Pathways From Toddler Information Processing to Adolescent Lexical Proficiency.

This study examined the relation of 3-year core information-processing abilities to lexical growth and development. The core abilities covered four domains-memory, representational competence (cross-modal transfer), processing speed, and attention. Lexical proficiency was assessed at 3 and 13 years with the Peabody Picture Vocabulary Test (PPVT) and verbal fluency. The sample (N = 128) consisted of 43 preterms (< 1750 g) and 85 full-terms. Structural equation modeling indicated concurrent relations of toddler information processing and language proficiency and, independent of stability in language, direct predictive links between (a) 3-year cross-modal ability and 13-year PPVT and (b) 3-year processing speed and both 13-year measures, PPVT and verbal fluency. Thus, toddler information processing was related to growth in lexical proficiency from 3 to 13 years.

[Constraint during care in elderly people with cognitive disorders]. / La contrainte lors des soins chez le sujet âgé atteint de troubles cognitifs.

Constraints in the care of vulnerable elderly people are part of the daily life of services. This practice must not avoid multidisciplinary reflection by preserving the autonomy of patients' decisions despite cognitive disorders. The search for consent and reasons for refusing care must be the leitmotif and coercion the exception and must be supported.

Autism spectrum disorder is associated with ventricular enlargement in a low birth weight population.

OBJECTIVE: To determine the relation of neonatal cranial ultrasound abnormalities to autism spectrum disorders (ASD) in low birth weight (LBW) adult survivors, a population at increased ASD risk. STUDY DESIGN: This is a secondary analysis of a prospectively-followed regional birth cohort of 1105 LBW infants systematically screened for perinatal brain injury with cranial ultrasound in the first week of life and later assessed for ASD using a two-stage process [screening at age 16 years (n = 623) followed by diagnostic assessment at age 21 years of a systematically selected subgroup of those screened (n = 189)]; 14 cases of ASD were identified. For this analysis, cranial ultrasound abnormalities were defined as ventricular enlargement (indicative of diffuse white matter injury), parenchymal lesions (indicative of focal white matter injury), and isolated germinal matrix/intraventricular hemorrhage. RESULTS: Compared with no cranial ultrasound abnormalities, any type of white matter injury (ventricular enlargement and/or parenchymal lesion) tripled the risk for screening positively for ASD [3.0 (2.2, 4.1)]. However, the risk of being diagnosed with ASD depended on type of white matter injury. With ventricular enlargement, the risk of ASD diagnosis was almost seven-fold that of no cranial ultrasound abnormality [6.7 (2.3, 19.7)], and no elevated risk was found for parenchymal lesion without ventricular enlargement [1.8 (0.2, 13.6)]. Isolated germinal matrix/intraventricular hemorrhage did not increase risk for a positive ASD screen or diagnosis. CONCLUSION: In LBW neonates, cranial ultrasound evidence of ventricular enlargement is a strong and significant risk factor for subsequent development of rigorously-diagnosed ASD.

Association between transient hypothyroxinaemia of prematurity and adult autism spectrum disorder in a low-birthweight cohort: an exploratory study.

BACKGROUND: Transient hypothyroxinaemia of prematurity (THOP) is associated with increased risk of cerebral palsy and lower IQ in low-birthweight infants. This study explores whether THOP is also associated with increased risk of autism spectrum disorders (ASD). METHODS: This secondary analysis uses data from a birth cohort of newborns weighing 500 -2000 g (n = 1105) who were followed to age 21 years, when they were assessed for ASD in the second of a two-stage process. Of the 187 assessed at age 21, 14 had ASD. Neonatal thyroxine results were available for 12/14 and 165/173 participants diagnosed with and without ASD, respectively. THOP was defined as thyroxine z-score <-2.6. Unadjusted relative risks (RR) and confidence intervals (CI) were calculated. RESULTS: The mean neonatal thyroxine z-score in young adults diagnosed with ASD was 0.5 SD lower [95% CI -0.16, 1.06] than in those without ASD. Participants with THOP were at 2.5-fold greater risk of ASD (RR 2.5 [95% CI 0.7, 8.4]). While neither of these differences was statistically significant, in a secondary subgroup analysis of those whose mothers did not have hypertension during pregnancy, THOP significantly increased the RR for ASD (5.0 [95% CI 1.2, 20.5]). CONCLUSION: While the primary relation between THOP and ASD found here is not statistically significant, the magnitude of association and significant relationship observed in the subgroup whose mothers did not have hypertension during pregnancy suggest that it is worthy of further investigation.

Rett syndrome: an eye-tracking study of attention and recognition memory.

AIM: The aim of this study was to examine attention and recognition memory for faces and patterns in Rett syndrome, a severely disabling neurodevelopmental disorder caused by mutations in the X-linked MECP2 gene. METHOD: Because Rett syndrome impairs speech and hand use, precluding most neuropsychological testing, the visual paired-comparison paradigm (VPC) was used, together with eye tracking. In the VPC, two identical stimuli are presented for familiarization. On test, the familiar stimulus and a new one are paired, and recognition inferred from preferential looking to the novel target. Attention is measured by looking time, gaze dispersion, and number/length of fixations. Twenty-seven female patients with Rett syndrome (mean age 10y 6mo; SD 6y 8mo, age range 2-22y) from the Rett clinic at a children's hospital were assessed in this study, along with 30 age- and sex-matched typically developing participants (outpatients from the same hospital). RESULTS: Although patients with Rett syndrome showed recognition of both faces and patterns, with novelty scores greater than chance (50%), their performance was significantly poorer than that of the typically developing comparison group. Their attention to both was less mature and marked by a more narrowly focused gaze, with fewer and longer fixations. When inspecting faces, attention to the eyes was similar in both groups; however, patients with Rett syndrome tended to ignore the nose and mouth. INTERPRETATION: This is one of the first studies to characterize attention and memory in individuals with Rett syndrome. Visually based techniques, such as the VPC, open a new avenue for quantifying the cognitive phenotype associated with this syndrome.

[Safety and efficacy of immune checkpoint inhibitors in elderly patients]. / Tolérance et efficacité des inhibiteurs de points de contrôle immunitaire en monothérapie chez les patients âgés.

Immune checkpoint inhibitors (ICI) are the standard of care for many solid tumors with specific physiopathology mechanisms and adverse events. While the percentage of elderly patients increase from years to years, these patients are underrepresented in clinical trials. Immunosenescence and inflammaging, two main components of the aging of our immune system, and their consequences on the safety and the efficacy are today major focus of clinical research. However, there are still no risk assessment score specific to ICI in elderly patients. In this review we showed the global reassuring data on safety from several retrospective and subgroup analysis, in elderly patients. In summary, impairment of the general state is an independent factor of occurrence of adverse events treatment related whatever the age. Here, we highlight the necessity to use of geriatric evaluation screening test in clinic, the need of specific risk score ICI use in the erdely population and mostly the inclusion of elderly patients in clinical trial to generate specific data.

Implications of infant cognition for executive functions at age 11.

Recent work suggests that executive functions, the cornerstone of higher-level cognitive operations, are driven by basic information processing abilities. Using structural equation modeling, with latent variables, the present study provides the first evidence that this driving force begins in infancy, such that abilities in infancy predict executive functions at age 11. Information processing abilities in three domains (attention, processing speed, and memory) were assessed when participants were infants (7 and 12 months) and toddlers (24 and 36 months) and were used to predict three executive functions (working memory, inhibition, and shifting) when participants were 11 years old. A model relating infant abilities to age-11 executive functions fit well, and accounted for 9% to 19% of the variance in the executive functions. Paths from both speed and memory in infancy to age-11 working memory were significant, as was the path from Speed in infancy to age-11 Shifting. A model using abilities in toddlerhood as predictors fit similarly. These findings implicate early basic cognitive abilities in the development of executive functions.

Information Processing from Infancy to 11 Years: Continuities and Prediction of IQ.

This study provides the first direct evidence of cognitive continuity for multiple specific information processing abilities from infancy and toddlerhood to pre-adolescence, and provides support for the view that infant abilities and form the basis of later childhood abilities. Data from a large sample of children (N = 131) were obtained at five different time points (7, 12, 24, 36 months, and 11 years) for a large battery of tasks representing four cognitive domains (attention, processing speed, memory, and representational competence). Structural equation models of continuity were assessed for each domain, in which it was assumed that infant abilities → toddler abilities → 11-year abilities. Abilities at each age were represented by latent variables, which minimize task-specific variance and measurement error. The model for each domain fit the data. Moreover, abilities from the three age periods predicted global outcome, with infant, toddler, and contemporaneous 11-year measures, respectively, accounting for 12.3%, 18.5%, and 45.2% of the variance in 11-year IQ. These findings strengthen contentions that specific cognitive abilities that can be identified in infancy show long-term continuity and contribute importantly to later cognitive competence.

Modeling a cascade of effects: the role of speed and executive functioning in preterm/full-term differences in academic achievement.

This study identified deficits in executive functioning in pre-adolescent preterms and modeled their role, along with processing speed, in explaining preterm/full-term differences in reading and mathematics. Preterms (< 1750 g) showed deficits at 11 years on a battery of tasks tapping the three basic executive functions identified by Miyake - updating/working memory, inhibition, and shifting. Confirmatory factor analysis showed that these executive functions, though correlated, were distinct from one another and from processing speed, which later proved to account for much of the intercorrelation among executive functions. In the best-fitting structural equation model, the negative effects of prematurity on achievement were completely mediated by the three executive functions and speed in a cascade of effects: prematurity → slower processing speed → poorer executive functioning (working memory) → lower achievement in math and reading.

The structure of memory in infants and toddlers: an SEM study with full-terms and preterms.

There is considerable dispute about the nature of infant memory. Using SEM models, we examined whether popular characterizations of the structure of adult memory, including the two-process theory of recognition, are applicable in the infant and toddler years. The participants were a cohort of preterms and full-terms assessed longitudinally--at 1, 2, and 3 years--on a battery containing tasks of immediate and delayed recognition, recall, and memory span (a measure of short-term capacity). Results were in accord with adult models which assume that short- and long-term memory are distinct, and that two processes--familiarity and recollection--underlie recognition memory, while one alone--recollection--supports recall. The finding that prematurity, which entails risk of hippocampal compromise, affected recollection, but not familiarity, accords well with adult findings that hippocampal damage selectively affects recollection. These findings reveal striking similarity between the structure and theoretical underpinnings of infant and adult memory.

Basic Information Processing Abilities at 11 years Account for Deficits in IQ Associated with Preterm Birth.

Although it is well established that preterms as a group do poorly relative to their full-term peers on tests of global cognitive functioning, the basis for this relative deficiency is less understood. The present paper examines preterm deficits in core cognitive abilities and determines their role in mediating preterm/full-term differences in IQ. The performance of 11-year-old children born preterm (birth weight <1750g) and their full-term controls were compared on a large battery of 15 tasks, covering four basic cognitive domains -- memory, attention, speed of processing and representational competence. The validity of these four domains was established using latent variables and confirmatory factor analysis (CFA). Preterms showed pervasive deficits within and across domains. Additionally, preterm deficits in IQ were completely mediated by these four cognitive domains in a structural equation model involving a cascade from elementary abilities (attention and speed), to more complex abilities (memory and representational competence), to IQ. The similarity of findings to those obtained with this cohort in infancy and toddlerhood suggest that preterm deficits persist - across time, across task, and from the non-verbal to the verbal period.

Executive and non-executive functions in low birthweight/preterm adolescents with differing temporal patterns of inattention.

OBJECTIVE: This study assesses whether low birthweight/preterm (LBW/PT) adolescents with persistent inattention (PIA) have neuropsychological deficits that distinguish them from adolescents with school age limited inattention (SAL) and those largely unaffected (UA). METHOD: Three latent classes (PIA, SAL, UA), derived from an earlier analysis of a LBW/PT birth cohort were compared on non-executive and executive functioning measures assessed at age 16. RESULTS: The PIA class displayed the poorest performance on executive functioning, which was exaggerated in the context of lower IQ. The PIA and the SAL classes had poorer performance on non-executive functioning relative to the UA class. Both types of functioning mediated the relationship of class to school service use and grade retention. CONCLUSION: Neuropsychological impairment characterizes children and adolescents with inattention problems. Problems in executive functioning characterize the subset whose inattention persists through adolescence. Subsequent research can examine the potential for remediating these deficits to address academic and social problems.

A cognitive approach to the development of early language.

A controversial issue in the field of language development is whether language emergence and growth is dependent solely on processes specifically tied to language or could also depend on basic cognitive processes that affect all aspects of cognitive competence (domain-general processes). The present article examines this issue using a large battery of infant information-processing measures of memory, representational competence, processing speed, and attention, many of which have been shown to predict general cognition in a cohort of full-terms and preterms. Results showed that various aspects of infant memory and representational competence (a) related to language at both 12 and 36 months, (b) predicted similarly for the two groups, and (c) predicted 36-month language, independently of birth status, 12-month language, and the 12-month Bayley Mental Development Index. Additionally, the results established predictive validity for the MacArthur 12-month language measure. These findings support a domain-general view of language.

Information Processing in Toddlers: Continuity from Infancy and Persistence of Preterm Deficits.

The present report assesses information processing in the toddler years (24 and 36 months), using a cohort of preterms (<1750 g) and full-terms initially seen in infancy. The children received a battery of tasks tapping 11 specific abilities from four domains - memory, processing speed, attention, and representational competence. The same battery had been used earlier - at 7 and 12 months. There were four main findings. (1) Preterms showed no 'catch-up,' but rather persistent deficits in immediate recognition, recall, encoding speed, and attention. (2) There was significant continuity from infancy through the toddler years for most aspects of information processing. (3) These specific abilities combined additively to account for global cognitive ability, consistent with the componential theory of intelligence. (4) Toddler information processing abilities completely mediated the relative deficits of preterms in general cognitive ability. Thus, although the toddler years have often been characterized as a period of discontinuity and transformation, these results indicate that continuity prevails for information processing abilities over the first three years of life.

Attentional shifting and disengagement in Rett syndrome.

OBJECTIVE: The purpose of the present study was to deepen our understanding of attention (a core cognitive ability) in Rett syndrome (RTT), an x-linked neurodevelopmental disorder caused by mutations in the MECP2 gene. We focused on 2 key aspects of visual orienting-shifting and disengaging attention-both of which are critical for exploring the visual world. We used gaze-based measures and eye-tracking technology to minimize demands on the limited verbal and motor abilities associated with RTT. METHOD: Shifting and disengaging attention were examined in 31 children (2-12 years) with Rett Syndrome (RTT) and 31 age-matched typically developing (TD) controls. Using the gap-overlap paradigm, the frequency and speed of shifting attention from a central to peripheral target were compared on Baseline trials, where the central stimulus disappears as the peripheral target appears, and Overlap trials, where the central stimulus remains, thus requiring disengagement. RESULTS: Our findings revealed that children with RTT had more "sticky fixations" (p < .001). That is, they had fewer saccades to the peripheral target than TD children, and this was true on both baseline (77% vs. 95%), and overlap trials (63% vs. 90%). The younger children in the RTT group also had slower saccadic RTs (SRTs) than their TD counterparts (p = .04). Within the RTT group, SRTs correlated with symptom severity. Surprisingly, disengagement cost (the relative difference between gap and overlap SRTs) did not differ across groups. CONCLUSION: Our results suggest that children with Rett have difficulty shifting attention and, to a lesser extent, disengaging attention, whereas with other disorders, problems with disengagement are paramount. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Impaired Visual Search in Children with Rett Syndrome.

AIM: This study aims to investigate selective attention in Rett syndrome, a severely disabling neurodevelopmental disorder caused by mutations in the X-linked MECP2 gene. METHOD: The sample included 28 females with Rett syndrome (RTT) and 32 age-matched typically developing controls. We used a classic search task, in conjunction with eye-tracking technology. Each trial included the target and several distractors. The distractors varied in number and differed from targets in either a "single feature" (color or shape), creating a pop-out effect, or in a "conjunction of features" (color and shape), requiring serial search. Children searched for the target in arrays containing five or nine objects; trials ended when the target was fixated (or 4000 ms elapsed). RESULTS: Children with Rett syndrome had more difficulty finding the target than typically developing children in both conditions (success rates less than 50% versus 80%) and their success rates were little influenced by display size or age. Even when successful, children with RTT took significantly longer to respond (392 to 574 ms longer), although saccadic latency differences were observed only in the single-feature condition. Both groups showed the expected slowing of saccadic reaction times for larger arrays in the conjunction-feature condition. Search failures in RTT were not related to symptom severity. CONCLUSIONS: Our findings provide the first evidence that selective attention, the ability to focus on or select a particular element or object in the environment, is compromised by Rett syndrome. They reinforce the notion that gaze-based tasks hold promise for quantifying the cognitive phenotype of RTT.

Development of a Brief Parent-Report Screen for Common Gastrointestinal Disorders in Autism Spectrum Disorder.

Gastrointestinal dysfunction in children with autism spectrum disorder (ASD) is common and associated with problem behaviors. This study describes the development of a brief, parent-report screen that relies minimally upon the child's ability to report or localize pain for identifying children with ASD at risk for one of three common gastrointestinal disorders (functional constipation, functional diarrhea, and gastroesophageal reflux disease). In a clinical sample of children with ASD, this 17-item screen identified children having one or more of these disorders with a sensitivity of 84%, specificity of 43%, and a positive predictive value of 67%. If found to be valid in an independent sample of children with ASD, the screen will be useful in both clinical practice and research.

Eating attitudes and weight concerns in female low birth weight adolescents.

OBJECTIVE: Studies of clinically referred patients have implicated low birth weight (LBW) as a possible risk factor for eating disorders. This study examines eating attitudes and weight concerns in nonreferred LBW female adolescents. METHOD: 274 LBW girls (mean age 15.9) belonging to a prospective regional LBW birth cohort completed the Eating Attitudes Test (EAT-26) and items from the Eating Symptoms Inventory on weight perception and weight dissatisfaction. RESULTS: Only 2.3% scored above threshold for eating disorder risk on the EAT-26. A total of 25% perceived themselves as overweight and 18.7% perceived themselves as underweight, while 63.4% desired to lose and 17.7% desired to gain weight. Girls who perceived themselves as overweight or desired to lose weight had higher mean EAT scores than those who did not. CONCLUSION: Nonreferred adolescent girls born at LBW are not, as a whole, at risk for abnormal eating attitudes and negative perceptions of their weight.

A Cognitive Cascade in Infancy: Pathways from Prematurity to Later Mental Development.

Using data from a longitudinal study of preterms and full-terms, the present study examined the structure of infant cognition at 12 months, the extent to which five 12-month abilities (attention, speed, recognition, recall, and representational competence) mediated the relation from prematurity to mental development at 2 - 3 years, and how continuity and change in infant information processing from 7 to 12 months affected later outcome. The results indicated that 12-month measures of infant information processing completely mediated the effect of prematurity on outcome and the infant measures form a 'cognitive cascade,' similar to that seen at 7 months, in which the two more elementary abilities (attention and speed) influenced the more complex ones, which in turn influenced later cognition. Additionally, despite cross-age stability, 7- month assessments contribute to outcome independently of their 12-month counterparts, suggesting that infant abilities undergo important developmental transformations in the second half of the first year of life.

Weight concerns in male low birth weight adolescents: relation to body mass index, self-esteem, and depression.

OBJECTIVE: To compare weight concerns and self-reported body mass index (BMI) of low birth weight (LBW) adolescent boys to those of a normative sample and examine relationships among BMI, weight concerns, self-esteem, and depression in the LBW cohort. METHODS: LBW boys (n = 260; mean age, 16.0) belong to the Neonatal Brain Hemorrhage Study birth cohort. Normative boys (n = 305; mean age, 16.5) belong to the National Health and Nutrition Examination Survey. Both samples were assessed in 2001-2004 with self-report questionnaires. BMI was calculated from self-reported height and weight. Weight perception and weight dissatisfaction were assessed with the Eating Symptoms Inventory. In LBW boys, self-esteem was measured with the Rosenberg Self-Esteem Scale and depression with the Beck Depression Inventory. RESULTS: Based on self-reported height and weight, LBW boys were more likely to be healthy weight or underweight and less likely to be overweight than normative boys. Despite having healthier self-reported BMIs, LBW boys reported more weight concerns than the normative sample. A total of 46.9% of LBW boys perceived their weight as abnormal, and 76.5% desired weight change. Weight concerns in LBW boys mostly reflected a perception of being underweight (31.2% of the cohort) and a desire to gain weight (47.5% of the cohort), although only 6.5% were clinically underweight. Weight concerns, but not BMI, were related to clinical depression and lower self-esteem. CONCLUSIONS: LBW adolescent boys are at high risk of experiencing weight concerns. Weight concerns rather than BMI are associated with emotional problems in LBW boys.