The role of early social play behaviors and language skills for shy children's later internalizing difficulties in school.

Research has demonstrated links from early childhood shyness to socioemotional problems later in life. This longitudinal study explored the role of early social play behaviors and language skills in the associations between childhood shyness and later internalizing and language difficulties in school. Participants were N = 7,447 children (50.1% girls) from the Norwegian Mother, Father, and Child Cohort Study (MoBa). Latent direct, indirect, and interaction path analyses were performed within a structural equation framework. Results showed that mother-rated childhood shyness from age 18 months to age five years was associated with mother-rated internalizing difficulties and language problems at age eight years. Lower levels of teacher-reported social play behaviors and poorer language skills in preschool increased the risk of later anxiety problems among shy children, whereas higher levels of language competencies and social play behaviors buffered against later anxiety problems. The study identifies some of the early risk and protective factors that may influence shy children's socio-emotional functioning and adjustment.

The effect of special educational assistance in early childhood education and care on psycho-social difficulties in elementary school children.

BACKGROUND: Three to seven percent of pre-schoolers have developmental problems or child psychiatric disorders. Randomized controlled trials (RCTs) indicate that interventions in early childhood education and care (ECEC) improve long-term outcomes of children from disadvantaged backgrounds. It is unknown if such effects generalize beyond the well-structured context of RCTs and to children who may not have a disadvantaged background but have developmental problems or psychiatric disorders. METHODS: We used data from the population-based Norwegian Mother, Father and Child Cohort Study, recruiting pregnant women from 1999 to 2009, with child follow-up from ages 6, 18, and 36 months to ages 5, 7, and 8 years. This sub-study included 2499 children with developmental problems or psychiatric disorders at age five. We investigated the effects of special educational assistance at age five on mother-reported internalizing, externalizing, and communication problems at age eight. We analysed bias due to treatment by indication with directed acyclic graphs, adjusted for treatment predictors to reduce bias, and estimated effects in different patient groups and outcome domains with a hierarchical Bayesian model. RESULTS: In the adjusted analysis, pre-schoolers who received special educational assistance had on average by 0.1 (0.04-0.16) standardised mean deviation fewer psycho-social difficulties in elementary school. CONCLUSION: In a sample of children from mostly higher socioeconomic backgrounds we estimate a positive effects of special educational assistance during the transition from preschool to the school years. It may therefore be considered as an intervention for pre-schoolers with developmental or behaviour problems. More research with improved measurements of treatment and outcomes is needed to solidify the findings and identify success factors for the implementation of special educational assistance in ECEC.

Associations between poor gross and fine motor skills in pre-school and peer victimization concurrently and longitudinally with follow-up in school age - results from a population-based study.

BACKGROUND: Children with poor motor skills are at increased risk of peer victimization. However, it is unclear whether poor gross and fine motor skills are differently linked to peer victimization among pre-school and schoolchildren. AIMS: To investigate associations between poor gross and fine motor skills measured in pre-school and the associations to peer victimization measured concurrently and in school age. SAMPLE: Data from the Norwegian Mother, Father and Child Cohort Study (MoBa), and the Medical Birth Registry of Norway were used. Participants with complete questionnaires at 3, 5, and 8 years (n = 23 215) were included. METHODS: A longitudinal design and an autoregressive cross-lagged model were used to investigate if poor gross and fine motor skills at 3 and 5 years predicted peer victimization at 5 and 8 years. Because emotional difficulties are associated with both motor skills and peer victimization, the results were adjusted for emotional difficulties. RESULTS: Only poor fine motor skills at 3 years had a significant association to peer victimization at 5 years. Poor gross motor skills at 5 years had a stronger association to peer victimization measured concurrently compared to poor fine motor skills, and only poor fine motor skills at 5 years was significantly linked to peer victimization at 8 years. No gender difference was found between these paths. CONCLUSIONS: Teachers and parents should be aware that motor skills predict peer victimization, and that poor gross and fine motor skills have different associations to peer victimization measured at different ages.

Associations Between Language Difficulties, Peer Victimization, and Bully Perpetration From 3 Through 8 Years of Age: Results From a Population-Based Study.

Background and Purpose Schoolchildren with language difficulties experience more peer victimization compared to their typically developing (TD) peers. Whether these children also bully their peers (bully perpetration) more than TD children is unclear. Furthermore, little is known about peer victimization and bully perpetration among preschool children with language difficulties and how it may be related to different paths of language difficulties. This study aimed to investigate associations between language difficulties, peer victimization, and bully perpetration from preschool to school age as well as the risk of peer victimization and bully perpetration for children with different developmental paths of language difficulties and mild language difficulties compared to TD children. Method The sample was drawn from the Norwegian Mother, Father and Child Cohort Study. Participants with completed questionnaires at 3, 5, and 8 years of age (n = 22,628) were included. Paths between latent variables of language skills at 3, 5, and 8 years of age, peer victimization at 5 and 8 years of age, and bully perpetration at 8 years of age were examined with structural equation modeling. Logistic regression was used to investigate peer victimization and bully perpetration for predefined paths of language difficulties. Results Poor language skills at 3 and 5 years of age were associated with peer victimization at 5 years of age. Poor language skills at 5 and 8 years of age were associated with peer victimization and bully perpetration at 8 years of age. The association between poor language skills at 5 years of age and bully perpetration at 8 years of age was stronger for girls. Persistent paths of language difficulties at 3, 5, and 8 years of age showed the highest risk of peer victimization and bully perpetration. Conclusions Language difficulties are associated with peer victimization and bully perpetration. The risk of peer victimization and bully perpetration differs according to different developmental paths of language difficulties from preschool to school age.

Gender gaps in preschool age: A study of behavior, neurodevelopment and pre-academic skills.

Background: Female educational advantage is evident from elementary school and throughout the education system. Understanding the gender differences that precede school entry might provide important insight as to why girls outperform boys later in their educational careers. Aims: The aim of this study was to explore gender differences in early literacy and numeracy skills, as well as a range of neurodevelopmental and behavioral domains between the age of five and six years. Methods: We used questionnaire data from preschool teachers in the Norwegian Mother, Father and Child Cohort Study reported for 7467 children attending the final year in preschool, to explore gender differences and age patterns by fitting flexible regression models predicting pre-academic, behavioral and neurodevelopmental outcomes. Results: We found gender differences favoring girls for all outcomes except internalizing behavior. For neurodevelopment and behavior, differences in adjusted standardized scores ranged from 46% of a standard deviation (95% confidence interval (CI) 0.41, 0.50) in overall school readiness to 31% of a standard deviation difference in externalizing behavior problems (CI 0.21, 0.41). We found gender differences for all literacy skills in favor of girls. The gender gap in naming and adding numbers was small, but in favor of girls. Increasing age was associated with improved pre-academic skills and school readiness, as well as reduction of attention problems and language difficulties, the latter especially for boys. Conclusions: We conclude that gender differences favoring girls exist prior to school entry for a broad range of pre-academic, behavioral and neurodevelopmental skills relevant to school functioning.

Predicting Literacy Skills at 8 Years From Preschool Language Trajectories: A Population-Based Cohort Study.

Purpose This article explored the predictive values of three main language delay (LD) trajectories (i.e., persistent, late onset, and transient) across 3-5 years on poor literacy at 8 years. Additionally, the effect of gender was assessed, using both gender-neutral and gender-specific thresholds. Method The data comprised mother-reported questionnaire data for 8,371 children in the Norwegian Mother, Father, and Child Cohort Study. Analyses were conducted using binary logistic regression in SPSS to make predictions about risk. Results LD reported at preschool age was associated with excess risk of poor literacy at 8 years with odds ratios ranging from 3.19 to 9.75 dependent on trajectory, persistent LD being the strongest predictor. The odds ratio of transient LD was similar to that of late-onset LD. Gender was not found to play an important role in the association between oral language and literacy, as the gender difference disappeared when gender-specific deficit criterion was used. Conclusion Our study supports the longitudinal association between preschool oral language and school-aged literacy skills and highlights the importance of different LD trajectories across preschool ages in predicting later literacy. Furthermore, practitioners are recommended to consider gender-specific cutoffs in relation to language and literacy measures.

Peer-Victimization of Young Children With Developmental and Behavioral Difficulties-A Population-Based Study.

OBJECTIVE: The aim is to investigate if young children with developmental and behavioral difficulties (DBDs) have greater risk of peer-victimization compared with typically developing (TD) children. METHOD: The sample was drawn from the Norwegian Mother and Child Cohort Study (MoBa). MoBa has collected population-based data on children's health and development for 114,500 children. We included children that were 5 years of age (n = 41,609). Multivariate logistic regression was used to estimate the effect of different DBDs and of co-occurring DBDs on peer-victimization compared with TD children. Categories of DBDs included autistic traits, emotional difficulties, behavioral difficulties, general learning difficulties, attention difficulties/impulsive behavior, motor development difficulties, language difficulties, and hearing and vision difficulties. Results were adjusted for socioeconomic status and the child's sex. RESULTS: Peer-victimization was 2.8% (933) among TD children, and 8.0% (615) among children with DBD. The highest risk of peer-victimization was found among children with autistic traits and children with five or more co-occurring DBDs (adjusted odds ratios [ORs] = 12.76; 95% confidence interval [CI] 8.64-18.84; p ≤ .001) and 17.37 (95% CI 12.15-24.82; p ≤ .001)], respectively. The lowest risk was found among children with hearing and vision difficulties and children with only one DBD [adjusted ORs = 1.98 (95% CI 1.71-2.29; p ≤ .001) and 1.95 (95% CI 1.70-2.22; p ≤ .001)]. CONCLUSION: Children with DBD have a substantially higher risk of peer-victimization compared with TD children. Peer-victimization varies with type of DBD and increases cumulatively by number of DBDs.

Language Delay and Externalizing Problems in Preschool Age: A Prospective Cohort Study.

This study sought to examine the direction of causation between language delay and two externalizing problems; inattention and aggression. Autoregressive fixed effects models were fitted to data from 25,474 children (age 1.5 to 5 years; 50.8% boys) in the population-based longitudinal Norwegian Mother and Child Cohort Study (MoBa), to model the direction of causality for language delay and inattention and aggression, respectively. The most parsimonious model for the relationship between language delay and inattention was one where both common factors and reciprocal causation were estimated. Adjusted for common factors, language delay was estimated to have a non-significant effect on inattention by b = 0.12 (p = 0.06), and inattention to have a significant effect on language delay by b = 0.19 (p = 0.03). The most parsimonious model for the direction of causality for language delay and aggression was one where the entire association could be explained by language delay having effect on aggression b = 0.12 (p < 0.02). It appears that while language delay can best be conceptualized as an epiphenomenon of inattention partly related to both common factors and causal processes, aggression can best be conceptualized as caused by language delay. This illumination of the hypothetical causal links between two common problem domains in preschool-aged children has clear implications on where to implement interventions to prevent co-occurrence of language delay and externalizing problems.

Language difficulties and internalizing problems: Bidirectional associations from 18 months to 8 years among boys and girls.

Studies have shown that early language difficulties are associated with later internalizing problems. Less is known about the nature of the association: the bidirectional relationship over time, the role of different types of language difficulties, and gender differences. The present study examined bidirectional longitudinal associations between parent-rated language difficulties and internalizing problems in a four-wave cross-lagged model from 18 months to 8 years. Data from the Norwegian Mother and Child Cohort Study were used (N = 114,000). Gender-specific dichotomized language variables were created, and associations were investigated uniquely for boys and girls. Logistic regression analyses showed that all cross-lagged associations from 18 months to 5 years were significant for girls (odds ratios [ORs] = 1.48-1.94). For boys, only internalizing problems at 3 years predicted change in language difficulties (OR = 2.33). From 5 to 8 years, the cross-lagged associations between semantic language difficulties and internalizing problems were significant and strong for girls (ORs = 1.92-2.97) and nonsignificant for boys. The results suggest that the associations between language difficulties and internalizing problems are bidirectional from an early age, and that girls are especially vulnerable for developing co-occurring language difficulties and internalizing problems during the years of transition to school.

Norway's high-quality center care reduces late talking in high- and low-risk groups.

OBJECTIVES: To examine whether attendance in Norwegian high-quality center care in the first 3 years of life buffers the negative effects of biomedical risk factors on children's late talking (LT) at 3 years of age. METHODS: Data on 75,128 children from the Norwegian Mother and Child Cohort Study were analyzed and include information on child care arrangements, LT, and a variety of covariates. A biomedical risk group (N = 6893) was constructed on the basis of information from the Medical Birth Registry of Norway on children's Apgar scores 5 minutes after birth, birth weight, and gestational age. Late talking was reported by mothers when their children were 3 years old. RESULTS: In line with previous research, children born with biomedical risk factors were at higher risk for LT at age 3 years than children born without biomedical risk factors. Child care arrangement at age 1 was not significantly related to LT at age 3 years. At both 1.5 and 3 years of age, center care attendance was related to a reduced chance of LT, independently of whether the children were in the biomedical risk group or not. However, our main hypothesis was not confirmed. Center care attendance did not buffer the negative effects of biomedical risk factors on LT for boys or girls (all p > .05). CONCLUSION: Although attendance in Norwegian center care is positive for children's language development in general, it does not buffer the negative effects of biomedical risk factors on children's LT.

Potentially curative radiotherapy for non-small-cell lung cancer in Norway: a population-based study of survival.

PURPOSE: The efficacy of curative irradiation in the treatment of non-small-cell lung cancer patients is considered limited. The purpose of this study was to evaluate long-term survival in a population-based approach. METHODS AND MATERIALS: Cases of non-small-cell lung cancer diagnosed from 1993 to 2001 were identified in the Cancer Registry of Norway. Electronic linkage with national data from the hospitals' radiotherapy verification systems identified those who received potentially curative doses (≥ 50 Gy). Hospital records were reviewed for all patients. RESULTS: A total of 497 patients (336 men) were identified with a radiation dose of ≥ 50 Gy delivered to the lung region. Of these, 41% received 60 Gy or more. The majority (70%) of patients included had advanced stage disease: 24% Stage IIIA and 46% Stage IIIB. The overall 1-, 3-, and 5-year observed survival rates were 53%, 16%, and 9%, respectively. Multivariable analyses identified stage and chemotherapy, but not radiation dose, as significant independent prognostic variables for survival. However, 68% of patients treated with chemotherapy participated in prospective studies with inclusion criteria that excluded patients with less favorable prognostic factors, leading to a selection bias. The number of fractions and the radiation doses varied widely among different hospitals. CONCLUSION: The long-term prognosis after radiation therapy is poor. More sophisticated, targeted, and uniform delivery of radiation therapy is needed. The apparent benefit of chemotherapy may in part be due to selection of patients with more favorable prognostic factors for this therapy.

A prospective phase II study: high-dose pemetrexed as second-line chemotherapy in small-cell lung cancer.

PURPOSE: To investigate the efficacy and tolerability of high-dose pemetrexed as second-line chemotherapy in small cell lung cancer (SCLC). PATIENTS AND METHODS: Patients with verified SCLC who had received one prior chemotherapy regimen, aged 18-75 years, WHO Performance Status 0-2, no clinical signs of brain metastases and measurable disease were eligible. Patients received pemetrexed 900 mg/m(2) IV every 3 weeks. Four courses were planned for all patients. Patients with relapse later than 3 months since last course of first-line chemotherapy were defined as "sensitive", those with relapse within 3 months as "refractory". Toxicity was graded using the CTCAE v3.0. RESULTS: 36 patients were accrued, 34 received study treatment. Median age was 61 (range 43-74), 18 (53%) males and 16 (47%) females. Mean number of courses administered was 2.5. One patient (3%) had partial response, three (9%) had stable disease and 29 (85%) progressed. One patient (3%) was not evaluable for response. Median TTP (n=33) was 7.7 weeks ("sensitive": 8.4 weeks, "refractory": 5.1 weeks). Median OS (n=34) was 17.6 weeks ("sensitive": 22.6 weeks, "refractory": 15.3 weeks). Of grade 3-4 haematological toxicity, anemia was observed in 2 (6%) patients, leukopenia in 6 (18%), granulocytopenia in 9 (27%) and thrombocytopenia in 3 (9%). Febrile neutropenia occurred in 6 (18%) patients. There were no treatment related deaths. CONCLUSION: High-dose pemetrexed monotherapy to patients with recurrent SCLC yielded moderate toxicity, but limited treatment efficacy.

Weekly docetaxel with concurrent radiotherapy in locally advanced non-small cell lung cancer: a phase I/II study with 5 years' follow-up.

This Phase I/II study investigated weekly docetaxel (Taxotere) with concurrent radiotherapy in 42 patients with untreated stage III non-small cell lung cancer (NSCLC). All patients were treated with chest irradiation: 2Gy administered 5 days/week for 5 weeks, to a total of 50Gy. Docetaxel (1-h infusion) was administered on days 1, 8, 22, and 29< or =2 h before radiation fractions 1, 6, 16, and 21 (i.e. every week excluding the third week of treatment). In the Phase I study (n=12), docetaxel was started at 20 mg/m2 per week (n=3) and escalated in 10 mg/m2 increments (30 mg/m2, n=3; 40 mg/m2, n=6). Dose-limiting toxicity (grade 3-4 esophagitis) occurred with docetaxel 40 mg/m2. The Phase II study (n=30), therefore, evaluated docetaxel 30 mg/m2 (considered recommended dose). All patients except one experienced asymptomatic grade 3-4 lymphopenia; four patients (9.5%) had grade 3-4 esophagitis. The overall response rate was 45.5%, with eight (24.2%) complete responses. The median time to progression at the recommended dose of 30 mg/m2 (n=33) was 12.0 months and the median survival time was 13.6 months. The 1-year survival rate was 60.6%. Five patients (one from Phase I and four from Phase II) were alive after >5 years. In conclusion, weekly docetaxel 30 mg/m2 plus radiotherapy is active and well tolerated in stage III NSCLC.

Cisplatin and etoposide regimen is superior to cyclophosphamide, epirubicin, and vincristine regimen in small-cell lung cancer: results from a randomized phase III trial with 5 years' follow-up.

PURPOSE: To investigate whether chemotherapy with etoposide and cisplatin (EP) is superior to cyclophosphamide, epirubicin, and vincristine (CEV) in small-cell lung cancer (SCLC). PATIENTS AND METHODS: A total of 436 eligible patients were randomized to chemotherapy with EP (n = 218) or CEV (n = 218). Patients were stratified according to extent of disease (limited disease [LD], n = 214; extensive disease [ED], n = 222). The EP group received five courses of etoposide 100 mg/m(2) intravenously (IV) and cisplatin 75 mg/m(2) IV on day 1, followed by oral etoposide 200 mg/m(2) daily on days 2 to 4. The CEV group received five courses of epirubicin 50 mg/m(2), cyclophosphamide 1,000 mg/m(2), and vincristine 2 mg, all IV on day 1. In addition, LD patients received thoracic radiotherapy concurrent with chemotherapy cycle 3, and those achieving complete remission during the treatment period received prophylactic cranial irradiation. RESULTS: The treatment groups were well balanced with regard to age, sex, and prognostic factors such as weight loss, and performance status. The 2- and 5-year survival rates in the EP arm (14% and 5%, P =.0004) were significantly higher compared with those in the CEV arm (6% and 2%). Among LD patients, median survival time was 14.5 months versus 9.7 months in the EP and CEV arms, respectively (P =.001). The 2- and 5-year survival rates of 25% and 10% in the EP arm compared with 8% and 3% in the CEV arm (P =.0001). For ED patients, there was no significant survival difference between the treatment arms. Quality-of-life assessments revealed no major differences between the randomized groups. CONCLUSION: EP is superior to CEV in LD-SCLC patients. In ED-SCLC patients, the benefits of EP and CEV chemotherapy seem equivalent, with similar survival time and quality of life.

The effect of patient's delay and doctor's delay in patients with malignant germ cell tumours.

In 103 patients with malignant germ cell tumours the initial clinical diagnosis was incorrect in 45 (44%). The correct diagnosis was established within 2 months in only 31% of the patients, and delayed by more than 6 months in 27%. Stage, distribution and survival were correlated with the histology, but not with the duration of symptoms or the patient's/doctor's delay. Rapidly growing tumours often belonged to the non-seminornaious group where advanced tumour stages and low survival rates were more common than in the seminoma group. The overall prognosis of patients with malignant germ cell tumours may be increased by an early diagnosis of testicular tumours in non-symptomatic patients, especially in men with possible risk factors (cryptorchidism, atrophic testis, antecedent contralateral testicular cancer).