Infant Neuromotor Development and Childhood Problem Behavior.

BACKGROUND: Research of adults and school-aged children suggest a neurodevelopmental basis for psychiatric disorders. We examined whether infant neuromotor development predicted internalizing and externalizing problems in young children. METHODS: In Generation R, a population-based cohort in the Netherlands (2002-2006), trained research assistants evaluated the neuromotor development of 4006 infants aged 2 to 5 months by using an adapted version of Touwen's Neurodevelopmental Examination (tone, responses, and senses and other observations). We defined nonoptimal neuromotor development as scores in the highest tertile. Mothers and fathers rated their children's behavior at ages 1.5, 3, 6, and 10 years with the Child Behavior Checklist (n = 3474, response: 86.7%). The associations were tested with generalized linear mixed models. RESULTS: Overall, neuromotor development predicted internalizing scores, but no association was observed with externalizing scores. Nonoptimal muscle tone was associated with higher internalizing scores (mothers' report: ß = .07; 95% confidence interval [CI]: 0.01 to 0.13; fathers' report: ß = .09, 95% CI: 0.00 to 0.16). In particular, nonoptimal low muscle tone was associated with higher internalizing scores (mothers' report: ß = .11; 95% CI: 0.05 to 0.18; fathers' report: ß = .13; 95% CI: 0.04 to 0.22). We also observed an association between senses and other observations with internalizing scores. There was no relationship between high muscle tone or reflexes and internalizing scores. CONCLUSIONS: Common emotional problems in childhood have a neurodevelopmental basis in infancy. Neuromotor assessment in infancy may help identify vulnerability to early internalizing symptoms and offer the opportunity for targeted interventions.

Infant muscle tone and childhood autistic traits: A longitudinal study in the general population.

In a longitudinal population-based study of 2,905 children, we investigated if infants' neuromotor development was associated with autistic traits in childhood. Overall motor development and muscle tone were examined by trained research assistants with an adapted version of Touwen's Neurodevelopmental Examination between ages 2 and 5 months. Tone was assessed in several positions and items were scored as normal, low, or high tone. Parents rated their children's autistic traits with the Social Responsiveness Scale (SRS) and the Pervasive Developmental Problems (PDP) subscale of the Child Behavior Checklist at 6 years. We defined clinical PDP if scores were >98th percentile of the norm population. Diagnosis of autism spectrum disorder (ASD) was clinically confirmed in 30 children. We observed a modest association between overall neuromotor development in infants and autistic traits. Low muscle tone in infancy predicted autistic traits measured by SRS (adjusted beta = 0.05, 95% CI for B: 0.00-0.02, P = 0.01), and PDP (adjusted beta = 0.08, 95% CI for B: 0.04-0.10, P < 0.001). Similar results emerged for the association of low muscle tone and clinical PDP (adjusted OR = 1.36, 95% CI: 1.08-1.72, P = 0.01) at age 6 years. Results remained unchanged if adjusted for child intelligence. There was no association between high muscle tone and SRS or PDP. Exclusion of children with ASD diagnosis did not change the association. This large study showed a prospective association of infant muscle tone with autistic traits in childhood. Our findings suggest that early detection of low muscle tone might be a gateway to improve early diagnosis of ASD. Autism Res 2017, 10: 757-768. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Relation of infant motor development with nonverbal intelligence, language comprehension and neuropsychological functioning in childhood: a population-based study.

Within a population-based study of 3356 children, we investigated whether infant neuromotor development was associated with cognition in early childhood. Neuromotor development was examined with an adapted version of Touwen's Neurodevelopmental Examination between 9 and 20 weeks. Parents rated their children's executive functioning at 4 years. At age 6 years, children performed intelligence and language comprehension tests, using Dutch test batteries. At age 6-9 years, neuropsychological functioning was assessed in 486 children using the validated NEPSY-II-NL test battery. We showed that less optimal neurodevelopment in infancy may predict poor mental rotation, immediate memory, shifting, and planning; but not nonverbal intelligence or language comprehension.

The potential adverse effect of energy drinks on executive functions in early adolescence.

INTRODUCTION: Manufacturers of energy drinks (EDs) claim their products improve cognitive performance. Young adolescents are in a critical developmental phase. The impact of ED intake on their development is not yet clear. Therefore, we studied the associations of both caffeine intake and ED consumption with executive functions (EFs), and the role of pubertal status and sleeping problems. METHODS: A sample of 509 participants (mean age: 13.1 years, SD 0.85; age range: 11-16 years) participated in the study. The level of pubertal development was classified in five pubertal status categories. Participants were asked to report their caffeine (for example coffee) and ED consumption for each day of the week. In addition, they indicated sleep quality by reporting problems falling asleep or waking up and/or interrupted sleep. EFs were assessed by self- and parent reports of the Behavior Rating Inventory of Executive Function (BRIEF). RESULTS: Consuming on average one or more ED(s) a day was associated with more problems in self-reported behavior regulation and metacognition, and with more problems in parent-reported metacognition. Only high caffeine consumption (two or more cups a day) was associated with parent-reported problems with metacognition. The sum of caffeine and ED use was associated with a higher amount of problems with self-reported metacognition and parent reported behavior regulation. The effect estimates for the association between caffeine and ED use combined and EFs did not exceed those of EDs or caffeine separately. Adjusting for pubertal status, gender, educational level, number of sleeping problems and hours of sleep did not change the effect estimates substantially. CONCLUSION: The observed associations between ED consumption and EFs suggest that regular consumption of EDs-even in moderate amounts-may have a negative impact on daily life behaviors related to EF in young adolescents.

Screening for autism spectrum disorders with the brief infant-toddler social and emotional assessment.

OBJECTIVE: Using parent-completed questionnaires in (preventive) child health care can facilitate the early detection of psychosocial problems and psychopathology, including autism spectrum disorders (ASD). A promising questionnaire for this purpose is the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). The screening accuracy with regard to ASD of the BITSEA Problem and Competence scales and a newly calculated Autism score were evaluated. METHOD: Data, that was collected between April 2010 and April 2011, from a community sample of 2-year-olds (N = 3127), was combined with a sample of preschool children diagnosed with ASD (N = 159). For the total population and for subgroups by child's gender, area under the Receiver Operating Characteristic (ROC) curve was examined, and across a range of BITSEA Problem, Competence and Autism scores, sensitivity, specificity, positive and negative likelihood ratio's, diagnostic odds ratio and Youden's index were reported. RESULTS: The area under the ROC curve (95% confidence interval, [95%CI]) of the Problem scale was 0.90(0.87-0.92), of the Competence scale 0.93(0.91-0.95), and of the Autism score 0.95(0.93-0.97). For the total population, the screening accuracy of the Autism score was significantly better, compared to the Problem scale. The screening accuracy of the Competence scale was significantly better for girls (AUC = 0.97; 95%CI = 0.95-0.98) than for boys (AUC = 0.91; 95%CI = 0.88-0.94). CONCLUSION: The results indicate that the BITSEA scales and newly calculated Autism score have good discriminative power to differentiate children with and without ASD. Therefore, the BITSEA may be helpful in the early detection of ASD, which could have beneficial effects on the child's development.

How does emotional wellbeing relate to underachievement in a general population sample of young adolescents: a neurocognitive perspective.

Underachievement in school during early adolescence predicts future economic and personal difficulties. Particular neurocognitive skills on the domain of executive functions start to mature during adolescence. This fact and the physical and psychological changes typical for the transition from childhood to adulthood make adolescents vulnerable to emotional problems. The current study investigated the relationship between mild emotional problems which are highly prevalent among adolescents and underachievement in school, and the role of neurocognitive functioning in this relation. This study was conducted in a substantial sample of typical developing young adolescents who just made the transition to secondary education. Pupils were on average 12.5 years old (standard deviation 0.5), and 45% of the included sample were girls. Emotional wellbeing was associated with underachievement [Odds ratio (OR) 5.15, 95% confidence interval (CI) 3.06-8.68] after adjusting for background variables. Self-reported neurocognitive functioning partly explained the relation between emotional wellbeing and underachievement (OR 2.22, 95% CI 1.23-3.99), yet, emotional wellbeing remained statistically associated with underachievement after correcting for additional confounders (OR 1.99, 95% CI 1.08-3.66). The observed findings suggest that emotional wellbeing plays an essential role in underachievement during the first year of secondary education.

Early infant neuromotor assessment is associated with language and nonverbal cognitive function in toddlers: the Generation R Study.

OBJECTIVE: Numerous studies in high-risk populations established that variations in infant neuromotor development predict poor cognitive function. It is unclear whether this association is found in the general population. Moreover, previous population-based studies mostly focused on motor milestone achievement. METHODS: This study was embedded in the Generation R Study, a population-based cohort in Rotterdam, the Netherlands. Neuromotor development was assessed with an adapted version of Touwen's Neurodevelopmental Examination when infants (1205 males, 1278 females) were on average 12 weeks old (standard deviation 1, range, 9-15 weeks). To measure language function at age 1.5 years, the MacArthur Short Form Vocabulary Checklist was used. At 2.5 years, mothers completed the Language Development Survey and the Parent Report of Children's Abilities measuring language and nonverbal cognitive functioning, respectively. RESULTS: After adjustment for confounders, less optimal neuromotor development, that is, more low tone symptoms, was associated with a delay in receptive language at 1.5 years (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.05-1.34) and in expressive language at multiple time points (OR, 1.11; 95% CI, 1.02-1.21). Higher scores on overall neuromotor development, indicating a less optimal neuromotor development, was associated with an increased risk of a delay in nonverbal cognitive function at 2.5 years (OR, 1.19; 95% CI, 1.05-1.35). CONCLUSIONS: The results of this study suggest that infants with more low tone symptoms, indicating minor deviances from normal neuromotor development, are somewhat more vulnerable to language delays than those infants who do not have these symptoms.

Fetal programming of infant neuromotor development: the generation R study.

The objective of the study was to examine whether infant neuromotor development is determined by fetal size and body symmetry in the general population. This study was embedded within the Generation R Study, a population-based cohort in Rotterdam. In 2965 fetuses, growth parameters were measured in mid-pregnancy and late pregnancy. After birth, at age 9 to 15 wks, neuromotor development was assessed with an adapted version of Touwen's Neurodevelopmental Examination. Less optimal neuromotor development was defined as a score in the highest tertile. We found that higher fetal weight was beneficial to infant neurodevelopment. A fetus with a 1-SD score higher weight in mid-pregnancy had an 11% lower risk of less optimal neuromotor development (OR: 0.89; 95% CI: 0.82-0.97). Similarly, a fetus with a 1-SD score larger abdominal-to-head circumference (AC/HC) ratio had a 13% lower risk of less optimal neuromotor development (OR: 0.87; 95% CI: 0.79-0.96). These associations were also present in late pregnancy. Our findings show that fetal size and body symmetry in pregnancy are associated with infant neuromotor development. These results suggest that differences in infant neuromotor development, a marker of behavioral and cognitive problems, are at least partly caused by processes occurring early in fetal life.

Maternal folic acid supplement use in early pregnancy and child behavioural problems: The Generation R Study.

Folate deficiency during embryogenesis is an established risk factor for neural tube defects in the fetus. An adequate folate nutritional status is also important for normal fetal growth and brain development. The aim of the present research was to study the association between folic acid use of the mother during pregnancy and child behavioural development. Within a population-based cohort, we prospectively assessed folic acid supplement use during the first trimester by questionnaire. Child behavioural and emotional problems were assessed with the Child Behaviour Checklist at the age of 18 months in 4214 toddlers. Results showed that children of mothers who did not use folic acid supplements in the first trimester had a higher risk of total problems (OR 1.44; 95 % CI 1.12, 1.86). Folic acid supplement use protected both from internalising (OR of no supplement use 1.65; 95 % CI 1.24, 2.19) and externalising problems (OR 1.45; 95 % CI 1.17, 1.80), even when adjusted for maternal characteristics. Birth weight and size of the fetal head did not mediate the association between folic acid use and child behaviour. In conclusion, inadequate use of folic acid supplements during early pregnancy may be associated with a higher risk of behavioural problems in the offspring. Folic acid supplementation in early pregnancy, aimed to prevent neural tube defects, may also reduce mental health problems in children.

Maternal symptoms of anxiety during pregnancy affect infant neuromotor development: the generation R study.

Several studies found that maternal symptoms of anxiety or depression are related to functioning and development of the offspring. Within a population-based study of 2,724 children, we investigated the effect of maternal anxiety or depression on infant neuromotor development. Symptoms of anxiety and depression were measured during pregnancy and after giving birth; infant neuromotor development was assessed by trained research nurses during a home visit at the age of 3 months. The current study showed that mothers who were anxious during pregnancy had an elevated risk of having an infant with non-optimal neuromotor development.

Does gestational duration within the normal range predict infant neuromotor development?

AIM: To examine the extent to which infant neuromotor development is determined by gestational duration and birth weight within the normal range. METHODS: The study was embedded within the Generation R Study, a population-based cohort in Rotterdam, the Netherlands. An adapted version of Touwen's Neurodevelopmental Examination was used to assess 3224 infants (1576 males and 1648 females) at corrected ages between 9 and 15 weeks. Non-optimal neuromotor development was defined as a score in the highest tertile. RESULTS: Infant neuromotor development was significantly affected by gestational duration (odds ratio 0.8, 95% confidence interval 0.7;0.8). Adding a quadratic term of gestational duration to the model revealed a highly significant curvilinear association between gestational duration and neuromotor development; after adjusting for post-conceptional age this was still significant. Although babies with a 1 kg lower birth weight had a 30% higher risk of non-optimal neuromotor development, this association disappeared after adjustment for post-conceptional age. CONCLUSIONS: Our findings indicate that differences in infant neuromotor development can be explained even by variations in gestational duration within the normal range. If an infant is found to have minor neuromotor delays, account should be taken of this.