The impact of processing speed on cognition in temporal lobe epilepsy.

PURPOSE: To characterize the impact of slowed processing speed on the efficiency of broader cognitive function in temporal lobe epilepsy (TLE). METHODS: Participants included 100 patients with TLE and 89 healthy controls (mean ages 36.8 and 33.6, respectively) administered a neuropsychological battery consisting of 15 cognitive metrics. Confirmatory factor analysis using structural equation modeling (SEM) latent variable modeling demonstrated a cognitive structure representing the domains of verbal intelligence, immediate memory, delayed memory, executive function, working memory, and processing speed. Furthermore, the latent variable measurement model determined the direct and indirect relationships of verbal intelligence and processing speed with immediate memory, delayed memory, executive function, and working memory. RESULTS: Following SEM of hypothesized structural models, the results demonstrated that, among controls, intelligence had a direct and unmediated (by processing speed) relationship with all identified cognitive domains. In contrast, among participants with TLE, processing speed mediated the relationship between verbal intelligence and performance across all cognitive domains. CONCLUSION: Slowing of cognitive/psychomotor processing speed appears to play a critical mediating role in the broader cognitive status of participants with TLE and may serve as a target through which to attempt to exert a broad positive impact on neuropsychological status.

PACER Performance of Children Aged 11-14 With Attention-Deficit Hyperactive Disorder.

PURPOSE: The purposes of this study were to examine the performance on the progressive aerobic cardiovascular endurance run (PACER) test in children with and without attention-deficit hyperactive disorder (ADHD) over the course of a school year, and also to investigate the possible influence of age, sex, school sport participation, and body mass index on results. METHODS: Utilizing a repeated measures design, 892 middle school children aged 11-14 years (mean = 12.25, SD = 0.94) including 55 children with ADHD participated. While controlling for age, sex, sports participation, and body mass index, children were tested on the PACER 3 times during the school year. Procedures specified in the FITNESSGRAM test manual were explicitly followed. Hierarchical linear modeling was applied to analyze the data. RESULTS: Children with ADHD performed 8.6 fewer laps at intercept (baseline), than did healthy children without ADHD (t878 = -6.20, P < .001). However, no significant differences emerged for time (slope). In addition, no significant interactions were found for ADHD with age, sex, sports participation, or body mass index. CONCLUSION: A diagnosis of ADHD, independent of selected predictor variables, explained lower PACER performance.

CDC Grand Rounds: Newborn Screening for Hearing Loss and Critical Congenital Heart Disease.

Newborn screening is a public health program that benefits 4 million U.S. infants every year by enabling early detection of serious conditions, thus affording the opportunity for timely intervention to optimize outcomes (1). States and other U.S. jurisdictions decide whether and how to regulate newborn screening practices. Most newborn screening is done through laboratory analyses of dried bloodspot specimens collected from newborns. Point-of-care newborn screening is typically performed before discharge from the birthing facility. The Recommended Uniform Screening Panel includes two point-of-care conditions for newborn screening: hearing loss and critical congenital heart disease (CCHD). The objectives of point-of-care screening for these two conditions are early identification and intervention to improve neurodevelopment, most notably language and related skills among infants with permanent hearing loss, and to prevent death or severe disability resulting from delayed diagnosis of CCHD. Universal screening for hearing loss using otoacoustic emissions or automated auditory brainstem response was endorsed by the Joint Committee on Infant Hearing in 2000 and 2007* and was incorporated in the first Recommended Uniform Screening Panel in 2005. Screening for CCHD using pulse oximetry was recommended by the Advisory Committee on Heritable Disorders in Newborns and Children in 2010 based on an evidence review† and was added to the Recommended Uniform Screening Panel in 2011.§.

Developmental trajectories of acculturation: links with family functioning and mental health in recent-immigrant Hispanic adolescents.

The present study was designed to examine acculturative changes, and their effects on mental health and family functioning, in recent-immigrant Hispanic adolescents. A sample of 302 Hispanic adolescents was assessed five times over a 2½-year period. Participants completed measures of Hispanic and U.S. practices, collectivist and individualist values, and ethnic and U.S. identity at each time point. Baseline and Time 5 levels of mental health and family functioning were also assessed. Latent class growth analyses produced two-class solutions for practices, values, and identifications. Adolescents who increased over time in practices and values reported the most adaptive mental health and family functioning. Adolescents who did not change in any acculturation domain reported the least favorable mental health and family functioning.

Performance by middle school children with and without asthma on the pacer.

Asthma is a chronic lung disease characterized by airway hyper-reactivity, inflammation, and obstruction. Asthma is also a leading cause of school absenteeism, and thus of concern to physical educators and health professionals. The purpose of this study was to assess aerobic performance by children with and without asthma. All participants were tested on the Progressive Aerobic Cardiovascular Endurance Run (PACER). Of particular interest was children's aerobic performance over an extended time, i.e., 15 months. Participants (Grades 4-8, N=809) were tested on the PACER three times during the school year with two follow-up tests during the succeeding school year. Among the 809 participants were 103 children with mild-moderate asthma. Hierarchical Linear Modeling (HLM) was applied to analyze the data. Notwithstanding their lower scores at baseline (intercept), children with asthma increased their PACER scores at a rate more than double that of their peers without asthma. Although more than one PACER trial may be needed to accurately determine children's aerobic performance, repeated trials may be especially necessary for children with asthma. It was further concluded that the PACER is an effective tool with which to assess aerobic performance by middle school children with well-managed asthma.

The Impacts of Three Educational Technologies on Algebraic Understanding in the Context of COVID-19.

The current study investigated the effectiveness of three distinct educational technologies-two game-based applications (From Here to There and DragonBox 12+) and two modes of online problem sets in ASSISTments (an Immediate Feedback condition and an Active Control condition with no immediate feedback) on Grade 7 students' algebraic knowledge. More than 3,600 Grade 7 students across nine in-person and one virtual schools within the same district were randomly assigned to one of the four conditions. Students received nine 30-minute intervention sessions from September 2020 to March 2021. Hierarchical linear modeling analyses of the final analytic sample (N = 1,850) showed significantly higher posttest scores for students who used From Here to There and DragonBox 12+ compared to the Active Control condition. No significant difference was found for the Immediate Feedback condition. The findings have implications for understanding how game-based applications can affect algebraic understanding, even within pandemic pressures on learning.

Age and sex differences in object control skills by children ages 5 to 14.

Object control skills provide children the tools to be physically active-a major societal priority. At the fundamental movement level, object control skills form the foundation of further sports skill development. The purpose of this study was to examine children's (ages 5 to 14 years, Grades K-8) development of four key object control skills: catching, throwing, kicking, and striking. 186 children were tested on selected items from the Object Control Subtest of the Test of Gross Motor Development-2, using a cross-sectional and correlational design. As anticipated, significant differences were found for age on all four skills. These improvements were characterized by early, rapid gains at ages 9 to 10, beyond which development occurred at a slower rate for catching, throwing, and kicking; striking development continued at a steady rate to age 14 years. Contrary to previous findings, no overall sex differences were found for catching or kicking. Overall sex differences favoring boys were observed for throwing and striking. Implications for evolutionary contributions to throwing and striking were discussed.

Likely Impact of the COVID-19 Pandemic on Newborn Hearing Screening and Follow-up Services in the United States in 2020.

This perspective aims to highlight aspects of the Early Hearing Detection and Intervention (EHDI) newborn hearing screening and follow-up processes that were impacted by the COVID-19 pandemic and considers factors that likely impacted follow-up after failing newborn hearing screening among infants born in the United States during 2020. Efforts to minimize the potential impact of missed or delayed identification of hearing loss in infants and young children will also be discussed to help guide future program improvement activities.

Assessing Impact of COVID-19 Pandemic on Receipt and Timeliness of Newborn Hearing Screening and Diagnostic Services Among Infants Born in Four States.

The study compares receipt and timeliness of newborn hearing screening and follow-up diagnostic services between the pre-pandemic birth cohort and the pandemic birth cohort in four participating states. Findings from this study will help inform state Early Hearing Detection and Intervention (EHDI) programs in the future should a major public health event occur again.

Frequency of Early Intervention Sessions and Vocabulary Skills in Children with Hearing Loss.

BACKGROUND: A primary goal of early intervention is to assist children in achieving age-appropriate language skills. The amount of intervention a child receives is ideally based on his or her individual needs, yet it is unclear if language ability impacts amount of intervention and/or if an increased frequency of intervention sessions results in better outcomes. The purpose of this study was to determine the relationship between the frequency of early intervention sessions and vocabulary outcomes in young children with hearing loss. METHODS: This was a longitudinal study of 210 children 9 to 36 months of age with bilateral hearing loss living in 12 different states. Expressive vocabulary skills were evaluated using the MacArthur-Bates Communicative Development Inventories. RESULTS: A higher number of intervention sessions reported at the first assessment predicted better vocabulary scores at the second assessment, and more sessions reported at the second assessment predicted better scores at the third assessment. For each increase in the number of sessions reported, there was a corresponding, positive increase in vocabulary quotient. In contrast, children's vocabulary ability at an earlier time point did not predict intervention session frequency at a later point in time. CONCLUSIONS: A significant prospective effect was apparent with more therapy sessions resulting in improved vocabulary scores 9 months later. These findings underscore the importance of early intervention. Pediatricians and other health care professionals can help apply these findings by counseling parents regarding the value of frequent and consistent participation in early intervention.

Reading Proficiency Trends Following Newborn Hearing Screening Implementation.

OBJECTIVES: To investigate trends in population-level school-aged reading scores among students with hearing loss in an urban Colorado school district after implementation of universal newborn hearing screening (UNHS) and Early Hearing Detection and Intervention. METHODS: The final sample included 1422 assessments conducted during the 2000-2001 through 2013-2014 school years for 321 children with hearing loss in grades 3 through 10. Longitudinal hierarchical linear modeling analyses were used to examine reading proficiency (controlling for birth year, grade in school, free and reduced lunch status, additional disability services, and English not spoken in the home). The Colorado Student Assessment Program was administered to students in third through 10th grades throughout the state. The test years chosen included children born before and after implementation of UNHS. RESULTS: After implementation of UNHS, significant longitudinal reading proficiency improvements were observed by birth year and grade overall and for all subgroups. However, gains in reading proficiency were substantially less for children eligible for free and reduced lunch and those with moderate-severe to profound hearing loss. With each succeeding birth cohort and grade, increased numbers of children participated in testing because of improved language skills, with higher proportions identified as proficient or advanced readers. CONCLUSIONS: Notable improvements in reading proficiency after Early Hearing Detection and Intervention implementation were demonstrated, as all groups of children with hearing loss became more likely to achieve proficient and advanced reading levels. On the other hand, some disparities increased, with greater improvements in reading proficiency for children in economically advantaged families.

Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004-2006.

BACKGROUND: The National Birth Defects Prevention Network collects state-specific birth defects surveillance data for annual publication of prevalence estimates and collaborative research projects. In 2006, data for 21 birth defects from 1999 through 2001 were presented as national birth prevalence estimates. The purpose of this report was to update these estimates using data from 2004 through 2006. METHODS: Population-based data from 11 active case-finding programs, 6 passive case-finding programs with case confirmation, and 7 passive programs without case confirmation were used in this analysis. Pooled birth prevalence estimates for 21 birth defects, stratified by case ascertainment approach, were calculated. National prevalence estimates, adjusted for maternal race/ethnicity and maternal age (trisomy 13, trisomy 18, and Down syndrome only) were determined using data from 14 programs. The impact of pregnancy outcomes on prevalence estimates was also assessed for five specific defects. RESULTS: National birth defects prevalence estimates ranged from 0.72 per 10,000 live births for common truncus to 14.47 per 10,000 live births for Down syndrome. Stratification by type of surveillance system showed that active programs had a higher prevalence of anencephaly, anophthalmia/microphthalmia, cleft lip with or without cleft palate, reduction defect of upper limbs, and trisomy 18. The birth prevalence of anencephaly, trisomy 13, and trisomy 18 also varied substantially with inclusion of elective terminations. CONCLUSION: Accurate and timely national estimates of the prevalence of birth defects are needed for monitoring trends, assessing prevention efforts, determining service planning, and understanding the burden of disease due to birth defects in the United States.

The relationship between depressive symptoms and walking among Hispanic older adults: a longitudinal, cross-lagged panel analysis.

OBJECTIVES: This study examines the relationship between depressive symptoms and walking behavior across 30 months in a prospective study of 217 community-dwelling, Hispanic older adults in Miami, Florida (ages 70-100 years). METHOD: Analyses examine the direction of the relationship between depressive symptoms and physical activity (i.e., walking) over time, as well as test for a potential bi-directional or reciprocal relationship between these two variables. RESULTS: Structural equation modeling (SEM) with a cross-lagged panel design revealed that walking was unrelated to subsequent depressive symptoms. However, depressive symptoms were related to subsequent walking behavior at every time-point, such that higher levels of depressive symptoms were predictive of less walking in the future. Older adults who had clinically-relevant depressive symptoms at the initial assessment had 1.34 times the risk of not walking 30 months later, compared to older adults without clinically-relevant depressive symptoms. CONCLUSION: Results support the need for primary care providers to evaluate and address depressive symptoms among older adults, as a means of reducing sedentary behavior and potentially improving health. Further research on the prevention and management of depressive symptoms and sedentary behavior is needed, given the morbidity related to both of these health risks, particularly for minority and low-socio-economic status (SES) older adults.

Early Intervention, Parent Talk, and Pragmatic Language in Children With Hearing Loss.

BACKGROUND AND OBJECTIVES: Pragmatic language skills form the foundation for conversational competence, whereas deficits in this area are associated with behavioral problems and low literacy skills. Children who are deaf or hard of hearing demonstrate significant delays in this critical area of language. Our purpose with this research was to identify variables associated with pragmatic language ability in children who are deaf or hard of hearing. METHODS: This was a longitudinal study of 124 children with bilateral hearing loss between 4 and 7 years of age living in Colorado. As part of a comprehensive speech and language assessment, pragmatic language skills were evaluated annually by using the Pragmatics Checklist. RESULTS: The children's pragmatic skills increased significantly with age. Higher levels of pragmatic language ability at 7 years of age were predicted by (1) meeting Early Hearing Detection and Intervention 1-3-6 guidelines (hearing screening by 1 month, identification of hearing loss by 3 months, and receiving intervention by 6 months of age), (2) greater quantity of parent talk, (3) higher nonverbal intelligence, (4) lesser degrees of hearing loss, and (5) higher maternal education. CONCLUSIONS: With the findings of this study, we underscore the importance of pediatricians and other health care professionals counseling parents about the value of adherence to the Early Hearing Detection and Intervention 1-3-6 guidelines with regard to intervention outcomes. The strong association between amount of child-directed parent talk in the first 4 years of life and pragmatic language outcomes at 7 years of age emphasizes the need for professionals to encourage parents to talk to their children as much as possible.

The relationship of neighborhood climate to perceived social support and mental health in older Hispanic immigrants in Miami, Florida.

OBJECTIVE: This study examines the relationship of neighborhood climate (i.e., neighborhood social environment) to perceived social support and mental health outcomes in older Hispanic immigrants. METHOD: A population-based sample of 273 community-dwelling older Hispanic immigrants (aged 70 to 100) in Miami, Florida, completed self-report measures of neighborhood climate, social support, and psychological distress and performance-based measures of cognitive functioning. Structural equation modeling was used to model the relationship of neighborhood climate to elders' perceived social support and mental health outcomes (i.e., cognitive functioning, psychological distress). RESULTS: Neighborhood climate had a significant direct relationship to cognitive functioning, after controlling for demographics. By contrast, neighborhood climate had a significant indirect relationship to psychological distress, through its relationship to perceived social support. Moreover, social support mediated the relationship between neighborhood climate and psychological distress. DISCUSSION: Findings suggest that a more positive neighborhood social environment may be associated with better mental health outcomes in urban, older Hispanic immigrants.

Longitudinal Relationships Between Family Functioning and Identity Development in Hispanic Adolescents: Continuity and Change.

The present study was designed to investigate trajectories of identity development and their relationship to family functioning in a sample of Hispanic adolescents and their primary caregivers. Two hundred fifty adolescents completed measures of identity coherence and confusion and of family functioning, and parents completed measures of family functioning. Significant variability over time and across individuals emerged in identity confusion, but not in identity coherence. As a result, the present analyses focused on identity confusion. Changes in adolescent-reported, but not parent-reported, family functioning were significantly related to changes in identity confusion. Follow-up analyses suggested that family functioning primarily influences identity confusion in early adolescence, but that identity confusion begins to exert a reciprocal effect in middle adolescence. Exploratory latent growth mixture modeling (LGMM) analyses produced three classes of adolescents based on their baseline values and change trajectories in identity confusion. The potential for family-strengthening interventions to affect identity development is discussed.

Relationships of Social Context and Identity to Problem Behavior among High-Risk Hispanic Adolescents.

The present study was designed to examine the extent to which (a) family and school functioning and (b) personal and ethnic identity is associated with conduct problems, drug use, and sexual risk taking in a sample of 227 high-risk Hispanic adolescents. Adolescents participated in the study with their primary parents, who were mostly mothers. Adolescents completed measures of family and school functioning, personal and ethnic identity, conduct problems, and drug use. Parents completed measures of family functioning and adolescent conduct problems. Results indicated that school functioning and personal identity confusion were related to alcohol use, illicit drug use, and sexual risk taking indirectly through adolescent reports of conduct problems. Adolescent reports of family functioning were related to alcohol use, illicit drug use, and sexual risk taking through school functioning and conduct problems. Results are discussed in terms of the problem behavior syndrome and in terms of the finding of relative independence of contextual and identity variables vis-à-vis conduct problems, substance use, and sexual risk taking.

Built environment and physical functioning in Hispanic elders: the role of "eyes on the street".

BACKGROUND: Research on neighborhood effects increasingly includes the influences of the built environment on health and social well-being. OBJECTIVES: In this population-based study in a low-socioeconomic-status (SES), Hispanic neighborhood, we examined whether architectural features of the built environment theorized to promote direct observations and interactions (e.g., porches, stoops) predicted Hispanic elders' social support and psychological and physical functioning. METHODS: We coded built-environment features for all 3,857 lots in the 403-block area of an urban Miami, Florida, community. We then conducted three annual assessments of social support, psychological distress, and physical functioning in a population-based sample of 273 low-SES Hispanic elders (70-100 years of age). We used structural equation modeling analytic techniques to examine hypothesized relationships between the built environment and elders' social support, psychological distress, and physical functioning over a 3-year period. RESULTS: After controlling for age, sex, and income, architectural features of the built environment theorized to facilitate visual and social contact had a significant direct relationship with elders' physical functioning as measured 3 years later, and an indirect relationship through social support and psychological distress. Further binomial regression analyses suggested that elders living on blocks marked by low levels of positive front entrance features were 2.7 times as likely to have subsequent poor levels of physical functioning, compared with elders living on blocks with a greater number of positive front entrance features [b = 0.99; chi(2) (1 df) = 3.71; p = 0.05; 95% confidence interval, 1.0-7.3]. CONCLUSIONS: Architectural features that facilitate visual and social contacts may be a protective factor for elders' physical functioning.

Partitioning the population attributable fraction for a sequential chain of effects.

BACKGROUND: While the population attributable fraction (PAF) provides potentially valuable information regarding the community-level effect of risk factors, significant limitations exist with current strategies for estimating a PAF in multiple risk factor models. These strategies can result in paradoxical or ambiguous measures of effect, or require unrealistic assumptions regarding variables in the model. A method is proposed in which an overall or total PAF across multiple risk factors is partitioned into components based upon a sequential ordering of effects. This method is applied to several hypothetical data sets in order to demonstrate its application and interpretation in diverse analytic situations. RESULTS: The proposed method is demonstrated to provide clear and interpretable measures of effect, even when risk factors are related/correlated and/or when risk factors interact. Furthermore, this strategy not only addresses, but also quantifies issues raised by other researchers who have noted the potential impact of population-shifts on population-level effects in multiple risk factor models. CONCLUSION: Combined with simple, unadjusted PAF estimates and an aggregate PAF based on all risk factors under consideration, the sequentially partitioned PAF provides valuable additional information regarding the process through which population rates of a disorder may be impacted. In addition, the approach can also be used to statistically control for confounding by other variables, while avoiding the potential pitfalls of attempting to separately differentiate direct and indirect effects.

Longitudinal relationships between cognitive functioning and depressive symptoms among Hispanic older adults.

This study examines the relationship between cognitive functioning and depressive symptoms across 3 years in a prospective study of 273 community-dwelling, Hispanic older adults in Miami. The analyses extend the literature by testing for a bidirectional or reciprocal relationship between depressive symptoms and cognitive functioning over time and by examining the relationship between these variables among Hispanics, an understudied population at risk of developing depressive symptoms and cognitive impairments. Structural equation modeling with a cross-lagged panel design showed that depressive symptoms were unrelated to subsequent cognitive functioning. However, cognitive functioning was related to subsequent depressive symptoms at every time point, such that poorer cognitive functioning was related to higher depressive symptoms. Findings suggest that cognitive declines may predict depressive symptoms in community-dwelling Hispanic older adults.