Screening for Neurological Dysfunction in the Specific Learning Difficulty Child

A developmental questionnaire was given to the parents of 140 children. Seventy of the children had a history of specific learning difficulties which had not responded to normal remedial education. The remaining 70 had no history of specific learning difficulties. The research was undertaken to ascertain whether the developmental questionnaire could be used as a reliable instrument to detect the neuro-developmental delay underlying the specific learning difficulties and preventing remedial intervention from being effective.

The results revealed that the screening questionnaire did discriminate between the two populations. At a 98% confidence level, a child with a score of 7 or more belonged to the specific learning difficulty group and a child scoring 2 or less did not. A score of 7 or more is therefore necessary to identify a neuro-developmentally based specific learning difficulty. The two populations were also compared on individual questions to identify which early developmental factors were significant in predicting later learning difficulties when viewed as part of a developmental profile.

Do Mainstream Schoolchildren Who Were Born Preterm Have Motor Problems?

Children who are born preterm now have improved survival chances owing to major changes in obstetric and neonatal intensive care. Previous studies have indicated that such children who are attending mainstream school have an increased risk of long-term motor impairment when compared with those who were born at full term. The present study describes the motor outcome in a geographically defined population born at or below 32 weeks of gestational age, alongside a group of full-term children who were matched for age, gender and school. Motor skills were assessed using the Movement Assessment Battery for Children (Movement ABC) and the Developmental Test of Visual Motor Integration (VMI), in addition to a detailed perinatal history.

A total of 280 preterm children were assessed alongside 210 controls. There were highly statistically significant differences between the preterm and full-term cohorts on both the Movement ABC (p<0.001, Mann-Whitney U) and the VMI (p<0.001, independent sample t-test), with the preterm group performing considerably worse than their peers. Using the 5th percentile on the Movement ABC, 30.7% of the preterm group were impaired compared with 6.7% of the controls.

Occupational therapists may find increased referral levels of preterm children because of motor difficulties and associated functional problems.

Developmental coordination disorder in school-aged children born very preterm and/or at very low birth weight: a systematic review

OBJECTIVE

: To systematically review and synthesize the literature to document the association between infants born very preterm and/or very low birth weight (VLBW) and the presence of developmental coordination disorder (DCD) at school age.

METHODS

: Seven databases were systematically searched. Studies were included if they examined very preterm (<32 weeks) and/or VLBW (<1500 g) infants to school age (age, 5-18 years), had a full-term and/or normal birth weight comparison group, and used a formal measure of motor impairment. Studies that included only infants who were small for gestational age or diagnosed with cerebral palsy were excluded. Two independent reviewers completed abstract and full-text screening, data extraction, and quality assessment of included studies.

RESULTS

: Sixteen articles were included, with 7 studies incorporated into 2 meta-analyses using cutoff scores of either <5th or 5-15th percentile on the Movement Assessment Battery for Children. Both analyses showed a significant increase in the likelihood of DCD for children born very preterm and/or 1500 g or less, with odds ratios of 6.29 (95% confidence interval, 4.37-9.05, p < .00001) and 8.66 (95% confidence interval, 3.40-22.07, p < .00001) for <5th or 5-15th percentile scores, respectively.

CONCLUSIONS

: Consistent across studies, DCD is more prevalent in the VLBW/very preterm population than full-term/normal birth weight control children and the general school-age population, with significantly greater odds of developing the disorder. Clinical practice should focus on early identification of and intervention for children with DCD, while research should focus on determining the mechanisms underlying DCD in the preterm population.

Emerging self-regulation in toddlers born preterm or low birth weight: differential susceptibility to parenting?

The differential susceptibility to parenting model was examined in relation to toddler self-regulation in a prospective longitudinal study of infants born preterm or low birth weight. We followed 153 mother-infant dyads across five time points between the infant's Neonatal Intensive Care Unit stay and 24 months postterm. Assessments of infant temperament, quality of early parenting interactions, contextual variables, and toddler effortful control and behavior problems were conducted. Results supported differential susceptibility and dual risk models in addition to documenting main effects of early parenting on children's emerging self-regulation. Our data suggested that preterm or low birth weight infants who were prone to distress or rated by mothers as more difficult were particularly susceptible to the effects of early negative parenting.

Visual-motor, visual-perceptual, and fine motor outcomes in very-low-birthweight children at 5 years

The prevalence and severity of visual-motor deficits and the relation of visual-motor function to visual perception and fine motor skills was examined in a group of 83 neurologically and intellectually normal (IQ >84) very-low-birthweight (VLBW) children at age 5. Fifteen children (17%) had below average visual motor scores (<1SD below mean). While relatively few children (N=9) had below average scores in visual perception (11%), 58 (71%) had below average scores for fine motor skills. Nineteen (23%) were considered impaired (<1.5SD); of these, eight were severely impaired (<2SD). Fine motor scores were significantly lower in children who had been born <28 weeks' gestation, with hyaline membrane disease, or had required a longer period of ventilation. There was significant correlation between visual-motor and fine motor scores (r = 0.50, P < 0.001) and between visual-motor and visual perception scores (r = 0.42, P < 0.001). The implications of these findings and management of these 'normal' children need further research. Previous reports of visual-motor dysfunction in school-age VLBW children could be related to fine motor difficulties.