Griffiths Scales Research Articles

Predictive value of brain-specific proteins in serum for neurodevelopmental outcome after birth asphyxia.

Brain-specific proteins have been used to detect cerebral injury after birth asphyxia. Previous investigations suggest that serum protein S-100beta, brain-specific creatine kinase (CK-BB), and neuron-specific enolase (NSE) are capable of identifying patients with a risk of developing hypoxic-ischemic encephalopathy. Whether detection of elevated serum concentrations of these proteins reflects long-term neurodevelopmental impairment remains to be investigated. We examined serum protein S-100beta, NSE, and CK-BB at 2, 6, 12, and 24 h after birth in 29 asphyxiated infants and 20 control infants. Neurodevelopmental follow-up examinations were performed at 20 mo of age using the German revision of the Griffiths scales for developmental assessment. Elevated concentrations of serum protein S-100beta, NSE, and CK-BB within 24 h after asphyxia did not correlate with long-term neurodevelopmental delay. We conclude that serum protein S-100beta, NSE, and CK-BB, sampled on the first day of life, is of limited value in predicting severe brain damage after birth asphyxia.

A retrospective case-control study of developmental and other outcomes in a cohort of Australian children conceived by intracytoplasmic sperm injection compared with a similar group in the United Kingdom

Objective To investigate the possibility that children born after ICSI were at increased risk for neurodevelopmental delay. Design Retrospective case-control study. Setting IVF clinic. Patient(s) Fifty-eight singleton children born after ICSI and 38 normally conceived singleton children (controls), matched for relevant sociodemographic characteristics, from Australia and 208 case-patients and 221 controls from the United Kingdom. Main outcome measure(s) Antenatal and perinatal, and sociodemographic characteristics; physical health, including congenital abnormalities; and neurodevelopment by using the Griffiths scales of mental development. Result(s) Eighty-five percent of case-patients and 96% controls were assessed at a mean age of 13 months. Neurodevelopmental scores were similar in all children. Perinatal outcome was similar, apart from more caesarean sections in the case-patients. Rates of congenital anomalies were similar (5.6% among case-patients vs. 5.7% among controls). Children from fathers with oligozoospermia showed no extra problems. Children born after ICSI in the United Kingdom and Australia were similar. Conclusion(s) Children conceived after ICSI did not differ from their naturally conceived peers in physical health or development at ages up to 15 months.

Alcohol, breastfeeding, and development at 18 months.

We aimed to replicate a previous study of 1-year-olds that reported a deficit in motor development associated with moderate alcohol use during lactation, using a different but comparable population. The mental development of 915 18-month-old toddlers from a random sample of a longitudinal population-based study in the United Kingdom was measured using the Griffiths Developmental Scales. Frequent self-administered questionnaires during and after pregnancy provided maternal data. The dose of alcohol available to the lactating infant was obtained by multiplying the alcohol intake of the mother by the proportion of breast milk in the infant's diet. We compared this dose with the Griffiths Scales of Mental Development, taking into account potentially confounding variables. Three of the Griffiths scales increased slightly but significantly with increasing infant alcohol exposure; there was no association in the remaining 2 or average of the scales. We were unable to replicate the earlier deficit in motor skills associated with lactation alcohol use. One reason may be that the dose of alcohol reaching the lactating infant is small, and tests of infants and toddlers have limited ability to pick up small effects. Studies of older children may resolve the question of the safety of drinking while nursing.

Outcome for children born after in utero laser ablation therapy for severe twin-to-twin transfusion syndrome.

To examine the postnatal development of a group of children born after in utero laser ablation therapy for severe twin-to-twin transfusion syndrome. Retrospective cohort outcome study involving assessment of neurodevelopment and physical well being. Harris Birthright Centre, King's College Hospital, London. Twins and singleton survivors treated via laser ablation therapy for twin-to-twin transfusion syndrome over a four-year period. Of 54 families contacted to participate in the study, who had been treated for twin-to-twin transfusion syndrome during a four-year period, 24 families attended for paediatric assessment; 12 pairs of twins and 12 singleton survivors were assessed for perinatal, neurological and neurodevelopmental outcome using the Griffiths scales of mental development. A further 20 families were assessed via a proforma after contact with their general practitioner. A comparison of these groups showed no significant differences in sociodemographic factors or severity of disease between responders (44 families, 81.5%) and non-responders (10 families). The group of children assessed by a paediatrician had low birthweight (1619g donor, 1814g recipient, 1877g singleton) and had been born preterm (33 weeks twins, 31.2 weeks singleton) with attendant increased resuscitation, neonatal unit admission (mean 40 days) and instrumental delivery. Mean Griffiths scores were within the normal range of ability (91.2 donor vs 97.7 recipient and 101.6 singletons) with the only significant difference being in the locomotor subscale where donor (82.6) and recipient (85.3) were less than singletons: -99.1 (P < 0.05). There was no cerebral palsy in the singleton survivors, but there were five cases in the twin group. All except one affected child (with quadriplegia) had mean Griffiths scores in the normal range. In the GP proforma group there was one case, in a twin, of cerebral palsy. The overall cerebral palsy rate was 9%: 0% in the singleton survivors group and 13.3% in the twin survivors group. This pilot data highlights the need for careful long term follow up of children affected by twin-to-twin transfusion syndrome.

Outcome for children born after in utero laser ablation therapy for severe twin-to-twin transfusion syndrome

Objective To examine the postnatal development of a group of children born after in utero laser ablation therapy for severe twin-to-twin transfusion syndrome. Design Retrospective cohort outcome study involving assessment of neurodevelopment and physical well being. Setting Harris Birthright Centre, King’s College Hospital, London. Participants Twins and singleton survivors treated via laser ablation therapy for twin-to-twin transfusion syndrome over a four-year period. Methods Of 54 families contacted to participate in the study, who had been treated for twin-to-twin transfusion syndrome during a four-year period, 24 families attended for paediatric assessment; 12 pairs of twins and 12 singleton survivors were assessed for perinatal, neurological and neurodevelopmental outcome using the Griffiths scales of mental development. A further 20 families were assessed via a proforma after contact with their general practitioner. A comparison of these groups showed no significant differences in sociodemographic factors or severity of disease between responders (44 families, 81.5%) and non-responders (10 families). Results The group of children assessed by a paediatrician had low birthweight (1619g donor, 1814g recipient, 1877g singleton) and had been born preterm (33 weeks twins, 31.2 weeks singleton) with attendant increased resuscitation, neonatal unit admission (mean 40 days) and instrumental delivery. Mean Griffiths scores were within the normal range of ability (91.2 donor vs 97.7 recipient and 101.6 singletons) with the only significant difference being in the locomotor subscale where donor (82.6) and recipient (85.3) were less than singletons: -99.1 ( P<0.05). There was no cerebral palsy in the singleton survivors, but there were five cases in the twin group. All except one affected child (with quadriplegia) had mean Griffiths scores in the normal range. In the GP proforma group there was one case, in a twin, of cerebral palsy. Conclusion The overall cerebral palsy rate was 9%: 0% in the singleton survivors group and 13.3% in the twin survivors group. This pilot data highlights the need for careful long term follow up of children affected by twin-to-twin transfusion syndrome.

Effects of Maternal Depression on Cognitive Development of Children Over the First 7 Years of Life

The effects of postnatal depression on cognitive test scores at 20 months and 4; 8 years of age as well as the timing (onset in the early postnatal period versus later), severity, number of episodes, duration of longest phase, recency, and chronicity of material depression on children's cognitive scores at 6; 3 years was investigated. In South Bavaria, Germany, 1,329 mothers of singletons were screened when the children were 6; 3 years of age for the presence of depressive symptoms since the birth of their infant. A standard interview (SADS-L) was used to ascertain DSM-IV diagnosis and details of depressive episodes. Ninety-two mothers were diagnosed as having suffered DSM-IV defined depression (7%). Seven hundred and twenty-one mothers had no depressive episodes or symptoms from their children's birth until 6; 3 years and were used as control group. The children had been assessed with the Griffiths Scales of Babies' Abilities (20 months), the Columbia Mental Maturity Scales (CMM) at 4; 8 years, and the Kaufman Assessment Battery for Children (K-ABC) at 6; 3 years. No significant main effects of severity, timing of onset, duration, or chronicity of depression of the child's cognitive development were found. Significant interactions of gender with chronicity of maternal depression (i.e. early-onset major and repeated episodes) were detected. Low SES boys or boys born at neonatal risk of mothers with chronic depression had lower Achievement Scores in the K-ABC at 6; 3 years than children of mothers with less severe depression or controls. It is concluded that maternal depression per se has negligible effects on children's cognitive development. Long-term effects may be found when maternal depression is chronic, the child is a boy and neonatal risk-born, or the family suffers other social risks.

Should infants be screened for anaemia? A prospective study investigating the relation between haemoglobin at 8, 12, and 18 months and development at 18 months

AIMSTo investigate the relation between haemoglobin in children followed longitudinally from 8 to 18 months, and developmental outcome at 18 months.METHODSThe Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) is...

The construct validity of the Griffiths Scales of Mental Development.

The aim of this study was to contribute to our knowledge of the construct validity of the Griffiths Scales of Mental Development (Griffiths Scales) through an examination of the underlying dimensions tapped by the six subscales, using Common Factor Analysis. A sample of 430 South African children, from four ethnic groups (i. e. White, Mixed Race, Asian and Black) participated. The correlation coefficients obtained for the South African groups were compared to those Griffiths obtained in her work with the British standardization sample of the Griffiths Scales. The pattern of correlation for South African and British subjects was found to be similar. This suggests that the Scales are measuring a construct which is consistent across cultures and through time. A factor analysis was performed with the data for each South African ethnic group separately and the factor solutions were compared to determine whether the Griffiths Scales measure similar or different constructs for the groups. The results indicate that the Griffiths Scales tend to measure one factor, and including only common variables, the factor appears to be similar cross-culturally.

Gender differences in cognitive abilities at 2 years in ELBW infants. Extremely low birth weight.

Gender differences in cognitive abilities exist for children born at term. For very preterm infants uncertainty exists regarding the presence and extent of such differences and their relationship to perinatal brain injury and neurological impairment. This study examined gender differences in cognitive abilities in a cohort of 336 extremely low birth weight (ELBW) infants at 2 years corrected age. Infants were classified as at low or high perinatal risk at birth according to four perinatal risk factors. A subgroup of 33 neurologically impaired infants was identified. Outcome at 2 years was measured by the overall General Quotient (GQ) on the Griffiths scale and its five subscale scores. Female ELBW children were superior to male ELBW children by 4.1 GQ points (95% CI 1.0, 7.1). If the impaired subgroup was excluded, the difference in GQ was 3.2 points (95% CI 0.4, 5.6), and this difference was predominantly due to female infants being superior in the hearing and speech subscale (6.0 points, 95% CI 2.6, 9.5). These differences were relatively independent of perinatal risk status. Gender differences in the Griffiths GQ for ELBW infants are similar to expected differences for term infants and are unlikely to cause substantial bias in interpreting outcome studies for ELBW infants, unless these involve tests of specific cognitive abilities such as language.

Effects of gestation and birth weight on the growth and development of very low birthweight small for gestational age infants: a matched group comparison

AIMSTo investigate the effects of small for gestational age (SGA) in very low birthweight (VLBW) infants on growth and development until the fifth year of life.METHODSVLBW (< 1500 g) infants,...

The CRIB (Clinical Risk Index for Babies) score and neurodevelopmental impairment at one year corrected age in very low birth weight infants.

To assess the ability of the Clinical Risk Index for Babies (CRIB) to predict long-term neurodevelopmental impairment in very low birth weight (VLBW) infants. Single-center cohort study. Tertiary neonatal care hospital and follow-up clinic. Four hundred fifty-five VLBW infants consecutively admitted from 1992 to 1997 inclusive. Calculations of CRIB scores from birth weight, gestational age, the presence of congenital malformations, worst base excess, maximum and minimum appropriate fraction of inspired oxygen (FIO2) during the first 12 h of life was possible in 430 infants. Three hundred eighty-six infants survived until discharge (89%) and 352 (91%) were examined at 1 year corrected age using the Griffiths scales of mental development. Major neurodevelopmental impairment (general quotient < 2 standard deviations below average) was observed in 76 infants (22%). CRIB scores and the individual CRIB components differed significantly between infants with and those without neurodevelopmental impairment. By logistic regression analysis, CRIB scores and minimum FIO2 were independent predictors of death, while CRIB and maximum FIO2 were independently associated with neurodevelopmental impairment. For combined poor outcome (death or impairment), CRIB, minimum and maximum FIO2 were independent predictors. In predicting major neurodevelopmental impairment, the area under the receiver operating characteristic curve for CRIB (0.703 +/- 0.035) did not differ significantly from that of birth weight (0.697 +/- 0.035) or any other CRIB component. While high CRIB scores are associated with major neurodevelopmental impairment, the CRIB score is of limited value for stratification in randomized trials or for adjustments in comparing performance between hospitals with neurodevelopmental impairment as the main outcome measure.

Behaviour and Development of Stunted and Nonstunted Jamaican Children

In order to examine the mechanism whereby stunted children have poor developmental levels, we compared the behaviour of stunted (N = 78) and nonstunted (N= 26) children aged 12 to 24 months, and examined the relationship of their behaviour to their developmental levels. The effect of nutritional supplementation with or without psychosocial stimulation on the stunted children's behaviour was also examined. The children were observed at home during 4 days over a period of 6 months. The stunted children showed significantly more apathy, and less enthusiasm and variety in exploring, were less happy and more fussy. Caretakers’ vocalisations to them were less warm or instructive. Stunted children's activity level, exploratory and happy behaviours were predictive of change in developmental levels measured on the Griffiths Scales, from enrolment to 12 and 24 months later. Supplementation predicted mental age at 12 and 24 months after enrolment, however, it had no significant effect on behaviour.

Behaviour and development of stunted and nonstunted Jamaican children.

In order to examine the mechanism whereby stunted children have poor developmental levels, we compared the behaviour of stunted (N = 78) and nonstunted (N = 26) children aged 12 to 24 months, and examined the relationship of their behaviour to their developmental levels. The effect of nutritional supplementation with or without psychosocial stimulation on the stunted children's behaviour was also examined. The children were observed at home during 4 days over a period of 6 months. The stunted children showed significantly more apathy, and less enthusiasm and variety in exploring, were less happy and more fussy. Caretakers' vocalisations to them were less warm or instructive. Stunted children's activity level, exploratory and happy behaviours were predictive of change in developmental levels measured on the Griffiths Scales, from enrolment to 12 and 24 months later. Supplementation predicted mental age at 12 and 24 months after enrolment, however, it had no significant effect on behaviour.

Neurodevelopmental outcome of very low birth weight babies admitted to a Malaysian nursery

To examine the prevalence and pattern of neurodevelopmental handicap at 2 years of age in very low birth weight infants (VLBW) admitted in 1993 to a level 3 Malaysian nursery. All VLBW babies born in the hospital or referred for neonatal care during 1993 were enrolled prospectively in the study. At 2 years of age development was assessed using the Griffiths mental scales. Neurological, hearing and visual assessments were graded into five groups according to functional handicap. Control infants were randomly selected during attendance at a primary health care clinic. One hundred and fifty VLBW infants were admitted and 82 (54.6%) survived to 2 years, of whom 77 (93.9%) were assessed. The mean General Quotient (GQ) on the Griffiths Scales was 94 (15.7) for the study group and 104 (8.3) for the 60 controls. For GQ, 21 (27.3%) of the study population were 1 or more SD below the mean (18 between 1 and 2 SD and 3 > 2 SD) compared with 1 (1.6%) of the controls who was 1-2 SD below the mean. Visual impairment occurred in 2 study infants and none of the controls. There was no hearing impairment in either group. Cerebral palsy occurred in 3 (1 mild and 2 moderate-severe) of the study group and none of the controls. Functionally 18 (23.3%) of the study group had mild handicap, 1 (1.3%) moderate, 2 (2.5%) severe, 2 (2.5%) multiply severe and 54 (70.2%) were normal. Although survival was low, overall rates of functional handicap were similar to those reported in developed countries but the proportion with moderate or severe handicap was low.

Children born after intracytoplasmic sperm injection: population control study

Intracytoplasmic sperm injection is often successful for treatment of male infertility; over 20 000 children have been born as a result.1 This bypassing of natural barriers to sperm selection has...

Iron supplemented formula milk related to reduction in psychomotor decline in infants from inner city areas: randomised study.

Objective: To compare the effect of unmodified cows‘ milk and iron supplemented formula milk on psychomotor development in infants from inner city areas when used as the main milk source.Design:...

Visual information processing in infants with focal brain lesions.

Visual information processing for faces were tested by means of the Fagan test of infant intelligence (FTII) in six infants of approximately 12 months of age affected by congenital unilateral brain lesions. Magnetic resonance imaging (MRI) was used to determine the side and size of the lesions. In addition to the FTII, all infants were submitted to a psychometric evaluation using the Griffiths scales. Visual acuity, visual field, and ocular motility were also assessed. Three infants showed damage in the left hemisphere and three in the right. The severity of the lesions, as revealed by MRI scan, was similar in the two groups. All infants except one had normal or borderline cognitive scores on the Griffiths scales. Conversely, four infants showed abnormal results on the FTII, which were not associated with the severity of the lesions, psychometric scores, or the presence of visual deficits. A preference for stimuli presented on the left side of the screen was found, independent of the side of the lesions. This effect was stronger for novel stimuli. The results of this study confirm the importance of early assessment of neuropsychological functions in infants with focal brain lesions.

Supportive parenting strategies for facilitating the development of VLBW infants: A parenting intervention

To evaluate the influence of the severity of prematurity based on birth weight on maternal distress and sensitivity and on infant development.Sixty-eight mothers and their preterm babies (30 babies classified into Extremely-Low-Birth Weight-ELBW and 38 into Very-Low-Birth Weight-VLBW) were assessed at 9 months of infant corrected age, using: Griffiths Scales for infant development, CARE-Index for maternal sensitivity during 5-minute of mother-infant interaction, and Parenting Stress Index-Short Form (PSI-SF) for maternal distress. Sixty-six healthy full-term infants (FT) and their mothers were assessed with the same procedure.ELBW, VLBW and FT groups showed similar levels at CARE-Index and PSI-SF. Nevertheless, considering infant development as outcome, a significant interaction between birth weight and maternal distress emerged, with higher Hearing & Language mean quotients in association with Non-Distressed mothers, but only in VLBW infants, compared to FT ones. Also the interaction between birth weight and maternal sensitivity influenced infant development: higher quotients (Eye-hand coordination, Hearing & Language, Locomotor) were significantly associated with sensitive mothers but only in ELBW infants.The severity of prematurity, in interaction with the degree of maternal distress and sensitivity, influenced the level of infant development.Taken together, these results suggest the relevance of considering severity of prematurity and maternal variables in order to implement appropriate interventions for supporting parenting role after a preterm birth and promoting an adequate infant development.

Note on an MMPI-2 scale of early sexual abuse.

The mean of 191 female psychiatric inpatients on the Griffith, Myers, and Tankersley (1996) MMPI-2 scale of childhood sexual abuse was compared with means of 2 community samples (58 sexually abused women and 57 nonabused women). The mean of the patients was substantially larger than that of the nonabused women but slightly larger than that of the abused women. The scale may measure general maladjustment or psychopathology instead of, or in addition to, specific sequelae of sexual abuse. Further investigation is necessary to cross-validate the scale in community samples and to examine whether scores differentiate abused and non-abused women in clinical samples. This note illustrates use of an archival data set with results of recent research.

MRI findings and sensorimotor development in infants with bilateral spastic cerebral palsy

The correlation between MRI findings and sensorimotor development was investigated in a group of 48 infants with bilateral spastic cerebral palsy (CP). The ages at MRI examination and cognitive assessment were fairly homogeneous (mean 15 months and 17 months, respectively). The following MRI parameters were scored: size of lateral ventricles, extension of white matter lesions and of white matter reduction, thinning of corpus callosum, presence and size of cystic areas, dimension of subarachnoid spaces and presence of cortical abnormalities. Cognitive assessment included Griffiths Developmental Scales and Uzgiris-Hunt Scales. The patients were subdivided into six classes according to intellectual level (DSM-III-R). For the whole group a highly significant correlation was found between all MRI parameters and the level of cognitive development. This result was probably due to the inclusion of 14 untestable, severely mentally retarded infants, who showed very severe MRI abnormalities. However, when the untestable infants were excluded from the analysis, it was the presence of cysts and the entity of white matter reduction that correlated with both Griffiths Scales and Uzgiris-Hunt Scales. These results indicate the clinical value of MRI findings and particularly of white matter abnormalities for early identification of sensorimotor impairment in infants with bilateral spastic CP.