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Gender stereotypes facilitate people's processing of social information by providing assumptions about expected behaviors and preferences. When gendered expectations are violated, people often respond negatively, both on a behavioral and neural level. Little is known about the impact of family kinship on the behavioral and neural reactions to gender-stereotype violations. Therefore, we examined whether parents show different responses when gender stereotypes are violated by their own children vs unknown children. The sample comprised 74 Dutch families with a father (Mage = 37.54), mother (Mage = 35.83), son, and daughter aged 3-6 years. Electroencephalography measurements were obtained while parents viewed pictures of their own and unknown children paired with toy or problem behavior words that violated or confirmed gender stereotypes. In half of the trials, parents evaluated the appropriateness of toy-gender and behavior-gender combinations. Parents showed stronger late positive potential amplitudes toward gender stereotype-violating behaviors by own children compared to unknown children. Moreover, parents' P1 responses toward gender stereotype-violating child behaviors were stronger for boys than for girls and for parents who evaluated gender-stereotype violations as less appropriate than gender-stereotype confirmations. These findings indicated that gender-stereotype violations by parents' own children are particularly salient and viewed as less appropriate than gender-stereotype confirmations.
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Mães , Pais , Criança , Feminino , Masculino , Humanos , Comportamento Infantil , Estereotipagem , PaiRESUMO
White matter dysmaturation is commonly seen in preterm infants admitted to the neonatal intensive care unit (NICU). Animal research has shown that active sleep is essential for early brain plasticity. This study aimed to determine the potential of active sleep as an early predictor for subsequent white matter development in preterm infants. Using heart and respiratory rates routinely monitored in the NICU, we developed a machine learning-based automated sleep stage classifier in a cohort of 25 preterm infants (12 females). The automated classifier was subsequently applied to a study cohort of 58 preterm infants (31 females) to extract active sleep percentage over 5-7 consecutive days during 29-32â weeks of postmenstrual age. Each of the 58 infants underwent high-quality T2-weighted magnetic resonance brain imaging at term-equivalent age, which was used to measure the total white matter volume. The association between active sleep percentage and white matter volume was examined using a multiple linear regression model adjusted for potential confounders. Using the automated classifier with a superior sleep classification performance [mean area under the receiver operating characteristic curve (AUROC) = 0.87, 95% CI 0.83-0.92], we found that a higher active sleep percentage during the preterm period was significantly associated with an increased white matter volume at term-equivalent age [ß = 0.31, 95% CI 0.09-0.53, false discovery rate (FDR)-adjusted p-value = 0.021]. Our results extend the positive association between active sleep and early brain development found in animal research to human preterm infants and emphasize the potential benefit of sleep preservation in the NICU setting.
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Recém-Nascido Prematuro , Substância Branca , Lactente , Feminino , Humanos , Recém-Nascido , Substância Branca/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Imageamento por Ressonância Magnética , SonoRESUMO
Children form stereotyped expectations about the appropriateness of certain emotions for men versus women during the preschool years, based on cues from their social environments. Although ample research has examined the development of gender stereotypes in children, little is known about the neural responses that underlie the processing of gender-stereotyped emotions in children. Therefore, the current study examined whether 3-year-olds differ in the neural processing of emotional stimuli that violate gender stereotypes (i.e., male faces with fearful or happy expressions) or confirm gender stereotypes (i.e., female faces with fearful or happy expressions), and whether boys and girls differ in their neural processing of the violation and confirmation of gender stereotypes. Data from 72 3-year-olds (±6 months, 43% boy) were obtained from the YOUth Cohort Study. Electroencephalography data were obtained when children passively viewed male and female faces displaying neutral, happy, or fearful facial expressions. This study provided first indications that happy male faces elicited larger P1 amplitudes than happy female faces in preschool children, which might reflect increased attentional processing of stimuli that violate gender stereotypes. Moreover, there was preliminary evidence that girls had larger negative central (Nc) responses, associated with salience processing, toward female happy faces than male happy faces, whereas boys had larger Nc responses toward male happy faces than female happy faces. No gender differences were found in the processing of neutral and fearful facial expressions. Our results indicate that electroencephalography measurements can provide insights into preschoolers' gender-stereotype knowledge about emotions, potentially by looking at the early occipital and late fronto-central responses.
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Emoções , Expressão Facial , Adulto , Adolescente , Humanos , Feminino , Masculino , Pré-Escolar , Estudos de Coortes , Emoções/fisiologia , Medo/psicologia , Felicidade , Eletroencefalografia , Potenciais Evocados/fisiologiaRESUMO
INTRODUCTION: The use of low-dose aspirin by pregnant women to prevent preterm pre-eclampsia is gradually increasing. The administration of aspirin during pregnancy improves perinatal outcome, which could translate into improved child outcome in the long term. However, antenatal exposure to aspirin could have adverse effects on child development that may manifest later in life. The aim of this follow-up study is to assess the long-term effects of antenatal exposure to low-dose aspirin compared with placebo on survival, (neuro)development, behaviour and general health at 4 years corrected age. METHODS AND ANALYSIS: This is a follow-up study of the Dutch double-blind randomised controlled APRIL trial which assessed the effectiveness of treatment with aspirin (80 mg daily) compared with placebo for the prevention of preterm birth in women with a previous spontaneous preterm birth. Treatment was initiated before 16 weeks of gestation and continued until 36 weeks or birth. We aim to follow-up all 379 children born to women who participated in the APRIL trial and survived the neonatal period, at the corrected age of 4 years. The main outcomes are (neuro)development as assessed by the Ages and Stages Questionnaire, and behaviour as assessed by the Strength and Difficulties Questionnaire. Additional outcomes include mortality, growth and general health from birth up to 4 years, and a composite outcome including mortality, abnormal (neuro)development and problem behaviour. Analyses will be performed by intention-to-treat using a superiority design. ETHICS AND DISSEMINATION: Institutional Review Board approval was obtained from the Medical Research Ethics Committee from Amsterdam Medical Center (no. W20 289#20.325). The results will be published in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER: The APRIL trial (NTR5675, NL5553; EudraCT number 2015-003220-31) and the APRIL follow-up study (NL8950) are registered in the Dutch trial register. The study is funded by the Amsterdam Reproduction & Development research institute.
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Nascimento Prematuro , Aspirina/efeitos adversos , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Membro 13 da Superfamília de Ligantes de Fatores de Necrose TumoralRESUMO
OBJECTIVE: To compare academic attainment at age 12 years in preterm children born below 30 weeks of gestation with matched term-born peers, using standardized, nationwide and well-validated school tests. STUDY DESIGN: This population-based, national cohort study was performed by linking perinatal data from the nationwide Netherlands Perinatal Registry with educational outcome data from Statistics Netherlands and included 4677 surviving preterm children born at 250/7-296/7 weeks of gestational age and 366â561 controls born at 40 weeks of gestational age in 2000-2007. First, special education participation rate was calculated. Subsequently, all preterm children with academic attainment test data derived at age 12 years were matched to term-born children using year and month of birth, sex, parity, socioeconomic status, and maternal age. Total, language, and mathematics test scores and secondary school level advice were compared between these 2 groups. RESULTS: Children below 30 weeks of gestation had a higher special education participation rate (10.2% vs 2.7%, P < .001) than term-born peers. Preterm children had lower total (-0.37 SD; 95% CI -0.42 to -0.31), language (-0.21 SD; 95% CI -0.27 to -0.15), and mathematics (-0.45 SD; 95%CI -0.51 to -0.38) z scores, and more often a prevocational secondary school level advice (62% vs 46%, P < .001). CONCLUSIONS: A substantial proportion of children born before 30 weeks of gestation need special education at the end of elementary schooling. These children have significant deficits on all measures of academic attainment at age 12 years, especially mathematics, compared with matched term-born peers.
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Nascimento Prematuro , Criança , Gravidez , Feminino , Recém-Nascido , Humanos , Estudos de Coortes , Nascimento Prematuro/epidemiologia , Idade Gestacional , Matemática , EscolaridadeRESUMO
INTRODUCTION: Vaginal progesterone and a cervical pessary are both interventions that are investigated for the prevention of preterm birth (PTB). Thus far, beneficial or harmful effects of these interventions on long-term child health and development are described, but evidence is not robust enough to draw firm conclusions. With this follow-up study, we intent to investigate if progesterone or a pessary is superior for the prevention of PTB considering the child's health at 4-6 years of corrected age. METHODS AND ANALYSIS: This study is a follow-up study of the Quadruple-P trial; a multicentre, randomised clinical trial (NL42926.018.13, Eudractnumber 2013-002884-24) which randomises women with an asymptomatic midtrimester short cervix to daily progesterone or a pessary for the prevention of PTB. All children born to mothers who participated in the Quadruple-P study (n=628 singletons and n=332 multiples) will be eligible for follow-up at 4-6 years of corrected age. Children will be assessed using parental questionnaires. Main outcomes are child (neuro)development and behaviour. Other outcomes include child mortality, growth and general health. A composite of adverse child outcomes will be compared between the progesterone and pessary groups reporting OR and the corresponding 95% CI. Analyses will be performed separately for singletons and multiples and using the intention-to-treat approach. ETHICS AND DISSEMINATION: The Medical Research Ethics Committee from Amsterdam UMC confirmed that de Medical Research Involving Human Subjects Act (WMO) did not apply to our study (W20_481 #20.531). Results will be published in a peer-reviewed journal and shared with stakeholders and participants. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER: Dutch Trial Register (NL9646).
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Pessários , Nascimento Prematuro , Medida do Comprimento Cervical , Colo do Útero/diagnóstico por imagem , Criança , Feminino , Seguimentos , Humanos , Recém-Nascido , Estudos Multicêntricos como Assunto , Gravidez , Nascimento Prematuro/prevenção & controle , Progesterona/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: This study aimed to examine the severity of posttraumatic stress disorder (PTSD) symptoms in children of parents with cancer and to identify individual and family factors associated with these symptoms. METHODS: The sample consisted of 175 children (52% girls, aged M = 11.98, SD = 3.20, range = 6-20 years) from 92 families, of which 90 parents with a current or past cancer diagnosis and 71 healthy co-parents also completed questionnaires. Children reported on PTSD symptoms, trauma-related cognitions, emotion regulation difficulties, general family functioning, and family communication. Both parents reported on their own PTSD symptoms. Associations were investigated using multilevel regression. RESULTS: Twenty-seven percentage of the children showed clinically relevant PTSD symptoms. Intraclass correlations indicated that children from the same family showed little overlap in these symptoms. Multilevel analyses showed that child trauma-related cognitions and emotion regulation difficulties were related to higher levels of PTSD symptoms at the individual level. General family functioning was only related to child PTSD symptoms at the family level. Child PTSD severity was unrelated to parental PTSD symptoms and family communication at the family level when taking into account the other factors. CONCLUSIONS: The current study highlights the psychological impact of parental cancer on children. Individual factors contributed more strongly to child PTSD symptoms than family factors. Trauma-related cognitions and emotion regulation difficulties might be targeted through specific psychoeducation for children and parents, family-oriented support and interventions, and evidence-based treatments for child PTSD.
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Neoplasias , Transtornos de Estresse Pós-Traumáticos , Idoso , Criança , Família , Feminino , Humanos , Masculino , Pais/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e QuestionáriosRESUMO
Evidence exists that people's brains respond differently to stimuli that violate social expectations. However, there are inconsistencies between studies in the event-related potentials (ERP) on which differential brain responses are found, as well as in the direction of the differences. Therefore, the current paper examined which of the two most frequently used tasks, the Impression Formation Task (IFT) or Implicit Association Test (IAT), provided more robust ERP components in response to the violation of gendered expectations. Both IFT and IAT paradigms were administered in a counter-balanced way among 25 young adults (age 22-31, 56% male), while brain activity was assessed with electroencephalography. The IFT and IAT specifically measured the violation of gendered expectations with regard to toy preferences and behavioral tendencies of young children. The results showed that both tasks were able to elicit relevant ERP components. Yet, the IFT evoked ERP effects of the violation of gendered expectations on all but one of the selected ERP components; the P1, N1, and LPP. The IAT only elicited different P3 amplitudes when expectations were violated. We recommend the use of IFT paradigms when studying neural processes underlying the violation of social expectations.
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Potenciais Evocados , Motivação , Adulto , Encéfalo/fisiologia , Criança , Pré-Escolar , Eletroencefalografia/métodos , Potenciais Evocados/fisiologia , Feminino , Humanos , Masculino , Adulto JovemRESUMO
Parental gender socialization refers to ways in which parents teach their children social expectations associated with gender. Relatively little is known about the mechanisms underlying gender socialization. An overview of cognitive and neural processes underlying parental gender socialization is provided. Regarding cognitive processes, evidence exists that parents' implicit and explicit gender stereotypes, attitudes, and gendered attributions are implicated in gender socialization. Other cognitive factors, such as intergroup attitudes, gender essentialism, internal motivation for parenting without gender stereotypes, gender identity, and conflict resolution are theoretically relevant mechanisms underlying gender socialization, but need further investigation. Regarding neural processes, studies demonstrated that attentional processing, conflict monitoring, behavior regulation, and reward processing might underlie stereotypes and biased behavior. However, more research is necessary to test whether these neural processes are also related to parental gender socialization. Based on this overview, a framework is presented of neural and cognitive factors that were theoretically or empirically related to gender socialization.
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BACKGROUND: Third-trimester routine ultrasounds are increasingly offered to monitor fetal growth. In addition to limited evidence for its clinical effectiveness, little is known about its importance for pregnancy-specific anxiety and mother-to-infant bonding. METHODS: 1275 low-risk women participated in a Dutch nationwide pragmatic cluster-randomized trial and answered questionnaires on pregnancy-specific anxiety (PRAQ-R) and prenatal mother-to-infant bonding (MAAS) before and after a third-trimester routine ultrasound was offered to the intervention group. Linear mixed model regression analyses were performed to examine the effect of offering a third-trimester routine ultrasound on pregnancy-specific anxiety and mother-to-infant bonding. In addition, we examined whether the effect depended on maternal background characteristics and level of satisfaction with the ultrasound procedure. RESULTS: We found no effect of offering a third-trimester routine ultrasound on pregnancy-specific anxiety and mother-to-infant bonding. However, interaction analyses showed that women with high levels of depressive symptoms at baseline and women who were very satisfied with the ultrasound procedure benefited somewhat more from offering a third-trimester routine ultrasound in terms of mother-to-infant bonding compared with women with low or no depressive symptoms, or less satisfied women. CONCLUSIONS: The relationship between offering a third-trimester routine ultrasound with pregnancy-specific anxiety and mother-to-infant bonding is limited. A beneficial effect only applies to some subgroups of women. This implies that, in terms of psychological outcomes, there are no counterarguments to implementing a third-trimester routine ultrasound. Strong evidence for offering all pregnant women a third-trimester routine ultrasound for psychological reasons, however, is lacking.
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Mães , Ultrassonografia Pré-Natal , Ansiedade/prevenção & controle , Feminino , Humanos , Lactente , Gravidez , Terceiro Trimestre da Gravidez , Inquéritos e QuestionáriosRESUMO
(Hetero)sexual double standards (SDS) entail that different sexual behaviors are appropriate for men and women. There is large variation in whether people endorse SDS in their expectations about the sexual behavior of women and men (i.e., SDS-norms). To explain these individual differences, we examined associations between SDS-norms of Dutch adolescents (aged 16-20 years, N = 566) and what parents, peers, and the media teach adolescents about appropriate sexual behavior of boys and girls (i.e., SDS-socialization). Adolescents completed an online survey at school. Regarding SDS-socialization, more traditional SDS-norms conveyed by the media and peers, but not of parents, and less perceived sexual activity of female peers, were associated with more traditional SDS-norms. Only for boys, exposure to sexy girls/women on social media and sexual music videos of female artists were associated with more traditional SDS-norms. Thus, SDS-socialization by peers and the media and opposite gender models (for boys) are important in light of adolescents' SDS-norms.
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Comportamento do Adolescente , Socialização , Adolescente , Adulto , Feminino , Humanos , Masculino , Pais , Grupo Associado , Comportamento Sexual , Adulto JovemRESUMO
Background: Preterm infants with pre- or postnatal growth restriction may have an additional risk of adverse neurodevelopmental outcome. Whereas reduced cognitive ability and behavioral problems have consistently been associated with prematurity, a more comprehensive evaluation is necessary to identify those preterm infants who are at increased risk for difficulties in school performance. This study evaluated the association between extremely low birth weight (ELBW) and the need for special education and determined if there is an additional risk for the need for special education among small for gestational age (SGA) children. Methods: This is a single-center cohort study including singleton children born below 30 weeks' gestation between 1990 and 2011 and followed into 2019. ELBW + was defined as a birth weight below 1,000 g, which was compared to ELBW-. Within all ELBW+ children, SGA+ was defined as a birth weight <10th percentile according to Fenton, which was compared to SGA-. The dichotomous outcome measurement was the need for special education at 8 years of age or not, reflecting if the children required a special educational setting designed to accommodate educational, behavioral, and/or medical needs. Results: In total, 609 children were eligible for follow-up, of whom 390 (64%) children were assessed at 8 years. Of these, 56 (14%) children needed special education, most often determined by cognitive deficiency (43%), behavioral problems (29%), or both (16%). Among the 191 ELBW+ children, 35 (18%) attended special education, compared to 21 (11%) among ELBW- children (p-value 0.041). A decreasing risk for the need for special education was found from 25% in ELBW+/SGA+ children to 16% in ELBW+/SGA- children and 11% in ELBW-/SGA- children (p-value 0.025). Multivariable logistic regression showed an odds ratio of 2.88 (95% CI 1.20-6.78) for ELBW+/SGA+ children vs. ELBW-/SGA- children for the need for special education. Conclusions: This study showed that ELBW children are at increased risk for the need for special education compared to non-ELBW children. In addition, children that are both ELBW and SGA do have the highest risk for the need for special education. Classifying children as ELBW and SGA can be useful in follow-up for identifying preterm children with an additional risk for adverse long-term outcome.
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INTRODUCTION: Preterm birth is one of the main problems in obstetrics, and the most important cause of neonatal mortality, morbidity and neurodevelopmental impairment. Multiple gestation is an important risk factor for preterm birth, with up to 50% delivering before 37 weeks. Progesterone has a role in maintaining pregnancy and is frequently prescribed to prevent (recurrent) preterm birth and improve pregnancy outcomes in high-risk patients. However, little is known about its long-term effects in multiple gestations. The objective of this follow-up study is to assess long-term benefits and harms of prenatal exposure to progesterone treatment in multiple gestations on child development. METHODS AND ANALYSIS: This is a follow-up study of a multicentre, double-blind, placebo-controlled randomised trial (AMPHIA trial, ISRCTN40512715). Between 2006 and 2009 women with a multiple gestation were randomised at 16-20 weeks of gestation to weekly injections 250 mg 17α-hydroxyprogesterone caproate or placebo, until 36 weeks of gestation or delivery. The current long-term follow-up will assess all children (n=1355) born to mothers who participated in the AMPHIA trial, at 11-14 years of age, with internationally validated questionnaires, completed by themselves, their parents and their teachers. MAIN OUTCOMES ARE CHILD COGNITION AND BEHAVIOUR: Additional outcomes are death (perinatal and up to age 14), gender identity, educational performance and health-related problems. We will use intention-to-treat analyses comparing experimental and placebo group. To adjust for the correlation between twins, general linear mixed-effects models will be used. ETHICS AND DISSEMINATION: Amsterdam UMC MEC provided a waiver for the Medical Research Involving Human Subjects Act (W20_234#20.268). Results will be disseminated through peer-reviewed journals and summaries shared with stakeholders, patients and participants. This protocol is published before analysis of the results. TRIAL REGISTRATION NUMBER: NL8933.
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Nascimento Prematuro , Adolescente , Feminino , Seguimentos , Identidade de Gênero , Humanos , Recém-Nascido , Masculino , Estudos Multicêntricos como Assunto , Gravidez , Gravidez Múltipla , Nascimento Prematuro/prevenção & controle , Progesterona , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVE: This study aimed to identify latent classes of adjustment in children confronted with parental cancer, based on profiles of traumatic stress symptoms, health-related quality of life (HRQoL), and satisfaction with life. In addition, correlates of classes were examined. METHOD: Families were recruited through social media, health care providers, and cancer support centers. The sample consisted of 175 children (52% girls, aged M = 11.98, SD = 3.20, range = 6-20 years) from 92 families, including 90 parents with a current or past cancer diagnosis and 71 healthy parents. Children and parents completed self-report questionnaires at home. A latent profile analysis was conducted to identify classes based on child traumatic stress symptoms, HRQoL, and satisfaction with life. RESULTS: Four classes were identified, which were labeled (a) average functioning across domains (64%); (b) high stress, below-average HRQoL and life satisfaction (14%); (c) high stress, below-average HRQoL, and average satisfaction (11%); and (d) high functioning across domains (11%). Child age, parent traumatic stress symptoms, and perceived parental warmth were significantly associated with class membership. Child gender, which parent was diagnosed with cancer, and illness phase were unrelated to class membership. CONCLUSIONS: Meaningful subgroups of children can be distinguished based on positive and negative indicators of adjustment to parental cancer. Whereas the majority of children appear to adjust well, 25% of children display high levels of traumatic stress and impaired HRQoL, in some cases combined with low life satisfaction; these children may need specific attention to improve adjustment in the long term. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Neoplasias , Qualidade de Vida , Idoso , Criança , Família , Humanos , PaisRESUMO
BACKGROUND: The Ages and Stages Questionnaire Social-Emotional (ASQ-SE) is a parent-report screening instrument designed to assess children's social-emotional development and detect those at risk for delay or problems. Psychometric properties of this questionnaire have been studied before, but the ASQ-SE has never been compared to the Social-Emotional Scale of the Bayley-III (Bayley-III-SE). AIM: To compare the Dutch ASQ-SE (ASQ-SE-NL) to the Dutch Bayley-III-SE (Bayley-III-NL-SE; criterion measure). METHOD: A Dutch community sample of mothers with children aged 3-41 months (n = 1014) filled out both questionnaires. Cut-off scores for the ASQ-SE-NL were determined using: 1) >1 SD above the mean and 2) ROC curves. For the Bayley-III-NL, Dutch norm scores were used. RESULTS: Specificity (70.8% and 88.5%) and screen-out accuracy (0.65 and 0.77) of the ASQ-SE-NL were good. Sensitivity was only sufficient (70.6%) when using ROC curves and only for the ASQ-SE-NL ≥18 months age versions. Screen-in accuracy was insufficient (<0.49). Positive predictive value was 34.7% and 32.7%, and negative predictive value was 87.5% and 92.3%. False positive cases on the ASQ-SE-NL scored significantly lower on the Bayley-III-NL-SE than true negative cases. CONCLUSION: Using the Bayley-III-NL-SE as the criterion, the ASQ-SE-NL performed well in identifying children not at risk for delay or problems. The ASQ-SE-NL sufficiently detected children at risk for delay or problems in the ≥18 months ASQ-SE-NL age versions when cut-off scores were determined by ROC curves. The ASQ-SE-NL can be used in a monitoring routine, but early rescreening is advised after a positive test result, given the number of false positive results.
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Emoções , Pais , Criança , Desenvolvimento Infantil , Pré-Escolar , Deficiências do Desenvolvimento/diagnóstico , Feminino , Humanos , Lactente , Programas de Rastreamento , Psicometria , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Examining relationships of toddler abilities in attention, cognitive, motor, and language development, and behavioral problems, with distinct attention profiles at 6 years of age in children born moderate-to-late preterm and full term. METHOD: Longitudinal study with a cohort of 88 moderate-to-late preterm and 83 full term born children. At 18 months attention abilities were assessed. At 24 months cognitive, motor, and language development was examined and behavioral problems were screened. At 6 years ten measures of attention were administered, which were used to classify children in one of four attentional functioning profiles (normal attention, overall poorer attention, poorer cognitive attention, and behavioral attention problems). Performance at 18 and 24 months was examined in relation to these four distinct attention profiles, as well as in relation to normal (first profile) versus subaverage attention (second, third, and fourth profiles) using multinomial logistic regressions. RESULTS: Orienting and alerting attention, and receptive language were related to distinct attention profiles. Specifically, children with an overall poorer attention profile at 6 years were differentiated by lower orienting attention and receptive language scores at toddler age, while those with a poorer cognitive attention profile showed lower early alerting attention at 18 months. Children with a behavioral attention problems profile at 6 years were differentiated by lower orienting attention but higher alerting attention scores at toddler age. Orienting attention and receptive language, but not alerting attention, at toddler age were related to normal versus subaverage attention, with lower scores predicting subaverage attention. CONCLUSIONS: Children at risk of poorer attentional functioning at school-age, expressed in distinct attention profiles, already showed differentiated functioning in attention abilities and in language comprehension as toddlers. Distinguishing distinct attention profiles could be important for future research and clinical practice, as is early monitoring of attention and language abilities in children at risk.
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Nascimento Prematuro , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Idioma , Masculino , GravidezRESUMO
Aim: Long-term outcome data in preterm children is often limited to cross-sectional measurement of neurodevelopmental impairment (NDI) at the corrected age of 24-36 months. However, impairments may only become overt during childhood or resolve with time, and individual trajectories in outcome over time may vary. The primary aim of this study was to describe NDI in very preterm born children at three subsequent ages of 2, 5, and 8 years of age. As a secondary aim, a longitudinal analysis was performed on the individual longitudinal trajectories in NDI from 2 to 8 years of age. Methods: Single-center prospective cohort study including children born between 1990 and 2011 below 30 weeks' gestation and followed into 2019. The outcome measurement was NDI assessed at 2, 5, and 8 years of age. NDI is a composite score that includes cognitive, neurological, visual, and auditory functions, in which problems were categorized as none, mild, moderate, or severe. Cognitive function measured as total DQ/IQ score was assessed by standardized psychometric tests. Neurological, visual, and auditory functions were assessed by the neonatologist. Results: In total, 921 children were eligible for follow-up, of whom 726 (79%) children were assessed. No NDI was seen in 54, 54, and 62%, mild NDI was seen in 31, 36, and 30%, and moderate-to-severe NDI was seen in 15, 9.2, and 8.6% of the children at 2, 5, and 8 years, respectively. From 2 to 8 years, 63% of the children remained in the same NDI category, 20% of the children improved to a better NDI category, and 17% deteriorated toward a worse NDI category. No differences were found in baseline characteristics of infants that improved or deteriorated. Extreme prematurity, male gender and low parental education were associated with worse NDI status at all time points. Although we observed considerable individual variation over time in NDI status, the course of the trajectories in NDI were not associated with gestation, gender, and parental education. Conclusions: Continued follow-up until school life is essential in order to provide optimal and individually focused referrals and care when needed.
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As indicated by the World Health Organization, preterm birth is a relevant public health issue, being one of the leading causes of death in children under five years of age [...].
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Nascimento Prematuro , Criança , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologiaRESUMO
OBJECTIVE: To identify attention profiles at 7 and 13 years, and transitions in attention profiles over time in children born very preterm (VP; <30 weeks' gestation) and full term (FT), and examine predictors of attention profiles and transitions. METHODS: Participants were 167 VP and 60 FT children, evaluated on profiles across five attention domains (selective, shifting and divided attention, processing speed, and behavioral attention) at 7 and 13 years using latent profile analyses. Transitions in profiles were assessed with contingency tables. For VP children, biological and social risk factors were tested as predictors with a multinomial logistic regression. RESULTS: At 7 and 13 years, three distinct profiles of attentional functioning were identified. VP children were 2-3 times more likely to show poorer attention profiles compared with FT children. Transition patterns between 7 and 13 years were stable average, stable low, improving, and declining attention. VP children were two times less likely to have a stable average attention pattern and three times more likely to have stable low or improving attention patterns compared with FT children. Groups did not differ in declining attention patterns. For VP children, brain abnormalities on neonatal MRI and greater social risk at 7 years predicted stable low or changing attention patterns over time. CONCLUSIONS: VP children show greater variability in attention profiles and transition patterns than FT children, with almost half of the VP children showing adverse attention patterns over time. Early brain pathology and social environment are markers for attentional functioning.
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Atenção , Lactente Extremamente Prematuro , Adolescente , Criança , Cognição , Idade Gestacional , Humanos , Recém-Nascido , Imageamento por Ressonância MagnéticaRESUMO
Language development in toddlerhood forms the foundation for speech and language comprehension throughout childhood. Children born moderately preterm are at increased risk for problems in receptive and expressive language functioning, and they may need specific support or interventions. To understand the underlying mechanisms of language development, an integrated model of gestational age, attention capacities, and maternal sensitivity was examined in relation to receptive and expressive language functioning in toddlerhood. Our sample included 221 children (gestational age between 32-41 + 6 weeks; 54.7% born moderately preterm; 51.6% boys; 69.1% highly educated mothers). At 18 months (corrected age), attention capacities were measured using an eye-tracking procedure and maternal sensitivity was observed during mother-child interaction. Language was assessed at 24 months (corrected age). Results showed children with a higher gestational age scored higher on receptive language. This association was direct, as well as indirect through the child's alerting attention. Expressive language was related to maternal sensitivity. Gestational age and alerting attention capacities specifically were related to language comprehension, whereas maternal sensitivity was related to speech. As language comprehension and speech in toddlerhood show different associations with biological, child, contextual, and regulation factors, they should be viewed as separate constructs in research and practice.