Infant Attentional behaviors Are Associated With ADHD Symptomatology and Executive Function in Early Childhood

One year respiratory and neurodevelopmental outcome of premature neonates after exposure to plasticizers in the neonatal intensive care unit - A prospective cohort study

BACKGROUND

Premature neonates have an increased risk of long-term effects, including impaired respiratory and neurodevelopment. During NICU admission, they are exposed to endocrine-disrupting phthalates and alternative plasticizers. The objective was to study the association between cumulative NICU-based plasticizer exposure and respiratory and neurodevelopmental outcome during the first year of life.

METHODS

Premature neonates (gestational age <31 weeks and/or birth weight <1500 g) were prospectively enrolled at the Antwerp University Hospital, Belgium. Outcome was assessed at 12 months corrected age, using the Bayley Scales of Infant and Toddler Development-III and validated questionnaires for respiratory outcome. Urinary concentrations of plasticizers' biomarkers were measured weekly during NICU stay. Weighted quantile sum regression was utilized to assess associations between plasticizer biomarkers' mixtures and outcome.

RESULTS

Exposure of premature neonates (n = 110) to specific plasticizer mixtures correlated with worse fine motor (ß -0.96; 95%-CI -1.76, -0.15; p = 0.02) and receptive language development (ß -0.77; 95%-CI -1.23, -0.32; p = 0.001), and better gross motor (ß 2.24; 95%-CI 0.62, 3.86; p = 0.01) and expressive language development (ß 1.50; 95%-CI 0.33, 2.67; p = 0.02). NICU exposure to different plasticizer mixtures was associated with eczema (aOR 3.12; 95%-CI 1.23, 9.11; p = 0.02), repeated ear infections (aOR 5.53; 95%-CI 1.87, 23.14; p = 0.01), and respiratory-related healthcare visits during the first year of life (aOR 8.50; 95%-CI 2.05-55.91; p = 0.01).

CONCLUSIONS

Cumulative NICU exposure to phthalates and alternative plasticizers was associated with increased respiratory morbidity and eczema during the first year of life. Exposure to specific plasticizer mixtures correlated with worse or better neurodevelopment at one year of age.

Neuropsychology's Role in Multidisciplinary Follow-Up Care of Neurologically Complex Infants and Toddlers

BACKGROUND

Adverse effects on brain development prenatally and during early childhood can disrupt cognitive development, with earlier neural insults often proving to be particularly detrimental. As such, infants and toddlers with neurological conditions are at increased risk for medical and neurodevelopmental complications. Pediatric neuropsychologists are well suited to evaluate brain-behavior relationships and identify emergent delays in these patients. The roles of pediatric neuropsychology in the care of neurologically complex young children are reviewed and discussed by highlighting a novel neonatal intensive care unit (NICU) follow-up clinic model.

METHODS

The Developmentally Ready: Engagement for Achievement of Milestones (DREAM) Clinic is a multidisciplinary NICU follow-up clinic designed for the care of neurologically complex young children. The DREAM Clinic is led by neonatal neurology and supported by pediatric neuropsychology, neonatology, physical medicine and rehabilitation, and pediatric psychology.

RESULTS

The review of pediatric neuropsychologists' contributions to the DREAM Clinic elucidated that pediatric neuropsychologists are valuable care partners to both medical providers and families in this multidisciplinary setting.

CONCLUSIONS

The DREAM Clinic provides a model for the structure, feasibility, and importance of involving pediatric neuropsychologists in the multidisciplinary developmental follow-up care of neurologically complex young children.

The utility of multiple assessments in infancy and toddlerhood to predict middle childhood ADHD symptoms: Temperamental, behavioral, and genetic contributions

BACKGROUND

Early intervention is effective for reducing ADHD symptoms and related impairments, yet methods of identifying young children in need of services are lacking. Most early predictors of ADHD previously identified are of limited clinical utility. This study examines several theoretically relevant predictors of ADHD in infancy and toddlerhood and whether assessment at multiple time points improves prediction. We also examine whether links between early risk factors and middle childhood ADHD are driven by shared genetic and/or environmental mechanisms to identify potential early intervention targets.

METHOD

614 twins (52.12 % female, 58.50 % non-Hispanic White) participated in a larger study on genetic and environmental contributions to mental health outcomes. Caregiver-reported attention and behavior problems in infancy (M = 12.67 months) and toddlerhood (M = 32.18 months) and caregiver-reported temperament (attentional focusing, impulsivity, inhibitory control) in toddlerhood were used to predict caregiver-reported ADHD symptoms in middle childhood (M = 8.78 years).

RESULTS

Only behavior problems in infancy and toddlerhood were robust predictors of caregiver-reported ADHD symptoms in middle childhood. Using multiple timepoints did not improve predictive ability. The relationship between infant behavior problems and caregiver reported middle childhood ADHD symptoms was explained by both environmental and genetic influences, whereas environmental influences almost entirely explained the relationship between toddler behavior problems and caregiver-reported middle childhood ADHD symptoms.

IMPLICATIONS

Behavior problems in toddlerhood showed the strongest predictive utility, and links to later ADHD were largely driven by environmental factors, suggesting that psychosocial interventions modifying the child's environment may be particularly effective for reducing ADHD risk.

Effect of an early music intervention on emotional and neurodevelopmental outcomes of preterm infants at 12 and 24 months

Background

Few studies have found long-term effects of early musical environmental enrichment in the NICU on preterm infant's development. This study examines how early music enrichment affects emotional development and effortful control abilities in 12- and 24-month-old very preterm (VPT) infants.

Methods

One hundred nineteen newborns were recruited, including 83 VPTs and 36 full-term (FT) infants. The VPT infants were randomly assigned to the music intervention (44 VPT-Music) or control (39 VPT-control) groups. VPT-Music infants listened specifically designed music intervention from the 33rd week of gestation until hospital discharge. At 12 and 24 months, children were clinically evaluated using the Bayley-III Scales of Infant and Toddler Development and the Laboratory Temperament Assessment Battery, and at 24 months, with 3 additional episodes of the Effortful Control Battery.

Results and discussion

Our analysis showed that during a fear eliciting task, the VPT-Music group expressed lower level of fear reactivity and higher positive motor actions than VPT-controls and FT infants. At 24 months, the VPT-music group had lower scores for negative motor actions in the joy task, compared to both VPT-control and FT groups. In addition, both FT and VPT-music had higher scores of sustained attention compared to VPT-controls, but the contrasts were not significant. No significant effects on mental, language and motor outcomes were identified and for all three dimensions of the ECBQ.

Conclusion

The present study suggests that an early music intervention in the NICU might influence preterm children's emotional processing at 12 and 24 months. Limitations and suggestions for future research are highlighted.

What is typical: Atypical in young children's attention regulation?: Characterizing the developmental spectrum with the Multidimensional Assessment Profiles-Attention Regulation Infant-Toddler (MAPS-AR-IT) Scale

While attention dysregulation is a promising early indicator of neurodevelopmental risk, in particular attention-deficit/hyperactivity disorder (ADHD), it is difficult to characterize clinical concern due to its developmental expectability at the transition to toddlerhood. Thus, explicating the typical:atypical continuum of risk indicators is among the key future directions for research to promote early identification and intervention, and prevent decrements in the attainment of developmental milestones into early childhood. In this paper, we present the Multidimensional Assessment Profiles-Attention Regulation Infant-Toddler (MAPS-AR-IT) Scale, a novel parent-report survey of dimensional, developmentally specified indicators of attention (dys)regulation. Item Response Theory was employed to characterize the typical:atypical spectrum of both normative and more concerning dysregulation (including the contexts in which behavior occurs). We provide evidence of the validity of this measure in capturing the full typical:atypical spectrum via a longitudinal sample of typically developing children at 12-18 months of age (baseline) via concurrent scores on well-validated temperament and clinical measures. We also examine longitudinal stability and predictive validity if the MAPS-AR-IT via a clinical interview of ADHD symptoms at 24-30 months (follow-up). While not diagnostic, we present evidence of the utility of the MAPS-AR-IT in explicating individual neurodevelopmental risk and elucidating the broader typicality of behaviors related to attention (dys)regulation.

Longitudinal Predictors of Neurodevelopmental Outcomes in Children with Down Syndrome

This study examined longitudinal predictors of neurodevelopmental outcomes in children with Down syndrome (DS). Participants were assessed at Wave 1 during infancy on measures of looking behavior and caregivers provided infant sensory ratings. At Wave 2, child-age participants completed a developmental assessment and caregivers provided ratings of executive function, ADHD symptoms, and autism symptoms. Longer looking durations and greater sensory dysregulation during infancy were predictive of higher ADHD symptom ratings and other neurodevelopmental outcomes during childhood. The findings suggest that early indicators of neurodevelopmental dysregulation may be detectable during infancy in DS.

Research Review: A systematic review and meta-analysis of infant and toddler temperament as predictors of childhood attention-deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with onset as early as preschool and impairment across the lifespan. Temperament factors, specifically those that theoretically map onto ADHD symptoms, may be early markers of risk for developing later childhood ADHD that could be identifiable in infancy or toddlerhood. This meta-analysis examined the associations between these early temperamental factors and later symptoms and diagnosis of ADHD and mapped early temperament constructs onto the three ADHD symptom dimensions.

METHODS

A systemic review of the literature was conducted to identify prospective longitudinal studies that included theoretically relevant temperament constructs (sustained attention, activity level, inhibition, and negative emotionality) examined from birth to 36 months old and ADHD (symptoms or diagnosis) in preschool or childhood. The association between each temperament construct and ADHD outcomes was examined using pooled standardized estimates in meta-analyses.

RESULTS

Forty-eight articles (n = 112,716 infants/toddlers) prospectively examined temperament and the relation to childhood ADHD symptoms or diagnosis. Activity level (k = 18) in infancy and toddlerhood was moderately associated with childhood ADHD (r = .39, CI = 0.27, 0.51, p < .001). Moderate effect sizes were also observed for sustained attention (k = 9; r = -.28, CI = -0.42, -0.12, p < .001) and negative emotionality (k = 33; r = .25, CI = 0.16, 0.34, p < .001) with ADHD. The specificity of each temperament construct for later ADHD symptom dimensions was such that activity level and negative emotionality were predictive of all three symptom dimensions (i.e., inattention, hyperactivity/impulsivity, and combined), whereas sustained attention was only associated with combined symptoms.

CONCLUSIONS

Infant and toddler temperament is an early risk factor for the development of childhood ADHD that could be utilized for early intervention identification. Yet, this systematic review found that relatively few prospective longitudinal studies have examined sustained attention (k = 9) and inhibition (k = 15) in infancy and toddlerhood in relation to later ADHD highlighting the need for further research.

Links between Daytime Napping, Night-Time Sleep Quality and Infant Attention: An Eye-Tracking, Actigraphy and Parent-Report Study

The current study explored the potential influence of infant sleep, measured by parental report and actigraphy, and family functioning on attention development using eye tracking. The use of actigraphy in parallel with parental report, has the advantage of measuring participant’s sleep throughout the night without parental observation and the ability to objectively assess sleep quality. An eye-tracking version of the Gap-Overlap task was used to measure visual attention. Questionnaires and behavioural assessment were used to assess family function, and general cognitive development. Fifty infants (Mean age = 13.44 months, SD = 3.10) participated in the study, 23 of which had full final datasets. Results show that daytime sleep duration, as measured by parental report, and proportion of light sleep at night, as measured by actigraphy, are linked to visual attention. A higher proportion of light sleep, a marker of poorer sleep quality, and less daytime sleep were negatively linked with facilitation and disengagement on the Gap-Overlap task. Family functioning was not associated with attention. The results provide initial evidence that in addition to the amount of daytime sleep; quality of night-time sleep as measured by proportion of light sleep, is a potentially useful sleep variable which requires further focus in the study of attention development.

Systematic Review and Meta-analysis: The Science of Early-Life Precursors and Interventions for Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

To evaluate which early neurocognitive and behavioral precursors are associated with the development of attention-deficit/hyperactivity disorder (ADHD) and whether these are currently targeted in early interventions.

METHOD

We conducted 2 systematic reviews and meta-analyses of empirical studies to examine the following: (1) early-life (0-5 years) neurocognitive and behavioral precursors associated with familial likelihood for ADHD, an early ADHD diagnosis/elevated ADHD symptoms, and/or the presence of later-childhood ADHD; and (2) interventions delivered to children aged 0 to 5 years targeting the identified precursors or measuring these as outcomes. Standardized mean differences (Hedges' g) and pre-post-treatment change scores (SMD) were computed.

RESULTS

A total of 149 studies (165,095 participants) investigating 8 neurocognitive and behavioral domains met inclusion criteria for part 1. Multi-level random-effects meta-analyses on 136 studies revealed significant associations between ADHD and poorer cognitive (g = -0.46 [95% CIs: -0.59, -0.33]), motor (g = -0.35 [CIs: -0.48, -0.21]) and language (g = -0.43 [CIs: -0.66, -0.19]) development, social (g = 0.23 [CIs: 0.03, 0.43]) and emotional (g = 0.46 [CIs: 0.33, 0.58]) difficulties, early regulatory (g = 0.30 [CIs: 0.18, 0.43]) and sleep (g = 0.29 [CIs: 0.14, 0.44]) problems, sensory atypicalities (g = 0.52 [CIs: 0.16, 0.88]), elevated activity levels (g = 0.54 [CIs: 0.37, 0.72]), and executive function difficulties (g = 0.34 [CIs: 0.05, 0.64] to -0.87 [CIs: -1.35, -0.40]). A total of 32 trials (28 randomized, 4 nonrandomized, 3,848 participants) testing early interventions that targeted the identified precursors met inclusion criteria for part 2. Multi-level random-effects meta-analyses on 22 studies revealed significant intervention-related improvements in ADHD symptoms (SMD = 0.43 [CIs: 0.22, 0.64]) and working memory (SMD = 0.37 [CIs: 0.06, 0.69]).

CONCLUSION

Children aged 0 to 5 years with current or later-emerging ADHD are likely to experience difficulties in multiple neurocognitive/behavioral functions. Early interventions show some effectiveness in reducing ADHD symptoms, but their effects on neurocognitive/behavioral difficulties require further study.

Behavioural Measures of Infant Activity but Not Attention Associate with Later Preschool ADHD Traits

Mapping infant neurocognitive differences that precede later ADHD-related behaviours is critical for designing early interventions. In this study, we investigated (1) group differences in a battery of measures assessing aspects of attention and activity level in infants with and without a family history of ADHD or related conditions (ASD), and (2) longitudinal associations between the infant measures and preschool ADHD traits at 3 years. Participants (N = 151) were infants with or without an elevated likelihood for ADHD (due to a family history of ADHD and/or ASD). A multi-method assessment protocol was used to assess infant attention and activity level at 10 months of age that included behavioural, cognitive, physiological and neural measures. Preschool ADHD traits were measured at 3 years of age using the Child Behaviour Checklist (CBCL) and the Child Behaviour Questionnaire (CBQ). Across a broad range of measures, we found no significant group differences in attention or activity level at 10 months between infants with and without a family history of ADHD or ASD. However, parent and observer ratings of infant activity level at 10 months were positively associated with later preschool ADHD traits at 3 years. Observable behavioural differences in activity level (but not attention) may be apparent from infancy in children who later develop elevated preschool ADHD traits.