Impairment In Preschool Children Research Articles

How do primary health-care practitioners identify and manage communication impairments in preschool children?

Communication impairments (CIs) in preschool children are common and can have long-term adverse consequences if not detected and treated early. This study investigated the knowledge, training and practice of primary health-care practitioners in the identification and management of CIs in preschool-aged children. A cross-sectional survey of 277 primary health-care practitioners in the Inner West and South West Sydney was undertaken. The majority of practitioners surveyed understood the importance of early identification of CIs. Eight per cent ofpractitioners correctly identified all of the 'red flags' for verbal and non-verbal communication. The majority (80%) correctly described the management of a typical case presentation. Two-thirds of practitioners reported using a tool in their practice for developmental surveillance, but the quality of surveillance tools was variable. One-third felt their training in this area was poor and 90% indicated they would like further training. Barriers to referral included waiting times, availability and cost of services. We concluded that primary health-care practitioners are aware that CIs are significant and they need to be identified early. There are opportunities for further training and promoting high-quality developmental surveillance in primary care. In addition, there are broader health system issues that include promotion of an integrated response to the detection and management of CIs.

Commentary: Advancing measurement of ASD severity and social competence: a reply to Constantino and Frazier (2013)

Commentary: Advancing measurement of ASD severity and social competence: a reply to Constantino and Frazier (2013)

Perinatal risk factors for neurocognitive impairments in preschool children born very preterm.

This study aimed to compare a broad array of neurocognitive functions (processing speed, aspects of attention, executive functioning, visual-motor coordination, and both face and emotion recognition) in very preterm and term-born children and to identify perinatal risk factors for neurocognitive dysfunctions. Children who were born very preterm (n=102; 46 males, 56 females), defined as a gestational age of less than 30 weeks and/or birthweight under 1000 g, and a comparison group of term-born children (n=95; 40 males, 55 females) were assessed at age 5 with the Wechsler Preschool and Primary Scale of Intelligence, Stop Signal Task, several tasks of the Amsterdam Neuropsychological Tasks, and a Digit Span task. When sociodemographic characteristics were taken into account, very preterm children scored worse than term-born children on all neurocognitive functions, except on tasks measuring inhibition and sustained attention, for which results were inconclusive. Effect sizes for group effects were small to medium (r(2) varying between 0.02 and 0.07). Principal component isolated four factors: visual-motor coordination, face/emotion recognition, reaction time/attention, and accuracy/attention. When sociodemographic and child characteristics at birth were accounted for, bronchopulmonary dysplasia was significantly negatively associated with all four components and also with working memory. Very preterm children are at risk for problems on a broad array of neurocognitive functions. Bronchopulmonary dysplasia is an independent risk factor for impaired neurocognitive functioning.

Individual development of preschool children-prevalences and determinants of delays in Germany: a cross-sectional study in Southern Bavaria

BackgroundEven minor abnormalities of early child development may have dramatic long term consequences. Accurate prevalence rates for a range of developmental impairments have been difficult to establish. Since related studies have used different methodological approaches, direct comparisons of the prevalence of developmental delays are difficult. The understanding of the key factors affecting child development, especially in preschool aged children remains limited. We used data from school entry examinations in Bavaria to measure the prevalence of developmental impairments in pre-school children beginning primary school in 1997–2009.MethodsThe developmental impairments of all school beginners in the district of Dingolfing- Landau, Bavaria were assessed using modified “Bavarian School Entry Model” examination from 1997 to 2009 (N=13,182). The children were assessed for motor, cognitive, language and psychosocial impairments using a standardised medical protocol. Prevalence rates of impairments in twelve domains of development were estimated. Using uni- and multivariable logistic regression models, association between selected factors and development delays were assessed.ResultsThe highest prevalence existed for impairments of pronunciation (13.8%) followed by fine motor impairments (12.2%), and impairments of memory and concentration (11.3%) and the lowest for impairments of rhythm of speech (3.1%). Younger children displayed more developmental delays. Male gender was strongly associated with all developmental impairments (highest risk for fine motor impairments = OR 3.22, 95% confidence interval 2.86-3.63). Preschool children with siblings (vs. children without any siblings) were at higher risk of having impairments in pronunciation (OR 1.31, 1.14-1.50). The influence of the non-German nationality was strong, with a maximum risk increase for the subareas of grammar and psychosocial development. Although children with non-German nationality had a reduced risk of disorders for the rhythm of speech and pronunciation, in all other 10 subareas their risk was increased.ConclusionsIn preschool children, most common were delays of pronunciation, memory and concentration. Age effects suggest that delays can spontaneously resolve, but providing support at school entry might be helpful. Boys and migrant children appear at high risk of developmental problems, which may warrant tailored intervention strategies.

Cerebral Damage May Be the Primary Risk Factor for Visual Impairment in Preschool Children Born Extremely Premature

OBJECTIVES To investigate the importance of cerebral damage and retinopathy of prematurity (ROP) for visual impairment in preschool children born extremely premature and to determine the primary risk factor of the two. METHODS A clinical follow-up study of a Danish national cohort of children born extremely premature (gestational age, <28 weeks). The study sample consisted of 262 extremely preterm children born between February 13, 2004, and March 23, 2006, of whom 178 children (67.9%) participated. A matched control group consisted of 56 term-born children (gestational age, 37 to <42 weeks). All participants were identified through the National Birth Register and invited to participate in a clinical examination. The children were evaluated with regard to visual acuity, foveal sequelae, and maximum ROP stage and the presence of global developmental deficits (an indicator for cerebral damage) that was measured by the Ages and Stages Questionnaire. RESULTS Global developmental deficits and foveal sequelae occurred more often in extremely preterm children than in term-born control children and increased with ROP severity (χ2 test; P=.11 and P<.001, respectively). Global developmental deficits, moderate to severe foveal abnormality, and ROP treatment were independently associated with visual impairment (P<.05, for better and worse eyes). A stepwise multiple logistic regression for better-eye logarithmic visual acuities of 0.3 or greater (Snellen scale, ≤0.5) yielded an odds ratio of 8.7 (95% CI, 3.0-25.2; P<.001) for global developmental deficit and 6.3 (95% CI, 2.2-18.5; P<.001) for moderate to severe foveal sequelae. CONCLUSION Cerebral damage and ROP are independent risk factors for visual impairment in children born extremely premature, and cerebral damage may be the primary risk factor.

Review of preschool vision screening referrals in South Auckland, New Zealand

Background: Limited data are available on the causes of visual impairment in preschool children in New Zealand. We aimed to review demographic and visual parameters in children referred to the Ophthalmology Department, Manukau Super Clinic from vision screening programs in South Auckland.Methods: Retrospective medical record review of 131 children, aged three to five years, referred from community‐based vision screening programs to the Ophthalmology Department for further assessment. Medical records were reviewed to determine: the reason for referral; findings from ophthalmic assessments; treatment received; and visual acuity at the final visit. The main outcome measures were the cause of visual impairment in children referred from preschool vision screening and the visual acuity at the final follow‐up visit.Results: Thirty‐eight (29.0 per cent) children were discharged after their initial assessment as false positive referrals. Almost half (45.5 per cent) of the children were prescribed glasses for the correction of refractive error, amblyopia or strabismus. Twenty‐nine (22.1 per cent) children were diagnosed with amblyopia with an average follow‐up period of 17.5 ± 2.7-months. In general, compliance with therapy for amblyopia was poor with 48.3 per cent non‐compliant with their prescribed treatment regimen. Despite this, visual outcomes were good with an average final visual acuity in the amblyopic eye of 0.294 ± 0.231-logMAR (Snellen 6/12).Conclusions: The ‘positive predictive value’ for the Counties‐Manukau preschool vision screening program was 47.4 per cent, suggesting that the visual acuity measurements alone produce a significant number of false positive results. In children diagnosed with amblyopia, early detection and intervention showed significant improvement in vision in the amblyopic eye, with many children also showing improved binocular function.

Language Development and Assessment in the Preschool Period

Most young children make significant progress in learning language during the first 4 years of life. Delays or differences in patterns of language acquisition are sensitive indicators of developmental problems. The dynamic, complex nature of language and the variability in the timing of its acquisition poses a number of challenges for the assessment of young children. This paper summarises the key developmental milestones of language development in the preschool years, providing a backdrop for understanding difficulties with language learning. Children with specific language impairment (SLI) are characterised illustrating the types of language difficulties they exhibit. Genetic evidence for language impairment suggests complex interactions among multiple genes of small effect. There are few consistent neurobiological abnormalities and currently there is no identified neurobiological signature for language difficulties. The assessment of young children's language skills thus focuses on the evaluation of their performances in comparison to typically developing peers. Assessment of language abilities in preschool children should involve an evaluation of both expressive and receptive skills and should include an evaluation of more than one dimension of language. The use of a single measure of a language component, such as vocabulary, is considered inadequate for determining whether preschool children have typical language or language impairment. Available evidence supports the inclusion of measures of phonological short-term memory in the assessment of the language abilities of preschool children. Further study of genetic, neurobiological and early behavioural correlates of language impairments in preschool children is needed.

Attitudes of typically developing children's parents toward inclusive education of visually impaired preschool children

This paper presents the results of pilot research on attitudes of parents who have typically developing children toward integrating children with visual impairments into regular preschool education system. The research is the result of a study on the advantages of adapted questionnaire which assesses attitudes of typically developing children's parents on inclusion of children with visual impairments. The sample consists of 34 parents who have typically developing children. We analyzed their attitudes toward inclusion of children with visual impairments and the relation of those attitudes with gender and education. The results contribute to better understanding of the position of visually impaired children in the inclusive education system.

Cognitive impairment in preschool children with epilepsy

Studies have shown that underlying pathology and early onset of seizures are both significant factors contributing to cognitive impairment in children with epilepsy. However, there are only few studies focusing on cognitive impairment in preschool children with epilepsy. The purpose of this study was to describe the cognitive performance in a population-based cohort of preschool children with epilepsy. The aims of the study were to determine frequency of cognitive impairment, level of cognitive functions, and epilepsy-related factors correlating with cognitive impairment. The study group consisted of a population-based cohort (N = 64) of preschool children (3-6 years 11 months) with active epilepsy. Medical data and results from previous psychological evaluations were reviewed retrospectively from the medical records. A logistic regression model was used for the prediction of cognitive impairment. Prevalence of epilepsy was 3.2 per 1,000 children. Cognitive function was considered to be within normal or borderline range for 50%, mildly retarded for 22%, and moderately to severely retarded for 28%. Cognitive impairment was related to complicated epilepsy, age at onset of epilepsy, abnormal magnetic resonance imaging (MRI), and additional neurologic problems. Age at the onset of seizures was the only significant predictor of cognitive impairment. The results concur with those of earlier studies on cognitive impairment in childhood epilepsy. Age at onset of epilepsy is also an important factor for cognitive impairment on young children with epilepsy. The results suggest that cognitive impairment is evident early in the course of epilepsy.

Prevalence and Risk Factors for Visual Impairment in Preschool Children: The Sydney Paediatric Eye Disease Study

To assess the prevalence and associations of visual impairment (VI) in preschool children. Cross-sectional, population-based study. A total of 2461 children (73.8% participation rate), aged 6 to 72 months, were examined in the Sydney Paediatric Eye Disease Study during 2007-2009; of whom 1188, aged 30 to 72 months, with complete visual acuity (VA) data in both eyes, were included in this report. Measurement of VA was attempted on all children using the Electronic Visual Acuity (EVA) system or a logarithm of the minimum angle of resolution (logMAR) chart. Visual impairment was defined as presenting VA <20/40 in children aged ≥48 months and <20/50 in those aged <48 months. Post-cycloplegic refraction was measured, and myopia was defined as spherical equivalent (SE) ≤-0.50 diopters (D), hyperopia was defined as SE ≥2.00 D, astigmatism was defined as cylinder ≥1.00 D, and anisometropia was defined as SE difference ≥1.00 D between 2 eyes. Ethnicity, birth parameters, and sociodemographic information were collected in questionnaires completed by parents. Visual impairment prevalence and its associations with child demographic factors and birth parameters. Visual impairment was found in 6.4% of the worse eye and 2.7% of the better eye in our sample. Refractive errors (69.7%) and amblyopia (26.3%) were the principal causes of VI in the worse eye. Astigmatism (51.3%) and hyperopia (28.9%) were the main refractive errors causing VI. In regression analysis controlling for other factors, VI was independently associated with low birthweight of <2500 g (odds ratio 2.4, 95% confidence interval, 1.1-5.3), but not with age, gender, ethnicity, or measures of socioeconomic status (P > 0.05). Visual impairment in at least 1 eye was found in 6.4% of Australian preschool children, with bilateral VI found in 2.7%. Uncorrected refractive errors and amblyopia were the principal ocular conditions associated with VI. Low birthweight was a significant risk factor independent of age, gender, and ethnicity. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Kindergarten attendance may reduce developmental impairments in children: Results from the Bavarian Pre-School Morbidity Survey

The relative risks and benefits of children attending kindergarten or pre-school remain uncertain and controversial. We used data from the Bavarian Pre-School Morbidity Survey (BPMS) to look at the prevalence of developmental impairments in pre-school children entering primary school and to assess if these were correlated with the duration of kindergarten attendance. We collected data from all school beginners in the district of Dingolfing, Bavaria from 2004 to 2007 (n = 4,005) and utilised a retrospective cross-sectional study design to review the information. The children were assessed for motor, cognitive, language and psychosocial impairments using a standardized medical assessment. Point prevalence of impairments of speech, cognition, motor functioning and psychosocial functioning were compared by chi(2)-test for the variable of time spent in kindergarten. We detected a high incidence of impairments, with boys showing higher rates than girls in all the areas assessed. Longer length of time spent in kindergarten was associated with reduced rates of motor, cognitive and psychosocial impairments. There was no clear correlation between length of kindergarten attendance and speech disorders. Kindergarten attendance may have a positive effect on a number of domains of development including motor, cognitive and psychosocial development, but no significant effect on speech impairments. Implications for public health policies are discussed.

Comorbidity of motor and language impairments in preschool children of Taiwan

Comorbidity of motor and speech/language impairments was investigated in 363 preschool children between the ages of 5 and 6 years (boys: 205, age 6.04 ± 0.48 years; girls: 158, age 5.98 ± 0.53 years). The children were sampled from two municipals of Taiwan, and were determined to present no apparent neurological, musculoskeletal, cardiopulmonary system impairment or mental insufficiency. They were administered with three speech/language tests and a motor test (Movement Assessment Battery for Children, or M-ABC). The results showed a significant correlation between the total score of the motor test and the total score of each of the speech and language tests. Regression analysis that controlled for IQ (C-TONI) further showed that manual dexterity, but not ball skills or balance, of M-ABC was predictive of all scores on the speech and language tests. To determine a deficit on a test, a score at or below the 10th percentile of the norm or a score at or below 1.25 SD from the group mean was established as the cutoff. For the speech/language impairment, a deficit on at least two out of the three tests also applied. Following these criteria, 22 children (6.1%) were identified to have Developmental Speech and Language Disorder (DSLD), and 45 (12.4%) to have Developmental Coordination Disorder (DCD). Comorbid DSLD and DCD were found in six children (1.65%). Chi-square analysis revealed a significant correlation between DSLD and DCD ( p < .03). The odds of DSLD was higher (by about three-fold) among the children with DCD than among the children without (0.15 vs. 0.05). Comorbid motor and speech/language impairments in preschool children appear to be a significant clinical condition that requires the attention of the therapeutic community. Manual dexterity, in particular, seems to be an important clue for understanding the shared mechanism of motor and speech/language impairments.

Identifying Language Comprehension Impairment in Preschool Children

This study examined the validity of 3 discourse comprehension measures for preschool children and the ability of a combination of them to classify children with and without language impairment. Thirty-seven children with typical language and 12 children with language impairment completed 3 measures of oral story comprehension: the Joint Story Retell task, the Expectancy Violation Detection task, and comprehension questions. Discriminant analyses revealed that each measure successfully classified pre-identified groups. The clinical combination of all 3 measures resulted in 96% accurate identification of the language status of this cohort. Results support these procedures as valid measures of discourse comprehension and monitoring and provide preliminary evidence that their combination can be validly employed for identifying young children with language comprehension impairment.

Functional Impairment in Preschool Children With ADHD-Combined Subtype vs. ADHD-Hyperactive/Impulsive Subtype

Functional Impairment in Preschool Children With ADHD-Combined Subtype vs. ADHD-Hyperactive/Impulsive Subtype

Fernseher im Kinderzimmer - ein möglicher Risikofaktor für expressive Sprachstörungen bei 5- und 6-jährigen Kindern

There are a number of established risk factors for expressive language-impairment. Does reading aloud with children reduce the risk? Are extensive TV viewing and a TV set in the child's bedroom associated with an increased risk in preschool kids? Testing for expressive language impairment was carried out as part of the school entrance health examinations in four Bavarian districts. Testing included: correct use of the plural, comparative/superlative forms, syntax, verb flexion and use of articles (a maximum of 5 mistakes could be made). Parents were asked to answer a questionnaire on a number of biographic, sociodemographic and lifestyle factors potentially related to expressive language impairment. The participation rate in the 4 districts was 88.3 % on average. Complete data were acquired for 3234 children. The prevalence for expressive language impairment (more than one mistake) was 12.2 (95 % CI: 11.3-13.2 %). Children who did not speak German predominantly at home were more often affected than children of German nationality: 44.4 % (95 % CI: 32.3-54.6 %) versus 9.9 % (95 % CI: 8.9 %-10.8 %). Logistic regression analyses identified only a TV set in the child's bedroom as an independent risk factor for expressive language impairment: OR 1.82 (95 % CI: 1.15-2.88). Possession of an own TV in a child's bedroom appears to be an important, independent risk factor for expressive language impairment in preschool children.

Subjektive Aspekte bei Müttern von Kindern mit Sprachentwicklungsstörungen

The purpose of this study was to evaluate the subjective burden in mothers of speech impaired children against the presence or absence of emotional disorders such as anxiety and depression. A total of 89 mothers (age 33.3+/-5.5 years, range: 19.6-43.8 years) of 89 speech impaired preschool children (23 girls, 66 boys, age: 3.9+/-1.5 years, range: 1.6-7.1 years) were examined. Screening for a depressive or anxiety disorder was performed using the German version of the Hospital Anxiety and Depression Scale HADS-D. The "Short Questionnaire on Current Burden" (Kurzfragebogen zur Aktuellen Belastung, KAB) was used to measure the level of perceived subjective burden at the time of the investigation. A higher score in the KAB test occurred significantly more often in mothers with a positive HADS depression/anxiety subscale result than in those with a negative one. There is a need for specific assessment of wellbeing in mothers of speech impaired children. In clinical practice, one may restrict oneself to the use of a screening test for anxiety and depression.

Maternal stress, social support and preschool children's intelligence

Background Despite some research suggesting maternal stress may be associated with cognitive impairment in preschool children, there has been little direct investigation of the association between maternal stress, social support and children's intelligence. Aim To determine whether maternal stress and social support during pregnancy and during the child's early years of life are associated with the intelligence test performance of preschool children. Study design Five hundred and fifty European mothers and children enrolled in the Auckland Birthweight Collaborative Study at birth were interviewed when the child was 3½ years of age. Subjects All children were full term gestation and approximately half the sample were small for gestational age at birth (SGA = birthweight ≤ 10th percentile). Outcome measure The cognitive ability of children aged 3½ years was assessed using the Stanford Binet Intelligence Scale 4th Edition. Results In the total sample, maternal stress and lack of social support during pregnancy were significantly associated with lower intelligence test scores of children. In the group of SGA children, maternal stress post pregnancy was significantly associated with lower intelligence test scores in children. There is evidence that for some children the presence of good social support for mothers may reduce the negative effects of maternal stress on children's cognitive development. Conclusion Maternal stress and lack of social support appear to be associated with lower intelligence test scores of preschool children. Social support may attenuate some of the negative effects of maternal stress on intelligence in children born small for gestational age.

Diagnostic Accuracy of the Structured Photographic Expressive Language Test: Third Edition (SPELT-3)

This study examined the empirical evidence for using the Structured Photographic Expressive Language Test: Third Edition (SPELT-3; Dawson, Stout, & Eyer, 2003) to diagnose language impairment in preschool children. The SPELT-3 is a revision of the SPELT-II (Werner & Kresheck, 1983), which has been proven in the past to have high levels of discriminant accuracy in identifying preschoolers with language impairment. Forty-two 4- and 5-year-old children with a specific language impairment (SLI) and 43 children with typically developing (TD) language abilities were studied to determine the classification accuracy and other aspects of validity for the SPELT-3. Results from both an exploratory and a confirmatory sample indicated 90% sensitivity and 100% specificity when a cutoff standard score of 95 was applied to the data. In addition, use of the SPELT-3 was supported by additional data on convergent and divergent aspects of validity. The data provide empirical support for the use of the SPELT-3 for the purpose of differentiating between children with normal language and those with impaired language.

The predictive value of a preschool diagnosis of developmental language impairment

To evaluate language and cognitive outcomes in elementary school children with a prior preschool diagnosis of developmental language impairment (DLI). A cohort of preschool children, consecutively diagnosed with isolated language impairment, was reassessed in elementary school. Measures used were the communication domains of the Battelle Developmental Inventory (BDI) and the Vineland Adaptive Behavior Scale, Peabody Picture Vocabulary and Expressive One Word Picture Vocabulary. Cognition was assessed using the BDI cognitive domain. Language impairment was defined as performance more than 1.25 SD below normative means on a language measure. Specific language impairment (SLI) was defined as language impairment concurrent with a cognitive score not more than one SD below the normative mean. A total of 43/70 (61%) children were reassessed. Mean age in preschool was 3.6 +/- 0.7 years and 7.4 +/- 0.7 years at follow up. A total of 36/43 (84%) showed persistent language impairment. The mean BDI cognitive domain score was 80.0 +/- 14.2 (15/42 below -2 SDs). Only 11/42 (26%) children met current research criteria for SLI, 24/42 (57%) had language impairment but had cognitive scores more than one SD below normative means, and 4/42 (10%) had normal language and cognitive skills. No factors could be identified at intake that predicted language outcome using univariate or multivariate analysis. While a preschool diagnosis of developmental language impairment predicted persisting language impairment, the specificity of this impairment did not persist. This suggests either undiagnosed cognitive impairment in preschool children with apparently isolated language impairment or an evolving profile of more global developmental impairment.

Treatment of unilateral visual impairment in preschool children modestly improves visual acuity*1

How effective is treatment for unilateral visual impairment detected by preschool vision screening? Multicentre randomised controlled trial. Glasses plus patch treatment slightly but significantly improved visual acuity (both uncorrected and best corrected) compared with no treatment in children with mild to moderate unilateral visual impairment at 52 weeks (see Table 1; see notes). Glasses alone modestly improved best corrected visual acuity compared with no treatment; however there was no significant difference in uncorrected visual acuity between these groups.Table 1 LogMAR visual acuity scores by treatment group at 52 weeks.Visual acuityNo treatmentGlasses aloneGlasses plus PatchMean logMARMean logMARMean difference (95% CI) from no treatmentMean logMARMean difference (95% CI) from no treatmentUncorrected0.4240.3810.043 (-0.05 to 0.013)0.3360.088 (0.01 to 0.17)Best corrected0.3010.2160.085 (0.02 to 0.15)0.1930.109 (0.05 to 0.17) Treatment with glasses alone or in combination with patches can modestly improve visual acuity in children with mild to moderate unilateral visual impairment, compared with no treatment.