Griffiths Scales Research Articles

Griffiths III – Revision process, standardisation and psychometric properties and a link to neurorehabilitation

Objective: As the significance of understanding the process of early childhood development more fully increases, so does the need to establish with more confidence the value and role of developmental assessment. The rapidly shifting nature of children’s development poses problems for the assessment of young children. Clinical skills and judgment are required to differentiate between what is intellectual and what may be primarily neurophysiological or socio-emotional. The underpinning constructs and variables of measures must be revisited from time to time to ensure that they stay relevant and useful especially when considering aspects of remediation or rehabilitation. This paper describes the process undertaken to revise the Griffiths Scales of Child Development, now known as Griffiths III, in order to aligned it to modern developmental and psychometric theory and in so doing meet the needs of users worldwide. Methods: A blueprint and guiding principles for the revision were developed based on a literature review, expert interview information and input from Griffiths' users. An expert development team constructed each subscale by delineating the construct tapped, reviewing existing items from the previous version to select those that could be included, and developing new items. A try- out version of the Griffiths III subscales was administered and item statistics were used to identify items that worked well, that needed revision and that should be discarded. The final version was administered to the standardisation sample in the UK and Ireland. Results and conclusion: The construct coverage of the subscales and the psychometric properties of the Griffiths III for children from 1 to 72 months will be reported together with reflections of the revision process. The alignment between this and the way in which the newly launched Griffiths III could enhance the planning of best practices in the neurorehabilitation of children will be highlighted.

Adaptation of a Developmental Test to Accommodate Young Children with Low Vision

Introduction This study analyzed the effects of accommodations for children with low vision in the Griffiths Mental Development Scales–Extended Revised (GMDS-ER). Methods The sample comprised 25 children with low vision and chronological ages between 28 and 76 months. There were two assessment phases: in the first, the Griffiths Scales were administered according to the procedures described in the manual; about two to four weeks later, a second assessment was performed with the same instrument that had been adapted for low vision. Results The results indicated that there were some favorable differences in the use of item accommodations for children with low vision, including statistically significant improvements of scores in sub-scales A, locomotor; C, language; and E, performance, as well as in the full scale. All children, except one, increased their full scale score; in the subscales, the number of children that increased their scores varied. The combination of different types of accommodations (materials, administration conditions, and success criteria) generated the best results. Still, many children increased their scores with only accommodations to materials (for instance, enhancement of contours and greater visual contrast). Discussion The results demonstrated the importance of adapting developmental standardized tests for children with low vision. Future studies should increase the sample size and control variables related to type of visual impairment. Implications for practitioners Test developers and test users should consider accommodations for young children with low vision. That way, the developmental level could be described more precisely and intervention could be better adjusted to each child's abilities. Furthermore, a more accurate developmental assessment of effective child's competencies and difficulties may be useful in terms of eligibility criteria for special education services.

Preterm infant development, maternal distress and sensitivity: The influence of severity of birth weight

ObjectiveTo evaluate the influence of the severity of prematurity based on birth weight on maternal distress and sensitivity and on infant development. MethodsSixty-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 9months 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. ResultsELBW, 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. ConclusionThe severity of prematurity, in interaction with the degree of maternal distress and sensitivity, influenced the level of infant development. Practical implicationsTaken 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.

Mother-Toddler Play Interaction in Extremely, Very Low Birth Weight, and Full-Term Children: A Longitudinal Study.

Introduction: Although preterm birth represents a risk factor for early mother-infant interactions, few studies have focused on toddlerhood, an important time for the development of symbolic play, autonomous skills, and child's socialization competences. Moreover, no study has looked at the effect of birth weight on mother-child interactions during this period. Expanding on the available literature on prematurity, the main objective of this study was to explore the quality of mother-toddler interactions during play, using a longitudinal research design, as well as taking into account the effect of birth weight.Method: 16 Extremely Low Birth Weight (ELBW), 24 Very Low Birth Weight (VLBW), 25 full-term children, and their mothers were recruited for the present study. Mother-child dyads were evaluated at 18, 24, and 30 months of child age. Ten minutes of mother-child play interaction were recorded and later coded according to the Emotional Availability Scales (EAS). Furthermore, the child's level of development was assessed through the Griffiths Scale, and its contribution controlled for.Results: ELBW dyads showed an overall lower level of emotional availability, compared to VLBW and full-term dyads, but no main effect of birth weight was found on specific EA dimensions. Moreover, a significant effect of child age emerged. Overall scores, and Child Responsiveness and Involvement scores improved over time, independently of birth weight. Lastly, a significant effect of the interaction between birth weight and child age was found. Between 18 and 30 months, the overall quality of the interaction significantly increased in ELBW and VLBW dyads. Additionally, between 18 and 30 months, VLBW children significantly improved their responsiveness, while their mothers' sensitivity, structuring, and non-intrusive behaviors improved. In contrast, no change emerged in full-term dyads, although scores were consistently higher than those of the other groups.Discussion: Birth weight affects the quality of mother-toddler interactions. Monitoring the relational patterns of preterm dyads during toddlerhood is important, especially in the case of ELBW children.

Discriminant ability of the Infant Neurological International Battery (INFANIB) as a screening tool for the neurological follow-up of high-risk infants in Colombia.

The aim of this study was to assess the discriminative ability of the Infant Neurological International Battery (INFANIB), applied at 3, 6 and 9 months of corrected age (CA), on neurological outcomes at 1 year of CA. An observational analytic study was conducted on a cohort of 5857 infants, followed up to 1 year of CA in a Kangaroo Mother Care programme from 1993 to 2010 in Bogotá, Colombia. Infants were included if they had two complete INFANIB results at 3 or 6 or 9 months of CA and at 12 months of CA, including the Griffiths Scale. The outcome was defined as the presence of a neurological abnormality, as evidenced by the results of both the INFANIB and Griffiths Scale. The sensitivity of the INFANIB at 3 months was 62.2%, and specificity was 76.1%, with a receiver operating characteristic (ROC) area of 0.69. At 6 months, the results were 77.5% for sensitivity and 74.4% for specificity (ROC 0.76), and at 9 months, they were 77.2% for sensitivity and 91.1% for specificity (ROC 0.84). The INFANIB was an appropriate neurological screening test with regard to determining which Colombian infants would benefit from a timely intervention for neuromotor disorders.

Severe Neonatal Anaemia, MRI Findings and Neurodevelopmental Outcome

Background and Objective: Severe neonatal anaemia can impair cerebral oxygen supply. Data on long-term outcomes following severe neonatal anaemia are scarce. Methods: Clinical data and neurodevelopmental outcome of 49 (near) term infants with haemoglobin concentration after birth <6.0 mmol/l were retrospectively collected and analysed. In a subgroup of 28 patients, amplitude-integrated EEG was available and in 25 infants cerebral MRI was obtained. Infants were followed up at 14-35 months of age and assessed with the Griffiths Scale of Mental Development or Bayley Scale of Infant Development. Results: Eighteen patients (37%) died during the neonatal period. In 25 patients MRI was performed. A predominant pattern of injury on MRI was seen in the basal ganglia and thalami in 7 patients (28%), whereas some form of white matter injury was present in 16 (64%) and a combination in 3 (12%). Follow-up data were available for 26 patients (84% of survivors). Formal assessment of neurodevelopmental outcome was performed in 20 of 31 (65%) infants who survived (median age: 19 months, range: 14-35). Sixteen infants (80%) had a developmental quotient appropriate for age in the first 2 years after birth. On motor outcome, 1 patient (5%) scored below average (Z-score -1.10). One patient developed cerebral palsy. Conclusion: Early neurodevelopmental outcome in surviving patients with severe neonatal anaemia was within the normal range in the majority of the survivors. MRI showed mild-to-moderate white matter injury in two thirds of the infants. Prospectively collected data with a longer follow-up period are needed.

Developmental status of preschool children receiving cART: a descriptive cohort study.

HIV is known to cause neurodevelopmental problems in infants and young children. The impact of HIV on the development of preschool-age children has been less well described. The study was conducted at an urban paediatric HIV clinic in Johannesburg, South Africa. A sample of convenience was used. Sixty-eight medically stable children between the ages of 3 and 5 years were assessed with the Griffiths Scales of Mental Development. Children were excluded from the study if they had severe HIV encephalopathy, which made it impossible for them to participate in the items on the Griffiths Scales of Mental Development. The children had started combination antiretroviral treatment (cART) at a mean age of 8.1 months. The majority of the children were virologically suppressed and did not present with wasting or stunting. Severe overall developmental delay (z-scores < -2SD) was detected in 55.88% of children. Developmental facets related to speech, cognition and perception were the most severely affected. Personal-social development was the least affected with only 13.4% of the children demonstrating severe delay. Despite having early access to cART, children infected with HIV are still at risk for severe developmental delay across a number of facets. Very early initiation of cART may help alleviate this problem. All preschool children infected with HIV should have routine developmental screening.

Neurodevelopmental outcome of extremely low birth weight infants at 24 months corrected age: a comparison between Griffiths and Bayley Scales

BackgroundThe availability of accurate assessment tools for the early detection of infants at risk for adverse neurodevelopmental outcomes is a major issue. The purpose of this study is to compare the outcomes of the Bayley Scales (Bayley-II vs Bayley-III) in a cohort of extremely low birth weight infants at 24 months corrected age, to define which edition shows the highest agreement with the Griffiths Mental Development Scales Revised.MethodsWe performed a single-centre cohort study. We prospectively enrolled infants with a birth weight of 401–1000 g and/or gestational age < 28 weeks. Exclusion criteria were the presence of neurosensory disabilities and/or genetic abnormalities. Infants underwent neurodevelopmental evaluation at 24 months corrected age using the Griffiths and either the Bayley-II (birth years 2003–2006) or the Bayley-III (birth years 2007–2010).ResultsA total of 194 infants were enrolled. Concordance was excellent between the Griffiths and the Bayley-III composite scores for both cognitive language and motor abilities (weighted K = 0.80 and 0.81, respectively) but poorer for the Bayley-II (weighted K = 0.63 and 0.50, respectively). The Youden’s Index revealed higher values for the Bayley-III than for the Bayley-II (75.9 vs 69.6 %). Compared with the Griffiths, the Bayley-III found 3 % fewer infants as being severely impaired in cognitive-language abilities and 7.8 % fewer infants as being mildly impaired in motor skills while the Bayley-II showed, compared with the Griffiths, higher rates of severely impaired children both for cognitive-language and motor abilities (14.1 and 15.3 % more infants respectively).DiscussionOur study suggests that the Bayley-III, although having a higher agreement with the Griffiths compared to the Bayley-II, slightly tends to underestimate neurodevelopmental impairment compared with the Griffiths, whereas the Bayley-II tends to overestimate it. ConclusionsOn the basis of these findings, we recommend the use of multiple measures to assess neurodevelopmental outcomes of extremely low birth weight infants at 24 months.

Pattern of mother-child feeding interactions in preterm and term dyads at 18 and 24 months.

Literature on mother–child feeding interactions during the transition to self-feeding in preterm populations is lacking, particularly through observational methods. The present research study aims to look at the longitudinal patterns of mother–toddler feeding interactions, comparing preterm and full term dyads. To this end, a multi-method approach was used to collect data from 27 preterm to 20 full-term toddlers and their mothers. For each dyad, mother–child interactions were observed during the snack time at 18 and 24 months of age and then assessed through the Italian version of the Feeding Scale. Higher scores on the scale indicate a less healthy pattern of interaction. Additionally, at both points in time, mothers completed the BDI-II questionnaire as a screen for maternal depression and the child’s developmental stage was assessed using the Griffiths Scales. A series of repeated measures Analysis of Variances were run to detect differences in feeding interactions between the two groups at the time of assessment. Our results show that preterm dyads report overall higher levels of maternal negative affection, interactional conflicts, and less dyadic reciprocity during the meal compared to full-term dyads. Additionally, longitudinal data show that dyadic conflict decreases in both groups, whereas the child’s food refusal behaviors increase in the preterm group from 18 to 24 months. No differences were reported for both the BDI-II and the child’s development for the two groups. The results reveal that regardless of maternal depression and the child’s developmental stage, the two groups show different trajectories in the pattern of feeding interactions during the transition to self –feeding, at 18 and 24 months, with overall less positive interactions in preterm mother–child dyads.

Early Neurodevelopmental Findings Predict School Age Cognitive Abilities in Duchenne Muscular Dystrophy: A Longitudinal Study.

ObjectiveNeurodevelopmental and cognitive difficulties are known to occur frequently in boys with Duchenne muscular dystrophy but so far none of the published studies have reported both early neurodevelopmental assessments and cognitive tests in the same cohort. The aim of the present longitudinal study was to establish the correlation between early neurodevelopmental assessments performed in preschool boys and the cognitive scales performed at school age or later.MethodsWe performed cognitive tests at school age (mean age 5.7 year ±1.7 SD) (69 months+19 SD) in a cohort of Duchenne boys, previously assessed using the Griffiths scales before the age of 4 years (mean age when the Griffiths scales were performed 30 months ±8.9 SD).ResultsThe range of total Developmental quotients on the Griffiths ranged between 56 and 116 (mean 89 ± 15.6 SD). The total Intelligence Quotients on the Wechsler scales ranged between 35 and 119 (mean 87 ± 17.2 SD). There was a significant correlation between the findings on the two scales. P = <0.0001. When we subdivided the cohort according to site of mutations, there was a difference between boys with mutations upstream exon 44 and those with mutations in exon 44–45 affecting Dp140 on both Developmental and Intelligence Quotient (p 0.01 and p 0,003 respectively).ConclusionsOur results confirm that Duchenne boys tend to slightly underperform on both neurodevelopmental and cognitive assessments. Early neurodevelopmental findings correlated with the cognitive results obtained at school age with a clear concordance between subscales exploring similar domains on the two scales.

Massage therapy improves the development of HIV-exposed infants living in a low socio-economic, peri-urban community of South Africa

The aim of this study was to assess the effect of massage therapy on the growth and development of infants of HIV-infected mothers in a low socio-economic community in Cape Town. It was a prospective, randomised, controlled intervention trial that included massage therapy and control groups of HIV-infected mothers and their normal birth weight infants who were enrolled in the prevention of mother-to-child transmission (PMTCT) programme. Participants were recruited at the 6-week clinic visit and followed up every 2 weeks until their infants were 9 months of age. Mother–infant pairs in the massage therapy and control groups included 73 and 88 at 6 weeks and 55 and 58 at 9 months, respectively. Mothers in the intervention group were trained to massage their infants for 15min daily. The socioeconomic status, immunity, relationship with the partner and mental pain of mothers; the infants’ dietary intake, anthropometry and development (Griffiths Mental Development Scales); and haematological and iron status of mothers and infants were assessed at baseline and follow-up. Nine infants (5.3%) were HIV-infected on the HIV DNA PCR test at 6 weeks. Despite significantly higher levels of maternal mental pain, infants in the massage therapy compared to control group scored higher in all five of the Griffiths Scales of Mental Development and significantly higher in the mean quotient (p=0.002) and mean percentile (p=0.004) for the hearing and speech scale at 9 months. Based on the mean difference in scores, the massage therapy group showed greater improvement for all five scales compared to the control group. The mean difference in scores was significantly greater for the hearing and speech quotient (21.9 vs. 11.2) (p<0.03) and the general quotient percentile (19.3 vs. 7.7) (p=0.03) in the massage therapy compared to the control group. These scales remained significant when adjusting for the relationship with the partner and maternal mental pain. Both groups had lower scores in the performance scale at 9 months although this was significantly worse in the control compared to the massage therapy group when adjusting for maternal CD4 count, anaemia, relationship with the partner and mental pain. There were no significant differences in the anthropometric measurements between the two groups. In conclusion, based on the Griffiths Scales, massage therapy improved the overall development and had a significant effect on the hearing and speech and general quotient of HIV-exposed infants in this study.

"New beginnings" in South African shelters for the homeless: piloting of a group psychotherapy intervention for high-risk mother-infant dyads.

The New Beginnings program was developed at the Anna Freud Centre and originally piloted in Her Majesty Prisons in the United Kingdom. This study aimed to explore the use of this manualized parent-infant psychotherapy group model in an African setting with high-risk mother-infant dyads, and describes the implementation and investigation of this 12-week group psychotherapy intervention in two Johannesburg shelters for homeless women. The measures used to investigate treatment efficacy were the Parent Development Interview (A. Slade, J.L. Aber, I. Bresgi, B. Berger, & M. Kaplan,), the Emotional Availability Scales (Z. Biringen, J.L. Robinson, & R.N. Emde,), the Kessler-10 (R.C. Kessler et al.,), and the Griffiths Scales of Mental Development (D. Luiz et al., . At pretesting, infants exhibited delays in a number of developmental areas, and mothers showed high levels of depression and generally low capacities for reflective function. While significant shifts in the mothers' capacities for reflective function were not found in the treatment condition, significant shifts were found in the infants' speech abilities and in the mothers' abilities to structure their interactions with their infants. This suggests that the program enabled mothers to become more sensitized to their infants' needs in interaction and that communication between mother and infant increased. The number of sessions attended by the dyads correlated with improvements made by the mothers and their infants.

The impact of a developmental movement programme on the performance of rural hearing-impaired children on the Griffiths Scales of Mental Development

Being hearing impaired does not only affect a child’s academic performance, but can also influence his or her overall development and ability to succeed academically. Neurodevelopmental movement programmes are generally not accepted as evidenced-based practice, and their effect on academic performance is often underrated. Movement, however, is regarded by many as being essential to learning, and there seems to be a positive interchange between the brain and the body. This article reports on research conducted on the impact of a neurodevelopmental movement programme on the development of 4- to 8-year-old hearing-impaired children. Children were selected from a special needs school in QwaQwa, a rural area in the Free State province of South Africa. Two groups of children (one an experimental and the other a comparison group) were used in this research, with both groups undergoing a pre-test and post-test phase using the Griffiths Mental Development Scales–Extended Revised. The experimental group was subjected to a 14-week neurodevelopmental movement programme. The comparison group underwent a placebo intervention. The results indicate that the children in the experimental group showed an improvement in some aspects of specific development following the intervention (locomotor functioning, performance-related abilities, and practical reasoning skills). General developmental age showed significant improvement in both the experimental group and the comparison group. This result may support the critique against movement programmes, where the placebo effect is offered as the reason for change in children participating in movement programmes. The results of this empirical investigation aid in understanding the impact of movement programmes on a hearing-impaired child’s general development.

Early neurodevelopmental assessment in Duchenne muscular dystrophy

The aim of this study was to assess neurodevelopmental profile in young boys affected by Duchenne muscular dystrophy and to establish the correlation between neurodevelopmental findings, and the type and site of mutations. A structured neurodevelopmental assessment (Griffiths Scale of Mental Development) was performed in 81 DMD boys before the age of four years (range: 7-47 months). The mean total DQ was 87 (SD 15.3). Borderline DQ (between 70 and 84) was found in 32% and DQ below 70 in 12.3% of the patients. Children with mutations upstream or in exon 44 had higher DQ than those with mutations downstream exon 44 which are associated with involvement of dystrophin isoforms expressed at high levels in brain. The difference was significant for total and individual subscale DQ with the exception of the locomotor subscale. Items, such as ability to run fast, or getting up from the floor consistently failed in all children, irrespective of the age or of the site of mutation. Our results help to understand the possible different mechanisms underlying the various aspects of neurodevelopmental delay, suggesting that the involvement of brain dystrophin isoforms may cause a delay in the maturation of coordination and dexterity.

Predictive and Concurrent Validity of Standardized Neurodevelopmental Examinations by the Griffiths Scales and Bayley Scales of Infant Development II

Standardized examinations of preterm infants are used to identify candidates for early intervention. We aimed to assess the predictive power and concurrent validity of the mental development index of the Bayley scales of infant development II (Bayley MDI) and the Griffiths scales developmental quotient (Griffiths DQ) in healthy term and preterm infants <1500 g birth weight without major perinatal complications.137 Infants (89 term, 48 preterm) were examined by both tests at a corrected age of 6, 12, and 22 months, and 114 went on to undergo Bayley assessments at 39 months.There were significant correlations between Bayley and Griffiths results at 6, 12, and 22 months (r=0.530, 0.714, and 0.833, respectively, p<0.001) but Bland Altman plots revealed major systematic bias at 6 months (Griffiths>Bayley, mean differences 14.3±9.8) and 22 months (Bayley>Griffiths, mean difference 5.2±13.9) and wide 95% limits of agreement at 6, 12 and 22 months (35.9%, 40.0%, and 52.4%, respectively). The agreement for a presumptive diagnosis of developmental impairment in the group of preterm infants between Bayley examinations obtained at 39 months corrected age (reference) and previous examinations was poor at 6, 12, and 22 months for both Bayley and Griffiths (Cohen's kappa for Griffiths: 0.225, 0.192, 0.369; for Bayley: 0.121, 0.316, 0.369, respectively).Caution should be exercised when interpreting results from standardized neurodevelopmental examinations obtained during the first 2 years of life in comparatively well preterm infants.

Association of complex lipids containing gangliosides with cognitive development of 6-month-old infants

BackgroundHuman breastmilk contains gangliosides which may play an important role in infant neurodevelopment. AimA pilot study was conducted to assess the impact of infant formula supplemented with gangliosides from complex milk lipid on cognitive functions of normal healthy infants. Study designThe study was a double-blind, randomized, controlled, parallel group clinical trial in which infants received the treatment or control product from 2 to 8weeks of age until 24weeks of age. The control group (n=30) received standard infant formula and the treatment group (n=29) received the same formula supplemented with complex milk lipid to increase the ganglioside content to approximately 11 to 12μg/ml. A reference group (n=32) consisted of normal healthy exclusively breast-fed infants. Outcome measuresCognitive development using the Griffith Scales and serum gangliosides was measured before (2–8weeks of age) and after intervention (24weeks of age). ResultsGanglioside supplementation using complex milk lipids significantly increased ganglioside serum levels (control group vs treatment group, P=0.002) and resulted in increased scores for Hand and Eye coordination IQ (P<0.006), Performance IQ (P<0.001) and General IQ (P=0.041). Cognitive development scores and serum ganglioside levels for the treatment group did not differ from the reference group. ConclusionsSupplementation of infant formula with complex milk lipid to enhance ganglioside content appears to have beneficial effects on cognitive development in healthy infants aged 0–6months, which may be related to increased serum ganglioside levels.

Poor repertoire General Movements predict some aspects of development outcome at 2 years in very preterm infants

BackgroundObservation of the quality of endogenously generated “General Movements” has been proved to be a reliable and sensitive tool in the assessment of fragile neonates. The absence of fidgety movements at 2–4months post-term is highly predictive of Cerebral Palsy. On the contrary, the presence of a poor repertoire pattern during the writhing period is not reliable in predicting motor or neurobehavioral disorders at any stage of development. AimTo examine if the presence of a PR pattern at 1month post-term was associated with lower neurodevelopmental quotients at 2years. Study designGeneral Movements evaluation at 1 and 3months and the Griffiths Scales of Mental Development at 2years were administered to a sample of very preterm infants. Infants were divided into two groups: poor repertoire pattern group and normal pattern group. Student's t Test and Chi squared test and ANOVA were used to compare neonatal variables and results between the two groups. Subjects79 very preterm infants (birthweight≤1500g or gestational age≤32weeks), born January 2003 to December 2006 who had a follow-up at 2years. Outcome measureGriffiths developmental quotient at 2years. ResultsThe Poor Repertoire group had lower Gestational Age, lower Birth Weight, lower Apgar scores at birth and lower Developmental Quotient at 2years. Eye and Hand Coordination (subscale D) was the domain mostly responsible for such a difference. Quality of fidgety movements (normal or abnormal fidgety) at 3months did not show any correlation with outcome measures at 2years. ConclusionThe presence of a PR pattern at 1month post-term seems to predict lower neurodevelopmental scores at 2years especially in the domain of eye and hand coordination. Longer follow-up is necessary in order to ascertain if such difference will continue to persist at older ages.

The association between observed non-verbal maternal responses at 12 months and later infant development at 18 months and IQ at 4 years: A longitudinal study

Background An infant's early environment has an important influence on their development. For example, the sensitivity and warmth of a mother's responses towards her infant is associated with the infant's later socio-emotional development. However, it is less clear whether maternal responses are associated with the infant's later cognitive development. Method We used data from a large UK cohort study to investigate the association between non-verbal maternal responses and later infant development and IQ. Maternal responses were rated at 12 months during an observed mother–infant interaction. Infant development was assessed using the Griffiths scales at 18 months and IQ at 4 years was assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Data on the infant's developmental level at 6 months (prior to the maternal response ratings) was also available. The complete case sample comprised 732 mother–infant pairs. Results There was evidence for an association between positive maternal responses and infant development at 18 months. After adjusting for infant developmental level at 6 months and other confounders, we found a difference of 0.25 standard deviations (coef 2.0, 95% CI (0.8–3.2), p = 0.002) on the Griffiths scales between infant's whose mothers showed positive compared to neutral non-verbal responses at 12 months. However, an association between positive maternal responses and IQ at 4 years diminished following adjustment for maternal educational attainment. Conclusion The results provide evidence that positive maternal responses are associated with improved development in infants at 18 months. However, the association between maternal response and IQ at 4 years may be explained by higher educational attainment in mothers who show positive responses. Future studies are needed to explore the influence of maternal responses on different aspects of infant development as well as the role of maternal factors such as education.

Retrasos lingüísticos y cognitivos en niños prematuros extremos a los 2 años: ¿retrasos generales o específicos?

This study determined whether very preterm infants, without frank cerebral damage, exhibited lower linguistic abilities and a higher rate of risk at 2 years as compared to full-term infants and normative values. It also aimed to identify whether risk of lexical delay was associated with absence of word combination and cognitive impairment and which biological and social risk factors were associated with them. One hundred fifty preterms and 44 full terms, without frank cerebral damage, were examined by administering to their parents the Italian form of the MB-CDI in order to assess lexical and grammar production. Preterms’ cognitive development was evaluated through the Griffiths Scales. Preterms exhibited lower abilities in lexicon (word production, emergence of decontextualized production) and grammar (use of bounded morphology in verbs) and a higher rate of risk for lexical delay and/or absence of word combination than full terms. In detail, 18% of preterms showed generalized delay in linguistic and cognitive competencies, 16% a specific delay in language, and 4% a specific cognitive impairment. Significant predictors were broncho-pulmonary dysplasia and male gender for risk of lexical delay, male gender for absence of word combination, and broncho-pulmonary dysplasia for cognitive impairment. Very preterm infants exhibit a higher risk for linguistic delay at 2 years, suggesting that in some infants this appears the expression of a general cognitive impairment, while in others it is specific for language. Risk factors associated to preterm birth should also be considered for an early identification of risk for linguistic and cognitive delay.

Thyroid-stimulating hormone levels in the first days of life and perinatal factors associated with sub-optimal neuromotor outcome in pre-term infants.

To identify perinatal factors associated with sub-optimal neuromotor outcome in infants without evident central nervous system lesions (intraventricular hemorrhage/ periventricular leukomalacia), with gestational age ≤30 (group I) and of 31-32 weeks (group II). A total of 102 premature infants admitted to the Neonatal Intensive Care Unit of Pisa, at 26-32 weeks of gestation, were studied. Data about perinatal factors and TSH values at 3-4 days of life were collected. The assessment of neuromotor development was performed at 18 months of corrected age, using the locomotor subscale of the Griffiths Scales of Mental Development. Risk factors supposed to be predictive of sub-optimal neuromotor outcome (odds ratio >1) were at ≤30 weeks: male sex, small for gestational age, patent duct arterious, respiratory distress syndrome, and at 31-32 weeks: Apgar at 5 min <7, respiratory distress syndrome, patent duct arterious and birth weight <1500 g. A strong correlation was also found between TSH screening values >4,3 mU/l and suboptimal neuromotor outcome in both groups. Several perinatal factors, acting on an immature and more vulnerable nervous system, such as the pre-term one, different for different gestational ages, are associated with a sub-optimal neuromotor outcome. Higher, but within the normal range, TSH values at screening seem to be a strong risk factor for neuromotor outcome in preterm infants without intraventricular hemorrhage or periventricular leukomalacia.