Mental Processing Composite Research Articles

Social reasoning abilities in preterm and full-term children aged 5–7 years

BackgroundLiterature has evidenced behavioral and socio-emotional problems in preterm children, as well as long-term difficulties to establish and maintain social relationships in preterm population. Several studies have shown relations between behavior and social reasoning abilities in typically developing children and adults. AimThe present study aimed to investigate the social understanding and social reasoning abilities in preterm children aged between 5 and 7years in comparison to their full-term peers. Study designA social resolution task (SRT) was used to assess abilities to judge, identify and reason about others' behavior in relation to conventional and moral rules knowledge. Subjects102 preterm children and 88 full-term children were included in the study. ResultsCompared with their full-term peers, preterm children exhibited difficulties to understand and reason about inappropriate social behavior, particularly for situations related to the transgression of conventional rules. They used more irrelevant information and exhibited less social awareness when reasoning about the transgression of social rules.The only significant predictor for global SRT and social reasoning scores was the mental processing composite of the K-ABC, but the part of the variance of the SRT that could be explained by the general cognitive abilities was relatively small. ConclusionPreterm children demonstrated poorer social knowledge and social reasoning abilities compared with full-term children at early school age. Improving such abilities may reduce behavioral difficulties and peer relationship problems often described in the preterm population. These findings emphasize the need to early identify children at risk for impaired social development.

Cognitive outcome at 5years in very premature children without severe early cerebral abnormalities. Relationships with EEG at 6weeks after birth

This prospective study aimed to analyze the relationship between EEG at 6 weeks after birth and cognitive outcome at the age of 5 in children born very preterm who did not present with severe neonatal cerebral abnormalities. EEGs were recorded at 6 weeks of age in infants born <29 weeks of gestation or weighing <1000 g at birth. At 5 years, study participants underwent a neurological assessment and cognitive evaluation with the Kaufman Assessment Battery for Children (K-ABC). Fifty-eight children had an EEG at 6 weeks after birth. Fifty-one were evaluated at 5 years. Twenty-six children (51.0%) had one or more disabilities: neuromotor, sensory, behavioral, and/or cognitive. Children with EEG abnormalities had significantly more disabilities (20 of 25, 80%) than children with normal EEG (6 of 26, 23%) (P=0.0002). Thirty-five children underwent complete K-ABC assessment. Multiple linear regression analysis indicated a significant relationship between the overall EEG abnormalities (normal, dysmature, and/or disorganized) and two scales: mental processing composite (MPC) scales (P=0.0121), and sequential processing scales (P=0.0012). Dysmature EEGs were more predictive of lower MPC and sequential processing scales than disorganized EEGs. Immature occipital slow waves (i.e., too high for conceptional age) were consistently recorded in children with dysmature EEGs and associated with the lowest K-ABC scores. EEG abnormalities recorded at 6 weeks after birth, such as immature occipital slow waves, were associated with later cognitive impairments. EEG at 6 weeks can be an early and reliable tool for assessing the risk of future cognitive impairment.

Do very preterm twins and singletons differ in their neurodevelopment at 5 years of age?

ObjectiveTwins have inconsistently shown poorer outcomes than singletons. Although a high proportion of twins are born very preterm, data are sparse on the long-term outcomes in very preterm twins. The...

The Influence of Fetal Growth Reference Standards on Assessment of Cognitive and Academic Outcomes of Very Preterm Children

To compare 3 methods of identifying small-for-gestational-age (SGA) status in very preterm children as related to cognitive function and academic outcome. There were 1038 singletons in the Epipage Study, born before 33 weeks in 1997 without severe neurosensory impairment, who were classified as SGA when birth weight was below the 10th percentile according to: (1) birth weight (bw) reference: SGA(bw)/appropriate for gestational age (AGA)(bw); (2) intrauterine (intraut) reference: SGA(intraut)/AGA(intraut); and (3) intrauterine reference customized (cust) according to individual characteristics: SGA(cust)/AGA(cust). Cognitive function was assessed by the mental processing composite (MPC) score of the Kaufman Assessment Battery for Children at age 5 and academic achievement by a parental questionnaire at age8. Of the children, 15% were SGA(bw), 38% were SGA(intraut), and 39% were SGA(cust). All children SGA(bw) were also SGA(intraut) and SGA(cust). MPC was <85 in 32% of children and 27% had low academic achievement. AGA(bw)/SGA(intraut) children had a significantly increased risk of MPC <85 (adjusted OR 1.74, 95% CI 1.22-2.28) or low academic achievement (adjusted OR 1.64, 95% CI 1.05-2.55) compared with AGA(bw)/AGA(intraut) children. The SGA(cust) group was only slightly different from the SGA(intraut) group. An intrauterine reference identified very preterm infants at risk of poor cognitive or academic outcomes better than a birth weight reference. Customization resulted in only slight modifications of the SGA group.

Very preterm children free of disability or delay at age 2: Predictors of schooling at age 8: A population-based longitudinal study

AimTo study the predictive value of a developmental assessment at 2years corrected age (CA) for schooling at age 8 in children born very preterm and free of disability or delay; to identify other factors associated with schooling in this population. Methods244 children born before 33weeks in 1997, part of the population-based EPIPAGE cohort study, free of disability or delay, had their developmental quotient (DQ) evaluated with the Brunet-Lezine scale at 2years CA. The mental processing composite (MPC) score was evaluated at age 5 with the K-ABC battery. Data on schooling were obtained at age 8 by postal questionnaire. Schooling was considered appropriate if the child was attending age-appropriate grade level in a regular classroom environment without support at school. ResultsSchooling was appropriate for 172 (70%) children. The predictive value of a DQ≥100 for appropriate schooling was 0.80 [0.75;0.85]. In children with a DQ at age 2<100, schooling varied significantly according to their MPC score at age 5 whereas it didn't in children with a DQ≥100. In multivariate analysis, the rate of appropriate schooling was significantly related to global DQ at age 2 (p<0.01), gestational age≥29weeks (p<0.05), head circumference at age 2 (p<0.05) and mother's educational level (p<0.05). ConclusionA DQ≥100 cannot be solely used for the prediction of appropriate schooling at age 8. Mother's educational level, gestational age and head circumference at age 2 could be taken account. These factors could be used to individualise follow-up.

Neurodevelopment in the offspring of Japanese systemic lupus erythematosus patients

Objective: To evaluate pregnancy outcome of systemic lupus erythematosus (SLE) and the neuropsychological outcomes in offspring of SLE mothers. Study design: Pregnancy outcomes of SLE patients from 1989 to 2006 were determined and the neuropsychological development of the children born to SLE patients was examined suited for their age; Bayley Scales of Infant Development up to four years and Kauffmann Assessment Battery for Children from four years onwards. Results: Of the 233 deliveries, 58 (24.7%) were preterm, 72 (30.9%) were low-birth-weight, and 46 (19.7%) were IUGR. Twenty-six children enrolled in this study had normal intelligence. The mean MDI and PDI were 95.8 ± 10.1 and 94.6 ± 14.1, respectively. The mean scores for the Sequential Processing scale, Simultaneous Processing scale, and Mental Processing composite were 103.1 ± 13.3, 104.2 ± 10.2, and 104.2 ± 12.2, respectively. In the children with anti-Ro/SS-A antibody-positive mothers, mean gestational age and birth weight were significantly lower ( p < 0.05), as a result, the mean score of Sequential Processing and Mental Processing were significantly lower than that of negative mothers. The presence of maternal antiphospholipid antibody was not related to gestational age, birth weight and any score on the intelligence tests, except for the rate of IUGR. Conclusion: The rates of preterm delivery and IUGR were frequent in the SLE patients and careful monitoring and management of the disease during pregnancy are still necessary. We should examine the neurodevelopment of the children born from mothers with anti-Ro/SS-A antibody prospectively.

Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study

The increasing survival rates of children who are born very preterm raise issues about the risks of neurological disabilities and cognitive dysfunction. We aimed to investigate neurodevelopmental outcome and use of special health care at 5 years of age in a population-based cohort of very preterm children. We included all 2901 livebirths between 22 and 32 completed weeks of gestation from nine regions in France in Jan 1-Dec 31, 1997, and a reference group of 667 children from the same regions born at 39-40 weeks of gestation. At 5 years of age, children had a medical examination and a cognitive assessment with the Kaufman assessment battery for children (K-ABC), with scores on the mental processing composite (MPC) scale recorded. Data for health-care use were collected from parents. Severe disability was defined as non-ambulatory cerebral palsy, MPC score less than 55, or severe visual or hearing deficiency; moderate deficiency as cerebral palsy walking with aid or MPC score of 55-69; and minor disability as cerebral palsy walking without aid, MPC score of 70-84, or visual deficit (<3/10 for one eye). In total, 1817 (77%) of the 2357 surviving children born very preterm had a medical assessment at 5 years and 396 (60%) of 664 in the reference group. Cerebral palsy was diagnosed in 159 (9%) of children born very preterm. Scores for MPC were available for 1534 children born very preterm: 503 (32%) had an MPC score less than 85 and 182 (12%) had an MPC score less than 70. Of the 320 children in the reference group, the corresponding values were 37 (12%) and 11 (3%), respectively. In the very preterm group, 83 (5%) had severe disability, 155 (9%) moderate disability, and 398 (25%) minor disability. Disability was highest in children born at 24-28 completed weeks of gestation (195 children [49%]), but the absolute number of children with disabilities was higher for children born at 29-32 weeks (441 children [36%]). Special health-care resources were used by 188 (42%) of children born at 24-28 weeks and 424 (31%) born at 29-32 weeks, compared with only 63 (16%) of those born at 39-40 weeks. In children who are born very preterm, cognitive and neuromotor impairments at 5 years of age increase with decreasing gestational age. Many of these children need a high level of specialised care. Prevention of the learning disabilities associated with cognitive deficiencies in this group is an important goal for modern perinatal care for children who are born very preterm and for their families.

Neurodevelopmental Follow-up of Very Preterm Infants after Proactive Treatment at a Gestational Age of ≥23 Weeks

To determine the long-term neurodevelopmental outcome in extremely preterm infants after offering life support to all infants > or = 23 weeks gestation ("pro-active management"). With parental consent, all infants born at 23 to 25 completed weeks gestation were treated proactively. Surviving infants born from July 1996 to June 1999 were assessed for standardized cognitive and neurological outcomes at 5 years corrected age. 70 of 91 infants admitted to the neonatal intensive care unit survived until follow-up. 67 of the 70 surviving infants were examined at a median corrected age of 5.6 years; 12% had cerebral palsy and a Gross Motor Function Classification Scale score > 2; 4% were blind; 1% required a hearing aid; and 12% had a Kaufmann Assessment Battery for Children mental processing composite < 51, resulting in 18% sustaining a severe disability. 43% had normal results on a neurological examination, Gross Motor Function Classification Scale score = 0, mental processing composite > 85, and had neither severe visual nor hearing impairment. 57% qualified for regular schooling. Improved survival was not associated with an increased risk of severe disability when compared with results of earlier publications. These findings may result from proactive management and are important for counseling patients at risk of imminent extremely preterm delivery.

Impact of the use of antenatal corticosteroids on mortality, cerebral lesions and 5‐year neurodevelopmental outcomes of very preterm infants: the EPIPAGE cohort study

To assess the impact of antenatal corticosteroids (ACS) on neonatal mortality, cerebral lesions and 5-year neurodevelopmental outcome of infants born at 24-27 and 28-32 weeks of gestational age (GA). Observational population-based study including all births at GAs between 22 and 32 weeks in 1997 in nine regions of France. Survivors were assessed at the age of 5 years. The population enrolled in the follow up comprised 2323 infants; there were 23 deaths before age 5 years and outcome at 5 years was available for up to 1781 subjects. Two GA subgroups (24-27 and 28-32 weeks of GA) were analysed separately. Propensity scores were used to reduce bias in the estimation of the association between ACS treatment and outcomes. Neonatal death, neonatal white matter injury, cerebral palsy, mental processing composite (MPC) of the Kaufman Assessment Battery for Children test and behavioural difficulties at 5 years. In the 28- to 32-week GA subgroup, there was a significant association between ACS and a decreased risk of both neonatal death (OR = 0.61 [0.41-0.91]) and white matter injury (OR = 0.60 [0.46-0.79]) but only a nonsignificant trend for improved 5-year outcome (cerebral palsy, MPC < 70). In the 24- to 27-week GA subgroup, ACS was associated with a significant decrease risk of neonatal death (OR = 0.43 [0.27-0.68]) but there was only a trend for a lower risk of white matter injury and no beneficial impact on outcome at 5 years. Limiting the analysis to only those who received complete courses of ACS did not modify the results. The study shows that ACS therapy greatly increases the survival of very preterm infants, including the most immature, but there is little evidence that ACS affects long-term neurodevelopmental and behavioural outcome in 28- to 32-week survivors, and none in <28-week survivors.

Poor Predictive Validity of the Bayley Scales of Infant Development for Cognitive Function of Extremely Low Birth Weight Children at School Age

The Bayley Scales of Infant Development, Second Edition (BSID II) are commonly used to assess outcomes of extremely low birth weight (ELBW) infants. We sought to assess the predictive validity of the BSID II Mental Developmental Index (MDI) for cognitive function at school age. Of 330 ELBW infants admitted in 1992-1995, 238 (72%) survived to the age of 8 years, of whom 200 (84%) were tested at both 20 months' corrected age (CA) and 8 years. Mean birth weight was 811 g, mean gestational age was 26.4 weeks, 41% were boys, and 60% were black. Measures included the BSID II at 20 months' CA and the Kaufman Assessment Battery for Children (KABC) Mental Processing Composite (MPC) at 8 years' postnatal age. BSID II MDI and MPC scores were compared and the predictive validity calculated for all 200 ELBW children and for the 154 ELBW neurosensory-intact subgroup. Predictors of stability or change in cognitive scores were examined via logistic regression adjusting for gender and sociodemographic status. For all ELBW children, the mean MDI was 75.6 +/- 16 versus a mean KABC of 87.8 +/- 19. For the neurosensory-intact subgroup, the mean MDI was 79.3 +/- 16 and the mean KABC was 92.3 +/- 15. Rates of cognitive impairment, defined as an MDI or KABC of <70, dropped from 39% at 20 months' CA to 16% at 8 years for the total ELBW population and from 29% to 7% for the neurosensory-intact subgroup. The positive predictive value of having an MPC of <70 given an MDI of <70 was 0.37 (95% confidence interval [CI]: 0.27, 0.49) for all ELBW infants, 0.20 (95% CI: 0.10, 0.35) for the neurosensory-intact subgroup, and 0.61 (95% CI: 0.42, 0.77) for the neurosensory-impaired subgroup. The negative predictive values were 0.98, 0.99, and 0.85 for the 3 groups, respectively. Neurosensory impairment at 20 months' CA predicted lack of improvement of cognitive function (odds ratio: 6.9; 95% CI: 2.4, 20.2). Children whose cognitive scores improved between 20 months and 8 years had significantly better school performance than those whose scores stayed at <70, but they did less well than those whose scores were persistently >70. The predictive validity of a subnormal MDI for cognitive function at school age is poor but better for ELBW children who have neurosensory impairments. We are concerned that decisions to provide intensive care for ELBW infants in the delivery room might be biased by reported high rates of cognitive impairments based on the use and presumptive validity of the BSID II MDI.

Concurrent Validity of the Peabody Picture Vocabulary Test-Third Edition As an Intelligence and Achievement Screener for Low SES African American Children

Authors tested the validity of the Peabody Picture Vocabulary Test-Third Edition (PPVT-III) as a screening measure for intelligence and achievement. The PPVT-III and Kaufman Assessment Battery for Children (KABC) were administered to 416 African American children of low socioeconomic status in a counterbalanced design. Results indicated that the PPVT-III correlated .58 with the KABC Mental Processing Composite (MPC) score; however, participants scored significantly lower (M = 8.3 points) on the PPVT-III than on the MPC. Although receiver operating characteristic (ROC) analyses supported the use of the PPVT-III as a valid intellectual and achievement screener, the selection of a single cutoff score for the PPVT-III was problematic. The purpose of the screening program should guide selection of a cutoff score for the PPVT-III.

Short Forms of the K-ABC Mental Processing and Achievement Scales at Ages 4 to 12½ Years for Clinical and Screening Purposes

We used data from the Kaufman Assessment Battery for Children (K-ABC) standardization sample to develop short forms of the K-ABC Mental Processing Composite (MPC) and Achievement (ACH) scales for ages 4 to 12 1/2 years. Using seven quantitative and qualitative criteria, we selected the best MPC dyad, triad, and tetrad and the best ACH dyad. The preferred K-ABC short form for screening and clinical purposes at age 5 and older is a combination of the MPC tetrad (Hand Movements-Triangles-Word Order-Matrix Analogies) and the A CH dyad (Riddles-Reading Decoding). For age 4, the preferred short form is slightly different. We present psychometric properties for all selected short forms, including reliability and validity coefficients, and provide equations to allow computation of a child's estimated MPC and A CH standard score.

K-ABC and McCarthy scale performance among “at-risk” and normal preschoolers

This study assessed the degree of comparability between the McCarthy Scales of Children's Abilities (McCarthy) and the Kaufman Assessment Battery for Children (K-ABC) for 51 “at-risk” (Low Birthweight, Head Start, and Developmentally Delayed) and 33 “normal” preschool children. The K-ABC Mental Processing Composite (MPC) and McCarthy General Cognitive Index (GCI) correlated significantly for both groups, but was significantly greater for the at-risk preschoolers. The at-risk group achieved a significantly higher mean MPC than GCI, while the normal comparison subjects achieved a slightly lower mean MPC. As reflected in previous studies, the GCI seems to provide an accurate estimate of the at-risk child's typical classroom performance. While the MPC may afford an estimate of such children's capacity for academic growth, if provided appropriately tailored remediation, it may also be missing critical aspects of children's cognitive functioning. Mean score discrepancies for at-risk preschoolers were discussed in relation to the theoretical and psychometric properties of the K-ABC and McCarthy.