify the effect of parental separation on child cognitive and behavioural outcomes. It uses data on a sample of around 9000 children up to age 11, drawn from five waves of the United Kingdom Millennium Cohort Study. We use fixed-effects models to control for unobservable characteristics that do not vary over time, and explore the role of time and of post-separation conditions in mitigating these effects. We find that parental separation has detrimental but small effects on children’s behaviours, and that these effects appear stronger after a couple of years from separation. An intimate relationship between the child and the non-resident father, the presence of a new mother’s partner and of other relatives also play a role. No effect is found on cognitive development.

Effect of Caregiver Training on the Neurodevelopment of HIV-Exposed Uninfected Children and Caregiver Mental Health: A Ugandan Cluster-Randomized Controlled Trial.

Early childhood development programs typically combine healthy nutrition and cognitive stimulation in an integrated model. We separately delivered these 2 components in a cluster-randomized controlled trial to evaluate their comparative effectiveness in promoting healthy child development and caregiver mental health. This is the first study to do so for HIV-affected children and their infected mothers. Two hundred twenty-one HIV-exposed but uninfected child (2-3 years old) and caregiver dyads in 18 geographic clusters in Eastern Uganda were randomized by cluster to receive biweekly individualized sessions of either (1) Mediational Intervention for Sensitizing Caregivers (MISC) training emphasizing cognitive stimulation or (2) Uganda Community Based Association for Child Welfare (UCOBAC) program that delivered health and nutrition training. Children were evaluated at baseline, 6 months, 1 year (training conclusion), and 1-year posttraining with the Mullen Scales of Early Learning (MSEL), the Color-Object Association Test for memory, the Early Childhood Vigilance Test of attention, and the Behavior Rating Inventory of Executive Function (BRIEF-parent). The Caldwell Home Observation for the Measurement of the Environment (HOME) was completed by observers to gauge caregiving quality after training. Caregiver depression/anxiety (Hopkins Symptom Checklist-25) and functionality (list of activities of daily living) were also evaluated. Data collectors were blinded to trial arm assignment. Mediational Intervention for Sensitizing Caregivers resulted in significantly better quality of caregiving compared with UCOBAC midintervention with an adjusted mean difference (MadjDiff) of 2.34 (95% confidence interval [CI]: 1.54-3.15, p < .01), postintervention (MadjDiff = 2.43, 95% CI: 1.61-3.25, p < .01), and at 1-year follow-up (MadjDiff = 2.07, 95% CI: 1.23-2.90, p < .01). MISC caregivers reported more problems on the BRIEF for their child at 1-year posttraining only (p < .01). Caregiving quality (HOME) was significantly correlated with MSEL composite performance 1-year posttraining for both the MISC and the UCOBAC trial arms. Likewise, physical growth was significantly related to child development outcomes even though it did not differ between trial arms. Even though MISC demonstrated an advantage of improving caregiving quality, it did not produce better child cognitive outcomes compared with health and nutrition training. clinicaltrials.gov Identifier: NCT01640561.

Cognitive Outcome After Epilepsy Surgery in Children

Cognitive dysfunction in children with epilepsy is primarily contributed by etiology, seizures, frequency of interictal epileptiform discharges, and adverse effects of antiepileptic drugs. The direct effect of epilepsy surgery on cognitive outcome depends on two key factors: the function that is present in the epileptogenic zone to be removed, and the dysfunction outside the epileptogenic zone caused by epilepsy. Studies on cognitive outcome in children after various types of epilepsy surgery estimate "no significant change" in about 70% of children, improvement in cognition in 10%-15%, and decline in 10%-15%. In young children with epileptic encephalopathy, the reversible dysfunction outside the epileptogenic zone is larger and hence carry better chances of improved outcome after successful surgery. If the epileptogenic zone harbors significant cognitive function (memory, language, or other function), then a decline in function may occur with its resection. Understanding the pathophysiological basis for the cognitive changes after epilepsy surgery assists in counseling patients and families before surgery.

Long term cognitive outcomes of early term (37-38 weeks) and late preterm (34-36 weeks) births: A systematic review.

Background: There is a paucity of evidence regarding long-term outcomes of late preterm (34-36 weeks) and early term (37-38 weeks) delivery. The objective of this systematic review was to assess long-term cognitive outcomes of children born at these gestations. Methods: Four electronic databases (Medline, Embase, clinicaltrials.gov and PsycINFO) were searched. Last search was 5 th August 2016. Studies were included if they reported gestational age, IQ measure and the ages assessed. The protocol was registered with the International prospective register of systematic reviews (PROSPERO Record CRD42015015472). Two independent reviewers assessed the studies. Data were abstracted and critical appraisal performed of eligible papers. Results: Of 11,905 potential articles, seven studies reporting on 41,344 children were included. For early term births, four studies (n = 35,711) consistently showed an increase in cognitive scores for infants born at full term (39-41 weeks) compared to those born at early term (37-38 weeks) with increases for each week of term (difference between 37 and 40 weeks of around 3 IQ points), despite differences in age of testing and method of IQ/cognitive testing. Four studies (n = 5644) reporting childhood cognitive outcomes of late preterm births (34 - 36 weeks) also differed in study design (cohort and case control); age of testing; and method of IQ testing, and found no differences in outcomes between late preterm and term births, although risk of bias was high in included studies. Conclusion: Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks). This should be considered when discussing timing of delivery. For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores.

Low Prenatal Exposures to Fluoride: Are There Neurotoxic Risks for Children?

Low Prenatal Exposures to Fluoride: Are There Neurotoxic Risks for Children?

Maternal intelligence quotient (IQ) predicts IQ and language in very preterm children at age 5years.

Sociodemographic factors are linked to cognitive outcomes in children born very preterm (VPT; ≤30weeks gestation). The influence of maternal intellectual ability, a heritable trait, is unknown. Also undetermined is the extent to which associations between maternal and child intellectual ability vary according to parenting behaviors that target cognitive stimulation in the home. At age 5years, 84 VPT and 38 demographically matched full-term (FT) children underwent neurodevelopmental assessment. Children's intellectual ability was assessed using The Wechsler Preschool Primary Scale of Intelligence-III, and language was assessed with the Clinical Evaluation of Language Fundamentals Preschool-2. The Wechsler Test of Adult Reading estimated maternal intellectual ability. The StimQ-Preschool questionnaire provided a measure of cognitive stimulation in the home. Linear mixed-effects models examined independent effects and interactions between maternal intellectual ability and cognitive stimulation on children's outcomes. After covariate adjustment, maternal intellectual ability was associated with child intellectual (p<.001) and language (p=.002) abilities. Stronger associations were observed in FT mother-child dyads (B=.63, p=.04) than VPT dyads (B=.42, p=.01). Mothers of VPT children reported lower levels of Parental Involvement in Developmental Advance (p=.007) and Parental Verbal Responsiveness (p=.04). Group differences in Parental Involvement in Developmental Advance, but not Parental Verbal Responsivity, persisted after adjusting for social background (p=.03). There was no evidence of an interaction between maternal intellectual ability and Parental Involvement in Developmental Advance (p=.34). Instead, maternal intellectual ability (p<.001) and Parental Involvement in Developmental Advance (p=.05) independently predicted VPT children's outcomes. Maternal intellectual ability is an important trait linked to VPT and FT children's intellectual and language outcomes. Prematurity increases variation in the heritability of intellectual ability and shifts children from the expected range based on maternal ability. Parental involvement in activities that help children master new skills may promote cognitive development in VPT children born to mothers of lower intellectual ability.

Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6-12 Years of Age in Mexico.

Background:Some evidence suggests that fluoride may be neurotoxic to children. Few of the epidemiologic studies have been longitudinal, had individual measures of fluoride exposure, addressed the impact of prenatal exposures or involved more than 100 participants.Objective:Our aim was to estimate the association of prenatal exposure to fluoride with offspring neurocognitive development.Methods:We studied participants from the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) project. An ion-selective electrode technique was used to measure fluoride in archived urine samples taken from mothers during pregnancy and from their children when 6–12 y old, adjusted for urinary creatinine and specific gravity, respectively. Child intelligence was measured by the General Cognitive Index (GCI) of the McCarthy Scales of Children’s Abilities at age 4 and full scale intelligence quotient (IQ) from the Wechsler Abbreviated Scale of Intelligence (WASI) at age 6–12.Results:We had complete data on 299 mother–child pairs, of whom 287 and 211 had data for the GCI and IQ analyses, respectively. Mean (SD) values for urinary fluoride in all of the mothers () and children with available urine samples () were and , respectively. In multivariate models we found that an increase in maternal urine fluoride of (approximately the IQR) predicted 3.15 (95% CI: , ) and 2.50 (95% CI , ) lower offspring GCI and IQ scores, respectively.Conclusions:In this study, higher prenatal fluoride exposure, in the general range of exposures reported for other general population samples of pregnant women and nonpregnant adults, was associated with lower scores on tests of cognitive function in the offspring at age 4 and 6–12 y. https://doi.org/10.1289/EHP655

C-59How Do We Measure Cognitive Outcomes in Children Treated for Cancer?

C-59How Do We Measure Cognitive Outcomes in Children Treated for Cancer?

The importance of maternal diet quality during pregnancy on cognitive and behavioural outcomes in children: a systematic review and meta-analysis

ObjectivesThis systematic review and meta-analysis provides a quantitative summary of the literature exploring the relationship between maternal diet quality during pregnancy and child cognitive and affective outcomes. We investigate whether...