Nonverbal Cognitive Development Research Articles

Never-breastfed children face a higher risk of suboptimal cognition at 2 years of corrected age: A multinational cohort of very preterm children.

In a cohort of children born very preterm (VPT), we investigated the association between breast milk feeding (BMF) initiation and its duration on cognitive development at 2 years of corrected age. Data were obtained from the Effective Perinatal Intensive Care in Europe population‐based prospective cohort of children born <32 weeks of gestation, in 11 European countries, in 2011–2012. The study sample included 4323 children. Nonverbal cognitive ability was measured applying the Parental Report of Children's Abilities, except for France where the problem‐solving domain of the Ages & Stages Questionnaire was used. Verbal cognition was based on the number of words the child could say. To determine the association between BMF (mother's own milk) and nonverbal and verbal cognition (outcome categorized as optimal and suboptimal), adjusted risk ratios (aRRs) were estimated fitting Poisson regression models, with inverse probability weights to account for nonresponse bias. Overall, 16% and 11% of the children presented suboptimal nonverbal and verbal cognition, respectively. Never BMF was associated with a significantly increased risk for suboptimal nonverbal (aRR = 1.29, 95% confidence interval [CI] = 1.09–1.53) and verbal (aRR = 1.45, 95% CI = 1.09–1.92) cognitive development compared with those ever breastfed, after adjustment for perinatal and sociodemographic characteristics. Compared with children breastfed 6 months or more, children with shorter BMF duration exhibited a statistically nonsignificant elevated aRR. VPT children fed with breast milk had both improved nonverbal and verbal cognitive development at 2 years in comparison with never breastfed, independently of perinatal and sociodemographic characteristics. This study encourages targeted interventions to promote BMF among these vulnerable children.

Возможности развития мышления детей старшего дошкольного возраста средствами психолого-педагогического сопровождения

This experimental study featured the process of brain building in senior preschoolers, namely the characteristics of verbal and nonverbal thinking at this stage of ontogenesis. The authors substantiated the possibilities of psychological and pedagogical support for cognitive development. Mental operations were tested using standard psychological diagnostics. The article covers some psychological and pedagogical theories of brain development in preschoolers. In visual-figurative forms, the development level of mental operations proved to be more expressive than in verbal and logical forms. The research revealed various possibilities of targeted development of verbal and nonverbal brain building components in senior preschoolers, as well as the forms and methods of psychological and pedagogical support it requires. The author believes that traditional educational practices should be reformed. Organized educational environment, productive activities, and games develop cognitive interests and curiosity and catalyze the development of activities initiated by the child. Experimental data proved the effectiveness of specially created programs of psychological and pedagogical support for the verbal and non-verbal cognitive development of preschoolers.

Non-verbal cognitive development, learning, and symptoms of PTSD in 3- to 6-year-old refugee children

As IQ tests are commonly used as key assessment method, we address the question whether our commonly used standardized IQ tests are appropriate for children from families of diverse cultures and different educational levels in a refugee population. We examined 109 refugee children aged 3–7 years (M = 5.10 years, SD = 1.25) with the “Kaufman Assessment Battery for Children “ (KABC-II; Kaufmann & Kaufmann, 2015) on a language-free scale (Scale of Intellectual Functioning, SIF) and learning performance (subtest Atlantis). With a non-verbal IQ of 81.5 (SD = 18.01), the population mean of the refugee children is more than one standard deviation lower than the mean of the German norm population. Standardized scores follow the normal distribution and are not correlated to any of the assessed markers of adversity (flight duration, time spent in Germany, child PTSD in parent rating, parental symptom load, and parental education level).Conclusion: The interpretation of IQ test results for refugee children should be done cautiously as results may underestimate their cognitive capacity. Environmental factors, such as high illiteracy among parents in this study, the lack of institutional education of children and high lifetime stress, may explain our findings.Trial registration: DRKS00021150.What is Known:• There is a high pervasiveness for the use of standardized IQ tests in the German health and education system to determine eligibility for special education and social services.What is New:• Refugee children score significantly lower than German children in a language-free IQ test. As results are normally distributed and not correlated to any of the assessed markers of adversity, the low scores in the refugee group might be due to missing formal education.

Psychometric Properties of WISC-IV Verbal Scales: A Study of Students in China Who Are Blind

Introduction: Numerous studies have investigated the use of Wechsler tests on individuals with visual impairments. However, few studies have examined the utilization of the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV) for such individuals. This study investigated the reliability and validity of the WISC-IV Verbal Scales’ (i.e., the Verbal Comprehension Index [VCI] and the Working Memory Index [WMI]) scores for children with blindness in China. Methods: One hundred children with blindness were assessed using the Chinese version of the WISC-IV Verbal and Nonverbal Cognitive Development Scales. Results: The results of this study generally support the internal consistency reliability and validity of WISC-IV Verbal Scale scores for Chinese children who are blind. The split-half reliability coefficients ranged from .79 to .97, while Cronbach’s alpha or KR-20 (KR-20 is a measure of internal consistency reliability for measures with dichotomous choices) reliability coefficients ranged from .83 to .97. In terms of construct validity through exploratory factor analysis, the subtests of the WISC-IV Verbal Scale were confirmed to belong to VCI or the WMI as intended by the original structure of the WISC-IV. The convergent validity showed that the VCI and WMI scores were moderately and positively correlated with the Nonverbal Cognitive Development Scale. Discussion: The WISC-IV VCI and WMI were found to be valuable instruments for assessing the cognitive abilities of students in China with blindness. Finally, the limitations and significance of the study were also discussed. Implications for practitioners: The WISC-IV Verbal Scales may be used to assess the cognitive abilities of the numerous students in China who are blind and may be used as one of many tests to provide reference information for educational placement, educational planning, employment, and project evaluation.

Maternal mild thyroid dysfunction and offspring cognitive and motor development from infancy to childhood: the Rhea mother–child cohort study in Crete, Greece

BackgroundMaternal thyroid hormones’ supply is crucial for fetal neurodevelopment; however, the role of maternal mild thyroid dysfunction is not clear. We aimed to assess the association of maternal mild thyroid...

Serum iron deficiency was associated with lower cognitive development in the children of the Santal tribe of West Bengal.

Poor cognitive scores and low serum iron have been reported among chronically undernourished children from the Santal tribe, West Bengal. Our aim was to investigate the association between iron status and non-verbal cognitive development. We randomly selected 170 children (52.9% boys) aged 5-12years from the Purulia district of West Bengal during 2007-2008 and assessed their iron status: haemoglobin concentration, serum concentration of iron, ferritin, transferrin, total iron-binding capacity and transferrin saturation. Their non-verbal cognitive development was assessed using the Raven's Coloured Progressive Matrices. The haemoglobin concentration, serum iron, serum ferritin and transferrin saturation levels of the 27 children with an intellectual deficit and the 32 who had a below average intelligence quotient (IQ) were significantly lower (P<.05) than the 65 children with an average IQ. A large number of boys (55.6%) and girls (41.7%) who have an intellectual deficit had stage III iron depletion. The cognitive scores of children with stage II and III iron depletion were significantly lower (P<.05) than those with a normal IQ. The iron depletion stage was associated with the severity of non-verbal cognitive impairment and serum ferritin appeared to be a sensitive biomarker for predicting non-verbal cognitive development.

Standardisation of the Parent Report of Children's Abilities–Revised (PARCA-R): a norm-referenced assessment of cognitive and language development at age 2 years

The Parent Report of Children's Abilities-Revised (PARCA-R) can be used to identify preterm born children at risk for developmental delay at age 24 months. However, standardised scores for assessing all children in the general population and quantifying development relative to the norm are unavailable, thus limiting the use of the questionnaire. We aimed to develop scores that are standardised by age and sex for the PARCA-R to assess children's cognitive and language development at age 24-27 months. Anonymised data from PARCA-R questionnaires that were completed by parents of 2-year-old children in three previous studies were obtained to form a standardisation sample that was representative of the UK general population. Anonymised data were obtained from three further studies to assess the external validity and clinical validity of the standardised scores. We used the lambda-mu-sigma (lambda for skewness, mu for median, sigma for the coefficient of variation) method to develop scores that are standardised by age and sex for three scales (non-verbal cognitive development, language development, and total parent report composite [PRC]) for children in four 1-month age bands, spanning age 23·5-27·5 months. We included 6402 children (mean age 25 months and 1 day [range 23 months and 16 days to 27 months and 15 days]) in the standardisation sample and 709 (mean age 24 months and 19 days [23 months and 16 days to 27 months and 15 days]) to test the external validity and 1456 (mean age 24 months and 8·5 days [23 months and 16 days to 27 months and 15 days]) to test the clinical validity of the standardised scores. For all PARCA-R scales, mean standardised scores approximated 100 (SD 15) in both sexes and all age groups. These scores were independent of socioeconomic status. Standardised scores were close to 100 (15) in the external validation sample, showing the validity of the scores. Standardised scores for the total PRC scale for children born very preterm (<32 weeks' gestation) were 0·47 SD lower on average than the normative mean, and for children with neonatal sepsis were 0·73 SD lower on average than the normative mean. These scores were equivalent to a standardised score of 93 (95% CI 91-94) for children born very preterm and 89 (88-91) for children with neonatal sepsis, thus showing clinical validity. The PARCA-R provides a norm-referenced, standardised assessment of cognitive and language development at 24-27 months of age. The questionnaire is available non-commercially in English with translations available in 14 other languages, thus providing clinicians and researchers with a cost-effective tool for assessing development and identifying children with delay. Action Medical Research (Ref: GN2580).

Initiating joint attention use in infants at high-risk for autism spectrum disorder.

Impairment in initiating joint attention (IJA) is associated with autism spectrum disorder (ASD) in children, although it is unclear when impairments arise. Due to the early development of IJA use and late diagnosis of ASD, groups at high-risk of ASD, such as infants with an older sibling with ASD (ASIBs) and infants with fragile X syndrome (FXS), provide opportunities to study early IJA behaviours for children who are later diagnosed with ASD. This study analysed these two groups to determine if IJA use differed compared with typically developing (TD) peers at 12months and whether IJA was associated with later ASD outcomes. An experimental attention task was used to analyse IJA gaze shifts and gestures in the high-risk groups. Clinical best estimate diagnoses were given to each participant to compare IJA behaviours to ASD severity. No differences in the frequency of IJA gaze shifts and gestures were found between 12-month-old ASIBs and TD controls, but infants with FXS demonstrated a significantly reduced range of IJA gaze shifts relative to TD controls. Additionally, ASD outcomes at 24months were related to IJA use for infants with FXS at 12months, but not infant ASIBs, although these findings were explained by differences in nonverbal cognitive development. Although previous studies have reported delays in IJA use in children with FXS and ASIBs at ages 21 and 14months, respectively, our results suggest IJA behaviours for these high-risk groups are not distinct from TD children at 12months. When differences were found at 12months, they were explained by nonverbal cognitive development, particularly for infants with FXS. Differences in IJA use at 12months in this study were too small to serve as a potential indicator of later ASD.

Effect of breastfeeding on non-verbal cognitive development at 2-years of age in very preterm infants and the role of clinical and social risk: results from the EPICE cohort

Introduction There is a considerable controversy over the nature and the pathways involved in the relation between breastfeeding and cognitive development in very preterm infants. In a European cohort of very preterm infants we investigated the effect of breastfeeding on non-verbal cognitive development at 2 years of corrected age and variation by clinical and social risk. Methods Data were obtained from the EPICE (Effective Perinatal Intensive Care in Europe) population-based prospective cohort of infants born between 22 and 31 completed weeks of gestation, in 19 regions from 11 European countries, in 2011–2012. Of the 6792 infants discharged alive, 4425 children had a follow-up at 2 years of corrected age. For analysis, we included all infants with valid information on breastfeeding initiation, non-verbal cognitive development, and on clinical and social risk (n = 4032). Data on infant, obstetric and maternal characteristics and on neonatal morbidity were retrieved from medical records, using a structured form filled in by clinicians until discharge from the hospital. At 2 years of corrected age, data on child's health and development, breastfeeding and sociodemographic characteristics were collected using a structured questionnaire completed by parents. Non-verbal cognitive ability was measured applying the Parental Report of Children's Abilities (PARCA-R) except for France that used Ages and Stages Questionnaire (ASQ). We defined three risk groups based on perinatal factors: High-risk [born before 28 weeks of gestation or with a severe neonatal morbidity (severe congenital anomaly, bronchopulmonary dysplasia, intraventricular hemorrhage grade III or IV, cystic periventricular leukomalacia, retinopathy of prematurity, necrotizing enterocolitis)] (n = 1394, 34.6%); Medium-risk (birth 28–29 weeks of gestation or having growth restriction, but no morbidities) (n = 1485, 36.8%); Low-risk (birth at 30–31 weeks with no morbidities or growth restriction) (n = 1153, 28.6%). Social high-risk was defined as maternal age Results Overall, 15.8% (n = 638) of the children presented suboptimal non-verbal cognition. Never breastfed children were more likely to have suboptimal non-verbal cognition (Crude RR = 1.40, 95%CI: 1.20–1.64). Never-breastfeeding was associated with a significant increased risk in the clinical high-risk group (Crude RR = 1.52, 95%CI: 1.25–1.85), but not in the medium or low-risk groups (Crude RR = 1.05, 95%CI: 0.76–1.44, Crude RR = 1.22, 95%CI: 0.81–1.85, respectively). The stratified analysis by social risk found a significant effect in both low (Crude RR = 1.29, 95% CI: 1.08–1.54) and high-risk (Crude RR = 1.91, 95% CI: 1.29–2.83) groups. After adjustment for the region of birth, corrected age at completion of the questionnaire (months), migration status, clinical risk, and social risk, never-breastfeeding remained associated with an increased risk for suboptimal non-verbal cognition (RR = 1.27, 95% CI: 1.07–1.50). There was no interaction with clinical and social risk in adjusted models. Conclusions Breastfeeding promotes non-verbal cognitive development of very preterm children, independently of clinical and social risk. It provides evidence for specifically targeted interventions to protect, promote and support breastfeeding among these most vulnerable infants.

Learning Potential is Useful in Pre-schoolers with Fragile X and Down Syndrome

This paper examines the performance of both Down syndrome (DS) and Fragile X syndrome (FXS) pre-schoolers in cognitive tasks of nonverbal reasoning and short-term memory (visual and auditory) and the ability to stimulate cognitive s with a methodology of learning potential. It is the first study this methodology is applied to FXS. The basic scales of the Escala de Habilidades y Potencial de Aprendizaje en Preescolares [Skills and Learning Potential Preschool Scale] were administered in 20 preschools with Down syndrome and 16 male preschools with Fragile X syndrome matched for chronological age and level of nonverbal cognitive development. The results indicated that the group FXS runs better on memory tasks without differences in reasoning tasks before mediation. Also, it is possible to stimulate the implementation in cognitive tasks of preschool children with DS or FXS significantly improving the performance of both groups except for auditory memory and DS in categorization rules. As conclusions, the scale offers the opportunity to assess skills in young children and know the degree of cognitive modifiability. Furthermore, possible factors affecting the performance of the children before and during mediation are discussed.

Longitudinal Study of Language and Speech of Twins at 4 and 6 Years: Twinning Effects Decrease, Zygosity Effects Disappear, and Heritability Increases.

This study investigates the heritability of language, speech, and nonverbal cognitive development of twins at 4 and 6 years of age. Possible confounding effects of twinning and zygosity, evident at 2 years, were investigated among other possible predictors of outcomes. The population-based twin sample included 627 twin pairs and 1 twin without a co-twin (197 monozygotic and 431 dizygotic), 610 boys and 645 girls, 1,255 children in total. Nine phenotypes from the same comprehensive direct behavioral assessment protocol were investigated at 4 and 6 years of age. Twinning effects were estimated for each phenotype at each age using general linear mixed models using maximum likelihood. Twinning effects decreased from 4 to 6 years; zygosity effects disappeared by 6 years. Heritability increased from 4 to 6 years across all 9 phenotypes, and the heritability estimates were higher than reported previously, in the range of .44-.92 at 6 years. The highest estimate, .92, was for the clinical grammar marker. Across multiple dimensions of speech, language, and nonverbal cognition, heritability estimates are robust. A finiteness marker of grammar shows the highest inherited influences in this early period of children's language acquisition.

Cognitive profiles in childhood and adolescence differ between adult psychotic and affective symptoms: a prospective birth cohort study.

Differences between verbal and non-verbal cognitive development from childhood to adulthood may differentiate between those with and without psychotic symptoms and affective symptoms in later life. However, there has been no study exploring this in a population-based cohort. The sample was drawn from the MRC National Survey of Health and Development, and consisted of 2384 study members with self-reported psychotic experiences and affective symptoms at the age of 53 years, and with complete cognitive data at the ages of 8 and 15 years. The association between verbal and non-verbal cognition at age 8 years and relative developmental lag from age 8 to 15 years, and both adult outcomes were tested with the covariates adjusted, and mutually adjusted for verbal and non-verbal cognition. Those with psychotic experiences [thought interference (n = 433), strange experience (n = 296), hallucination (n = 88)] had lower cognition at both the ages of 8 and 15 years in both verbal and non-verbal domains. After mutual adjustment, lower verbal cognition at age 8 years and greater verbal developmental lag were associated with higher likelihood of psychotic experiences within individuals, whereas there was no association between non-verbal cognition and any psychotic experience. In contrast, those with case-level affective symptoms (n = 453) had lower non-verbal cognition at age 15 years, and greater developmental lag in the non-verbal domain. After adjustment, lower non-verbal cognition at age 8 years and greater non-verbal developmental lag were associated with higher risk of case-level affective symptoms within individuals. These results suggest that cognitive profiles in childhood and adolescence differentiate psychiatric disease spectra.

The Role of Executive Functions in Language Comprehension in Preschool Children

The aim of this study was to examine the relationship among various aspects of executive functions (inhibitory control, working memory, planning and cognitive flexibility) and language comprehension in preschool children. The final sample included 203 children, four or five years old, with average nonverbal cognitive development. The measuring instruments for assessment of the children’s executive functions were Grass/Snow task; Inhibition task (NEPSY-II); Digit Span task; CANTAB tasks and Dimensional Change Card Sort. The Reynell Developmental Language Scales were used for the assessment of language comprehension. The results showed that the only significant predictors of language comprehension were verbal working memory, as measured by the Digit Span task, and inhibitory control, as measured by the Grass/Snow task. This study emphasises the importance of inhibitory control and working memory for language comprehension in preschool children.

Learning potential and cognitive abilities in preschool boys with fragile X and Down syndrome

BackgroundEnhancing cognitive abilities is relevant when devising treatment plans. AimsThis study examined the performance of preschool boys with Down syndrome and fragile X syndrome in cognitive tasks (e.g., nonverbal reasoning and short-term memory), as well as in improving cognitive functions by means of a learning potential methodology. Methods and proceduresThe basic scales corresponding to the Skills and Learning Potential Preschool Scale were administered to children with Down syndrome and others with fragile X syndrome, matched for chronological age and nonverbal cognitive development level. ResultsThe fragile X syndrome group showed stronger performance on short-term memory tasks than the Down syndrome group prior to intervention, with no differences recorded in nonverbal reasoning tasks. In addition, both groups’ cognitive performance improved significantly between pre- and post-intervention. However, learning potential relative to auditory memory was limited in both groups, and for rule-based categorization in Down syndrome children. ConclusionThe scale offered the opportunity to assess young children’s abilities and identify the degree of cognitive modifiability. Furthermore, factors that may potentially affect the children’s performance before and during learning potential assessment are discussed.

Maternal and infant affect at 4months predicts performance and verbal IQ at 4 and 7years in a diverse population.

Using existing longitudinal data from 570 infants in the Maternal Lifestyle Study, we explored the predictive value of maternal and infant affect and maternal vocalizations during 2minutes of face-to-face interactions at 4months on IQ scores at 4.5 and 7years. After controlling for demographic factors, maternal depression, and prenatal drug exposure, maternal positive affect and maternal positive vocalizations emerged as predictors of both verbal and performance IQ at 4.5 and 7years. Although infant positive affect during the interaction with the mother was not predictive of these outcome measures, infant positive affect towards an examiner predicted verbal but not performance IQ at 4.5years. These results suggest that maternal positive affect may index emotional engagement in interaction that facilitates both verbal and nonverbal cognitive development, while infant social positive affect is specifically related to the acquisition of verbal reasoning abilities. These findings are significant because they are based on a discrete snapshot of observable behavior in infancy (just 2minutes of interaction), because they extend the range of maternal behaviors and characteristics known to support positive developmental outcomes, and because they are derived from high-risk infants where prevention efforts may be beneficial. Potential mechanisms for these associations are discussed, as are the clinical implications for identifying dyads most in need of targeted interventions.

Academically Resilient Latino Elementary Students Bridging the Achievement Gap

This study investigated associations between school-readiness patterns of Latino students and their subsequent academic achievement. After identifying a subgroup of students with academic risk at kindergarten entry who showed signs of later average or better academic skill development, academic data were gathered to explore how this group of “resilient” students (risk-catching up group) compared to their risk-lagging peers (those who entered kindergarten at high risk and continue to perform far below grade-level) and ready-proficient peers (those who entered kindergarten with low risk and continue to perform at a proficient level). Students were evaluated on individually administered measures that assessed cognitive and academic learning resources. A series of one-way MANOVAs identified that on academic measures of oral reading fluency (GORT-4) and verbal and nonverbal cognitive development (KBIT-2) students in the risk-catching up group performed consistent with their ready-proficient peers, and both groups scored significantly higher than the risk-lagging students. In contrast, scores on the California Standards Test ELA and math indicated that students in the risk-lagging group scored significantly lower than risk-catching up students who scored significantly lower than ready-proficient students. These findings provide evidence that the risk-catching up students made substantial progress to develop the academic skill base needed to support ongoing improvements in academic achievement; however, this growth was not fully discerned in the CST test results. Importantly, these results suggest that closing achievement gaps is an ongoing process, not an end point. The study highlights the importance of school readiness experiences for all students and that early and targeted interventions are needed to support a positive academic trajectory for all students.

Housing mobility and cognitive development: Change in verbal and nonverbal abilities

This study investigates the influence of housing instability on verbal and nonverbal cognitive development among at-risk children and adolescents involved in the child welfare system. Frequent residential changes threaten child mental health, especially among low-income families. Little is known regarding disruptions to cognitive growth, specifically the impact on verbal and nonverbal abilities. The study tests whether developmental timing of housing mobility affects cognitive development beyond individual and family risks. A nationally representative study of families (n=2,442) susceptible to housing and family instability tracked children and adolescents aged 4–14 years (M=8.95 years) over 36 months following investigation by the child welfare system. Youth completed standardized cognitive assessments while caregivers reported on behavior problems and family risk at three time points. Latent growth models examined change in cognitive abilities over time. Housing mobility in the 12 months prior to baseline predicts lower verbal cognitive abilities that improve marginally. Similar effects emerge for all age groups; however, frequent moves in infancy diminish the influence of subsequent housing mobility on verbal tasks. Housing instability threatened cognitive development beyond child maltreatment, family changes, poverty, and other risks. Findings inform emerging research on environmental influences on neurocognitive development, as well as identify targets for early intervention. Systematic assessment of family housing problems, including through the child welfare system, provides opportunities for coordinated responses to prevent instability and cognitive threats.

Causes of academic and behavioral difficulties among Japanese-Brazilian students: cognitive, linguistic and parental education factors

As in other countries with large immigrant populations, in Japan there is increasing interest in students from culturally and linguistically diverse backgrounds who experience learning and behavioral difficulties in the classroom. The causes of the problems have not been identified owing to a lack of appropriate and comparable assessments. In this study we focused on Japanese-Brazilian elementary school students, the largest ethnic minority group of students in Japan, and explored whether evaluation of their learning and behavior is influenced by the following aspects: language proficiency, cognitive capacity and family environment. We conducted a set of tasks to assess the students’ vocabulary and syntactic development in Japanese and Portuguese, and to evaluate their executive functions as an indicator of nonverbal cognitive development. Questionnaires were administered to teachers and parents in order to gain information about the children’s classroom performance and family environment, such as parents’ educational background and place of birth. Three key findings from our data include the following. (1) Some students in mainstream classrooms were ‘at-risk’ in their level of cognitive capacity. (2) Even among those with typical cognitive capacity, academic performance and classroom behavior were still rated lower than at grade level for the native population. (3) Teachers’ ratings of the two aspects were associated with different factors: low academic performance was significantly influenced by poor working memory, while problematic behavior was affected by Japanese grammatical skill and father’s educational background. This study used quantitative data to confirm that clear information about students’ linguistic, cognitive and environmental profiles, could be used to ensure that appropriate support is provided to students experiencing difficulties.

Communication disorders in preschool children

Abstract Communication disorders in preschool children present from a wide range of underlying disturbances of development, ranging from those secondary to a sensorineural hearing impairment and autism, through to primary specific speech and language impairments where there is no underlying neurological disorder and the child has normal non-verbal cognitive development. These are high prevalence disorders that can have long term, detrimental effects on wellbeing, activity and participation and yet for which there is both increasing understanding of the underlying aetiologies and an evidence base for intervention. This review discusses the clinical characteristics of the communication findings in preverbal, speech and language skills, the salient features to identify in the paediatric assessment and the direction of investigations informed from recent developments in our understanding of the genetics and the pathophysiology. It concludes with an overview of present effective interventions.

Effects of fish oil supplementation on learning and behaviour of children from Australian Indigenous remote community schools: A randomised controlled trial

Omega-3 fatty acids are essential for brain function. We recruited 409 children aged 3–13 years (M=8.27, SD=2.17) for a randomised controlled trial supplementing with placebo or fish oil capsules (providing 750mg docosahexaenoic plus eicosapentaenoic acids, and 60mg gamma linolenic acid/school day) for 20 school weeks (Phase 1) followed by one-way crossover to fish oil (Phase 2). Children undertook assessments of reading, spelling and non-verbal cognitive development (Draw-A-Person) at baseline, 20 and 40 weeks. Teachers completed Conners Behaviour Rating Scales (CBRS). The treatment group showed improvements in Draw-A-Person compared with the placebo during Phase 1 (p=0.029), with strongest effects in Indigenous 7–12 year olds (p=0.008). The placebo group showed significant within-group improvements after switching to treatment (p<0.001). There was no treatment effect for reading or spelling, and CBRS data were unable to be analysed. These findings may be understood in the context that sustained school attendance and nutrition interact to produce school-related achievement.