Risk Of Cognitive Delay Research Articles

Prenatal tobacco smoke exposure and risk for cognitive delays in infants born very premature

Prenatal tobacco smoke exposure (TSE) and prematurity are independent risk factors for abnormal neurodevelopment. The objectives were to compare differences in Bayley-III cognitive, language, and motor scores at 2 years corrected age (CA) in 395 infants born very preterm (≤ 32 weeks gestation) with and without prenatal TSE. We performed multivariable linear regression analyses to examine associations between prenatal TSE and neurodevelopmental outcomes and a mediation analysis to estimate direct effects of prenatal TSE on outcomes and indirect effects through preterm birth. In total, 50 (12.6%) infants had prenatal TSE. Infants with prenatal TSE had lower mean [95% CI] Cognitive score (82.8 [78.6, 87.1]) vs. nonexposed infants (91.7 [90.1, 93.4]). In children with and without prenatal TSE, there were significant differences in mean [95% CI] Language scores (81.7 [76.0, 87.4] vs. 92.4 [90.2, 94.6], respectively) and mean [95% CI] Motor scores (86.5 [82.2, 90.7] vs. 93.4 [91.8, 95.0], respectively); scores remained significant after controlling for confounders. Preterm birth indirectly mediated 9.0% of the total effect of prenatal TSE on Cognitive score (P = NS). However, 91% of the remaining total effect was significant and attributable to TSE’s direct harmful effects on cognitive development (β = − 5.17 [95% CI − 9.97, − 0.38]). The significant association is largely due to TSE’s direct effect on cognitive development and not primarily due to TSE’s indirect effect on preterm birth.

Intellectual Functioning of Children With Isolated PRS, PRS-Plus, and Syndromic PRS.

Describe the intelligence quotient (IQ) of children with Pierre Robin sequence (PRS). Prospective cohort study. Neurodevelopmental follow-up clinic within a hospital. Children with PRS (n = 45) who had been in the Neonatal Intensive Care Unit (NICU) were classified by a geneticist into 3 subgroups of isolated PRS (n = 20), PRS-plus additional medical features (n = 8), and syndromic PRS (n = 17) based on medical record review and genetic testing. Children with PRS completed IQ testing at 5 or 8 years of age with the Wechsler Preschool and Primary Scale of Intelligence, Third Edition (WPPSI-III) or Fourth Edition (WPPSI-IV) or the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) or Fifth Edition (WISC-V). IQ scores were more than 1 to 2 standard deviations below the mean for 36% of the overall sample, which was significantly greater compared to test norms (binomial test P = .001). There was a significant association between PRS subtype and IQ (Fisher's exact P = .026). While only 20% of children with isolated PRS were within 1 standard deviation below average and 35% of children with syndromic PRS were below 1 to 2 standard deviations, 75% of PRS-plus children scored lower than 1 to 2 standard deviations below the mean. PRS subgroups can help identify children at risk for cognitive delay. The majority of children with PRS-plus had low intellectual functioning, in contrast to the third of children with syndromic PRS who had low IQ and the majority of children with isolated PRS who had average or higher IQ.

Physical Discipline, Deprivation, and Differential Risk of Developmental Delay Across 17 Countries

Parenting behaviors have been studied largely in isolation with regard to child development in cross-national contexts. We examine and compare the relative strength of association between physical discipline and deprivation with risk of children's socioemotional and cognitive developmental delay in a cross-national sample. The sample was drawn from the UNICEF Multiple Indicator Cluster Survey. Analyses used observations with data on parental physical discipline, parenting behaviors associated with deprivation, and child developmental outcomes. The present analysis included 29,792 children aged 36-59 months across 17 countries. Using the Early Child Development Index, risk for cognitive or socioemotional developmental delay was indicated if a child could not accomplish 2 or more items within that specific subdomain. Overall risk for delay was indicated if a child was at risk in either subdomain. Associations among discipline, deprivation, and delay were assessed using multivariable logistic regression. Five of the 7 exposures were associated with risk of overall developmental delay. Physical discipline (odds ratio [OR]= 1.49 [95% CI= 1.39, 1.59]; p< .001) had the largest association with risk for socioemotional delay. Not having books (OR= 1.62 [95% CI= 1.42, 1.84]; p< .001) and not counting with the child (OR= 1.47 [95% CI= 1.32, 1.64]; p< .001) had the largest associations with risk of cognitive delay. The exposures of physical discipline and deprivation measured here have distinct associations with risk of socioemotional and cognitive delay cross-nationally. Programmatic and clinical interventions should seek to act on adversities that are relevant to the targeted delay.

Comparison between Ages & Stages Questionnaire and Bayley Scales, to predict cognitive delay in school age

ObjectiveTo compare the predictive value of the Spanish Ages & Stages Questionnaire third edition adapted for Chilean population (ASQ-Cl) and the Bayley Scale of Infant and Toddler Development 3rd edition (Bayley-III) for cognitive delay at school age, and to identify the domain predictors. MethodologyData were collected from 306 term and preterm children of medium-high socio-economic level enrolled in a prospective cohort study. Developmental outcomes at 8, 18 and 30 months were assessed via the ASQ-Cl and Bayley-III; at 6–8 years cognitive development was assessed using the Wechsler Intelligence Scale for Children (WISC-III). The area under the curve (AUC), sensitivity, specificity and predictive values were calculated, and logistic regression analysis was used. ResultsOf 227 children studied, 6.6% had cognitive delay. ASQ-Cl and Bayley-III generate equivalent AUC [0.77 and 0.80]. Sensitivity 67% and 53%; specificity of 72% and 88%, positive predictive value of 14% and 24%, negative predictive values of 97% and 96% respectively. Greater predictive validity was obtained at 30 months assessment. Deficit in the communication and gross motor skills and problem-solving domains of the ASQ-Cl and all the Bayley-III domains were significantly associated with cognitive delay. ConclusionsASQ-Cl can be used to identify children at risk for cognitive delay at 6–8 years of age, being comparable with the Bayley-III. Some domains of ASQ-Cl and all domains of Bayley-III were significant predictors for cognitive delay. These results support the use of ASQ-Cl as a screening tool for developmental delay.

Ages and Stages Questionnaire at 3 Years for Predicting IQ at 5-6 Years.

To assess the predictive value of the 36-month Ages & Stages Questionnaire (ASQ) score for IQ score at age 5 to 6 years in the general population and to identify factors associated with IQ <85 once the ASQ score is taken into account. Data were collected from 939 children enrolled in a population-based prospective cohort study. Developmental outcomes at 36 months were assessed via the ASQ and at 5 to 6 years via the Wechsler Preschool and Primary Scale of Intelligence. The ASQ threshold was identified via the receiver operating characteristic curve. Additional predictive factors to obtain an IQ <85 were investigated, and their interaction with ASQ score was studied. Sixty-nine children (7.3%) had an IQ <85. A 36-month ASQ score threshold of 270 was optimal to identify children with an IQ <85 at 5 to 6 years, with a 0.77 ± 0.11 sensitivity and 0.68 ± 0.03 specificity. Maternal educational level and occupational activity at the time of ASQ completion were associated with the risk of an IQ <85 at a given ASQ level. In the multivariate model, no interaction between the studied factors and ASQ score reached significance. In the general pediatric population, 36-month ASQ parental reports could be used to identify children at later risk of cognitive delay. Low maternal education level should also be considered as a major risk factor for lower IQ in preschool children regardless of ASQ score.

A pilot study of parent education intervention improves early childhood development among toddlers with sickle cell disease.

Young children with sickle cell disease (SCD) are at risk for cognitive delay. In addition to biologic risk factors associated with SCD, environmental factors contribute to cognitive dysfunction within this cohort. We completed a single-arm, prospective cohort study. Children with SCD between the ages of 3 and 36 months and their caregivers were followed between October 2010 and December 2013. The aim was to describe the role of a home visitation model, the home environment, and socioeconomic status in the development of young children with SCD. Primary outcome measures were the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) and the Home Observation for Measurement of the Environment (HOME). We hypothesized that the home visitation model, Parents as Teachers® (PAT), would encourage positive parent-child interactions and improve cognitive outcomes. Thirty-five participants had at least two PAT visits and BSID-III assessments. Mean scores within all five subtests of the BSID-III improved between enrollment and exit, with significant changes within cognitive (P = 0.016) and expressive language (EL) domains (P = 0.002). Multivariate modeling found the HOME score associated with the exit results of the cognitive domain. We report longitudinal results of the first home visitation program within the early childhood SCD population and show significant improvement in cognitive and EL development. Additionally, home environment was a significant predictor of cognitive development. Randomized controlled trials to test the impact of interventions targeting the home environment are warranted for this vulnerable population.

Eric: A new parental report instrument for identification of cognitive delay in at-risk infants

We describe development and testing of a new psychometric instrument, termed ERIC Early Report by Infant Caregivers (ERIC) for use in the NHS. ERIC will be used by parents to...

Perinatal and Socioeconomic Risk Factors for Variable and Persistent Cognitive Delay at 24 and 48 Months of Age in a National Sample

The objective of this paper is to examine patterns of cognitive delay at 24 and 48 months and quantify the effects of perinatal and sociodemographic risk factors on persistent and variable cognitive delay. Using data from 7,200 children in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), multiple logistic regression models identified significant predictors of low cognitive functioning at 24 and 48 months. Additional multiple logistic models predicting cognitive delay at 48 months were estimated separately for children with and without delay at 24 months. Of the nearly 1,000 children delayed at 24 months, 24.2% remained delayed by 48 months; 7.9% of the children not delayed at 24 months exhibited delay at 48 months. Low and very low birthweight increased cognitive delay risk at 24, but not 48 months. Low maternal education had a strongly increasing effect (OR = 2.3 at 24 months, OR = 13.7 at 48 months), as did low family income (OR = 1.4 at 24 months, OR = 7.0 at 48 months). Among children delayed at 24 months, low maternal education predicted delay even more strongly at 48 months (OR = 30.5). Low cognitive functioning is highly dynamic from 24 to 48 months. Although gestational factors including low birthweight increase children’s risk of cognitive delay at 24 months, low maternal education and family income are more prevalent in the pediatric population and are much stronger predictors of both persistent and emerging delay between ages 24 and 48 months.

Prophylactic academic intervention for children treated with cranial radiation therapy

This single case study investigated the feasibility and effectiveness of a prophylactic intervention for improving academic skills in a child with a brain tumour deemed at high risk for cognitive delay and academic failure because of cranial radiation treatment (CRT). An 8 year old boy participated in a 12 week home and hospital based tutoring programme. Standardized and non-standardized measures of academic achievement were administered at pre- and post-intervention. A follow-up assessment took place 8 months post-intervention (standardized measures only). Pre-test and follow-up neuropsychological data was collected. Significant improvement was observed on the Wechsler Individual Achievement Test–2nd Edition (WIAT-II) pseudoword decoding and spelling sub-tests and on measures of single word and grapheme knowledge. There was no improvement on the WIAT-II math sub-tests. At follow-up, gains were maintained or improved for reading-related sub-tests but declined for math and spelling sub-tests. Overall, neuropsychological data showed decreased performance. The gains in reading skills were made in the context of an overall decline in neuropsychological functioning, suggesting that the intervention helped to preserve reading skills and may be protective against difficulty with skill acquisition, but did not prevent a more global decrease in functioning. This study is the first reported prophylactic intervention delivered concurrently with intensive medical treatment.

Effects of Cytomegalovirus (CMV) Related Deafness on Pediatric Cochlear Implant Outcomes

Human cytomegalovirus (CMV) is a commonly recognized viral cause of perinatal sensorineural hearing loss. CMV-infected infants are also at risk for developmental neurological deficits. This retrospective study assesses the impact of CMV-induced deafness on pediatric cochlear implant outcomes. Thirteen patients from the Johns Hopkins pediatric cochlear implant database were identified with CMV-related deafness. A retrospective review of the medical records of the Johns Hopkins Hospital was performed. The mean age at implantation was 5.6 years. Follow-up audiometric data ranged from 6 to 48 months postoperatively. Mean speech perception scores were 4.5 (out of 6) following implantation. We have shown that cochlear implants can provide useful speech comprehension to patients with CMV-related deafness. Speech recognition scores were within the range established by our overall pediatric implant population. This observation underscores the importance of a multidisciplinary rehabilitation program following implantation in these patients at risk for cognitive delay.

Utility of the early screening profiles in identifying preschoolers at risk for cognitive delays

This study investigated the utility of the Early Screening Profiles (ESP; Harrison, 1990) to differentiate between preschoolers at risk for cognitive delays (n= 49) and non-risk preschoolers (n= 44). Step-wise discriminant function analysis was performed using the ESP Profiles and Total Screening scores as the predictors of group membership. The Total Screening score, by itself, was found to correctly classify approximately 81% of the preschoolers. In a separate discriminant analysis, the Cognitive/Language and Motor profiles were required to maintain a similar level of correct classifications as the ESP Total Screening score. © 2001 John Wiley & Sons, Inc.

Effects of early middle ear effusion on child intelligence at three, five, and seven years of age.

This study tested the hypothesis that children with prolonged middle ear effusion (MEE) during the first 3 years of life are at risk for cognitive delays or deficits. A prospective study enrolled 698 children from diverse backgrounds and controlled for eight demographic and environmental factors. Participants were recruited at birth and monitored for ear status frequently in the home; 379 children were assessed for cognition with the Stanford-Binet, 4th ed., at 3 years of age, 294 at 5 years, and 198 at 7 years. Using the SAS General Linear Models (GLM) procedure, we found a significant direct relation between duration of bilateral MEE and Stanford-Binet Composite and Nonverbal Reasoning/Visualization Factor scores at age 3, but not at age 5 or age 7. Statistical clustering analysis revealed four groups with different temporal patterns of MEE: Low MEE, Early MEE (peaking at 0-6 months), Later MEE (peaking at 6-12 months), and High MEE. GLM analyses revealed no direct effects, but several moderated effects, of MEE cluster on cognitive development at 3 years, but none at 5 or 7 years. In general, children in the Later MEE and High MEE groups appeared to be more adversely affected by bilateral MEE at 3 years, but effects were moderated in complex ways by socioeconomic status or home stimulation. Growth curve modeling across the three assessment periods showed no effects of total duration of MEE but did indicate that children in the Later MEE cluster had low scores at age 3 but caught up at ages 5 and 7. Prolonged MEE, especially between 6 and 12 months, may put children at risk for cognitive delays at 3 years, but the risk effect is not strong and effects are no longer detectable at 5 or 7 years.

Bayley-II Mental Developmental Index scores at 9 and 18 months for children under 1000 grams birthweight

AbstractThis study identified selected perinatal and neonatal variables that place ELBW children at particularly high risk for cognitive delay. Forty children weighing less than 1000 grams (ELBW) at birth underwent developmentol assessment at 9 and 18 months on the Bayley II Mental Development lndex (MDI). Decline in MDI scores between these two ages was evident for infants under 26 weeks gestation at birth as well as for children categorised with an impairment (outcome categories I and II). At 9 months, MDI scores were significantly lower for children with chronic lung disease, for those who required formal developmental intervention, and for those hospitalised for respiratory problems. At 18 months, cognitive scores were significantly lower for children on four variables: gestational age less than 26 weeks; semi-skilled, unskilled, unemployed parents (levels 5 and 6); formal intervention; and admission to hospital for respiratory illness. Greater emphasis on intervention for these at-risk variables is recommended.

Cavum septi pellucidi and cavum vergae in normal and developmentally delayed populations.

Recent studies have shown that the persistence of the cavum septi pellucidi beyond the neonatal period is a marker of cerebral dysgenesis. It has been suggested that the finding of a persistent cavum vergae is also a marker of disturbed brain development. In order to investigate this hypothesis we reviewed 161 brain magnetic resonance imaging scans from normal individuals for the presence of cavum septi pellucidi or cavum vergae, or both. In the 34 prospectively obtained normal adults, there were no individuals with either a cavum septi pellucidi or cavum vergae. In the "defined" normal subjects 3 of 127 individuals (2.4%) had a cavum septi pellucidi whereas a cavum vergae was noted in 26 of 127 (20.5%). We next reviewed the neuroimaging studies of 249 children and adults evaluated for mental retardation or developmental delay. A cavum septi pellucidi was found in 38 of 249 (15.3%) and a cavum vergae in 48 of 249 (19.3%) of these patients. A cavum septi pellucidi and cavum vergae were found together in 19 of 249 (7.6%). We interpret these data as showing that the cavum septi pellucidi is rarely seen in normal individuals although the cavum vergae is seen with the same frequency in normal and retarded populations. Thus we conclude that the cavum septi pellucidi serves as a significant marker of cerebral dysfunction manifested by neurodevelopmental abnormalities while the cavum vergae alone does not identify individuals at risk for cognitive delays.

Drag Exposed Children and the Foster Care System: In the Best Interests of the Child?

ABSTRACT Children born to substance abusing women face many risks that can impede optimal developmental outcome. These risks include both potential neurologic and organic sequelae of intrauterine substance exposure, as well as additional risk factors in their postnatal environment. Foster care placement is a common occurrence among this population. The current study was conducted to explore the developmental status of a group of drug exposed infants and toddlers in foster care. Twenty-seven children placed through a church-based foster care program were observed. All but one of the children were African-American and nearly half (48%) had been placed shortly after birth. The children ranged in age from 1 to 29 months. Home environment and caregiver-child interaction was assessed using the HOME Inventory and the NCAS Feeding and Teaching Scales. Children were also given physical, neurological, and developmental assessments (Mean age = 11.7 months). While the majority of the children fell within normal limits on developmental testing, 28% were considered at risk for cognitive delay and over half exhibited suspect or abnormal neurological signs. Many were felt to be at further risk because of poor home environment and/or caregiving. Implications for intervention and policy changes are discussed.

Detecting Developmental Delay With Cars: A Head-Start Application

Children At Risk Screener (CARS) can identify Head Start children at risk for cognitive delay. CARS correlates well with age, established cognitive and behavioral instruments, and standardized third-grade tests (five years later). Correlations between CARS scores and other measures suggest interractive behavioral mechanisms among parents, children, and learning environments.