Reliability and Validity of the Utrecht Tasks for Attention in Toddlers Using Eye Tracking (UTATE).

Attention problems hinder many children in their cognitive and social emotional development. Children at risk for developmental problems, like preterm born infants, are specifically known for attention difficulties. Early identification of attention difficulties is important for application of appropriate stimulation in trying to reduce further problems. Specifically designed instruments with good psychometric characteristics are needed to show difficulties in attention, that may contribute to early identification. The Utrecht Tasks of Attention in Toddlers using Eye tracking (UTATE) is an instrument to measure orienting, alerting and executive attention capacities in young children. Reliability and validity of the UTATE are specifically addressed in three studies, reported in this paper. A sample of 95 term born children assessed at 18 months of age was used that provided data for both the second and third study reported here. In addition, three other small samples were used, of which the first consisted of 12 children at 18 months with test-retest data available that are reported in the first study. Two other samples that were used in the third study, consisted of 14 children measured at 12 months, and 15 children examined at 24 months. The UTATE resulted in reliable information on eye movements and some first support for construct and predictive validity was found. Low scores on the UTATE at 18 months were found to be related to slower cognitive development as measured with the Bayley-III-NL at 24 months. Furthermore, a first indication that the UTATE is able to detect some age differences in attention was found. It is concluded that the UTATE can be used to study attention capacities in toddlers that underlie cognitive functioning and development, but further research is necessary.

Cognitive functioning in toddlerhood: The role of gestational age, attention capacities, and maternal stimulation.

Why do many preterm children show delays in development? An integrated model of biological risk, children's capacities, and maternal stimulation was investigated in relation to cognitive functioning at toddler age. Participants were 200 Dutch children (gestational age = 32-41 weeks); 51% boys, 96% Dutch nationality, 71.5% highly educated mothers. At 18 months, attention capacities were measured using eye-tracking, and maternal attention-directing behavior was observed. Cognitive functioning was measured at 24 months using the Bayley-III-NL. Cognitive functioning was directly predicted by children's attention capacities and maternal attention-maintaining behavior. Gestational age was indirectly related to cognitive functioning through children's attention capacities and through maternal attention-redirecting behavior. In this way, a combination of gestational age, children's attention capacities, and maternal stimulation was associated with early cognitive development. (PsycINFO Database Record

Introduction of the Utrecht Tasks for Attention in Toddlers Using Eye Tracking (UTATE): A Pilot Study.

Attention capacities underlie everyday functioning from an early age onwards. Little is known about attentional processes at toddler age. A feasible assessment of attention capacities at toddler age is needed to allow further study of attention development. In this study, a test battery is piloted that consists of four tasks which intend to measure the attention systems orienting, alerting, and executive attention: the Utrecht Tasks of Attention in Toddlers using Eye tracking [UTATE]. The UTATE assesses looking behavior that may reflect visual attention capacities, by using eye-tracking methods. This UTATE was studied in 16 Dutch 18-month-old toddlers. Results showed that the instrument is feasible and generates good quality data. A first indication of sufficient reliability was found for most of the variables. It is concluded that the UTATE can be used in further studies. Further evaluation of the reliability and validity of the instrument in larger samples is worthwhile.

Factor Structure of Attention Capacities Measured With Eye-Tracking Tasks in 18-Month-Old Toddlers.

OBJECTIVE: Attention capacities are critical for adaptive functioning and development. Reliable assessment measures are needed for the study of attention capacities in early childhood. In the current study, we investigated the factor structure of the Utrecht Tasks of Attention in Toddlers Using Eye-tracking (UTATE) test battery that assesses attention capacities in 18-month-old toddlers with eye-tracking techniques. METHOD: The factor structure of 13 measures of attention capacities, based on four eye-tracking tasks, was investigated in a sample of 95 healthy toddlers (18 months of age) using confirmatory factor analysis. RESULTS: Results showed that a three-factor model best fitted the data. The latent constructs reflected an orienting, alerting, and executive attention system. CONCLUSION: This study showed support for a three-factor model of attention capacities in 18-month-old toddlers. Further study is needed to investigate whether the model can also be used with children at risk of attention problems.

Attention capacities of preterm and term born toddlers: A multi-method approach.

OBJECTIVE: Many preterm children show difficulties in attention at (pre)school age. The development of attention capacities of preterm and term toddlers was compared using a longitudinal and multi-method approach at 12, 18 and 24months. METHOD: Attention was measured for 123 preterm (32-36weeks gestation) and 101 term born children, using eye tracking (18months), observations during mother-child interaction (18months), and mother-reports (12, 18, and 24months). RESULTS: Preterm toddlers had lower scores than term children on the eye-tracking measures of orienting and alerting. No group differences were found with observations, mother-reports, and the eye-tracking measure of executive attention. More preterm than term children had suboptimal scores on measures of the alerting system at 18months, possibly indicating difficulties in attention development. CONCLUSION: Preterm children showed an increased risk for suboptimal functioning in alerting attention capacities, as early as at a toddler age.

Behaviour and development in 24-month-old moderately preterm toddlers.

OBJECTIVE: Moderately preterm children (gestational age 32-36+6 weeks) are at risk of cognitive and behaviour problems at school age. The aim of this study was to investigate if these problems are already present at the age of 2 years. STUDY DESIGN: Developmental outcome was assessed at 24-months (corrected age) with the Bayley-III-NL in 116 moderately preterm (M=34.66 ± 1.35 weeks gestation) and 99 term born children (M=39.45 ± 0.98 weeks gestation). Behaviour problems were assessed with the Child Behaviour Checklist. RESULTS: With age corrected for prematurity, moderately preterm children scored below term peers on Receptive Communication skills (11.05 ± 2.58 vs 12.02 ± 2.74, p=0.02). Without correcting age for prematurity, moderately preterm children scored below term born peers on Cognition (8.97 ± 2.11 vs 10.68 ± 2.35, p<0.001), Fine Motor (10.33 ± 2.15 vs 11.96 ± 2.15, p<0.001), Gross Motor (8.47 ± 2.55 vs 9.39±2.80, p=0.05), Receptive Communication (10.09 ± 2.48 vs 12.02 ± 2.74, p<0.001) and Expressive Communication (10.33 ± 2.43 vs 11.49 ± 2.51, p=0.005) skills. Compared with term peers, more moderately preterm children showed a (mild) delay (ie, scaled score <7) in gross motor skills with age uncorrected for prematurity (20.7% vs 11.2%, p=0.04). Moderately preterm children had more internalising behaviour problems than term children (44.76 ± 8.94 vs 41.54 ± 8.56, p=0.03). No group differences were found in percentages of (sub)clinical scores. CONCLUSIONS: At the age of 2 years, uncorrected for prematurity, differences in cognition, communication, and motor development were present in moderately preterm children compared with term born peers. After correcting age for prematurity, a difference was only found for receptive communication skills. In addition, moderately preterm children show more internalising behaviour problems.

School outcome, cognitive functioning, and behaviour problems in moderate and late preterm children and adults: a review.

A large number of children (6 to 11% of all births) are born at a gestational age between 32 and 36 weeks. Little is known of long term outcomes for these moderate and late preterm children. In this review, results of 28 studies on school outcome, cognitive functioning, behaviour problems, and psychiatric disorders are presented. Overall, more school problems, less advanced cognitive functioning, more behaviour problems, and higher prevalence of psychiatric disorders were found in moderate and late preterm born infants, children, and adults compared with full term peers. Suggestions for future research are discussed.