A longitudinal study of the development of shifts of gaze to a peripheral stimulus in preterm infants with transient periventricular echogenicity

Cross-modal coherence and incoherence of early infant interactive behavior: links to attachment in infants born very preterm or full-term

Infants exhibit flexibly organized configurations of facial, vocal, affective, and motor behavior during caregiver-infant interactions that convey convergent messages about their internal states and desires. Prior work documents that greater cross-modal discrepancy at 4 months predicts disorganized attachment. Here, we evaluated whether: very preterm (VPT) or full-term (FT) status predicts cross-modal coherence or incoherence in infants' behavior with the caregiver at 3 months; and, regardless of prematurity, whether cross-modal interactive coherence or incoherence predicts 12-month attachment. Participants included 155 infants (85 FT; 70 VPT), and their mothers followed from birth to 12 months (corrected age). Infants' cross-modal coherent and incoherent responses were scored microanalytically from videotaped en-face interactions. Infants' attachment security was evaluated during Ainsworth's Strange Situation. Infants born VPT exhibited more incoherent cross-modal responses and insecure attachment than infants born FT. Regardless of prematurity, infants' coherent and incoherent cross-modal interactive behaviors at 3 months predicted different attachment patterns at 12 months.

Preterm Birth and the Development of Visual Attention During the First 2 Years of Life: A Systematic Review and Meta-analysis

Importance

Preterm birth is associated with an increased risk for long-lasting attention deficits. Early-life markers of attention abnormalities have not been established to date but could provide insights into the pathogenesis of attention abnormalities and could help identify susceptible individuals.

Objective

To examine whether preterm birth is associated with visual attention impairments in early life, and if so, in which attention functions and at which developmental period during the first 2 years of life.

Data Sources

PubMed and PsycINFO were searched on November 17, 2019, to identify studies involving visual attention outcomes in infants born preterm vs full term.

Study Selection

Peer-reviewed studies from the past 50 years met the eligibility criteria if they directly assessed visual attention outcomes until the age of 2 years in generally healthy infants born preterm or full term. The selection process was conducted by 2 independent reviewers.

Data Extraction and Synthesis

The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Random-effects models were used to determine standardized mean differences. The risk of bias was assessed both within and between studies.

Main Outcomes and Measures

Five nascent indices of visual attention were analyzed, including very basic functions-namely, the abilities to follow and fixate on visual targets-and more complex functions, such as visual processing (ie, habituation), recognition memory (ie, novelty preference), and the ability to effortfully focus attention for learning.

Results

A total of 53 studies were included, with 69 effect sizes and assessing a total of 3998 infants (2047 born preterm and 1951 born full term; of the 3376 for whom sex was reported, 1693 [50.1%] were girls). Preterm birth was associated with impairments in various attention indices, including visual-following in infancy (Cohen d, -0.77; 95% CI, -1.23 to -0.31), latency to fixate (Cohen d, -0.18; 95% CI, -0.33 to -0.02), novelty preference (Cohen d, -0.20; 95% CI, -0.32 to -0.08), and focused attention (Cohen d, -0.28; 95% CI, -0.45 to -0.11). In the neonatal period, preterm birth was associated with superior visual-following (Cohen d, 0.22; 95% CI, 0.03 to 0.40), possibly owing to the additional extrauterine exposure to sensory stimulation. However, this early association waned rapidly in infancy (Cohen d, -0.77; 95% CI, -1.23 to -0.31).

Conclusions and Relevance

The findings suggest that preterm birth is associated with impingements to visual attention development in early life, as manifested in basic and then complex forms of attention. Advancements in neonatal care may underlie improvements found in the current era and accentuate several early protective factors.

Do low birth weight infants not see eyes? Face recognition in infancy

BACKGROUND

Progress in neonatal medicine has dramatically improved the survival rate of preterm births, but the evidence suggests that these low-birth weight infants (LBWIs) go on to develop pervasive development disorders and attention deficit hyperactivity disorder (ADHD) at greater rates than the general population. Children with neurodevelopmental disorders are known to suffer from deficits in visual cognition, such as in face perception and attentional functions, the characteristics of which already manifest in early infancy.

PURPOSE

This study aimed to investigate visual cognition in LBWIs during infancy.

SUBJECTS

20 LBWIs and 20 normal-birth-weight infants (NBWIs: control) of age 9-10 months (corrected age was used for LBWIs).

METHOD

Children were held seated in front of an eye tracking system by a parent, and presented with facial photos as visual stimuli. During the familiarization phase, the child was presented with two images of the same human face (familiarization stimulus) on the left and right side of a display screen (5 × 10 s trials). Next, during the test phase, the child was presented with the same image on one side of the screen, and a photo of a different person's face (novel stimulus) on the other (2 × 5 s trials). Gaze behavior was assessed in terms of the total time spent looking at either facial stimulus, and specifically at the eyes of the stimuli, as well as the number of attentional shifts between stimuli, and novelty preference.

RESULTS/DISCUSSION

LBWIs spent significant less time looking at facial stimuli overall, and less time at the eye region, than NBWIs. These findings seem to evidence developmental differences in functions related to visual cognition.

Hyper-Reactivity to Salience Limits Social Interaction Among Infants Born Pre-term and Infant Siblings of Children With ASD

The ability to engage attention with selected stimuli is essential for infants to explore the world and process information relating to their surroundings. There are two main populations with a higher risk to develop attentional and social deficits whose deficits may arise from difficulties in regulating attention to salient cues: (1) siblings of children diagnosed with Autism; and (2) infants who were born pre-term. This study investigated infants' (N = 97) attention-engagement and pupil-dilation (PD) at 9 months of age, using a gaze-contingent paradigm and a structured social interaction. Specifically, we explored attention to stimuli with simple salient features (e.g., clear defined shapes, colors, and motions) vs. more complex non-social cues (amorphous shapes, colors, and motions) and social interaction in typically developing infants (TD, N = 25) and among two groups of infants at-risk to develop social difficulties (pre-terms, N = 56; siblings of children with Autism, N = 16). Findings show that the two risk groups preferred stimuli with simple features (F = 11.306, p < 0.001), accompanied by increased PD (F = 6.6, p < 0.001). Specifically, pre-term infants showed increased PD toward simple vs. complex stimuli (p < 0.001), while siblings showed a pervasive hyper-arousal to both simple and complex stimuli. Infants in the TD group preferred complex stimuli with no change in PD. Finally, the preference for the simple stimulus mediated the relationship between increased risk for social difficulties and decreased engagement duration in face-to-face interaction with the experimenter. Results suggest that activation of the attention-salience network shapes social abilities at infancy. Further, hyper-reactivity to salient stimuli limits social interaction among infants born pre-term and siblings of children with ASD.

Foundations of attention sharing: Orienting and responding to attention in term and preterm 5-month-old infants

Attention is the gateway to perceptual, cognitive, and socioemotional development in humans. We observed 104 5-month-old term and preterm infants and their mothers in social interactions to address three questions about the role of maturation in orienting and responding to attention. We used a fine-grained coding system to allow parallel comparisons across infant and maternal orienting, and sequential analysis to evaluate infant and maternal responding to attention. Orienting and responding to attention differed for attention to people versus objects, as did the relations between maturity and attention. We conclude that maturity contributes to orienting and responding to attention and that orienting and responding to attention are specific rather than homogenous. We discuss the implications of these conclusions for future studies of how attention influences cognitive and communicative development.

Early development of visual attention in infants in rural Malawi

Eye tracking research has shown that infants develop a repertoire of attentional capacities during the first year. The majority of studies examining the early development of attention comes from Western, high-resource countries. We examined visual attention in a heterogeneous sample of infants in rural Malawi (N = 312-376, depending on analysis). Infants were assessed with eye-tracking-based tests that targeted visual orienting, anticipatory looking, and attention to faces at 7 and 9 months. Consistent with prior research, infants exhibited active visual search for salient visual targets, anticipatory saccades to predictable events, and a robust attentional bias for happy and fearful faces. Individual variations in these processes had low to moderate odd-even split-half and test-retest reliability. There were no consistent associations between attention measures and gestational age, nutritional status, or characteristics of the rearing environment (i.e., maternal cognition, psychosocial well-being, socioeconomic status, and care practices). The results replicate infants' early attentional biases in a large, unique sample, and suggest that some of these biases (e.g., bias for faces) are pronounced in low-resource settings. The results provided no evidence that the initial manifestation of infants' attentional capacities is associated with risk factors that are common in low-resource environments.

Preterm-infant emotion regulation during the still-face interaction

Very-preterm (VPT), moderately-preterm (MPT), and full-term (FT) infants' emotion-regulation behaviors were assessed via the Still-Face procedure at a corrected age of four months. As a developmental task during the first year of life, emotion regulation is important for social and cognitive development. Although substantial evidence indicates that VPT infants exhibit emotion-regulation difficulties, little is known about MPT infants' emotion regulation capabilities, this group also possibly being at risk. The participants included 135 parent-infant dyads: 46 VPT (gestational age 24-32 weeks), 51 MPT (gestational age 32-34 weeks), and 38 FT (gestational age 37-41 weeks). The infants' affect, gaze-aversion, and self-comforting behaviors were coded. Preterm infants responded to parental still face in similar fashion to FT infants, displaying robust still-face and recovery effects. The preterm infants exhibited less developed emotion-regulation behaviors, however, manifested in less positive affect and more gaze aversion in the face-to-face and reunion episodes compared to FT infants. With respect to self-comforting behaviors, each group displayed a significantly different pattern of behaviors throughout the procedure, suggesting better emotion regulation skills among MPT infants compared to the VPT infants. The findings on gaze aversion and self-comforting behaviors could have implications for strategies to incorporate into intervention programs supporting development of emotion regulation skills.

Attention capacities of preterm and term born toddlers: A multi-method approach

OBJECTIVE

Many preterm children show difficulties in attention at (pre)school age. The development of attention capacities of preterm and term toddlers was compared using a longitudinal and multi-method approach at 12, 18 and 24months.

METHOD

Attention was measured for 123 preterm (32-36weeks gestation) and 101 term born children, using eye tracking (18months), observations during mother-child interaction (18months), and mother-reports (12, 18, and 24months).

RESULTS

Preterm toddlers had lower scores than term children on the eye-tracking measures of orienting and alerting. No group differences were found with observations, mother-reports, and the eye-tracking measure of executive attention. More preterm than term children had suboptimal scores on measures of the alerting system at 18months, possibly indicating difficulties in attention development.

CONCLUSION

Preterm children showed an increased risk for suboptimal functioning in alerting attention capacities, as early as at a toddler age.

Early visual attention in preterm and fullterm infants in relation to cognitive and motor outcomes at school age: an exploratory study

OBJECTIVE

Preterm infants are exposed to the visual environment earlier than fullterm infants, but whether early exposure affects later development is unclear. Our aim was to investigate whether the development of visual disengagement capacity during the first 6 months postterm was associated with cognitive and motor outcomes at school age, and whether associations differed between fullterms and low-risk preterms.

METHOD

Seventeen fullterms and ten low-risk preterms were tested in a gaze shifting task every 4 weeks until 6 months postterm. The longitudinal data were converted into single continuous variables by fitting the data with an S-shaped curve (frequencies of looks) or an inverse model (latencies of looks). Neuropsychological test results at school age were converted into composite z scores. We then performed linear regression analyses for each functional domain at school age with the variables measuring infant visual attention as separate predictors and adjusting for maternal level of education and group (fullterms versus preterms). We included an interaction term, visual attention*group, to determine whether predictive relations differed between fullterms and preterms.

RESULTS

A slower development of disengagement predicted poorer performance on attention, motor skills, and handwriting, irrespective of fullterm or preterm birth. Predictive relationships differed marginally between fullterms and preterms for inhibitory attentional control (P = 0.054) and comprehensive reading (P = 0.064).

CONCLUSION

This exploratory study yielded no indications of a clear advantage or disadvantage of the extra visual exposure in healthy preterm infants. We tentatively conclude that additional visual exposure does not interfere with the ongoing development of neuronal networks during this vulnerable period of brain development.

The early motor repertoire of children born preterm is associated with intelligence at school age

OBJECTIVE

The goal was to determine whether the quality of general movements (GMs) for preterm children had predictive value for cognitive development at school age.

METHODS

In this prospective cohort study, 60 preterm infants (gestational age, median: 30.0 weeks [range: 25-33 weeks]; birth weight, median: 1130 g [range: 595-1800 g]) without cerebral palsy were studied. The quality of GMs was assessed prospectively as normal or abnormal, from video recordings that were made at regular intervals until 17 weeks after term. At 7 to 11 years, intelligence was tested by using the Wechsler Intelligence Scale for Children III, Dutch version. Total IQ (TIQ), verbal IQ (VIQ), and performance IQ (PIQ) scores were calculated.

RESULTS

The median TIQ was 93 (range: 67-113), VIQ 96 (range: 68-117), and PIQ 92 (range: 65-119). Fifteen children (25%) had low TIQ scores (<85). When the quality of GMs normalized before 8 weeks after term, TIQ, VIQ, and PIQ scores were in the normal range. Consistently abnormal GMs to 8 weeks after term were associated with lower TIQ, VIQ, and PIQ scores. With correction for male gender and the educational levels of the parents, the likelihood ratio of consistently abnormal GMs for a low TIQ was 4.9 (95% confidence interval: 1.3-17.6). The model explained 22.4% of the variance.

CONCLUSIONS

The quality of GMs during the early postterm period is a marker for intelligence at school age. Abnormal GMs during the early postterm period may reflect injury or developmental disruptions of brain areas involved in cognitive development.

Representational momentum in children born preterm and at term

The term representational momentum (RM) refers to the idea that our memory representations for moving objects incorporate information about movement - a fact that can lead us to make errors when judging an object's location (the RM effect). In this study, we explored the RM effect in a sample of children born very prematurely and a sample born at term. Because preterm children are known to be at risk for problems with motion perception, we anticipated that they would show a weaker or absent RM effect. This prediction was confirmed. In addition, we found that, in both samples of children, 5-6year olds showed a reduced RM effect compared to 7-9year olds. These results demonstrate that the ability to represent motion information in memory shows continued development over this age range, and may help to elucidate factors contributing to problems with fine and gross motor planning and execution that have been observed in the preterm population. We propose that problems affecting the formation, maintenance, or use of predictive models, or motion extrapolation skills, may have cascading effects on the development of other abilities.

Effects of preterm experience on the developing visual system: a longitudinal study of shifts of attention and gaze in early infancy

Several studies on visual development support the notion that healthy, low-risk preterm infants benefit from their early exposure to the visual world. It has been suggested, however, that mainly early developing sensory and motor processes are enhanced as a result of visual experience and early exercise, whereas later maturing processes might not. This study investigates whether preterm infants' visual and attentional development is accelerated as a consequence of their early visual experience and whether early and later maturing processes are affected differently. Preterm and full-term infants' performance on a gaze and attention shifting task was examined during the first six months of life. Until about 16 weeks post- term, preterm infants were faster in disengaging and shifting their attention and gaze from a stimulus in their central visual field to the periphery, whereas no difference was found for simple gaze shifts without disengagement. This finding is in contrast to earlier accounts that only early developing mechanisms might be advanced as a result of additional visual experience, whereas later developing cortical processes might depend mainly on preprogrammed maturation processes. However, it is consistent with a number of findings on visual, motor, and speech development, which have indicated accelerated cortical functioning in healthy preterm infants before.

The quality of the early motor repertoire in preterm infants predicts minor neurologic dysfunction at school age

OBJECTIVE

The quality of a child's motor repertoire at age 3 to 4 months postterm is predictive of later cerebral palsy (CP). Its predictive power for minor neurologic dysfunction (MND) is unclear. This study aimed to investigate the predictive value of the quality of the early motor repertoire for the development of MND at school age.

STUDY DESIGN

We assessed the motor repertoire from video recordings made at 6 to 24 weeks postterm in 82 preterm infants (mean gestational age, 29.7 +/- 1.9 weeks; mean birth weight, 1183 +/- 302 g). At age 7 to 11 years, Touwen's neurologic examination was performed, and the children were classified as normal (n = 49; 60%), MND (n = 18; 22%), or CP (n = 15; 18%).

RESULTS

Multiple logistic regression analysis showed that the quality of fidgety movements (FMs) and the quality of the concurrent motor repertoire had independent prognostic value for MND at school age. Abnormal FMs evolved into MND in 64% of the children. Nine of the 28 children with normal FMs and an abnormal concurrent motor repertoire developed abnormally (32%). Only 1 child of the 21 children with normal FMs and a normal concurrent motor repertoire developed MND (5%).

CONCLUSIONS

Assessment of the quality of the early motor repertoire can accurately identify individual infants at high and low risk for MND at school age.

Toy-oriented changes during early arm movements: hand kinematics

In a recent cross-sectional study, we found that young infants changed their spontaneous arm movements in the presence of a toy, termed 'toy-oriented changes', in systematic ways beginning many weeks before their first consistent reaches [Bhat, A. N., Heathcock, J. H., & Galloway, J. C. (2005). Toy-oriented changes in hand and joint kinematics during the emergence of purposeful reaching. Infant Behavior and Development, 28(4), 445-465]. The purpose of the present study was to test specific hypotheses regarding toy-oriented changes in a longitudinal design.

METHODS

Thirteen infants were observed every other week from 8 weeks of age up to the onset of reaching. At each session, hand and joint motions were observed with and without a toy present using a high-speed motion capture system. This paper focuses on the toy-oriented changes in hand variables.

RESULTS

As predicted, infants displayed a meaningful pattern of toy-oriented changes, which systematically changed as infants approached the first week of reaching. During the Early phase (8-10 weeks before reaching), infants scaled down their movement length and speed in the presence of a toy. During the Mid phase (4-6 weeks before reaching), infants scaled up movement number and speed, increased movement smoothness, and decreased their hand-toy distance in the presence of a toy. During the Late phase (within 2 weeks of reaching), infants continued to change their hand's position to get closer to the toy and began contacting it. Interestingly, movement number and smoothness displayed similar developmental patterns, where movement length and speed displayed similar patterns.

CONCLUSION

Toy-oriented adaptation of arm movements emerges in the first months of life and forms a complex, yet tractable continuum with purposeful reaching. These results provide a foundation to test more specific hypotheses of hand and joint coordination in both typically developing infants and those infants born at risk for coordination impairments.