Arithmetic processing in children with spina bifida: Calculation accuracy, strategy use, and fact retrieval fluency

A scoping review of cognition in spina bifida and its consequences for activity and participation throughout life

Aim

The aim of this scoping review was to summarise findings concerning cognitive characteristics in people with spina bifida and explain how cognitive factors influence activities and participation in different areas and stages of life.

Methods

PubMed, Psych INFO, ERIC, Scopus, CINAHL and the Cochrane Library were searched for English language papers published in 2000–2018. A total of 92 papers were selected and quality was assessed according to the McMaster criteria. The results were presented related to body functions, activity and participation from the International Classification of Function and Health, ICF.

Results

People with spina bifida tended to have a lower IQ than those without. The majority also had cognitive difficulties manifested in problems with language, perception, memory, executive and attentional functions. Those difficulties affected activity and participation in all life domains in ICF. This may affect medical adherence and responsibility and by extension the prevention of secondary complications.

Conclusion

It is important for caregivers, professionals and especially individuals with spina bifida themselves to understand and handle both physical and cognitive consequences in all life circumstances. Having insight into one’s own assets and difficulties paves the way to managing life challenges, which could enhance health, self‐management and participation in society.

Exploratory study of the provision of academic and health-related accommodations to transition-age adolescents and emerging adults with spina bifida

PURPOSE

The purpose of this exploratory study was to investigate the types of academic and health-related accommodations provided to adolescents and emerging adults with spina bifida aged 9-20 years.

METHODS

Data were extracted from the paper and electronic records of transition-age youth enrolled in the study. Four open ended items involved content analysis.

RESULTS

The most frequently identified accommodation was enrollment in special education classes in 47.7% of the charts. Other academic accommodations that were most often reported were adaptive physical education (n = 71, 39.9%), tutoring (n = 28; 15.7%), and home schooling (n = 21; 11.8%). Clean intermittent catheterization was the most frequently identified health-related accommodation provided by the school nurse/aide (n = 57; 32%).The largest percentage of requests for additional accommodations were made during the middle school grades (15; 54.8%) followed by high school (10; 32.2%).

CONCLUSION

Findings demonstrated that persistent issues were identified by parents/adolescents regarding the provision of school-related accommodations. This is a relevant area for clinical practice to ensure students with special health care needs and those with spina bifida receive the academic and health-related accommodations in their Individualized Education Program/504 plans.

Academic achievement and needs of school-aged children born with selected congenital anomalies: A systematic review and meta-analysis

Children with congenital anomalies have poorer intellectual and cognitive development compared to their peers, but evidence for academic achievement using objective measures is lacking. We aimed to summarize and synthesize evidence on academic outcomes and special education needs (SEN) of school‐aged children born with selected major structural congenital anomalies. Electronic databases (MEDLINE, EMBASE, Scopus, PsycINFO, CINAHL, ProQuest Natural Science and Education Collections), reference lists and citations for 1990–2020 were systematically searched. We included original‐research articles on academic achievement in children with non‐syndromic congenital anomalies that involved school test results, standardized tests and/or SEN data. Random‐effects meta‐analyses were performed to estimate pooled mean test scores in mathematics and/or reading where possible and pooled odds ratios (ORs) for SEN in children with severe congenital heart defects (CHDs) and children with orofacial clefts (OFCs). Thirty‐nine eligible studies (n = 21,066 children) were synthesized narratively. Sixteen studies were included in meta‐analyses. Children with non‐syndromic congenital anomalies were at a higher risk of academic underachievement than controls across school levels. Children with severe CHD (pooled OR = 2.32, 95% CI: 1.90, 2.82), and children with OFC (OR = 1.38 (95% CI: 1.20, 1.57), OR = 3.07 (95% CI: 2.65, 3.56), and OR = 3.96 (95% CI: 3.31, 4.72) for children with cleft lip, cleft palate and cleft lip/palate, respectively) had significantly higher ORs for SEN than controls. Children with non‐syndromic congenital anomalies underperform academically and have higher SEN rates compared to their peers. Early monitoring and development of differential SEN are important to promote academic progress in these children.

Cognitive and motor function in adults with spina bifida myelomeningocele: a pilot study

PURPOSE

Determine the feasibility and utility of using a battery of tests utilized, so far, to assess neurological-cognitive functions in the typical adult population and identify the spectrum of these functions in adult SBM patients.

METHODS

Prospective study in which 15 participants (mean age = 28.7 ± 8.7 years, range = 19-45 years) completed the targeted battery of tests (n = 5-15/test) previously standardized to the general population. Results were compared with normative data.

RESULTS

Statistically significant differences with normative means were noted in the following tests: Montreal Cognitive Assessment (MoCA), Functional Activities Questionnaire (FAQ), and NIH Toolbox Fine Motor (Dexterity and Grip Strength) tests. Cohort means for NIH Toolbox Fluid, Crystallized, and Cognitive Composite Scores and Timed Up and GO (TUG) were not different from normative means.

CONCLUSION

All tests were successfully completed by cohort. Whereas many aspects of cognition were normal, tests assessing visual-constructural, calculation, motor, and fluency functions did show differences from population means. Numerous tests assessing multiple domains are needed and can be used in future aging studies to appreciate the spectrum of cognitive and motor abilities in adults with SBM.

Magnitude processing in populations with spina-bifida: The role of visuospatial and working memory processes

People with Spina Bifida usually experience difficulties with mathematics. In a series of other developmental disorders, a magnitude processing deficit was considered to be the main source of subsequent difficulties in mathematics. The processing of magnitude could be numerical (which is the larger number) or non-numerical such as spatial (e.g., which is the longer?) or temporal (which one last longer?) for instance. However, no study yet has examined directly magnitude processes in a population with Spina Bifida. On the other hand, recent studies in people with genetic syndromes have suggested that visuospatial and working memory processes play an important role in magnitude processing, including number magnitude. Therefore, in this study we explored for the first time magnitude representation using several tasks with different visuospatial and working memory processing requirements, cognitive skills frequently impaired in Spina Bifida. Results showed children with SB presented a global magnitude processing deficit for non-numerical and numerical comparison tasks, but not in symbolic number magnitude tasks compared to controls. Importantly, visuospatial skills and working memory abilities could partially explain the differences between groups in comparison and estimation tasks. This study proposes that magnitude processing difficulties in children with SB could be due to higher cognitive factors such as visuospatial and working memory processes.

Specific Mental Arithmetic Difficulties and General Arithmetic Learning Difficulties: The Role of Phonological Working Memory

The aim of this paper was to examine the role of phonological working memory in specific mental arithmetic difficulties and general arithmetic learning difficulties (ALD; difficulties presenting in both mental arithmetic and written arithmetic). In Study 1, we categorized 53 sixth graders into a control group, a group with specific mental arithmetic difficulties, and a group with general ALD. The findings indicated the group with specific mental arithmetic difficulties performed significantly worse on the task involving phonological working memory than did the control group. However, a significant difference was not found between the group with general ALD and the control group. In Study 2 involving 54 sixth graders, we decreased the load of phonological working memory by changing the format of the problems from horizontal (more reliance on phonological codes) to vertical (more reliance on visual resources). We found that the group with specific mental arithmetic difficulties performed comparably to the control group. In other words, when the working memory load is reduced, they no longer lag significantly behind on mental arithmetic. However, the group with general ALD still performed significantly worse than the control group when the problems were presented vertically, indicating that reduced phonological working memory load did not alleviate their arithmetic difficulties. The findings in both studies suggested that poor phonological working memory might contribute to the underlying mechanism for specific mental arithmetic difficulties but not as much for general ALD.

Neuropsychological care guidelines for people with spina bifida

While the neuropsychological profile for individuals with Spina Bifida (SB) can vary, often certain patterns of strengths and weaknesses are evident across the lifespan. Understanding variability related to neural structure, genetics, ethnicity, and the environment is key to understanding individual differences in outcomes and can be vital in planning interventions and tracking progress. This article outlines the SB Guideline for the Neuropsychological Care of People with Spina Bifida from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida and acknowledges that further research in SB neurocognitive profiles is warranted.

Role of Neurocognitive Factors in Academic Fluency for Children and Adults With Spina Bifida Myelomeningocele

OBJECTIVES

Fluency is a major problem for individuals with neurodevelopmental disorders, including fluency deficits for academic skills. The aim of this study was to determine neurocognitive predictors of academic fluency within and across domains of reading, writing, and math, in children and adults, with and without spina bifida. In addition to group differences, we expected some neurocognitive predictors (reaction time, inattention) to have similar effects for each academic fluency outcome, and others (dexterity, vocabulary, nonverbal reasoning) to have differential effects across outcomes.

METHODS

Neurocognitive predictors were reaction time, inattention, dexterity, vocabulary, and nonverbal reasoning; other factors included group (individuals with spina bifida, n=180; and without, n=81), age, and demographic and untimed academic content skill covariates. Univariate and multivariate regressions evaluated hypotheses.

RESULTS

Univariate regressions were significant and robust (R 2 =.78, .70, .73, for reading, writing, and math fluency, respectively), with consistent effects of covariates, age, reaction time, and vocabulary; group and group moderation showed small effect sizes (<2%). Multivariate contrasts showed differential prediction across academic fluency outcomes for reaction time and vocabulary.

CONCLUSIONS

The novelty of the present work is determining neurocognitive predictors for an important outcome (academic fluency), within and across fluency domains, across population (spina bifida versus typical), over a large developmental span, in the context of well-known covariates. Results offer insight into similarities and differences regarding prediction of different domains of academic fluency, with implications for addressing academic weakness in spina bifida, and for evaluating similar questions in other neurodevelopmental disorders. (JINS, 2019, 25, 249-265).

Place-value computation in children with mathematics difficulties

Recent research has provided initial evidence that children with math difficulties (MD) experience problems in processing place-value information in basic numerical tasks. However, it remains unclear whether these problems generalize to basic arithmetic operations. For instance, multi-digit addition problems with carryover specifically require the computation of place-value information. Yet little is known about the carry effect in children with MD. Therefore, the current study investigated whether problems in processing place-value information among third-grade children with MD (n = 29 9-year-olds) compared with an age-matched control group (n = 50) generalize to two-digit addition. The results indicate an increased carry effect for response latencies and error rates in children with MD. These findings suggest that deficits in processing place-value information among children with MD generalize to place-value computations in multi-digit arithmetic. Potential contributions of strategy use and working memory for difficulties in processing place-value information are discussed.

Fetal surgery for spina bifida aperta

Spina bifida aperta (SBA) is one of the most common congenital malformations. It can cause severe lifelong physical and neurodevelopmental disabilities. Experimental and clinical studies have shown that the neurological deficits associated with SBA are not simply caused by incomplete neurulation at the level of the lesion. Additional damage is caused by prolonged exposure of the spinal cord and nerves to the intrauterine environment and a suction gradient due to cerebrospinal fluid leakage, leading to progressive downward displacement of the hindbrain. This natural history can be reversed by prenatal repair. A randomised controlled trial demonstrated that mid-gestational maternal-fetal surgery for SBA decreases the need for ventriculoperitoneal shunting and hindbrain herniation at 12 months and improves neurological motor function at 30 months of age. This came at the price of maternal and fetal risks, the most relevant ones being increased prematurity and a persistent uterine corporeal scar. Recently minimally invasive fetal approaches have been introduced clinically yet they lack extensive experimental or clinical trials. We aim to provide clinicians with the essential information necessary to counsel SBA parents as the basis for considering referral of selected patients to expert fetal surgery centres. We review the reported clinical outcomes and discuss recent developments of potentially less invasive fetal SBA approaches.

Profiles of Neuropsychological Functioning in Children and Adolescents with Spina Bifida: Associations with Biopsychosocial Predictors and Functional Outcomes

OBJECTIVES

The current study examined neuropsychological performance among children with spina bifida (SB) to determine biological and functional correlates of distinct "profiles" of cognitive functioning.

METHODS

A total of 95 children with SB myelomeningocele (ages, 8-15 years) completed a neuropsychological assessment battery. Hierarchical and non-hierarchical cluster analyses were used to identify and confirm a cluster solution. Hypothesized predictors of cluster membership included lesion level, number of shunt surgeries, history of seizures, age, ethnicity, socio-economic status, and family stress. Outcomes included independence, academic success, expectations for the future, and quality of life.

RESULTS

Ward's cluster method indicated a three-cluster solution, and was replicated with two other cluster analytic methods. The following labels were applied to the clusters: "average to low average" (n=39), "extremely low to borderline" (n=27), and "broadly average with verbal strength" (n=29). Socio-econimc status, lesion level, and seizure history significantly predicted group membership. Cluster membership significantly predicted independence, academic success, parent expectations for the future, and child reported physical quality of life.

CONCLUSIONS

Findings from this study suggest qualitatively different cognitive profiles exist among children with SB, and the relevance of neuropsychological functioning for day-to-day adaptive functioning and quality of life. Clinical implications and future research are discussed. (JINS, 2016, 22, 804-815).

Neurocognitive predictors of mathematical processing in school-aged children with spina bifida and their typically developing peers: Attention, working memory, and fine motor skills

OBJECTIVE

Math and attention are related in neurobiological and behavioral models of mathematical cognition. This study employed model-driven assessments of attention and math in children with spina bifida myelomeningocele (SBM), who have known math difficulties and specific attentional deficits, to more directly examine putative relations between attention and mathematical processing. The relation of other domain general abilities and math was also investigated.

METHOD

Participants were 9.5-year-old children with SBM (n = 44) and typically developing children (n = 50). Participants were administered experimental exact and approximate arithmetic tasks, and standardized measures of math fluency and calculation. Cognitive measures included the Attention Network Test (ANT), and standardized measures of fine motor skills, verbal working memory (WM), and visual-spatial WM.

RESULTS

Children with SBM performed similarly to peers on exact arithmetic, but more poorly on approximate and standardized arithmetic measures. On the ANT, children with SBM differed from controls on orienting attention, but not on alerting and executive attention. Multiple mediation models showed that fine motor skills and verbal WM mediated the relation of group to approximate arithmetic; fine motor skills and visual-spatial WM mediated the relation of group to math fluency; and verbal and visual-spatial WM mediated the relation of group to math calculation. Attention was not a significant mediator of the effects of group for any aspect of math in this study.

CONCLUSION

Results are discussed with reference to models of attention, WM, and mathematical cognition.

The role of urodynamic studies in the diagnosis and treatment of patients with spina bifida

AIM

Spina bifida (SB) is a congenital deformity that is frequently seen in infancy. Surgical treatment and clinical follow-up of patients with the diagnosis of SB are important to provide education to the patients and their relatives, to increase patient survival, to ensure that they have a more comfortable life. Neuro-urological problems are highly important for the patients in terms of both social and medical.

MATERIALS AND METHODS

The medical records of patients who underwent surgery for SB and tethered cord syndrome at our clinic in the past year were retrospectively evaluated. The results of urodynamic studies of the patients were evaluated. The results of patients who underwent control urodynamic studies during the follow-up period were compared with the previous results, and their clinical courses were determined.

RESULTS

The most frequent urodynamic changes in patients were hyperactive detrusor activity and detrusor sphincter dyssynergy preoperatively.

CONCLUSION

A significant improvement was observed when the results of postoperative urodynamic studies were evaluated in patients who underwent surgery for tethered cord.

Functional plasticity in childhood brain disorders: when, what, how, and whom to assess

At every point in the lifespan, the brain balances malleable processes representing neural plasticity that promote change with homeostatic processes that promote stability. Whether a child develops typically or with brain injury, his or her neural and behavioral outcome is constructed through transactions between plastic and homeostatic processes and the environment. In clinical research with children in whom the developing brain has been malformed or injured, behavioral outcomes provide an index of the result of plasticity, homeostasis, and environmental transactions. When should we assess outcome in relation to age at brain insult, time since brain insult, and age of the child at testing? What should we measure? Functions involving reacting to the past and predicting the future, as well as social-affective skills, are important. How should we assess outcome? Information from performance variability, direct measures and informants, overt and covert measures, and laboratory and ecological measures should be considered. In whom are we assessing outcome? Assessment should be cognizant of individual differences in gene, socio-economic status (SES), parenting, nutrition, and interpersonal supports, which are moderators that interact with other factors influencing functional outcome.

Mathematics development and difficulties: the role of visual-spatial perception and other cognitive skills

Several neurocognitive abilities, including visual-spatial and language-based processes, attention, and fine motor/finger skills, are thought to play important roles in mathematical development and disability. Evidence for relations of specific neurocognitive skills and mathematical development and disability is presented, with a particular emphasis on findings from longitudinal studies. Why these particular neurocognitive skills are related to math is also discussed. We suggest that mathematics learning in children with congenital and acquired neurodevelopmental disorders, including children treated for cancer, is particularly vulnerable to disruption because these disorders often affect one or more of the neurocognitive systems that support math learning and performance. Implications for assessment of and interventions for math difficulties are discussed. The article ends with implications for mathematical functioning in children treated for acute lymphoblastic leukemia and brain tumors.

[Maternal-fetal surgery for spina bifida: future perspectives]

Open spina bifida or myelomeningocele (MMC) is a frequent congenital abnormality (450 cases per year in France) associated with high morbidity. Immediate postnatal surgery is aimed at covering the exposed spinal cord, preventing infection, treating hydrocephalus with a ventricular shunt. MMC surgical techniques haven't achieved any major progress in the past decades. Numerous experimental and clinical studies have demonstrated the MMC "two-hit" hypothetic pathogenesis: a primary embryonic congenital abnormality of the nervous system due to a failure in the closure of the developing neural tube, followed by secondary damages of spinal cord and nerves caused by long-term exposure to amniotic fluid. This malformation frequently develops cranial consequences, i.e. hydrocephalus and Chiari II malformation, due to leakage of cerebrospinal fluid. After 30 years of research, a randomized trial published in February 2011 proved open maternal-fetal surgery (OMFS) for MMC to be a real therapeutic option. Comparing prenatal to postnatal surgery, it confirmed better outcomes of MMC children after a follow up of 2.5 years: enhancement of lower limb motor function, decrease of the degree of hindbrain herniation associated with the Chiari II malformation and the need for shunting. At 5 years of age, MMC children operated prenatally seems to have better neurocognitive, motor and bladder-sphincter outcomes than those operated postnatally. However, risks of OMFS exist: prematurity for the fetus and a double hysterotomy at approximately 3-month interval for the mother. Nowadays, it seems crucial to inform parents of MMC patients about OMFS and to offer it in France. Future research will improve our understanding of MMC pathophysiology and evaluate long-term outcomes of OMFS. Tomorrow's prenatal surgery will be less invasive and more premature using endoscopic, robotic or percutaneous techniques. Beforehand, Achilles' heel of maternal-fetal surgery, i.e. preterm premature rupture of membranes, preterm labor and preterm birth, must be solved.

Longitudinal mediators of achievement in mathematics and reading in typical and atypical development

Longitudinal studies of neurodevelopmental disorders that are diagnosed at or before birth and are associated with specific learning difficulties at school-age provide one method for investigating developmental precursors of later-emerging academic disabilities. Spina bifida myelomeningocele (SBM) is a neurodevelopmental disorder associated with particular problems in mathematics, in contrast to well-developed word reading. Children with SBM (n=30) and typically developing children (n=35) were used to determine whether cognitive abilities measured at 36 and 60 months of age mediated the effect of group on mathematical and reading achievement outcomes at 8.5 and 9.5 years of age. A series of multiple mediator models showed that: visual-spatial working memory at 36 months and phonological awareness at 60 months partially mediated the effect of group on math calculations, phonological awareness partially mediated the effect of group on small addition and subtraction problems on a test of math fluency, and visual-spatial working memory mediated the effect of group on a test of math problem solving. Groups did not differ on word reading, and phonological awareness was the only mediator for reading fluency and reading comprehension. The findings are discussed with reference to theories of mathematical development and disability and with respect to both common and differing cognitive correlates of math and reading.

Mathematical outcomes and working memory in children with TBI and orthopedic injury

This study compared mathematical outcomes in children with predominantly moderate to severe traumatic brain injury (TBI; n550) or orthopedic injury (OI; n547) at 2 and 24 months post-injury. Working memory and its contribution to math outcomes at 24 months post-injury was also examined. Participants were administered an experimental cognitive addition task and standardized measures of calculation, math fluency, and applied problems; as well as experimental measures of verbal and visual-spatial working memory. Although children with TBI did not have deficits in foundational math fact retrieval, they performed more poorly than OIs on standardized measures of math. In the TBI group, performance on standardized measures was predicted by age at injury, socioeconomic status, and the duration of impaired consciousness. Children with TBI showed impairments on verbal, but not visual working memory relative to children with OI. Verbal working memory mediated group differences on math calculations and applied problems at 24 months post-injury. Children with TBI have difficulties in mathematics, but do not have deficits in math fact retrieval, a signature deficit of math disabilities. Results are discussed with reference to models of mathematical cognition and disability and the role of working memory in math learning and performance for children with TBI.

Curvas de referência de pontos brutos no Stanford-Binet Intelligence Scale de crianças e adolescentes

O trabalho teve como objetivo construir curvas de referência de pontos brutos das Áreas e do Total do Stanford-Binet em crianças e adolescentes paulistanos. Foram avaliadas individualmente 257 crianças e adolescentes, com idade média de 5 anos e 10 meses, sendo 130 (50,58%) do sexo feminino e 127 (49,42%) do sexo masculino, todas frequentadoras de Escolas Públicas de Educação Infantil e Fundamental, de diferentes regiões da cidade de São Paulo. O teste foi aplicado individualmente na própria escola das crianças, sempre a partir do primeiro item, independentemente da idade da criança. Os participantes foram agrupados por idade; calcularam-se medidas descritivas para cada faixa etária desta população. Foram confeccionadas curvas de referência para Áreas e Total do Stanford Binet com os pontos brutos obtidos. Os pontos brutos foram distribuídos de acordo com a curva normal.

Symbolic and non-symbolic number magnitude processing in children with developmental dyscalculia

The aim of this study was to evaluate if children with Developmental Dyscalculia (DD) exhibit a general deficit in magnitude representations or a specific deficit in the connection of symbolic representations with the corresponding analogous magnitudes. DD was diagnosed using a timed arithmetic task. The experimental magnitude comparison tasks were presented in non-symbolic and symbolic formats. DD and typically developing (TD) children showed similar numerical distance and size congruity effects. However, DD children performed significantly slower in the symbolic task. These results are consistent with the access deficit hypothesis, according to which DD children's deficits are caused by difficulties accessing magnitude information from numerical symbols rather than in processing numerosities per se.

Psycholinguistic and scholastic abilities in children with myelomeningocele

PURPOSE

To describe the performance of individuals with myelomeningocele regarding psycholinguistic and scholastic abilities.

METHODS

Participants were five individuals with myelomeningocele and lumbar sacral abnormalities, and chronological age between 9 years and 10 months and 11 years and 7 months (Group 1 - G1); five subjects with typical development (Group 2 - G2), matched to G1 for age, gender, and educational level. The evaluation consisted of interview with parents/caregivers, and application of the following tests: Illinois Test of Psycholinguistic Abilities (ITPA); School Performance Test; Speed Reading Test; and Rapid Automatized Naming Test.

RESULTS

The between-groups comparison in the ITPA subtests showed that the maximum values obtained by G1 corresponded approximately to the minimum values obtained by G2, confirming the difference between the groups, except for the auditory closure subtest. In the Scholastic Performance Test, significant alterations were observed on the performance of G1 in all tasks. In the Speed Reading and Rapid Automatized Naming tests, individuals in G1 also presented considerable deficits, making more mistakes and spending more time than G2 to perform the same tasks.

CONCLUSION

Individuals with myelomeningocele present deficits in psycholinguistic abilities, school performance, reading speed, and rapid automatized naming.

Desempenho psicolinguístico e escolar de irmãos com mielomeningocele

TEMA: mielomeningocele e consequências para o desenvolvimento de habilidades psicolinguísticas e escolares. PROCEDIMENTOS: o objetivo deste estudo foi descrever e refletir sobre o desempenho psicolinguístico e escolar de irmãos com mielomeningocele lombar baixa. Participaram do estudo um menino de 14 anos e 5 meses (P1) e sua irmã de 6 anos e 6 meses (P2). Os procedimentos constaram de entrevista com familiares, Observação do Comportamento Comunicativo (OCC), Teste de Vocabulário por Imagens Peabody - TVIP, Teste Illinóis de Habilidades Psicolinguísticas (ITPA), Perfil de Habilidades Fonológicas (PHF), Teste de Desempenho Escolar (TDE), e Reconhecimento de letras e números (RLN). A análise dos resultados foi descritiva respeitando os manuais dos instrumentos. RESULTADOS: a linguagem oral encontra-se sem alteração evidente. No ITPA e PHF, verificou-se que P1 e P2 apresentaram dificuldade nas habilidades de memória, closura auditiva, expressão verbal, combinação de sons e consciência fonológica. P1 ainda apresentou dificuldade na habilidade de recepção visual e P2 nas habilidades de associação auditiva e closura gramatical. Ambas as crianças apresentaram alteração nas atividades de aprendizagem. CONCLUSÃO: os participantes do estudo apresentaram comportamento comunicativo, habilidades de linguagem oral e vocabulário receptivo sem alterações evidentes. P1 e P2 apresentaram alterações nas habilidades psicolinguísticas bem como no desempenho de atividades envolvendo leitura, escrita e aritmética. As dificuldades apresentadas causam impacto importante nas atividades acadêmicas, demonstrando vulnerabilidade cerebral no sistema de suporte para atividade de aprendizagem.

Mathematical skills in 3- and 5-year-olds with spina bifida and their typically developing peers: a longitudinal approach

Preschoolers with spina bifida (SB) were compared to typically developing (TD) children on tasks tapping mathematical knowledge at 36 months (n = 102) and 60 months of age (n = 98). The group with SB had difficulty compared to TD peers on all mathematical tasks except for transformation on quantities in the subitizable range. At 36 months, vocabulary knowledge, visual-spatial, and fine motor abilities predicted achievement on a measure of informal math knowledge in both groups. At 60 months of age, phonological awareness, visual-spatial ability, and fine motor skill were uniquely and differentially related to counting knowledge, oral counting, object-based arithmetic skills, and quantitative concepts. Importantly, the patterns of association between these predictors and mathematical performance were similar across the groups. A novel finding is that fine motor skill uniquely predicted object-based arithmetic abilities in both groups, suggesting developmental continuity in the neurocognitive correlates of early object-based and later symbolic arithmetic problem solving. Models combining 36-month mathematical ability and these language-based, visual-spatial, and fine motor abilities at 60 months accounted for considerable variance on 60-month informal mathematical outcomes. Results are discussed with reference to models of mathematical development and early identification of risk in preschoolers with neurodevelopmental disorder.

The cognitive phenotype of spina bifida meningomyelocele

A cognitive phenotype is a product of both assets and deficits that specifies what individuals with spina bifida meningomyelocele (SBM) can and cannot do and why they can or cannot do it. In this article, we review the cognitive phenotype of SBM and describe the processing assets and deficits that cut within and across content domains, sensory modality, and material, including studies from our laboratory and other investigations. We discuss some implications of the SBM cognitive phenotype for assessment, rehabilitation, and research.

Preschool neurodevelopmental outcome of children following fetal myelomeningocele closure

OBJECTIVE

We sought to investigate the preschool neurodevelopmental outcomes of children following fetal myelomeningocele (fMMC) surgery.

STUDY DESIGN

Prior to the Management of Myelomeningocele Study trial, 54 children underwent fMMC closure at our institution. Thirty (56%) returned at 5 years of age for standardized neurocognitive examination. Scores were grouped as high-average, average, mildly delayed, and severely delayed by SD intervals.

RESULTS

Mean verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ), and full intelligence quotient (FIQ) scores were within normal population range. High-average or average scores for VIQ, PIQ, FIQ, and processing speed were found in 93%, 90%, 90%, and 60%, respectively. Mean FIQ and processing speed of nonshunted children were significantly higher than for those who required shunt placement (P=.02 and P=.01, respectively). Mean VIQ and PIQ tended to be higher in nonshunted fMMC children (P=.05).

CONCLUSION

The majority of fMMC children in this highly selective population had average preschool neurodevelopmental scores. fMMC children who did not require shunt placement were more likely to have better scores.

Errors in multi-digit arithmetic and behavioral inattention in children with math difficulties

Errors in written multi-digit computation were investigated in children with math difficulties. Third- and fourth-grade children (n = 291) with coexisting math and reading difficulties, math difficulties, reading difficulties, or no learning difficulties were compared. A second analysis compared those with severe math learning difficulties, low average achievement in math, and no learning difficulties. Math fact errors were related to the severity of the math difficulties, not to reading status. Contrary to predictions, children with poorer reading, regardless of math achievement, committed more visually based errors. Operation switch errors were not systematically related to group membership. Teacher ratings of behavioral inattention were related to accuracy, math fact errors, and procedural bugs. The findings are discussed with respect to hypotheses about the cognitive origins of arithmetic errors and in relation to current discussions about how to conceptualize math disabilities.

Mathematical development in spina bifida

Spina bifida (SB) is a neural tube defect diagnosed before or at birth that is associated with a high incidence of math disability often without co-occurring difficulties in reading. SB provides an interesting population within which to examine the development of mathematical abilities and disability across the lifespan and in relation to the deficits in visual-spatial processing that are also associated with the disorder. An overview of math and its cognitive correlates in preschoolers, school-age children and adults with SB is presented including the findings from a longitudinal study linking early executive functions in infancy to the development of later preschool and school age math skills. These findings are discussed in relation to socio-historical perspectives on math education and implications for intervention and directions for further research are presented.

Characteristics of a spina bifida population including North American Caucasian and Hispanic individuals

BACKGROUND

Meningomyelocele (MM) is a common human birth defect. MM is a disorder of neural development caused by contributions from genes and environmental factors that result in the NTD and lead to a spectrum of physical and neurocognitive phenotypes.

METHODS

A multidisciplinary approach has been taken to develop a comprehensive understanding of MM through collaborative efforts from investigators specializing in genetics, development, brain imaging, and neurocognitive outcome. Patients have been recruited from five different sites: Houston and the Texas-Mexico border area; Toronto, Canada; Los Angeles, California; and Lexington, Kentucky. Genetic risk factors for MM have been assessed by genotyping and association testing using the transmission disequilibrium test.

RESULTS

A total of 509 affected child/parent trios and 309 affected child/parent duos have been enrolled to date for genetic association studies. Subsets of the patients have also been enrolled for studies assessing development, brain imaging, and neurocognitive outcomes. The study recruited two major ethnic groups, with 45.9% Hispanics of Mexican descent and 36.2% North American Caucasians of European descent. The remaining patients are African-American, South and Central American, Native American, and Asian. Studies of this group of patients have already discovered distinct corpus callosum morphology and neurocognitive deficits that associate with MM. We have identified maternal MTHFR 667T allele as a risk factor for MM. In addition, we also found that several genes for glucose transport and metabolism are potential risk factors for MM.

CONCLUSIONS

The enrolled patient population provides a valuable resource for elucidating the disease characteristics and mechanisms for MM development.

The relationship of neuropsychological functioning to adaptation outcome in adolescents with spina bifida

Adolescents with spina bifida (SB) vary in their ability to adapt to the disease, and it is likely that numerous risk and protective factors affect adaptation outcomes. The primary aim was to test neuropsychological impairment, exemplified herein by executive dysfunction, as a risk factor in the Ecological Model of Adaptation for Adolescents with SB. Specific hypotheses were that: (1) executive functioning predicts the adaptation outcome of functional independence in adolescents with SB; (2) executive functioning mediates the impact of neurological severity on functional independence; and (3) family and adolescent protective factors are related to functional independence and moderate the relationship between executive functioning and functional independence. Forty-three adolescents aged 12-21 years completed neuropsychological measures and an interview that assessed risk, adolescent and family protective factors, and functional independence. Age, level of lesion, executive functioning, and the protective factor adolescent activities were significantly correlated with the functional independence outcome. In hierarchical regression analysis, the model accounted for 61% of the variance in functional independence outcomes. Executive functioning mediated the impact of neurological severity on functional independence.

Using kindergarten number sense to predict calculation fluency in second grade

Children's number sense in kindergarten was used to predict their calculation fluency in second grade (N = 198). Using block entry regression, usual predictors of age, reading, memory, and verbal and spatial cognition were entered in the first block and number sense measures were added in the second block. Number sense measures contributed a significant amount of variance over and above the more general predictors (26%-42%). Uniquely predictive subareas were active memory for numbers, number knowledge, and number combinations, with number combinations standing out as the strongest single predictor. Number sense screening in kindergarten, using "at-risk" versus "not-at-risk" criteria, successfully ruled out 84% of the children who did not go on to have calculation fluency difficulties and positively identified 52% of the children who later showed fluency difficulties. The relation of early number skills to later calculation fluency has important implications for math screening and intervention.

Factors of biological risk and reserve associated with executive behaviors in children and adolescents with spina bifida myelomeningocele

This study examined differences between healthy children (n = 35) and those with spina bifida myelomeningocele (SBM; n = 42) on the Behavior Rating Inventory of Executive Function (BRIEF), a measure of executive function behaviors. It also examined whether aspects of biological risk associated with SBM and reserve factors within the family could account for variability in BRIEF scores for children and adolescents with SBM. Patients in the SBM group exhibited more problems than both published norms and a local comparison group of healthy children in metacognition but not behavior regulation. Behavior regulation problems in children with SBM were predicted by parent psychological distress. More shunt-related surgeries and history of seizures predicted poorer metacognitive abilities.

A model of comprehension in spina bifida meningomyelocele: meaning activation, integration, and revision

Spina bifida meningomyelocele (SBM) is a neurodevelopmental disorder associated with adequate development of word reading and single word comprehension, but deficient text and discourse comprehension. Studies of comprehension in children with SBM are reviewed in relation to a comprehension model in which meanings are either activated from the surface code or constructed through resource-intensive integration and revision processes to form representations of the text base and models of the situation described by the text. Two new studies probed the construction of situation models in SBM. Experiment 1 tested the ability to build spatial and affective situation models from single sentences in 86 children with SBM (8 to 18 years of age) and 37 control children (8 to 16 years of age). Experiment 2 tested the ability to integrate across sentences to build spatial situation models in 15 children with SBM and 15 age-matched controls. Compared to age peers, children with SBM did not construct situation models that required integration of information across sentences, even though they could construct such models from single sentences. The data bear on the distinctive SBM neurocognitive profile, and more generally, on the significance of integration processes for the constructive aspects of language comprehension.

Prospective, declarative, and nondeclarative memory in young adults with spina bifida

The consequences of congenital brain disorders for adult cognitive function are poorly understood. We studied different forms of memory in 29 young adults with spina bifida meningomyelocele (SBM), a common and severely disabling neural tube defect. Nondeclarative and semantic memory functions were intact. Working memory was intact with low maintenance and manipulation requirements, but impaired on tasks demanding high information maintenance or manipulation load. Prospective memory for intentions to be executed in the future was impaired. Immediate and delayed episodic memory were poor. Memory deficits were exacerbated by an increased number of lifetime shunt revisions, a marker for unstable hydrocephalus. Memory status was positively correlated with functional independence, an important component of quality of life.

Special considerations for breastfeeding the infant with spina bifida

At present, no research has examined the unique breastfeeding needs of a mother and her infant with spina bifida (SB). This mother-infant dyad will face many unique challenges during the prenatal period, postdelivery, and postsurgical repair of the myelomeningocele (MMC). Each of these periods presents an opportunity for effective evidence-based nursing interventions to promote successful provision of human milk (HM). Beyond the need for nursing care during these crucial events, parents need education about the potential benefits of HM for the long-term complications of SB. Although there is no published evidence specifically related to the benefits of HM for mothers and their infants with SB, studies related to the general benefits of HM suggest that the mothers may enjoy enhanced maternal psychological adjustment while infants with SB may experience improved pain management, reduced infection rates, decreased incidence of allergy, improved cognitive development, and decreased incidence of obesity. Further research is needed to better understand the unique relationship between HM and SB.

A model of neurocognitive function in spina bifida over the life span

Spina bifida myelomeningocele (SBM), a neural tube defect that is the product of a complex pattern of gene-environment interactions, is associated with naturally occurring, systematic variability in the neural phenotype and in environmental factors that lead to systematic variability in the cognitive phenotype. We characterize the basis for variability in the cognitive phenotype of children with SBM with reference to a model of key biological, cognitive, and environmental events unfolding over the course of development from infancy to middle age. The cognitive phenotype is not domain-specific, but represents manifestations of unobservable constructs involving associative and assembled processing, the latter directly reflecting the impact of the neural phenotype on core deficits involving movement, timing, and attention orienting. The expression of the cognitive phenotype is variable, being moderated by features of the neural phenotype involving secondary CNS insults (such as hydrocephalus) that impair assembled processing, as well as by environmental factors (such as poverty, parenting, and education) that impair associative processing. The preservation of strengths in associative processing depends in part on the severity of the CNS deficits in SBM and the impact of the environment.