Child Cognitive Outcomes Research Articles

Plasma angiopoietin-2 is associated with age-related deficits in cognitive sub-scales in Ugandan children following severe malaria

BackgroundElevated angiopoietin-2 (Angpt-2) concentrations are associated with worse overall neurocognitive function in severe malaria survivors, but the specific domains affected have not been elucidated.MethodsUgandan children with severe malaria underwent neurocognitive evaluation a week after hospital discharge and at 6, 12 and 24 months follow-up. The relationship between Angpt-2 concentrations and age-adjusted, cognitive sub-scale z-scores over time were evaluated using linear mixed effects models, adjusting for disease severity (coma, acute kidney injury, number of seizures in hospital) and sociodemographic factors (age, gender, height-for-age z-score, socio-economic status, enrichment in the home environment, parental education, and any preschool education of the child). The Mullen Scales of Early Learning was used in children < 5 years and the Kaufman Assessment Battery for Children 2nd edition was used in children ≥ 5 years of age. Angpt-2 levels were measured on admission plasma samples by enzyme-linked immunosorbent assay. Adjustment for multiple comparisons was conducted using the Benjamini–Hochberg Procedure of False Discovery Rate.ResultsIncreased admission Angpt-2 concentration was associated with worse outcomes in all domains (fine and gross motor, visual reception, receptive and expressive language) in children < 5 years of age at the time of severe malaria episode, and worse simultaneous processing and learning in children < 5 years of age at the time of severe malaria who were tested when ≥ 5 years of age. No association was seen between Angpt-2 levels and cognitive outcomes in children ≥ 5 years at the time of severe malaria episode, but numbers of children and testing time points were lower for children ≥ 5 years at the time of severe malaria episode.ConclusionElevated Angpt-2 concentration in children with severe malaria is associated with worse outcomes in multiple neurocognitive domains. The relationship between Angpt-2 and worse cognition is evident in children < 5 years of age at the time of severe malaria presentation and in selected domains in older years.

Anemia, Diet, and Cognitive Development: Impact of Health Information on Diet Quality and Child Nutrition in Rural India

Lack of information about health risks may limit the adoption of improved nutritional and healthy behavior. This paper studies the effect of a nutrition information intervention on household dietary behavior, hemoglobin levels, and cognitive outcomes of children in rural India. Using experimental data and regression discontinuity design that exploits the exogenous cutoff of hemoglobin level for anemia, we find statistically insignificant treatment effects on dietary improvements, child health, and cognitive outcomes of children. Our findings suggest that light-touch nutrition information alone, even when parents are informed about the health risk of their children, may not promote healthy behavior and factors other than information might constrain households in making nutritional investments for their children.

No difference in cognitive outcomes in children born to women taking antiseizure medicines

There is no significant difference in cognitive outcomes at two years of age between children of women who took antiseizure medicines during pregnancy and children of women who did not, study results published in JAMA Neurology have suggested (7 June 2021)​[1]​. During the ‘Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs’ (MONEAD) study, children will […]

White matter alterations and cognitive outcomes in children born very low birth weight

BackgroundVery low birth weight (VLBW) infants are at risk for disrupted white matter maturation, yet little is known about the contributing factors, particularly at preschool-age when cognitive difficulties begin to emerge. We examined white matter microstructure in five-year-old VLBW and full-term (FT) children, and its association with cognitive outcomes and birth weight. MethodsMulti-shell diffusion and MR images were obtained for 41 VLBW (mean birth weight: 1028.6 ± 256.8 g) and 26 FT (3295.4 ± 493.9 g) children. Fractional anisotropy (FA), radial diffusivity (RD), neurite orientation dispersion index (ODI) and density index (NDI) were estimated using diffusion tensor and neurite orientation dispersion and density imaging models. Between-group analyses used a general linear model with group and sex as explanatory variables. Within-group associations between white matter microstructure, cognitive outcomes and birth weight were also investigated. ResultsVLBW compared to FT children showed lower FA and NDI across widespread white matter regions. Smaller clusters of atypical ODI were also found in VLBW children. Within-group analyses in FT children revealed that lower RD and higher NDI were associated with vocabulary acquisition and working memory. In VLBW children, higher FA and NDI, and lower RD and ODI, were associated with improved processing speed. In both groups, FA was positively associated with birth weight. ConclusionsOur findings demonstrate white matter alterations in young VLBW children, including widespread reductions in axon density that may reflect sustained myelination disruptions. The associations with cognitive outcomes may also highlight which of the VLBW children are at higher risk for later cognitive difficulties.

A study to compare short term postoperative cognitive outcomes in paediatric patients using intravenous propofol versus inhalational sevoflurane in maintenance of general anaesthesia

Postoperative cognitive dysfunction (POCD) is a newly diagnosed subtle impairment of memory, concentration, and speed of information processing after surgery. POCD in adults and geriatric population has been well established, but less explored in the paediatric age group. The aim of this study is to compare the effects of intravenous propofol and inhalational sevoflurane on short term postoperative cognitive outcomes in children. Experimental approach: 80 paediatric patients aged 5 - 15 years of ASA grade I and II posted for surgeries under general anaesthesia except neurosurgery were randomly allocated into two groups with 40 patients in each group. Group A received intravenous propofol and Group B received inhalational sevoflurane for maintenance of general anaesthesia. Cognitive assessment tests were done using Wechsler's Intelligence Scale for Children (WISC-V) both preoperatively and postoperatively at 6hr, 12hr and 24hr respectively. Major Findings: Comparison of various cognitive indices in Group A and B is significantly lower at 6 hours in comparison to the preoperative value. Comparison of various cognitive indices between preoperative and at 24 hours postoperative levels, in Group A and B showed that these parameters return to the preoperative state at 24 hours after surgery.Conclusion: There is no significant postoperative cognitive decline in patients comparing the cognitive functions preoperatively and 24 hour postoperative levels when using intravenous propofol versus inhalational sevoflurane. There was a transient but significant decline noted in the cognitive functions at 6 hour postoperatively compared to the preoperative period, noticed equally with both groups.

Effect of Early Childhood Development Interventions Implemented by Healthcare Providers to Improve Cognitive Outcomes in Children Aged 0-36 Months: A Systematic Review and Meta-Analysis

Effect of Early Childhood Development Interventions Implemented by Healthcare Providers to Improve Cognitive Outcomes in Children Aged 0-36 Months: A Systematic Review and Meta-Analysis

Income disparity in school readiness and the mediating role of perinatal maternal mental health: a longitudinal birth cohort study.

There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness. Prospective data from 505 mother-child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models. Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 s.d. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034). Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.

Associations between maternal thyroid function in pregnancy and child neurodevelopmental outcomes at 20 months in the Seychelles Child Development Study, Nutrition Cohort 2 (SCDS NC2).

Maternal thyroid hormones facilitate optimal foetal neurodevelopment; however, the exact role of the thyroid hormones on specific cognitive outcomes is unknown. The present study aimed to investigate associations between maternal thyroid function and neurodevelopmental outcomes in the Seychelles Child Development Study (SCDS) Nutrition 2 cohort (n 1328). Maternal free thyroid hormones (fT3, fT4 and fTSH) were assessed at 28 weeks' gestation with a range of child cognitive outcomes analysed at 20 months. Dietary iodine intake was analysed for a subset of women through a Food Frequency Questionnaire. Linear regression analysis was used to test associations between serum concentrations of maternal thyroid hormones and child neurodevelopment outcomes. Thyroid hormones were analysed as continuous data and categorised as quintiles. 95% of mothers had optimal thyroid function based on fTSH concentrations. Overall, the present study shows that maternal thyroid function is not associated with neurodevelopmental outcomes in this high fish-eating population. However, a positive association, using quintiles for fT3, was reported for the Mental Developmental Index, between Q3 v. Q4 (β 0⋅073; P 0⋅043) and for Q3 v. Q5 (β value 0⋅086; P 0⋅018). To conclude, mothers in our cohort, who largely have optimal thyroid function and iodine intakes, appear able to regulate thyroid function throughout pregnancy to meet neurodevelopmental needs. However, it is possible that minor imbalances of fT3, as indicated from our secondary analysis, may impact offspring neurodevelopment. Further investigation of the relationship between maternal thyroid function and infant neurodevelopment is warranted, particularly in populations with different dietary patterns and thereby iodine intakes.

Stunting and lead: using causal mediation analysis to better understand how environmental lead exposure affects cognitive outcomes in children

BackgroundMany children in Bangladesh experience poor nutritional status and environmental lead exposure, both of which are associated with lower scores on neurodevelopmental assessments. Recent studies have suggested that part of lead’s adverse effects on neurodevelopment are caused in part by lead’s effect on growth. New statistical methods are now available to evaluate potential causal pathways in observational studies. This study used a novel statistical method to test the hypothesis that stunting, a measure of linear growth related to poor nutrition, is a mediator and/or an effect modifier of the lead exposure’s adverse effect on cognitive development.MethodsParticipants were 734 children from a longitudinal birth cohort established in rural Bangladesh to study the health effects of prenatal and early childhood environmental metal exposures. Lead exposure was estimated using umbilical cord blood samples obtained at birth and blood obtained via venipuncture at age 20–40 months. Stunting was determined using the World Health Organization’s standards. Neurodevelopment was assessed at age 20–40 months years using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). We evaluated the effect of lead on stunting and whether the effect of lead on cognitive scores is modified by stunting status in multivariable regression analyses. We then conducted a novel 4-way mediation analysis that allows for exposure-mediator interaction to assess how much of the effect of lead on cognitive scores is explained by the pathway through stunting (mediation) and how much is explained by the interaction between lead and stunt (effect modification).ResultsStunting was not a mediator of the effect of lead in our analyses. Results suggested effect modification by stunting. In an area of Bangladesh with lower lead exposures (median umbilical cord blood lead concentration, 1.7 μg/dL), stunting modified the relationship between prenatal blood lead concentrations and cognitive score at age 2–3 years. A 1-unit increase in natural log cord blood lead concentration in the presence of stunting was associated with a 2.1-unit decrease in cognitive scores (β = − 2.10, SE = 0.71, P = 0.003). This interaction was not found in a second study site where lead exposures were higher (median umbilical cord blood lead concentration, 6.1 μg/dL, β = − 0.45, SE = 0.49, P = 0.360).ConclusionsWe used a novel method of mediation analysis to test whether stunting mediated the adverse effect of prenatal lead exposure on cognitive outcomes in Bangladesh. While we did not find that stunting acted as mediator of lead’s effect on cognitive development, we found significant effect modification by stunting. Our results suggest that children with stunting are more vulnerable to the adverse effects of low-level lead exposure.

Long-Term Head Start Impacts on Cognitive Outcomes for Children With Disabilities

Based on the Head Start Impact Study (HSIS) data, the current study examines Head Start’s long-term impacts on cognitive outcomes for children with disabilities: (a) Do children with disabilities who enroll in Head Start at age 4 years have better cognitive outcomes when they are 4 to 9 years old? (b) Are there other factors associated with long-term cognitive development for children with disabilities? Linear regression analysis indicated that Head Start enrollment had positive impacts on children’s short-term outcomes. However, the difference between Head Start and non-Head Start children became insignificant for cognitive scores measured at age 9 years. Children who were Black or Hispanic, without an individualized education plan, were non-English speaking at home, and who had lower preacademic skills prior to Head Start enrollment had significantly lower cognitive outcomes at age 9 years.

Dietary intake and cognitive development among children in Kisumu county, Kenya

Varied nutrient-dense and high-quality diet are key to ideal growth and cognitive function in the early years of life. Nutrient deficiency can lead to negative functional effects of the brain and poor cognitive function. High rates of poverty in developing countries predispose children to malnutrition. This study aimed at exploring factors associated with dietary intake and cognitive development among children in Kisumu County, Kenya.This was across-sectional study survey that recruited 192 children aged less than 24 months. Food frequency questionnaire and Bayleys Scale for Infant Development kit was used to collect data.It was revealed that a total of 51% were girls with 30% aged below 6 months. Only 12%had cognitive scores above average. Child cognitive scores were linked with age (p= 0.022), carbohydrate (p=0.021), fat (p=0.011) and iron (p=0.022) intake. Only 34% and 32% of children consumed diets adequate in proteins and iron,respectively. Of children aged above 18 months, only 13% consumed diet adequate in iron. Factors associated with carbohydrate intake included:mother's marital status (p=0.036) and her level of income (p=0.028) while protein intake related to the type of housing (p=0.013). Fat intake was linked with the mother's marital status (p=0.009) and her level of income (p=0.001) while the iron intake was linked to the mother's level of income (p=&lt;0.001) and her educational level (p&lt; 0.001). Vitamin A intake was linked to the ability to pay rent by the household (p=0.016). Further analysis revealed that children whose fathers were earning more than Kenya shillings 3000.00 per month had 0.2 times lower risk of being above average on cognitive scores compared to those whose fathers were earning less than Kenya shillings 3000.00 per month,while those with an inadequate intake of carbohydrate had 8 times more risk of having cognitive scores above average compared to those whose diets were adequate.In conclusion, majority of children consumed diets inadequate in protein and iron while 12% of children had cognitive scores above average. Mother’s marital status, education and income influenced child’s dietary intake while their age groups and father’s income were associated with child's cognitive outcomes.Policies to enhance parental education and income level should be formulated to improve child's dietary and cognitive outcomes.

Placental Gene Transcription and Child Cognitive and Behavioral Outcomes

Background/Aim: The placenta plays an important role in neurodevelopment by synthesizing key hormones and providing nutrients involved in brain development. To date, no study has examined child cognitive outcomes in the context of the placental transcriptome.Methods: Placental transcriptomic data for 637 mother-child dyads (327 girls; 310 boys) from the CANDLE study (ECHO/PATHWAYS consortium) were obtained using paired-end RNA sequencing. Genes (N=13321) were clustered using Weighted Gene Co-expression Network Analysis (WGCNA). Cluster eigenvectors (eigengenes) were used as explanatory variables for three different outcome measures from the 4-6-year visit: Stanford Binet-5 full scale intelligence quotient (FSIQ) and externalizing or internalizing score from the Child Behavior Checklist (CBCL). Associations between outcomes and eigengenes were modeled in separate regressions controlling for covariates, adjusting p-values using Benjamini-Hochberg FDR correction (significance cutoff = 0.05). Separate analyses in sex-stratified datasets examined effect modification by sex. Functions of gene clusters were inferred using Fisher’s exact test based on Gene Ontology terms (unadjusted p-value cutoff = 0.0001).Results: Overall, two clusters (macromolecule metabolism and cell membrane structure) were negatively associated with FSIQ. Four clusters (nuclear protein transport, mitochondrial cristae, angiogenesis, and ribosome structure) were positively associated with and one cluster (biomolecule location maintenance) was negatively associated with CBCL externalizing score. In girls, FSIQ was positively associated with one cluster (myeloid leukocyte activation). In boys, FSIQ was negatively associated with one cluster (protein modification) and positively associated with another cluster (macromolecule metabolism). CBCL externalizing score in boys was positively associated with one cluster (mitochondrial cristae). All associations became nonsignificant after p-value adjustment.Conclusion: In this first study to assess placental transcriptome relationships with childhood neurodevelopmental outcomes, we identified functional gene clusters involved in diverse biological pathways that may provide evidence for a mechanistic link between the placenta and child cognitive and behavioral outcomes that may differ by sex.

Trimester Specific Association of Prenatal Fluoride Exposure and Cognitive Outcomes in Children in Mexico

Background: There is increasing evidence suggesting that prenatal exposure to fluoride is associated with lower neurocognitive performance in offspring. The objective of this study is defining periods in early life associated with greater sensitivity to fluoride exposures.METHODS: This study focused on participants from the Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT) project. Fluoride in archived urine samples taken from mothers across the trimesters of pregnancy were measured and adjusted for urinary creatinine (MUFcr). The main outcome of this analysis was the General Cognitive Index (GCI) of the McCarthy Scales of Children’s Abilities at age 4. Regression models were used to assess the associations between prenatal fluoride at each trimester of pregnancy and GCI adjusted for gestational age, weight at birth, sex, parity , age at outcome measurement, and maternal characteristics including smoking history, marital status, age at delivery, IQ, education, and sub-cohort.RESULTS: Complete data were available for 256 mother-child pairs for trimester 1, 241 for trimester 2 and 115 for trimester 3. Mean and Standard Deviation (SD) of MUFcr were 0.93 (0.42) mg/L for trimester 1, 0.99 (0.53) for trimester 2 and 0.84 (0.41) for trimester 3. In multivariate models an increase of 1 mg/L MUFcr was associated with declines in GCI scores of -4.9 (95% CI; -8.80, -1.10) in trimester 1 and -3.35 (95%CI; -6.24, -0.47) in trimester 2, respectively. There were no significant associations between MUFcr and GCI score in trimester 3.CONCLUSION: In this study, trimester-specific analyses suggest that fluoride exposure during the early trimesters of pregnancy may have the strongest negative effect on offspring neurocognitive outcomes.

Divorce, Remarriage and Child Cognitive Outcomes: Evidence from Canadian Longitudinal Data of Children

ABSTRACT This study investigates the role of divorce and remarriage on cognitive outcomes of children. Using the rich panel data information from the National Longitudinal Survey of Children and Youth (NLSCY), collected biennially since 1994, we investigate the association between children’s math and reading performance and divorce and remarriage relative to intact families. We find that children who stay-in or move-to non-intact families have lower reading scores than those who stay in intact families. Although initial findings indicate that family structure has an overall small effect on children’s math performance, we find a differential impact of family structure on Math performance across gender and cultural heritage.

Does Maternal Depression Undermine Childhood Cognitive Development? Evidence from the Young Lives Survey in Peru.

This paper studies the effect of maternal depression on early childhood cognition in Peru, where rates of depression are around 50%. By using an instrumental variables approach, this study exploits variation in the exogeneity of the exposure to shocks during early life to instrument for maternal depression. The empirical strategy exploits a novel longitudinal data—the Young Lives survey—that includes information on cognitive outcomes of children and variation in their mothers’ mental health status between rounds of data collection. Results suggest that maternal depression is detrimental to a child’s vocabulary at age 5, but effects fade out by age 8. Effects do not vary by maternal education but are significant only for children living in disadvantaged households. Estimations indicate that the presence of a partner worsens the effect of maternal depression on vocabulary development, results that are driven mainly by households with heavy-drinking partners. Our findings make a strong case for recognizing maternal mental health problems as disorders of public health significance and guide maternal and infant health policies in Peru.

Subclinical hypothyroidism in pregnancy: controversies on diagnosis and treatment.

The negative impact of even subtle maternal thyroid hormone deficiency on the pregnancy outcome and intellectual development of the progeny has been known for many years, but unfortunately the diagnosis and treatment of subclinical hypothyroidism in pregnant women still evokes controversies. Due to physiological changes in thyroid function and thyroid hormones metabolism during pregnancy, the trimester‑specific reference ranges for thyroid‑stimulating hormone (TSH) and free thyroid hormones should be established. However, because of interassay variability and other confounders including ethnicity and iodine intake, such norms are reliable only for local populations and a specific laboratory method. In turn, the fixed reference ranges suggested by endocrine societies may carry a risk of misclassificating some healthy pregnant women to be hypothyroid. The effect of levothyroxine treatment on pregnancy and children's cognitive outcomes remains unclear. Therapeutic benefits in decreasing miscarriage and preterm delivery rates were observed when intervention was held in the first trimester in women with a TSH level between 2.5 to 10 mU/l, mainly higher than or equal to 4 mU/l. The possible harmful effect of treatment includes preterm delivery, gestational diabetes, hypertension, and pre‑eclampsia. The only 3 prospective, randomized, placebo‑controlled trials evaluating the efficacy of levothyroxine therapy on children's intelligence quotient were started in the second trimester, which may be too late to demonstrate differences between treatment and placebo groups. Awaiting the results of future trials, clinicians should be aware of the fact that low‑dose levothyroxine at a daily dose of 25 to 50 µg is probably not harmful and may be beneficial, but the routine implementation of the therapy in each pregnant women with a TSH level exceeding 2.5 mU/l seems too premature.

Is winning at the start important: Early childhood family cognitive stimulation and child development

Abstract We study the influence of early childhood family cognitive stimulation on child development. Using the China Family Panel Studies (CFPS) survey data, we find that early childhood family cognitive stimulation at the preschool stage plays an important role in young children’s later development. Our findings mainly demonstrate that the preschool stage family cognitive stimulation can significantly improve the school-aged children's cognitive outcome based on the cumulative value-added model with other factors controlled. However, this impact is different between urban cohorts and rural cohorts, and is substantially significant for children in rural regions. Moreover, early childhood cognitive development delays at the toddler stage also have significant adverse effects on children's later cognitive outcomes, especially language delays. Finally, we also explore behavioral factors of attention and priority of study as potential operating mechanisms of early family cognitive stimulation. The results imply that the effect channels of preschool family cognitive stimulation are complex and cannot be captured by these two measures.

Maternal glucose tolerance in pregnancy and child cognitive and behavioural problems in early and mid-childhood.

Maternal abnormal glucose tolerance during pregnancy may adversely affect offspring cognition and behaviour, but few prospective studies investigated this association at multiple points throughout childhood. We hypothesised that maternal abnormal glucose tolerance is associated with child cognitive and behavioural outcomes in early and mid-childhood. We examined the associations of maternal abnormal glucose tolerance at 26-28weeks of pregnancy with offspring cognitive and behavioural scores in 1421 children in the Project Viva pre-birth cohort. In early (mean 3.3years) and mid-childhood (mean 7.9years), we measured child cognition using validated instruments, the Kaufman Brief Intelligence Test, Wide Range Assessment of Memory and Learning, and the Wide Range Assessment of Visual Motor Abilities (WRAVMA); we assessed parent- and teacher-rated behavioural outcomes with the Strengths and Difficulties Questionnaire and the Behavioural Rating Inventory of Executive Function. We used linear regression models adjusted for potential confounders (maternal race/ethnicity, pre-pregnancy BMI, intelligence, age, parity, smoking status, education, and household income at enrolment, in addition to child's sex and age at assessment). Of 1421 mothers, 69 (4.9%) had gestational diabetes mellitus, 43 (3.0%) impaired glucose tolerance, 122 (8.6%) isolated hyperglycaemia, and 1187 (83.5%) normal glucose tolerance. Offspring born to women with gestational diabetes mellitus had lower total WRAVMA scores (-3.09 points; 95% CI -6.12, -0.05) in early childhood compared with offspring of women with normal glucose tolerance. None of the abnormal glucose tolerance categories during pregnancy were associated with any of the cognitive outcomes (verbal, non-verbal, and visual motor scores) or behavioural measures in mid-childhood. Children born to mothers who had gestational diabetes mellitus had slightly lower scores on one cognitive test in early childhood. We found no evidence to support that maternal abnormal glucose tolerance was associated with cognitive or behavioural development in mid-childhood.

Maternal depression impairs child emotion understanding and executive functions: The role of dysregulated maternal care across the first decade of life.

The long-term negative effects of maternal depression on child outcome are thought to be mediated in part by deficits in caregiving; yet, few studies utilized longitudinal cohorts and repeated observations to specify these links. We tested the impact of deficits in maternal regulatory caregiving across the first decade of life on children's emotional, social, and cognitive outcomes at 10 years. A community birth cohort was repeatedly assessed for maternal depression across the first year and again at 6 and 10 years. At 9 months, 6 years, and 10 years patterns of regulatory caregiving were assessed during mother-child interactions; at 6 and 10 years children underwent psychiatric diagnosis; and at 10 years children's emotion recognition (ERc), executive functions (EF), and social collaboration (SC) were evaluated. Depressed mothers displayed deficits to regulatory caregiving across development and their children exhibited more psychiatric disorders, lower SC, and impaired ERc. Structural equation modeling demonstrated both direct paths from dysregulated caregiving at 6 and 10 years to impaired child EF and ERc and mediated paths via child psychiatric disorder on all 3 outcomes. Effects of 9-month caregiving were only indirect, via child disorder, differentiating infants on risk versus resilient trajectories. Patterns of maternal caregiving were individually stable over time. Our findings demonstrate disruptions to core regulation-based abilities in children of depressed mothers beyond infancy, contribute to discussion on risk and resilience in the context of a distinct early life stress condition, and underscore late childhood as a period of specific vulnerabilities that should become a focus of targeted interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Impact of Preconception Treatment Initiation for Hypothyroidism on Neurocognitive Function in Children.

Levothyroxine treatment for hypothyroidism in early pregnancy has inconsistent outcomes. This study evaluated children's cognitive function to ascertain the impact of preconception maternal hypothyroidism treatment on fetal neurodevelopment. This prospective, single-center cohort study was conducted at a tertiary-care hospital. Women were assigned to the before conception (BC) and after conception (AC; 8-14 gestational weeks) groups by time point of hypothyroidism diagnosis and treatment. Levothyroxine treatment was adjusted based on results of a monthly thyroid function test. The Gesell Development Diagnosis Scale (GDDS; Chinese version) was used to assess neurocognitive development of children at age 6, 12, and 24 months, with total score as the primary outcome. Of the 466 participants, 187 and 279 were in the BC and AC groups, respectively. Both groups were comparable at baseline antenatal visit, except for a higher proportion of thyroid peroxidase (TPO) antibody-positive participants in the BC group (P < .001). No significant intergroup differences were evident on the GDDS neurodevelopmental assessment at age 6, 12, and 24 months (P > .05), except for unexpected slightly lower motor ability (P = .009) and total (P = .026) scores at 12 months and adaptability at 24 months (P = .037) in the BC group. Differences for motor ability (P < .001) and total score (P = .026) persisted on subgroup analysis for subclinical hypothyroidism, without significant differences in pregnancy and neonatal outcomes by severity and TPO status (P > .05). Preconception levothyroxine treatment did not induce significantly better cognitive outcomes in children up to age 2 than treatment initiated at 8 to 14 weeks of gestation.