The relationship between brain structure and cognition in transfused preterm children at school age.

Examine the relationship between brain structure and cognition in preterm children randomly assigned to a liberal red blood cell (RBC) transfusion strategy as neonates. Intelligence, achievement, and neuropsychological measures were assessed and structural imaging was obtained (n = 26; 38% male). Global brain volumes were related to cognitive outcome. Additionally, females performed lower on verbal fluency; lower performance was related to temporal white matter volume. Findings provide possible evidence of the adverse effect of a liberal RBC transfusion strategy in which females had decreased temporal lobe white matter directly related to poor verbal fluency.

Reading in subjects with an oral cleft: speech, hearing and neuropsychological skills.

OBJECTIVE: To evaluate speech, hearing, and neuropsychological correlates to reading among children, adolescents, and young adults with nonsyndromic cleft of the lip and/or palate (NSCL/P). METHOD: All testing was completed in a single visit at a Midwestern university hospital. Subjects in both the NSCL/P (n = 80) and the control groups (n = 62) ranged in age from 7-26 years (average age = 17.60 and 17.66, respectively). Subjects completed a battery of standardized tests evaluating intelligence, neuropsychological skills, and word reading. Subjects with NSCL/P also underwent speech assessment, and past audiology records were evaluated. RESULTS: After controlling for age and socioeconomic status, subjects with cleft performed significantly worse on a test of word reading. For subjects with cleft, word reading deficits were not associated with measures of speech or hearing, but were correlated with impairments in auditory memory. CONCLUSION: These findings show poorer reading among subjects with NSCL/P compared with those without. Further work needs to focus on correlates of reading among subjects with cleft to allow early identification and appropriate intervention/accommodation for those at risk.

Memory processes in learning disability subtypes of children born preterm.

The purpose of this study was to evaluate immediate auditory and visual memory processes in learning disability subtypes of 40 children born preterm. Three subgroups of children were examined: (a) primary language disability group (n = 13), (b) perceptual-motor disability group (n = 14), and (c) no learning disability diagnosis group without identified language or perceptual-motor learning disability (n = 13). Between-group comparisons indicate no significant differences in immediate auditory or visual memory performances between language and perceptual-motor learning disability groups. Within-group comparisons revealed that both learning disability groups performed significantly lower on a task of immediate memory when the mode of stimulus presentation and mode of response were visual.

Rapid automatized naming and immediate memory functions in Chinese children who read English as a second language.

This study examined reading performance of 102 Chinese Mandarin-speaking 4th graders in their second language (L2, English) as a function of performance in their first language (L1, Chinese). The results revealed that for Rapid Automatized Naming (RAN) and Rapid Alternating Stimulus (RAS) measures, the mean naming time decreased monotonically in high-achieving, average, and low-achieving readers. RAN and RAS differentiated poor readers from good and average readers but failed to differentiate between good and average readers. RAN deficits occurred in poor readers in both languages. Comparison of memory profiles revealed that patterns varied depending on the mode of stimulus presentation or response. Low-achieving readers performed poorly on a subtest involving visual components only and did relatively better on a subtest involving verbal components only. Poor readers in Chinese also encountered difficulties in learning English as a L2. RAN-character accounted for unique variance in two Chinese reading measures. RAN-letter explained unique variance in English mid-term reading grade. The unique variance captured by the Color Span Subtest 1 (visual-visual) was found in Chinese reading comprehension but not in English reading comprehension. Reading performance in L1 was predictive of reading performance in L2 and vice versa.

Height, BMI, and pituitary volume in individuals with and without isolated cleft lip and/or palate.

INTRODUCTION: Individuals with isolated cleft lip and/or palate (ICLP) are often reported to be of shorter stature relative to peers, and the objective of this study was to explore the role of the pituitary in relationship to growth. METHODS: Fifty-five males and 32 females with ICLP were compared to 121 healthy males and 158 healthy females with respect to height and BMI. Magnetic resonance imaging (MRI) scans were obtained from all ICLP participants and 47% of healthy group participants. RESULTS: Males with ICLP were shorter than healthy males and had lower BMI. However, the trajectories for height and BMI did not differ between groups. Analyses in a separate sample of adult males suggested that height normalizes in males with ICLP in their early 30s. There were no differences in mean pituitary volume and pituitary trajectories between male groups. Females with ICLP were shorter than healthy females and also had slower growth rates. They did not differ in mean BMI or BMI trajectories. Furthermore, there were no differences in mean pituitary volume, or in pituitary trajectories. DISCUSSION: Our findings suggest that there are no gross morphological differences in pituitary volume in individuals with ICLP, although more subtle differences may exist.

Neuropsychological, behavioral, and academic sequelae of cleft: early developmental, school age, and adolescent/young adult outcomes.

This article reviews behavioral, neuropsychological, and academic outcomes of individuals with cleft across three age levels: (1) infancy/early development, (2) school age, and (3) adolescence/young adulthood. The review points out that attachment, neurocognitive functioning, academic performance/learning, and adjustment outcomes are the result of a complex interaction between biological and environmental factors and vary with developmental level, sex, and craniofacial anomaly diagnosis. The degree to which associated genetic or neurodevelopmental conditions may explain inconsistent findings is unknown and suggests the need for caution in generalizing from group data on cleft.

Neurocognitive profiles of preterm infants randomly assigned to lower or higher hematocrit thresholds for transfusion.

OBJECTIVE: Preterm infants are frequently transfused with red blood cells based on standardized guidelines or clinical concerns that anemia taxes infants' physiological compensatory mechanisms and thereby threatens their health and well-being. The impact of various transfusion guidelines on long-term neurocognitive outcome is not known. The purpose of this study is to evaluate long-term neurocognitive outcome on children born prematurely and treated at birth with different transfusion guidelines. METHODS: Neurocognitive outcomes were examined at school age for 56 preterm infants randomly assigned to a liberal (n = 33) or restrictive (n = 23) transfusion strategy. Tests of intelligence, achievement, language, visual-spatial/motor, and memory skills were administered. Between-group differences were assessed. RESULTS: Those in the liberal transfusion group performed more poorly than those in the restrictive group on measures of associative verbal fluency, visual memory, and reading. CONCLUSIONS: Findings highlight possible long-term neurodevelopmental consequences of maintaining higher hematocrit levels.

Long-term outcome of brain structure in premature infants: effects of liberal vs restricted red blood cell transfusions.

OBJECTIVE: To assess the long-term outcome of brain structure in preterm infants, at an average age of 12 years, who received a red blood cell transfusion for anemia of prematurity. DESIGN: As neonates, this cohort of infants participated in a clinical trial in which they received red blood cell transfusions based on a high pretransfusion hematocrit threshold (liberal group) or a low hematocrit threshold (restricted group). These 2 preterm groups were compared with a group of full-term healthy control children. SETTING: Tertiary care hospital. PARTICIPANTS: Magnetic resonance imaging scans for 44 of the original 100 subjects were obtained. INTERVENTION: Liberal vs restricted transfusion. MAIN OUTCOME MEASURES: Intracranial volume, total brain tissue, total cerebrospinal fluid, cerebral cortex and cerebral white matter volume, subcortical nuclei volume, and cerebellum volume. RESULTS: Intracranial volume was substantially smaller in the liberal group compared with controls. Intracranial volume in the restricted group was not different from controls. Whole-cortex volume was not different in either preterm group compared with controls. Cerebral white matter was substantially reduced in both preterm groups, more so for the liberal group. The subcortical nuclei were substantially decreased in volume, equally so for both preterm groups compared with controls. When sex effects were evaluated, the girls in the liberal group had the most significant abnormalities. CONCLUSION: Red blood cell transfusions affected the long-term outcome of premature infants as indicated by reduced brain volumes at 12 years of age for neonates who received transfusions using liberal guidelines.

Rapid automatized naming and immediate memory functions in Chinese Mandarin-speaking elementary readers.

The purpose of this study was to evaluate rapid automatized naming skills (RAN) and immediate memory processes in 243 Chinese Mandarin-speaking elementary readers (ranging from Grade 1 to Grade 5). For RAN subtests, the mean naming time decreased monotonically with grade level in good and average readers, and a similar trajectory was found in poor readers, even though they were generally slower in rapid naming. Regardless of grouping methods (counting all participants or counting good readers only), RAN Character emerged as a significant predictor of various Chinese reading measures. Different from classical findings in English readers indicating that RAN Number was a better correlate of reading than RAN Object, RAN Object outperformed RAN Number and became a significant predictor of Chinese reading speed and spelling, suggesting that the differences in predictive power of RAN tasks may be language specific. Comparison of memory profiles for good, average, and poor readers revealed that the patterns varied depending on mode of stimulus presentation or response. Poor readers performed poorly on subtests involving a visual component and did relatively better on subtests involving verbal cues only, whereas a reversed pattern was shown in the group of good readers. The findings were interpreted to suggest that good and poor Chinese readers may be essentially different in applying visual strategies and verbal mediation during visual-verbal intra- and intermodal processing, and visual skills appear to be particularly important in reading of Chinese.

Spontaneous verbal labeling: visual memory and reading ability in children with cleft.

OBJECTIVE: The purpose of this study was to examine different types of short-term memory deficits (visual versus verbal) of children with cleft and to determine what type of memory deficits were associated with reading disorders. DESIGN: The study examined memory and reading in 48 consecutive cases of children with cleft, aged 7 to 9 years. A memory test designed to assess memory modalities (verbal-visual) was administered, along with tests of reading ability. RESULTS: Visual and verbal memory were examined with a one-way analysis of variance (ANOVA). The memory pattern indicated greatest deficit in visual memory. Two subgroups were formed, according to whether or not there was evidence of visual memory impairment. A hit rate predicting reading disability based on group membership was calculated to be 65%. Visual memory was significantly correlated with reading ability (r = .48). CONCLUSION: A brief visual memory test was almost as good as Full Scale IQ in predicting reading disability.

Overdiagnosis and medication for attention-deficit hyperactivity disorder in children with cleft: diagnostic examination and follow-up.

OBJECTIVE: To examine the diagnosis of attention-deficit hyperactivity disorder (ADHD) in children with cleft to determine whether language-learning characteristics are taken into account when making this diagnosis. DESIGN: Prospective examination of 177 consecutive patients. Objective behavioral ratings, cognitive assessments, and attention/impulsivity testing of 32 of the 177 children with nonsyndromic cleft lip and palate (CLP) who had previously been diagnosed as ADHD and were receiving medication were performed. the prospective 6- to 9-month follow-up examination was examined to determine the accuracy of prior and posttest diagnoses. SETTING: University hospital-based cleft palate clinic. MAIN OUTCOME MEASURES: Pretest/posttest design to determine accuracy of DSM-IV psychiatric diagnosis. RESULTS AND CONCLUSIONS: The results show that the proportion of children originally diagnosed with ADHD (18%) was significantly higher than posttest diagnosis of ADHD (6% p <.001). Also, the frequency of pretest diagnosis of learning disorder (LD; 31%) was significantly different from posttest diagnosis (66% p <.01). The overdiagnosis of ADHD and underdiagnosis of LD in this sample of children with nonsyndromic unilateral cleft lip and palate appears to be due to lack of language-learning assessment.

Do the reading disabilities of children with cleft fit into current models of developmental dyslexia?

OBJECTIVE: The purpose of this study was to determine whether the reading problems of children with cleft fit models of developmental dyslexia. DESIGN: The study compared children with nonsyndromic cleft lip and palate who had reading disability (n = 46) with those who did not have reading disability (n = 46). The children were matched for age, sex, and grade. The two groups were compared (t tests) on measures of verbal expression, phonemic awareness, and rapid naming. Also, regression analyses compared the relative relationships of these variables to reading disability. PARTICIPANTS: Children were selected from 154 patients originally screened. RESULTS: Children with reading disability scored significantly lower on rapid naming and verbal expression, with no differences found on phonemic awareness. Rapid naming was shown to have the most significant association with reading disability. CONCLUSION: Children with nonsyndromic cleft lip and palate show symptoms similar to a naming-memory deficit model of developmental dyslexia. Reading treatment should avoid sight word approaches and focus on oral phonics treatment.

Learning disability subtypes: classification of high functioning hyperlexia.

This study examined 30 children with hyperlexic reading patterns and average intelligence to determine if established learning disability subtypes could be applied to these children with hyperlexia. Two groups emerged. One type showed language learning disorder patterns with good visual memory. This group also showed a high percentage of phonetic word errors. A second hyperlexic group showed signs of nonverbal learning disorder with visual spatial deficits and impaired visual memory. This latter subgroup showed few phonetic errors with more sight word errors. These findings suggest subtypes of high functioning hyperlexia, one showing language deficits characteristic of dysphasia and one showing patterns similar to visual spatial dyslexia.