Preterm birth Flashcards
1
Q
preterm birth
A
- born before 37 weeks
- ~9% of children born each year
- 32-36 weeks = late to moderate preterm
- 29-31 weeks = very preterm
- <28 weeks = extremely preterm
2
Q
body and brain impact of preterm birth
A
- the lungs and brain are particularly susceptible to early damage
- De Kieviet et al. (2012):
- meta-analysis
- brain volumes measured later in life - most studies adolescences
- overall brain volume smaller
- less white matter & less grey matter
3
Q
cognition impact of preterm birth
A
- motor problems
- general learning difficulties
- speed of processing
- visuo-spatial impairments
- EFs
- more likely to be diagnosed with a dev disorder
4
Q
gestational gradient
A
the earlier a child is born, the greater their difficulties are likely to be
5
Q
best to worst ways of sampling when studying prevalence of disorders
A
- national sample of children born preterm and term born controls followed from birth e.g. EPICure study
- regional sample of children born preterm and term born controls contacted when older
- opportunistic sample recruited via advert
6
Q
best to worst ways for measurement when studying prevalence of disorders
A
- diagnostic interview
- disorder-specific questionnaire e.g. Conners rating scale for ADHD (based on DSM criteria)
- general psychopathology questionnaire e.g. SDQ
7
Q
strengths and difficulties questionnaire (SDQ)
A
- covers internalising and externalising areas of difficulty
- emotional symptoms
- peer relationship problems
- conduct problems
- inattention and hyperactive symptoms (ADHD)
- prosocial beh
8
Q
johnson & marlow (2014)
lecture & pre-reading
A
- EPICure study, SDQ & diagnostic interviews given at age 11 years
- parents more likely to report emotional and conduct
- teachers also more likely to report ADHD & ASD compared to diagnostic interviews
- behavioural & neuroimaging studies provide evidence of a neurodevelopmental original for mental health disorders in this population
- children born extremely preterm may have attention, emotional or peer relationship problems that don’t meet diagnostic criteria but which may impact on daily function, for which intervention may be beneficial
9
Q
ADHD diagnosis when preterm
johnson et al. (2010)
A
- 11% of those born preterm were likely to have a diagnosis of ADHD
- very preterm = 2-3 times increased risk of ADHD
- extremely preterm = 4 times increased risk of ADHD
- also many cases where children born preterm have higher level of ADHD symptoms but don’t reach clinical cut-off (e.g. Brogan et al., 2014)
10
Q
compare to ADHD in general population, children born preterm:
A
- are more likely to be diagnosed with the inattentive subtype
- are not at increased risk of comorbid conduct disorder
- don’t show the same 3:1 gender bias towards boys
11
Q
how can we test whether being preterm leads to a different form of ADHD
A
look at the cognitive and neural predictors of ADHD in children born preterm and those born at term
12
Q
inhibition in preterm children
mulder et al. (2009)
A
- very varied results across diff tests
- <26 weeks impaired on go/no-go (but only 2 studies)
13
Q
visual WM in children born preterm
jongbloed-pereboom et al. (2012)
A
- review of 9 studies testing school-age children & adolescents
- used a backwards span task or self-directed search
- 8/9 studies reported worse visual WM in children born preterm
- children at greater risk (lower gestational ages and/or lower birth weight, & children with additional medical risk factors) also tend to perform worse than control children
14
Q
EFs in children born preterm
de kieviet et al. (2012)
A
- 66 very preterm children aged 7-8 & matched controls
- no diff from controls: inhibition, processing speed, verbal WM
- worse than controls: visuospatial WM, RT variability
15
Q
EFs, inattention & being preterm
de kieviet et al. (2012)
A
- parents & teachers completed 2 questionnaires with some questions about inattention & hyperactivity
- child behaviour checklist/teacher report form
- parent/teacher disruptive behaviour disorder rating scale
- both parents & teachers rates the preterm children as more inattentive, but not more hyperactive, than the control children
- preterm birth correlates with inattentive symptoms (poorer attention skills)
- preterm birth correlates with cognitive functioning
- cognitive functioning correlates with inattentive symptoms
- does cognitive functioning mediate the relationship between preterm birth and symptoms of inattention? - yes, including visuospatial WM & lapses in attention there becomes a non-sig interaction
16
Q
reward processing & preterm
hodel et al. (2015)
A
- 4yos born at 32-36 weeks and term-born controls
- delay discounting task: children born moderate-to-late preterm were less likely than the term born children to choose the delayed reward no matter the size of the delayed reward
- Maudsley’s index of childhood delay aversion (MIDA): no difference between preterm and term-born children
17
Q
preterm birth and ADHD
retzler et al. (2018)
A
- 8-11yos born very preterm or born at term
- matched on the strengths and weaknesses of ADHD and normal-behaviour (SWAN) questionnaire
- continuum of symptoms, look across spectrum of ADHD scores
- relationship between WM very similar between the two groups
18
Q
early screening for autism
A
- as preterm children are at increased risk of dev disorders it makes sense to screen for them early in childhood in order to start interventions early
- one questionnaire that has been developed to identify autism in toddlers in modified checklist for autism in toddlers (M-CHAT)
- in general population: 5.7% screen positive for high risk of autism (Kleinman et al., 2008)
- in those born before 28 weeks (extremely preterm) 21-42% screened positive for autism (Kuban et al., 2008; Moore et al., 2012)
19
Q
autism in school age preterm children
hack et al. (2009)
A
- 219 extremely low birth weight (ELBW) children at age 8 years and 176 age matched controls
- parent completed the child symptom inventory (CSI-4) based on DSM4 criteria
- 4 ELBW fulfilled criteria for autism vs 1 control (3 already has diagnosis)
- 3 ELBW fulfilled criteria for Asperger’s (1 already had diagnosis)
- overall, autistic symptoms reported more often in ELBW group than in controls
20
Q
johnson et al. (2010) - autism
A
- 201 extremely preterm (EP) children at age 11yrs and 143 age matched controls
- parent completed the social communication questionnaire and the development and wellbeing assessment (DAWBA) diagnostic interview
- 16 preterm children (8%) obtained a diagnosis compared to 0 of the controls
- preterm children had higher SCQ scores than controls:
- increase in autistic symptoms in many preterm children, not just small subgroup with autism diagnosis
- more that have these difficulties - social and communication difficulties
21
Q
different form of autism in those born preterm?
A
- is characterised by social and communicative impairments rather than repetitive or stereotyped beh
- is associated with prior cog impairment that explains many social & communication difficulties
- is related to head circumference
22
Q
SEN
mackay et al. (2010)
A
- communication & interaction
- cognition and learning
- social, emotional and mental health difficulties
- sensory and/or physical needs
the earlier a child is born, the more likely they are to have SEN
23
Q
johnson et al. (2011) - reading
A
- 219 extremely preterm children at age 11 & 153 age matched controls
- completed word reading, non-word reading and reading comprehension subtests of WIAT
- phonological abilities test administered at age 6
- overall, the preterm group are worse at reading than controls
- 12 preterm children are classified as having a reading difficulty, compared to 3 controls
- more difficulties with children born preterm
24
Q
reading and preterm
aarnoudse-moens et al. (2011)
A
- 200 very preterm children and 230 age matched controls tested every year from age 4-8
- assessed with a comprehensive series of standardised tests that are part of the Dutch national pupil monitoring system
- preterm children had comparable early linguistic skills to term born controls at age 6
- very preterm children scored 0.4SD lower on simple word reading and 0.3SD lower on complex word reading at age 8
- the group diff in complex word reading remained when IQ was taken into account
- reading comprehension didn’t differ from controls
25
Q
do preterm children show the same cognitive difficulties underlying reading problems?
A
- Johnson et al. (2011) - phoneme deletion at 6yrs predicting reading at 11yrs in extremely preterm and term born children
- Wocadlo & Rieger (2007) - phonological awareness related to reading skills in very preterm children
- Aarnoudse-Moens et al. (2011) - no diff in early linguistic skills at age 4 for very preterm and term born children (but didn’t look at relationship with later reading skills)
26
Q
johnson et al. (2011) - mathematics
A
- visuospatial abilities test administered at age 6
- overall, the preterm group are worse at maths than the controls
- 20 preterm children are classified as having a maths deficits, compared to 2 controls
27
Q
developmental dyscalculia
von aster & shalev (2007)
A
- specific difficulty in mathematics
- some researchers argue it is characterised by a poor approximate number system (evolutionary system looking at quantity without counting)
- a cognitive system that supports that representation & manipulation of quantity information for mathematical achievement
- measured using dot comparison tasks
- not such a strong theory any more
28
Q
maths and preterm
simms et al. (2015)
A
- UK regional - PRISM study
- 115 very preterm (VP) children aged 9 & 77 age matched controls
- completed numerical operations and mathematical reasoning subtests of WIAT
- also completed a battery of tasks including IQ, EFs, visuospatial skills & maths specific measures
- VP group worse at maths than controls
- VP group have poorer WM & visuospatial skills than controls but no impairment in processing speed or inhibition
- importantly, the VP group show no difference in measures of the approximate number system
- VP group are worse than controls at counting and strategy choice but this accounted for by their poor WM & visuospatial skills
- although children born very preterm do have specific difficulties with maths, this doesn’t seem to be due to a problem in the approximate number system
- instead, their difficulties with maths seem to be due to their WM & visuospatial difficulties
29
Q
jorrit et al. (2012)
further reading
A
- to clarify the severity, specificity, and neurocognitive underpinnings of attention problems in very preterm children
- 66 preterm and 66 age-matched controls age 7-8
- symptoms of inattention assessed using parent and teacher-rated questionnaires
- neurocognitive measures: speed and consistency in speed of information processing, lapses of attention (tau), alerting, orienting, and executive attention, as well as verbal and visuospatial working memory
- large decrease in visuospatial WM abilities in preterm
- medium increases in tau and ratings of inattention in preterm
- tau & visuospatial WM were significant predictors of parent and teacher ratings of inattention
- increase lapses of attention and poorer visuospatial WM fully account for the attention problems in very premature children at school-age
