Innovative methods for remote assessment of neurobehavioral development.

In response to the COVID-19 pandemic, research institutions across the globe have modified their operations in ways that have limited or eliminated the amount of permissible in-person research interaction. In order to prevent the loss of important developmentally-timed data during the pandemic, researchers have quickly pivoted and developed innovative methods for remote assessment of research participants. In this manuscript, we describe methods developed for remote assessment of a parent child cohort with a focus on examining the perinatal environment, behavioral and biological indicators of child neurobehavioral development, parent-child interaction, as well as parent and child mental and physical health. We include recommendations relevant to adapting in-laboratory assessments for remote data collection and conclude with a description of the successful dissemination of the methods to eight research sites across the United States, each of whom are involved in Phase 1 of the HEALthy Brain and Child Development (HBCD) Study. These remote methods were born out of pandemic-related necessity; however, they have much wider applicability and may offer advantages over in-laboratory neurodevelopmental assessments.

Social determinants of health exacerbate disparities in COVID-19 illness severity and lasting symptom complaints.

BACKGROUND: Increasing reports of long-term symptoms following COVID-19 infection, even among mild cases, necessitates systematic investigation into the prevalence and type of lasting illness. Notably, there is limited data regarding the influence of social determinants of health, like perceived discrimination and economic stress, which may exacerbate COVID-19 health risks. The primary goals of this study are to test the bearing of subjective experiences of discrimination, financial security, and quality of care on illness severity and lasting symptom complaints. METHODS: 1,584 recovered COVID-19 patients that experienced mild to severe forms of the disease provided information about their illness, medical history, lasting symptoms, and psychosocial information. Prevalence data isolated differences in patients infected early versus late in the pandemic. Path analyses examined hypothesized associations between discrimination, illness severity, and lasting symptoms. Post hoc logistic regressions tested social determinants hypothesized to predict neurological, cognitive, or mood symptoms. RESULTS: 70.6% of patients reported presence of one or more lasting symptoms after recovery. Neural systems were especially impacted, and 19.4% and 25.1% of patients reported mood or cognitive/memory complaints, respectively. Path models demonstrated that frequency and stress about experiences of discrimination predicted increased illness severity and increased lasting symptom count, even when adjusting for sociodemographic factors and mental/physical health comorbidities. Notably, this effect was specific to stress related to discrimination, and did not extend to general stress levels. Further, perceived but not objective socioeconomic status (SES) was associated with increased lasting symptom complaints after recovery. Finally, associations between discrimination and illness differed with individual perceptions about quality of medical care. CONCLUSIONS: Lasting symptoms after recovery from COVID-19 are highly prevalent and neural systems are significantly impacted. Importantly, psychosocial factors (perceived discrimination and perceived SES) can exacerbate individual health risk. This study provides actionable directions for improved health outcomes by establishing that sociodemographic risk and medical care influence near and long-ranging health outcomes.

Optimizing imitation: Examining cognitive factors leading to imitation, overimitation, and goal emulation in preschoolers.

Humans imitate patently irrelevant actions known as overimitation, and rather than decreasing with age, overimitation increases with age. Whereas most overimitation research has focused on social factors associated with overimitation, comparatively little is known about the cognitive- and task-specific features that influence overimitation. Specifically, developmental contrasts between imitation and overimitation are confounded by the addition of irrelevant actions to causally necessary actions, increasing sequence length, cognitive load, and processing costs-variables known to be age dependent. We constructed a novel puzzle box task such that a four-step imitation, four-step overimitation, and two-step efficient sequence could be demonstrated using the same apparatus on video. In Experiments 1 and 2, 2.5- to 5-year-olds randomly assigned to imitation and overimitation groups performed significantly more target actions than baseline control groups. Rates of imitation and overimitation increased as a function of age, with older preschoolers outperforming younger preschoolers in both conditions. In Experiment 3, preschoolers were shown a video of an efficient two-step demonstration prior to testing. After they responded, they were shown a four-step overimitation video and were tested on the same puzzle box. Children imitated the efficient demonstration, but after watching the overimitation video, they also overimitated the irrelevant actions. Once again, older children overimitated more than younger children. Together, results show that preschoolers are faithful, flexible, and persistent overimitators. The fidelity and flexibility of overimitation are constrained not only by social factors but also by basic cognitive processes that vary across age groups. As these constraints diminish, overimitation and flexible (optimal) imitation increases.

Associations among the home language environment and neural activity during infancy.

Characteristics of the home language environment, independent of socioeconomic background, may account for disparities in early language abilities. Past studies have reported links between the quantity of language input within the home and differences in brain function during early childhood. The current study examined associations between home language input and EEG brain activity in a socioeconomically diverse sample of 6- to 12-month-old infants (N = 94). Replicating past studies, a positive correlation was found between measures of socioeconomic status and language input. Examining links between language input and brain activity, analyses yielded a negative association, with children who heard more adult words in the home demonstrating reduced EEG beta power (13-19 Hz) in the parietal region. Exploratory analyses revealed a significant interaction between language input and the amount of chaos and disorganization in the home. Specifically, among children living in high-chaos households, children who heard more adult words tended to have reduced EEG activity. Among children living in low-chaos homes, there was no link between adult word count and children's EEG activity. These findings demonstrate the importance of the early home environment context in shaping neurocognitive trajectories.

The independent and interacting effects of socioeconomic status and dual-language use on brain structure and cognition.

Family socioeconomic status (SES) is strongly associated with children's cognitive development, and past studies have reported socioeconomic disparities in both neurocognitive skills and brain structure across childhood. In other studies, bilingualism has been associated with cognitive advantages and differences in brain structure across the lifespan. The aim of the current study is to concurrently examine the joint and independent associations between family SES and dual-language use with brain structure and cognitive skills during childhood. A subset of data from the Pediatric Imaging, Neurocognition and Genetics (PING) study was analyzed; propensity score matching established an equal sample (N = 562) of monolinguals and dual-language users with similar socio-demographic characteristics (Mage = 13.5, Range = 3-20 years). When collapsing across all ages, SES was linked to both brain structure and cognitive skills. When examining differences by age group, brain structure was significantly associated with both income and dual-language use during adolescence, but not earlier in childhood. Additionally, in adolescence, a significant interaction between dual-language use and SES was found, with no difference in cortical surface area (SA) between language groups of higher-SES backgrounds but significantly increased SA for dual-language users from lower-SES families compared to SES-matched monolinguals. These results suggest both independent and interacting associations between SES and dual-language use with brain development. To our knowledge, this is the first study to concurrently examine dual-language use and socioeconomic differences in brain structure during childhood and adolescence.

Associations between cortical thickness and neurocognitive skills during childhood vary by family socioeconomic factors.

Studies have reported associations between cortical thickness (CT) and socioeconomic status (SES), as well as between CT and cognitive outcomes. However, findings have been mixed as to whether CT explains links between SES and cognitive performance. In the current study, we hypothesized that this inconsistency may have arisen from the fact that socioeconomic factors (family income and parental education) may moderate the relation between CT and neurocognitive skills. Results indicated that associations between CT and cognitive performance did vary by SES for both language and executive function (EF) abilities. Across all ages, there was a negative correlation between CT and cognitive skills, with thinner cortices associated with higher language and EF scores. Similarly, across all cognitive skills, children from higher-SES homes outperformed their age-matched peers from lower-SES homes. Moderation analyses indicated that the impact of SES was not constant across CT, with SES more strongly predictive of EF skills among children with thicker cortices and more strongly predictive of language skills among children with thinner cortices. This suggests that socioeconomic advantage may in some cases buffer against a neurobiological risk factor for poor performance. These findings suggest that links between brain structure and cognitive processes vary by family socioeconomic circumstance.

Associations among family socioeconomic status, EEG power at birth, and cognitive skills during infancy.

Past research has demonstrated links between cortical activity, measured via EEG power, and cognitive processes during infancy. In a separate line of research, family socioeconomic status (SES) has been strongly associated with children's early cognitive development, with socioeconomic disparities emerging during the second year of life for both language and declarative memory skills. The present study examined associations among resting EEG power at birth, SES, and language and memory skills at 15-months in a sample of full-term infants. Results indicate no associations between SES and EEG power at birth. However, EEG power at birth was related to both language and memory outcomes at 15-months. Specifically, frontal power (24-48Hz) was positively correlated with later Visual Paired Comparison (VPC) memory scores. Power (24-35Hz) in the parietal region was positively correlated with later PLS-Auditory Comprehension language scores. These findings suggest that SES disparities in brain activity may not be apparent at birth, but measures of resting neonatal EEG power are correlated with later memory and language skills independently of SES.

Socioeconomic disparities in neurocognitive development in the first two years of life.

Socioeconomic status (SES) is strongly associated with cognition and achievement. Socioeconomic disparities in language and memory skills have been reported from elementary school through adolescence. Less is known about the extent to which such disparities emerge in infancy. Here, 179 infants from socioeconomically diverse families were recruited. Using a cohort-sequential design, 90 infants were followed at 9 and 15 months, and 89 were followed at 15 and 21 months. SES disparities in developmental trajectories of language and memory were present such that, at 21 months of age, children of highly educated parents scored approximately .8 standard deviations higher in both language and memory than children of less educated parents. The home language and literacy environment and parental warmth partially accounted for disparities in language, but not memory development.

Family income, parental education and brain structure in children and adolescents.

Socioeconomic disparities are associated with differences in cognitive development. The extent to which this translates to disparities in brain structure is unclear. We investigated relationships between socioeconomic factors and brain morphometry, independently of genetic ancestry, among a cohort of 1,099 typically developing individuals between 3 and 20 years of age. Income was logarithmically associated with brain surface area. Among children from lower income families, small differences in income were associated with relatively large differences in surface area, whereas, among children from higher income families, similar income increments were associated with smaller differences in surface area. These relationships were most prominent in regions supporting language, reading, executive functions and spatial skills; surface area mediated socioeconomic differences in certain neurocognitive abilities. These data imply that income relates most strongly to brain structure among the most disadvantaged children.