Early precursors of low attention and hyperactivity in a preterm sample at age four

Cognitive, Behavioral and Socioemotional Development in a Cohort of Preterm Infants at School Age: A Cross-Sectional Study

More than 50% of children who survive prematurity have an atypical course of development at school age, as environmental demands become more demanding. This study examines the effects of preterm birth on the cognitive, behavioral and socioemotional development of 185 children at ages five and seven years. Weaknesses were found in attention, working memory, processing speed and the ability to correctly interpret emotions at both ages five and seven. Significant correlations were found in regression and moderation models. These findings suggest that school-age children who were preterm infants are at increased risk of exhibiting impairments in several developmental domains that may affect their overall quality of life.

Individual Attention Patterns in Children Born Very Preterm and Full Term at 7 and 13 Years of Age

OBJECTIVE

To identify attention profiles at 7 and 13 years, and transitions in attention profiles over time in children born very preterm (VP; <30 weeks' gestation) and full term (FT), and examine predictors of attention profiles and transitions.

METHODS

Participants were 167 VP and 60 FT children, evaluated on profiles across five attention domains (selective, shifting and divided attention, processing speed, and behavioral attention) at 7 and 13 years using latent profile analyses. Transitions in profiles were assessed with contingency tables. For VP children, biological and social risk factors were tested as predictors with a multinomial logistic regression.

RESULTS

At 7 and 13 years, three distinct profiles of attentional functioning were identified. VP children were 2-3 times more likely to show poorer attention profiles compared with FT children. Transition patterns between 7 and 13 years were stable average, stable low, improving, and declining attention. VP children were two times less likely to have a stable average attention pattern and three times more likely to have stable low or improving attention patterns compared with FT children. Groups did not differ in declining attention patterns. For VP children, brain abnormalities on neonatal MRI and greater social risk at 7 years predicted stable low or changing attention patterns over time.

CONCLUSIONS

VP children show greater variability in attention profiles and transition patterns than FT children, with almost half of the VP children showing adverse attention patterns over time. Early brain pathology and social environment are markers for attentional functioning.

Heterogeneity of the attentional system's efficiency among very prematurely born pre-schoolers

Very preterm birth increases the risk of ADHD as well as other neurodevelopmental disorders. Deficits within the attentional system were previously signaled in preterm children; however, studies lacked in consideration of an intragroup differentiation. Thus, this study aimed to verify whether deficits in the attentional mechanisms are inter-individually differentiated among very prematurely born children and if so, which biomedical and non-biomedical factors are associated with the profile of deficits within the attentional system. We tested the efficiency of attentional processes among 5-year-old children with the Attention Network Task - Child Version. The results have indicated that 26% of very preterm children presented with the suboptimal functioning of the attentional system (more than 1 SD below mean score of full-term children in attentional alerting and orienting), whereas 74% were characterized by the normal efficiency of attention. The profile of attentional deficits observed among very preterm preschoolers was associated with significantly lower birth weight and decreased family living standard. Very prematurely born children are thus a relatively heterogeneous group in terms of the efficiency of attentional system and deficits apply to only some of those children. Early developmental support aimed at enhancing attentional functioning should be addressed to children with lower birth weight in the first place.

Distinct Profiles of Attention in Children Born Moderate-to-Late Preterm at 6 Years

Objective

Attention difficulties are commonly reported by caregivers in school-aged children born moderate-to-late preterm (MLPT; 32–36 weeks’ gestation). We aimed to assess distinct aspects of attentional functioning (i.e. orienting, alerting and executive attention, processing speed and behavioral components) in children born MLPT and full term (FT), profiles of attentional functioning, and associated risk factors such as preterm birth.

Methods

Participants were 170 (87 MLPT and 83 FT) children, evaluated on cognitive and behavioral attention aspects at 6 years of age. We used a variable-centered approach to compare attentional functioning of children born MLPT and FT at group level, and a person-centered approach to identify profiles of attentional functioning. Neonatal and demographic characteristics of these profiles were compared.

Results

The variable-centered approach showed that at group level children born MLPT had poorer orienting attention and processing speed, and behavioral attention than children born FT. The person-centered approach revealed four profiles: (a) normal attentional functioning, (b) overall poorer attention, (c) poorer cognitive attention, and (d) behavioral attention problems. Children born MLPT were overrepresented in each of the suboptimal attention profiles, and were more dispersed across profiles than children born FT.

Conclusions

Children born MLPT are at increased risk of difficulties in some attention aspects, but at group level differences with children born FT are small. However, children born MLPT show considerable variation in the nature of attention difficulties and are twice as likely to show a suboptimal attention profile, indicating a cumulation of poorer attention scores.

A Meta-Analysis of the Association Between Birth Weight and Attention Deficit Hyperactivity Disorder

A large body of work has investigated the association between birth weight and ADHD and has resulted in mixed findings with regard to the direction and magnitude of this association. Despite the vast amount of research on this topic, a comprehensive and systematic quantification of the association between birth weight and ADHD has yet to be undertaken. A meta-analysis of 88 unique studies (N = 4,645,482) was conducted to quantify the overall effect size of birth weight on ADHD symptoms. Several variables were examined as moderators that may contribute to systematic variation in effect sizes. Overall, birth weight was found to have a small, but significant, association with ADHD symptoms such that individuals born at lower birth weights manifested greater symptoms of ADHD (r = -0.15). Sample type, mean birth weight of the sample, geographic region, the informant of ADHD symptoms, ADHD symptom measurement method, and race were all found to contribute significantly to heterogeneity in effect sizes. Notably, several early life risk factors previously found to be associated with both ADHD and birth weight, gestational age and prenatal smoking exposure, were not found to contribute to heterogeneity in effect sizes. The findings of the current analyses align with the growing recognition that early life adversity contributes to neurodevelopmental difficulties, and the findings highlight the importance of a better understanding of the mechanisms underlying the association between early life risk factors and adverse neurodevelopmental sequela, such as that observed in ADHD.

Attention in 3-Year-Old Children with VLBW and Relationships with Early School Outcomes

AIM

To compare attention skills of children with a very low birth weight (VLBW) with children with a normal birth weight (NBW) when entering primary school, and explore the association of attention skills with school career 2 years later.

METHODS

Participants were 151 children with VLBW and 41 with NBW. Attention was assessed at 3 years and 8 months of corrected age (CA) and school career at 5½ years of CA. Children performed two tests, parents completed three questionnaires, and an assessor systematically observed children's attention.

RESULTS

Children with VLBW had significantly lower mean scores on five of the six measures. Significantly more children with VLBW had scores in the clinical range on the Child Behavior Checklist completed by the parents (13% versus 0%) and scores representing dysfunction on assessor observations (19% versus 2%). At 5½ years of age, 36% of the children with VLBW followed special education or had grade retention. Dysfunctional attention as observed by the assessor was most strongly associated with need for learning support at 5½ years of age.

CONCLUSIONS

At preschool age, children with VLBW have attention difficulties. Attentive behavior at preschool age is a predictor of school career 2 years later.

[Formula: see text]Gestational age and gender influence on executive control and its related neural structures in preterm-born children at 6 years of age

Within preterm-born children, being born male and at a lower gestational age (GA) have both been associated with a heightened risk for developmental difficulties. However, in this population little is known about the combined effect and the influence of these risk factors on cortical structures and executive control. In the present study, 58 preterm-born children (GA ranging from 24.0 to 35.1 weeks) were administered the computerized Child Attention Network Task at 6 years of age. Brain magnetic resonance imaging was performed and analyzed using Voxel-Based Morphometry (VBM) in all children. At a behavioral level, boys born <28 weeks of GA had significantly less executive control than preterm-born girls <28 weeks (p = .001) and preterm-born boys ≥28 (p = .003). The reduced executive control in preterm-born boys <28 weeks gestation was related to lower cortical densities in the inferior frontal gyrus (IFG) and dorsolateral prefrontal cortex (DLPFC). The current study links the higher incidence of reduced executive control in preterm-born boys to a higher degree of prematurity (low GA) and identifies brain structural abnormalities in the prefrontal cortex related to these deficits. The implications of these results are discussed.

Perinatal medical variables predict executive function within a sample of preschoolers born very low birth weight

The goal was to identify perinatal predictors of early executive dysfunction in preschoolers born very low birth weight. Fifty-seven preschoolers completed 3 executive function tasks: Dimensional Change Card Sort-Separated (inhibition, working memory, and cognitive flexibility), Bear Dragon (inhibition and working memory), and Gift Delay Open (inhibition). Relationships between executive function and perinatal medical severity factors (gestational age, days on ventilation, size for gestational age, maternal steroids, and number of surgeries) and chronological age were investigated by multiple linear regression and logistic regression. Different perinatal medical severity factors were predictive of executive function tasks, with gestational age predicting Bear Dragon and Gift Open; and number of surgeries and maternal steroids predicting performance on Dimensional Change Card Sort-Separated. By understanding the relationship between perinatal medical severity factors and preschool executive outcomes, we can identify children at highest risk for future executive dysfunction, thereby focusing targeted early intervention services.

Neonatal neuronal apoptosis after betamethasone administration in pregnant Wistar rats

OBJECTIVE

To analyze the apoptosis of cortical and hippocampal neurons in newborn following the intramuscular administration of betamethasone in pregnant Wistar rats.

METHODS

Betamethasone or placebo was administered to 10 pregnant rats. Subsequently, 98 newborns were analyzed in three different groups: therapeutic dose (TD, 20 mg/kg), triple therapeutic dose (3TD, 60 mg/kg), and nine times TD (9TD, 180 mg/kg). Forty-four newborns were injected with placebo (control subjects--CTR). Neuronal apoptosis was measured by immunofluorescence using the TUNEL assay. The one-way analysis of variance, Tukey-Kramer (parametric) test and Kruskal-Wallis (non-parametric) test were used for statistical analysis.

RESULTS

The CA1 area of the hippocampus of TD and 3TD groups showed significant differences from that of the CTR group (p < 0.001). Compared to the CTR group, there was increased neuronal apoptosis in the dentate gyrus (DG) of animals in TD and 3TD groups (p < 0.0001). There were no significant differences in CA2 and CA3 regions as well as in amygdala and cortex.

CONCLUSION

Prenatal administration of betamethasone leads to significant changes in neuronal apoptosis in CA1 and DG regions.

Associations between maternal scaffolding and executive functioning in 3 and 4 year olds born very low birth weight and normal birth weight

BACKGROUND

Deficits in executive function, including measures of working memory, inhibition and cognitive flexibility, have been documented in preschoolers born very low birth weight (VLBW) compared with preschoolers born normal birth weight (NBW). Maternal verbal scaffolding has been associated with positive outcomes for both at-risk and typically developing preschoolers.

AIMS

The purpose of this study was to examine associations between maternal verbal scaffolding, Verbal IQ (VIQ) and executive function measures in preschoolers born VLBW.

SUBJECTS

A total of 64 VLBW and 40 NBW preschoolers ranging in age from 3 ½ to 4 years participated in the study.

OUTCOME MEASURES

VIQ was measured with the Wechsler Preschool and Primary Scale of Intelligence - Third Edition. Executive function tests included the Bear Dragon, Gift Delay Peek, Reverse Categorization and Dimensional Change Card Sort-Separated Dimensions.

STUDY DESIGN

Maternal verbal scaffolding was coded during a videotaped play session. Associations between maternal verbal scaffolding and preschoolers' measures of VIQ and executive function were compared. Covariates included test age, maternal education, and gender.

RESULTS

Preschoolers born VLBW performed significantly worse on VIQ and all executive function measures compared to those born NBW. Maternal verbal scaffolding was associated with VIQ for VLBW preschoolers and Gift Delay Peek for the NBW group. Girls born VLBW outperformed boys born VLBW on VIQ and Bear Dragon.

CONCLUSION

Integrating scaffolding skills training as part of parent-focused intervention may be both feasible and valuable for early verbal reasoning and EF development.

Neurodevelopmental outcomes of moderately preterm birth: precursors of attention deficit hyperactivity disorder at preschool age

Moderately preterm birth seems to be an evolutional risk condition at cognitive, behavioural and socio-relational levels. The study is aimed to investigate the likely occurrence of precursors of Attention Deficit Hyperactivity Disorder (ADHD) in moderately preterm children at preschool age. The research involved an experimental group made up of 50 moderately preterm children (mean: 34.6 weeks' gestational age, standard deviation [SD]: 2) without any medical and neurologic neonatal complications and low birth weight (mean:2100g., SD: 350g.) and a check group of 50 full term born children. Parents and teachers of children were administered specific questionnaires to detect ADHD. The outcomes show a risk of ADHD highlighting statically significant differences related to gender [F(2, 99) = 2.99, p = .04], birth [F(2, 99) = 9.6, p = .03] and interaction [F(2, 99) = 2.2, p = .01]. The moderately preterm children showed deficit in self-regulation [F(2, 99) = 1.14, p = .04] and attention deficit in daily life both in family [F(2, 99) = 7.8, p = .04] and school contexts [F(1, 99) = 3.3, p = .04]. The outcomes hint assessment paths aimed to monitor the aspects of cognitive, motor, behavioural development of moderately preterm children recognised as signs of problematic functioning profiles. Therefore, specific training will have been designed since preschool age in order to control the ADHD risk factors.

Early precursors of low attention and hyperactivity in moderately and very preterm children at preschool age

The low attention and hyperactivity are major morbidities associated with very and moderately preterm birth. The study has been aimed at investigating the likely occurrence of early precursors of Attention Deficit and Hyperactivity Disorder (ADHD) in very and moderately preterm children at preschool age. The involved children were: 25 very preterm children (M=29.4 weeks of gestational age, SD=2), with low birth weight (M=1200 g, SD=250 g); 35 moderately preterm children (M=34.6 weeks of gestational age, SD=1) with low birth weight (M=2100 g, SD=250 g); 60 healthy full-term children as the control group. Parents of children have been administered specific questionnaires to detect low attention and hyperactivity of their children at home. The data have shown the risk of precursors of ADHD, highlighting statistically significant birth-related differences in both hyperactivity/impulsivity [F(2,119)=3.5, P=0.03, η(2)=0.06] and inattention [F(2,119)=2.4, P=0.04, η(2)=0.04], where very preterm children have got higher scores in these two dimensions compared with full-term and moderately preterm children. The very preterm children have got higher scores of impulsivity and inattention than the full-term children (Tukey'HSD - Honestly Significant Difference; P<0.001).

Neonatal Intensive-Care Unit Graduates Show Persistent Difficulties in an Intra-Dimensional Shift Card Sort

Neonatal intensive-care unit (NICU) graduates, a group at risk for attention problems and ADHD, performed an intra-dimensional shift card sort at 34, 42, 51, and 60 months to assess executive function and to examine effects of individual risk factors. In the 'silly' game, children sorted cards (airplanes and dogs) so they were not the same as targets. In the 'same' game they did the opposite. Performance on the 'silly' game was poor, especially when it was presented first. Success in following 'silly' game rules improved with age, and was significantly linked to maternal education and birth weight for gestational age, a measure of intrauterine stress. Degree of CNS injury differentiated children who completed the task from children who did not, and also affected the need to repeat instructions in the 'same' game. These results confirm an increased likelihood of impairments in executive function during preschool years in NICU graduates.

Assessing independency in daily activities in very preterm children at preschool age

This study investigates whether very low birth weight (VLBW) preschoolers experience disability in daily activities and what the risk factors for disability in daily activities are. The Dutch Pediatric Evaluation of Disability Inventory (PEDI-NL) was used to detect disability in daily activities in 143 VLBW children without cerebral palsy (CP) at 44 months of corrected age (CA). Data from the psychomotor-developmental index (PDI) and the mental developmental index (MDI) of the Bayley Scales of Infant Development II (BSID II) at 24 months CA, and data relating to perinatal and socio-economic status were available. Disability in daily activities was found in 27 (19%) VLBW children without CP. High frequencies of disability were found in 19 (13%) children on the mobility domain and in 12 (8%) children on the social functioning domain. The multiple logistic regression analyses showed that low BSID II outcomes (<2 SD) were risk factors for disability in the mobility domain, but not for disability in the social functioning domain. The predictive value of the BSID II outcomes is moderate, 46% of the VLBW children with a low PDI and 44% with a low MDI developed a disability in the mobility domain. This study showed a higher frequency of disability in daily activities in VLBW preschoolers compared to term born peers. Therefore, it is suggested to assess VLBW children's performance of daily activities before they start school.

Emotional reactivity at 12 months in very preterm infants born at <29 weeks of gestation

The present study evaluated the socio-emotional development of very preterm born infants at 12 months corrected age. Forty-one infants born very preterm (<29 weeks of gestation) were compared to 22 infants born full term on a standardized behavioral assessment and a parental temperament questionnaire, both measuring emotional reactivity to joy, anger and fear, as well as sustained attention. The behavioral assessment showed that very preterm infants exhibited as much joy as full term infants during a joy-eliciting episode. However, they expressed a significantly higher reactivity in anger-eliciting situations and a reduced reactivity toward fear-eliciting situations. For all three emotion-eliciting situations, the preterm infants reacted with a higher level of motor activity. The preterm infants also exhibited a distinct attention pattern with a significantly higher initial attention level which declined rapidly throughout the episode. The questionnaire did not show any group differences. The clinical relevance of these results in terms of preliminary hallmarks of later behavioral difficulties such attention deficit/hyperactivity disorder are discussed as well as the inconsistencies observed between the questionnaire and the behavioral assessment.

Behavior Problems in Relation to Sustained Selective Attention Skills of Moderately Preterm Children

Attention skills may form an important developmental mechanism. A mediation model was examined in which behavioral problems of moderately preterm and term children at school age are explained by attention performance. Parents and teachers completed behavioral assessments of 348 moderately preterm children and 182 term children at 8 years of age. Children were administered a test of sustained selective attention. Preterm birth was associated with more behavioral and attention difficulties. Gestational age, prenatal maternal smoking, and gender were associated with mothers', fathers', and teachers' reports of children's problem behavior. Sustained selective attention partially mediated the relationship between birth status and problem behavior. Development of attention skills should be an important focus for future research in moderately preterm children.

The development of selective attention and inhibition in NICU graduates during the preschool years

Neonatal intensive care unit (NICU) graduates have a higher incidence of attention problems including attention deficit hyperactivity disorder (ADHD). Thus, we examined the effect of risk factors (birth weight (BW), central nervous system (CNS) injury, gender, maternal education) on attention/inhibition during reaction time, continuous performance and Go/No-Go tasks at 42, 51, and 60 months (n = 271). Very low BW NICU graduates (<1,500 g) performed worse than typical BW ones (>2,500 g), displaying poorer target/non-target discrimination. Males responded faster than females, but made more false alarms and random responses. Despite short duration tasks, attention waned. Performance improved with age, but even at 60 months children had difficulty inhibiting random responding.

Virtual environment to quantify the influence of colour stimuli on the performance of tasks requiring attention

Background

Recent studies indicate that the blue-yellow colour discrimination is impaired in ADHD individuals. However, the relationship between colour and performance has not been investigated. This paper describes the development and the testing of a virtual environment that is capable to quantify the influence of red-green versus blue-yellow colour stimuli on the performance of people in a fun and interactive way, being appropriate for the target audience.

Methods

An interactive computer game based on virtual reality was developed to evaluate the performance of the players.

The game's storyline was based on the story of an old pirate who runs across islands and dangerous seas in search of a lost treasure. Within the game, the player must find and interpret the hints scattered in different scenarios. Two versions of this game were implemented. In the first, hints and information boards were painted using red and green colours. In the second version, these objects were painted using blue and yellow colours. For modelling, texturing, and animating virtual characters and objects the three-dimensional computer graphics tool Blender 3D was used. The textures were created with the GIMP editor to provide visual effects increasing the realism and immersion of the players. The games were tested on 20 non-ADHD volunteers who were divided into two subgroups (A1 and A2) and 20 volunteers with ADHD who were divided into subgroups B1 and B2. Subgroups A1 and B1 used the first version of the game with the hints painted in green-red colors, and subgroups A2 and B2 the second version using the same hints now painted in blue-yellow. The time spent to complete each task of the game was measured.

Results

Data analyzed with ANOVA two-way and posthoc TUKEY LSD showed that the use of blue/yellow instead of green/red colors decreased the game performance of all participants. However, a greater decrease in performance could be observed with ADHD participants where tasks, that require attention, were most affected.

Conclusions

The game proved to be a user-friendly tool capable to detect and quantify the influence of color on the performance of people executing tasks that require attention and showed to be attractive for people with ADHD.

Early behaviour and development in breast-fed premature infants are influenced by omega-6 and omega-3 fatty acid status

BACKGROUND

The requirement of essential fatty acids (EFA) for the development of the brain is well documented.

OBJECTIVE

To investigate the early neurological development at term and 44 weeks gestational age in preterm infants in relation to EFA concentrations in breast milk and in infants' and mothers' plasma phospholipids.

METHOD

Fifty-one premature infants and their mothers were consecutively included in the study. The median gestational age was 34 weeks (range 24-36). The motor quality, motor and behavioural development were assessed by General Movements (GMs), the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) and a Self Regulation Scale.

RESULTS

Mother's education and gestational age correlated to several outcome variables. Multiple regression with correction for background factors showed negative associations between early breast milk concentrations of Mead acid and GMs and between AA and the BNBAS clusters Orientation and Range of States, respectively. Between 40 and 44 weeks gestational age, no expected increased scores were observed for Regulation of States, Range of States and Self Regulation. During the corresponding time, increased concentration of linoleic acid in mothers' plasma was negatively associated with improvement in Orientation and increased concentration of EPA in the infants' plasma was positively associated with improvement in Autonomic Stability.

CONCLUSIONS

The major omega-6 fatty acids and Mead acid were negatively associated with early development and omega-3 fatty acids positively associated. Mother's education and the gestational age influenced the outcome more strongly than mother's and infant's morbidities. Further follow-up will elucidate the significance of these early findings.

The development of effortful control in children born preterm

This prospective longitudinal study examined emerging effortful control skills at 24- and 36-months postterm in 172 children born preterm (<36 weeks gestation). Infant (neonatal health risks), family (sociodemographic risks), and maternal risk factors (depressive symptoms, anger expressions during play interactions) were assessed at six time points across 3 years. In addition, children's emerging effortful control skills, cognitive development, and mother-reported behavior and attention problems were assessed at 24 and 36 months. Analyses documented links between effortful control skills, cognitive skills, and concurrent attention problems in children born preterm. The study also found that preterm children's effortful control skills improved over time. In addition, neonatal health risks, family sociodemographic risks, and angry parenting interactions were associated with less optimal effortful control skills.

Fatty acid patterns early after premature birth, simultaneously analysed in mothers' food, breast milk and serum phospholipids of mothers and infants

Background

The supply of long-chain polyunsaturated fatty acids via the placenta is interrupted in premature infants, making them exclusively dependent on breast milk, which varies in fatty acid (FA) concentrations depending on the mother's diet.

Objective

To in a longitudinal study explore the relation between FA status in mothers and infants from an unselected cohort of prematures, not requiring intensive care.

Design

Breast milk and mothers' and infants' plasma phospholipid FA concentrations from birth to 44 weeks of gestational age were analysed and compared with mothers' food intake, assessed using a 3-day diary. Fatty acids were analysed by capillary gas-liquid chromatography.

Results

The energy intake was low in 75% of mothers, and 90% had low intake of essential FAs (EFAs). Dietary linoleic acid (LA, 18:2w6), but not w3 FAs, correlated to concentrations in breast milk. Infants' plasma and breast milk correlated for arachidonic (AA, 20:4w6), eicosapentaenoic (EPA, 20:5w3) and docosahexaenoic (DHA, 22:6w3) acids. A high concentration of mead acid (20:3w9) in the infants at birth correlated negatively to the concentrations of LA, AA and w3 FAs. Infants of mothers who stopped breastfeeding during the study period showed decreased DHA concentrations and increased w6/w3 ratios, with the opposite FA pattern seen in the mothers' plasma.

Conclusion

Although dietary w3 FAs were insufficient in an unselected cohort of mothers of premature infants, breastfeeding resulted in increased levels of DHA in the premature infants at the expense of the mothers, suggesting a general need to increase dietary w3 FAs during pregnancy and lactation.

Behavioral problems and cognitive performance at 5 years of age after very preterm birth: the EPIPAGE Study

OBJECTIVES

We compared the frequency of behavioral problems in very preterm and term children at 5 years of age. We hypothesized that behavioral problems would be associated with cognitive impairment and environmental factors and that differences between the 2 groups would be reduced but persist after adjusting for cognitive performance and environmental factors.

PATIENTS AND METHODS

The Etude Epidémiologique sur les Petits Ages Gestationnels (EPIPAGE) study was a prospective population-based cohort study that included all births occurring between 22 and 32 weeks' gestation and a control group of infants born at 39 to 40 weeks' gestation in 1997 in 9 French regions. Neonatal and obstetrics data were collected at birth. At 5 years of age, sociodemographic status and neurodevelopmental and cognitive development of the children, as well as maternal mental well-being, were assessed. The behavioral problems of 1102 very preterm and 375 term singletons without major impairments were studied by using the parent-completed Strengths and Difficulties Questionnaire.

RESULTS

Parents of very preterm children reported significantly more behavioral problems, with a twofold higher prevalence compared with term children for hyperactivity/inattention, emotional symptoms, and peer problems. Behavioral problems were associated with low cognitive performance, developmental delay, hospitalizations of the child, young maternal age, and poor maternal mental well-being. Very preterm children were still at higher risk of behavioral problems compared with term children after adjustment for cognitive performance and all others factors.

CONCLUSIONS

Behavioral problems were strongly related to cognitive impairment, but very preterm children were still at higher risk even after adjusting for cognitive performance. Early screening for behavioral problems should be encouraged for all very preterm children, and maternal well-being should also be the focus of special attention.

A Dialogue on the Future of Nursing Practice

PURPOSE

The challenges of health care; its safety, effectiveness, and efficiency; the quality of care; and the outcomes patients experience are issues central to nursing practice. This centrality needs to be affirmed as the profession shapes its practice over the next 50 years. The purpose of this article is to initiate a dialogue on the future of nursing practice.

METHODS

The methods used are observation, reflection, dialogue, and proposed actions.

FINDINGS

The results of this process are preliminary. They suggest that the establishment of nursing hospitals is a distinct possibility.

CONCLUSIONS

This article concludes with a series of arguments for and against this position along with an invitation for your participation in this dialogue.

NURSING IMPLICATIONS

The major implications of this article are not "nursing" implications per se but client and patient implications and the future contribution of nursing to improved health and patient care.

Vorboten hyperkinetischer Störungen - Früherkennung bereits im Säuglingsalter möglich?

Zusammenfassung: Fragestellung: Lassen sich auf der Grundlage der im Säuglingsalter erhobenen organischen und pyschosozialen Risikobelastung, der psychopathologischen Symptomatik, des kognitiven, motorischen und neurologischen Entwicklungsstandes sowie der Erziehungsbedingungen Kinder voneinander unterscheiden, die mit acht Jahren eine hyperkinetische Störung aufweisen bzw. unauffällig sind? Sind solche Vorboten hyperkinetischer Störungen für diese Störungsgruppe spezifisch? Methodik: Die 26 Grundschüler mit hyperkinetischen Störungen wurden 241 unauffälligen Grundschülern sowie 25 Kindern mit emotionalen Störungen und 30 Kindern mit Störungen des Sozialverhaltens gegenübergestellt und mit diesen im Hinblick auf Auffälligkeiten im Säuglingsalter verglichen. Ergebnisse: Als bedeutsamste Prädiktoren für spätere hyperkinetische Störungen erwiesen sich ein geringes Geburtsgewicht, die Herkunft der Mutter aus zerrütteten Verhältnissen, frühe Kontaktstörungen der Kinder sowie die Vernachlässigung der Säuglinge durch die Mutter. Schlussfolgerungen: Insgesamt bleibt die Vorhersage hyperkinetischer Grundschulkinder aus Auffälligkeiten im Säuglingsalter eher unbefriedigend und unspezifisch.

Vorboten hyperkinetischer Störungen - Früherkennung im Kleinkindalter

Zusammenfassung: Fragestellung: Im Rahmen der Mannheimer Risikokinderstudie wurde die Entwicklung von Kleinkindern bis ins Grundschulalter prospektiv verfolgt. Lassen sich auf der Grundlage der im Alter von zwei Jahren erhobenen psychopathologischen Symptomatik, des kognitiven, motorischen und neurologischen Entwicklungsstandes sowie der Erziehungsbedingungen Kinder voneinander unterscheiden, die mit acht Jahren eine hyperkinetische Störung aufweisen bzw. unauffällig sind? Sind solche Vorboten hyperkinetischer Störungen für diese Störungsgruppe spezifisch? Methode: Die 26 Grundschüler mit hyperkinetischen Störungen wurden 241 unauffälligen Grundschülern sowie 25 Kindern mit emotionalen Störungen und 30 Kindern mit Störungen des Sozialverhaltens gegenübergestellt und mit diesen im Hinblick auf Auffälligkeiten im Kleinkindalter verglichen. Ergebnisse: Als bedeutsamste Prädiktorkombination erwies sich die erhöhte motorische Unruhe und Irritierbarkeit sowie das verringerte Sprachverständnis der Zweijährigen mit hyperkinetischen Störungen im Grundschulalter. Schlussfolgerungen: Die Vorhersage hyperkinetischer Grundschulkinder gelingt im Kleinkindalter wie erwartet sicherer als im Säuglingsalter, ist jedoch in großen Teilen nicht spezifisch für hyperkinetische Auffälligkeiten.

Visual perceptual skills in children born with very low birth weights

INTRODUCTION

A disproportionate number of very low birth weight (VLBW; < or =1500 g) children require special education services and have school-related problems even when they are free from major disabilities and have average intelligence quotient scores. Visual-perceptual problems have been suggested as contributors to deficits in academic performance, but few data are available describing specific visual-perceptual problems. This study was designed to identify specific visual-perceptual skills in VLBW children.

METHOD

Participants were 92 VLBW children aged 4 through 5 years who were free from major disability and appropriate for gestational age at birth. The Test of Visual-Perceptual Skills (non-motor)-Revised was used.

RESULTS

Despite intelligent quotient scores in the average range, the majority (63% to 78.3%) of the children performed below age level on all seven subscales of a normed assessment of visual perceptual skills.

DISCUSSION

Results suggest that visual perceptual screening should be considered as a part of routine evaluations of preschool-aged children born prematurely. Early identification of specific deficits could lead to interventions to improve achievement trajectories for these high-risk children.