The practical utility of genetic screening in school settings

Can genetic screening be used to personalize education for students? Genome-wide association studies (GWAS) screen an individual's DNA for specific variations in their genome, and how said variations relate to specific traits. The variations can then be assigned a corresponding weight and summed to produce polygenic scores (PGS) for given traits. Though first developed for disease risk, PGS is now used to predict educational achievement. Using a novel simulation method, this paper examines if PGS could advance screening in schools, a goal of personalized education. Results show limited potential benefits for using PGS to personalize education for individual students. However, further analysis shows PGS can be effectively used alongside progress monitoring measures to screen for learning disability risk. Altogether, PGS is not useful in personalizing education for every child but has potential utility when used simultaneously with additional screening tools to help determine which children may struggle academically.

Teacher quality moderates the genetic effects on early reading

Children's reading achievement is influenced by genetics as well as by family and school environments. The importance of teacher quality as a specific school environmental influence on reading achievement is unknown. We studied first- and second-grade students in Florida from schools representing diverse environments. Comparison of monozygotic and dizygotic twins, differentiating genetic similarities of 100% and 50%, provided an estimate of genetic variance in reading achievement. Teacher quality was measured by how much reading gain the non-twin classmates achieved. The magnitude of genetic variance associated with twins' oral reading fluency increased as the quality of their teacher increased. In circumstances where the teachers are all excellent, the variability in student reading achievement may appear to be largely due to genetics. However, poor teaching impedes the ability of children to reach their potential.

Longitudinal outcomes of Haemophilus influenzae meningitis in school-age children

The purpose of this study was to investigate long-term outcomes of Haemophilus influenzae Type b meningitis in a cohort of school-age survivors. Findings from an initial assessment at mean age 10 years revealed neuropsychological, achievement, and behavioral sequelae in the children with neurologic complications during the acute-phase illness (H. Taylor, C. Schatschneider, & D. Rich, 1992). Here, the cohort was reassessed 1 and 2 years after the initial evaluation to investigate age-related influences on disease sequelae. After excluding children with hearing loss, the sample was divided into 2 groups: an affected group of 39 children with acute-phase neurologic complications and an unaffected group of 73 children without these complications. Growth-curve modeling showed poorer outcomes at the final assessment and less rapid improvement at follow-up for the affected group. Later age at assessment and later age at illness were associated with larger group differences in some outcomes. Results suggest that children with diffuse early brain insults are at risk for later-emerging sequelae.

Utility of kindergarten teacher judgments in identifying early learning problems

Most existing research on early identification of learning difficulties has examined the validity of methods for predicting future academic problems. The present study focused instead on the sensitivity of kindergarten teachers to learning problems in their students and on the continuity of teacher-identified problems over time. To identify early learning problems, kindergarten teachers in a suburban school district rated student progress toward six academic objectives as satisfactory or unsatisfactory. Twenty percent of the district's 303 kindergarten children received unsatisfactory ratings in at least one area. Thirty-eight of these children (identified group) were matched to 34 children with satisfactory ratings in all areas (nonidentified group). Results of testing conducted during kindergarten revealed poorer academic achievement in identified children than in nonidentified children. Children from the identified group also performed more poorly than children from the nonidentified group on tests of phonological processing and working memory/executive function and were rated by teachers as having more behavior and attention problems and lower social competence. Follow-up of the sample to first grade documented continued learning problems in the identified group. These findings support the use of teacher judgements in early detection of learning problems and argue against reliance on discrepancy criteria.

Neurodevelopmental outcomes of Ugandan infants with HIV infection: an application of growth curve analysis

Neurodevelopmental outcomes of human immunodeficiency virus Type 1 (HIV-1)-infected infants of non-drug-using mothers were assessed in a controlled, prospective study from birth to 24 months with 3 groups: 61 infants of HIV-infected mothers, 234 uninfected infants of HIV-infected mothers (seroreverters), and 115 uninfected infants of uninfected mothers. Compared with seroreverters and uninfected infants, HIV-infected infants demonstrated lower mental and motor development on the Bayley Scales and greater deceleration in their rate of motor development. HIV-infected infants with abnormal neurologic exams had lower motor and mental test scores and lower rates of motor Bayley Scales scores than their HIV-infected counterparts with normal neurologic exams. Contrary to prediction, no group differences in mean performance or growth rates were found on visual information processing on the Fagan Test of Infant Intelligence.

Neurodevelopmental outcomes of Ugandan infants with HIV infection: an application of growth curve analysis

Neurodevelopmental outcomes of human immunodeficiency virus Type 1 (HIV-1)-infected infants of non-drug-using mothers were assessed in a controlled, prospective study from birth to 24 months with 3 groups: 61 infants of HIV-infected mothers, 234 uninfected infants of HIV-infected mothers (seroreverters), and 115 uninfected infants of uninfected mothers. Compared with seroreverters and uninfected infants, HIV-infected infants demonstrated lower mental and motor development on the Bayley Scales and greater deceleration in their rate of motor development. HIV-infected infants with abnormal neurologic exams had lower motor and mental test scores and lower rates of motor Bayley Scales scores than their HIV-infected counterparts with normal neurologic exams. Contrary to prediction, no group differences in mean performance or growth rates were found on visual information processing on the Fagan Test of Infant Intelligence.

Predictors of early school age outcomes in very low birth weight children

The purpose of this study was to examine predictors of outcome in very low birth weight (< 1500 g) children. The very low birth weight sample consisted of 68 children weighing less than 750 g at birth and 65 children weighing 750 to 1499 g at birth who had been matched to the less than 750 g birth weight children in terms of hospital of birth, age, sex, and race. Mean ages for these two groups were 6.7 and 6.9 years, respectively. Outcomes were measured in terms of tests of cognitive function, neuropsychological abilities, and academic achievement and parent and teacher ratings of child behavior and school performance. A weighted sum of the number of major neonatal medical complications (Neonatal Risk Index) provided a composite measure of biological risk. Social risks were also assessed. Results indicated that the Neonatal Risk Index was the most consistent predictor of outcomes. Even after taking social risks into account, neonatal risk predicted overall cognitive ability and other achievement, neuropsychological, and behavior outcomes. Individual neonatal complications that predicted outcomes included severe cerebral ultrasonographic abnormality, chronic lung disease, necrotizing enterocolitis, and apnea of prematurity. Research and therapy to prevent or reduce neonatal complications and amelioration of social risks are of critical importance in improving outcomes of very low birth weight.

Acute-phase neurologic complications of Haemophilus influenzae type b meningitis: association with developmental problems at school age

The purposes of this study were to describe the incidence of acute-phase neurologic complications in a sample of 126 children with Haemophilus influenzae type b meningitis, and to determine if these complications were associated with higher rates of learning and behavior problems at school age. Risks were assessed by comparing rates of adverse psychoeducational outcomes in the 53 children in the sample with complications to corresponding outcome rates in the 67 children who were free of neurologic complications and who did not have abnormal electroencephalograms (EEGs) or computed tomographic (CT) scans. Comparisons were made by means of logistic regression analysis. Twenty-nine children (23% of the sample) had seizures, 16 (13%) were comatose or obtunded, 15 (12%) had sensorineural hearing loss, 8 (6%) had hemiparesis, and 7 (6%) had cranial nerve deficits other than hearing loss. Relative to children without complications, those with complications had higher rates of grade repetition and substandard performance on neuropsychological and achievement testing. Adverse outcomes, however, consisted primarily of more subtle cognitive and learning problems; only two of the children in the sample obtained prorated IQ scores below 70. Sequelae were associated with persistent neurologic deficits and bilateral hearing loss, as well as with transient symptoms including seizures, coma, and hemiparesis. While study findings argue against adverse consequences for the vast majority of children treated for this disease, the results clarify learning and behavior outcomes and indicate which children are at greatest risk.

Preinjury family environment as a determinant of recovery from traumatic brain injuries in school-age children

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than environmental factors as predictors of recovery. We addressed this concern using data collected during a prospective study of children with either TBI or orthopedic injuries (OI) and their families. Participants included 53 children with severe TBI, 56 with moderate TBI, and 80 with OI, all from 6 to 12 years of age at the time of injury. Measures of the preinjury family environment were collected shortly after the injury (baseline). Child cognitive and behavioral outcomes were assessed at baseline and at 6- and 12-month follow-ups. Individual growth curve analyses showed that measures of the preinjury family environment consistently predicted both the level of cognitive and behavioral functioning at 12 months postinjury and the rate of intraindividual change during the 12-month follow-up period, even after taking into account group membership and injury severity. In some cases, the preinjury family environment was a significant moderator of the effect of TBI, buffering its impact in high-functioning families and exacerbating it in low-functioning families. Thus, preinjury environmental factors predict recovery following TBI in children, even after accounting for injury-related variables.

Achievement in children with birth weights less than 750 grams with normal cognitive abilities: evidence for specific learning disabilities

Examined achievement, behavior, and neuropsychological outcomes at early school age in a regional population of children < 750-g birth weight who were neurologically intact and who scored in the broad average range on a test of cognitive ability. Comparison groups included children of birth weight 750-1,499 g and children born at full-term. The children < 750 g performed more poorly than the higher birth weight groups on tests of math, even after adjusting for group differences in cognitive ability. Corresponding group differences were found in language, perceptual motor, and attentional skills, but not in behavior outcomes. Findings document specific weaknesses in achievement and neuropsychological skills in children < 750 g birth weight and support the need for early identification and special education interventions.

School-age outcomes in children with birth weights under 750 g

BACKGROUND

Since the mid-1980s, increasing numbers of children with birth weights under 750 g have survived to school age.

METHODS

We matched a regional cohort of 68 surviving children born from 1982 through 1986 with birth weights under 750 g (mean, 670 g; gestational age, 25.7 weeks) with 65 children weighting 750 to 1499 g at birth and 61 children born at term. Growth, neurosensory status, and functioning at school age in the three groups were compared. Associations of biologic and social risk factors with major developmental outcomes were examined by means of logistic-regression analyses.

RESULTS

Children with birth weights under 750 g were inferior to both comparison groups in cognitive ability, psychomotor skills, and academic achievement. They had poorer social skills and adaptive behavior and more behavioral and attention problems. The mean (+/- SD) Mental Processing Composite score for the cohort was 87 +/- 15, as compared with 93 +/- 14 for children with birth weights of 750 to 1499 g and 100 +/- 13 for children born at term (P < 0.001). The rates of mental retardation (IQ < 70) in the three groups were 21, 8, and 2 percent, respectively; the rates of cerebral palsy were 9, 6, and 0 percent; and the rates of severe visual disability were 25, 5, and 2 percent. Major cerebral ultrasonographic abnormalities were associated with mental retardation (odds ratio, 5.4; 95 percent confidence interval, 1.8 to 15.8) and cerebral palsy (odds ratio, 15.2; 95 percent confidence interval, 3.0 to 77.4). Oxygen dependence at 36 weeks was associated with mental retardation (odds ratio, 4.5; 95 percent confidence interval, 1.2 to 10.7) and severe visual disability (odds ratio, 4.3; 95 percent confidence interval, 1.3 to 14.2). Social disadvantage, though associated with several neuropsychological outcomes, was not associated with major developmental impairment.

CONCLUSIONS

Children with birth weights under 750 g who survive represent a subgroup of very-low-birth-weight children who are at high risk for neurobehavioral dysfunction and poor school performance.