Bayley trajectories predict school readiness better than single assessments in formerly very preterm preschoolers.

BACKGROUND: Development of children born very preterm (VPT) is evaluated using the Bayley Scales of Infant Development. Early Bayley scores may not predict later outcomes. We studied whether VPT Bayley trajectories in the early years predicted school readiness better than single assessments. METHODS: We prospectively evaluated 53 VPT at 4-5 years using standardized measures of school readiness, including the domains of cognition, early mathematical and literacy abilities, and motor skills. Predictors were Bayley-III scores obtained 1-5 times/child between 6 and 35 months. Linear mixed models (LMM) with random effects extracted estimated random effect for slope (change in Bayley score/1 year) and fixed+random effect sum for the intercept (initial Bayley score) for each participant, to then evaluate 4-5-year outcomes prediction. RESULTS: Variability of individual trajectories prevailed across developmental domains. For the initial LMM, adding Bayley change to models with only initial score improved model fits for several Bayley-III domains. Models containing estimates for initial Bayley scores and Bayley change explained significantly more variability in school readiness scores (21-63%) than either variable alone. CONCLUSION: Neurodevelopmental follow-up of VPT is more relevant to school readiness when children are assessed multiple times in the first 3 years. Neonatal intervention research could use early trajectories rather than single timepoints as outcomes. IMPACT: This study is the first to examine individual Bayley scores and trajectories to predict school readiness of formerly preterm children at 4-5 years. Modeling demonstrated extreme variability of individual trajectories compared to the group's average trajectories. Models containing initial Bayley scores and Bayley change over time explained more variability in preschool readiness than either variable alone. Using the Bayley to predict future school readiness is enhanced by administration across multiple follow-up visits and inclusion of change across the first 3 years. Follow-up care models and clinical trial design for neonatal interventions may benefit from a trajectory-based approach to outcomes evaluation.

Associations of Parental Distress and Behavior with School Readiness in Children Born Very Preterm.

OBJECTIVE: Children born very preterm (VPT; gestational age [GA] <31 weeks) have robust school readiness difficulties relative to children born full-term (FT; GA ≥37 weeks). This study examined whether four aspects of parental well-being and behavior-distress, harshness, responsiveness and positive control, and cognitive stimulation-were linked to school readiness in a sample of children born VPT <31 weeks GA and whether these characteristics similarly impact VPT and FT children. METHODS: Parents of 4-year-olds born VPT (n = 55) and FT (n = 38) reported on parental distress, behavior, and cognitive stimulation. Children's cognition, executive function, motor skills, preacademic abilities, and behavior were assessed via neuropsychological tests and parent-report questionnaires. RESULTS: For both groups of children, higher psychological distress and harshness were associated with more behavior problems, and more cognitive stimulation was associated with higher scores on tests of cognitive, motor, and preacademic abilities. More parental distress was associated with lower cognitive ability only for children born VPT and more harshness was associated with lower preacademic skills only for children born FT. CONCLUSIONS: Identifying modifiable family factors associated with school readiness in children born VPT is essential for informing family-based interventions to improve school readiness in this population. Findings suggest that distress, harshness, and cognitive stimulation may be reasonable targets for interventions to improve school readiness in children born VPT.

Development of the mentalizing network structures and theory of mind in extremely preterm youth.

Adolescents born preterm (<37 weeks of gestation) are at elevated risk for deficits in social cognition and peer relationships. Theory of Mind (ToM) is a complex form of social cognition important for regulating social interactions. ToM and the underlying mentalizing network continue to develop across adolescence. The present study recruited 48 adolescents (12-17 years old) who were either born extremely preterm (EPT; <28 weeks of gestation) or full-term (FT) at birth. Cortical thickness, gray matter volume and surface area were measured in four regions of the mentalizing network: the temporoparietal junction, anterior temporal cortex, posterior superior temporal sulcus and frontal pole (mBA10). We also assessed the adolescents' performance on a ToM task. Findings revealed both group differences and group-by-age interaction effects in the gray matter indices within the temporal lobe regions of the mentalizing network. The EPT group also performed significantly worse than the FT group on the ToM task. The cortical structural measures that discriminated the EPT and FT groups were not related to ToM performance. These results highlight altered developmental changes in brain regions underlying mentalizing functions in EPT adolescents relative to FT controls.

School Readiness in 4-Year-Old Very Preterm Children.

The aims of this study were to identify the aspects of school readiness that best distinguish very preterm (VPT) preschoolers from full-term (FT) controls, determine the extent to which readiness problems in the VPT group reflected global cognitive weaknesses or more specific deficits, and identify distinct profiles of readiness problems. Fifty-three VPT (gestational age ≤ 30 weeks) 4-year-olds were compared to 38 FT (gestational age ≥ 37 weeks) controls on measures of global cognitive ability, executive function, motor skills, early literacy and numeracy, and psychosocial functioning. Latent class analysis (LCA) was also conducted to identify individual readiness profiles. The VPT group had the most pronounced difficulties on tests of spatial and nonverbal cognitive abilities, executive function, motor skills, phonological processing, and numeracy. The VPT group also had sex-related difficulties in processing speed, social functioning, and emotion regulation. These differences were evident in analyses of both continuous scores and rates of deficits. The VPT group's difficulties in motor skills, and VPT females' difficulties in social functioning and emotion regulation, were evident even when controlling for global cognitive ability. LCA suggested four profiles of readiness, with the majority of the VPT group assigned to profiles characterized by relative weaknesses in either cognitive abilities or psychosocial functioning or by more global readiness problems. The findings support the need to evaluate multiple aspects of school readiness in VPT preschoolers and inform efforts to design more targeted early educational interventions.

Exceeding expectations after perinatal risks for poor development: associations in term- and preterm-born preschoolers.

OBJECTIVE: To define parenting/social characteristics associated with better-than-expected cognitive and motor outcomes in preschoolers at similar perinatal biological risk-level including various gestational ages at birth (GA) and perinatal complications. STUDY DESIGN: Prospective cohort study (n = 87) of children at four years, median GA 29 weeks (IQR 26, 38). Assessments included Differential Ability Scales, Movement Assessment Battery, parenting styles, and social risk scores. Perinatal risk factors were weighted based on regression models for each outcome; individual calculated risk scores became predictors to extract standardized residuals from the mean (>1 SD above mean = better-than-expected). Mixed-effect regressions examined associations between positive adaptation and parenting/social factors. RESULT: Perinatal risk scores explained 21-53% outcome variability. Children across all GA displayed positive adaptation. Children of parents with higher authoritarian scores had higher odds of better-than-expected outcomes (OR 1.17, p = 0.0002). CONCLUSION: Parental structure may promote positive adaptation at preschool age in children with perinatal risk factors for poor development, including extreme prematurity.

The doctrine of normal tendency in active learning teaching methodology: investigations into probability distributions and averages.

Traditional lecture and active learning methods of teaching a university course are compared. The particular course is university calculus. The lecture method was applied to two sections of calculus. The active learning method was applied to two other sections. In all cases students were given an examination near the beginning of the course and a final examination at the end of the course. The score averages for the active learning method were higher than for the lecture method. The distribution of scores for the lecture method were non-normal multimodal in the first and final examinations. The distribution for the active learning method went from non-normal multimodal in the first examination to unimodal normal in the final examination. A new undeceivable nature evidence-based method is presented for measuring teaching efficacy by probability distribution. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43545-021-00154-1.

Resilience and vulnerability in very preterm 4-year-olds.

OBJECTIVE: The primary goal was to determine the prevalence and correlates of adaptive competence in 51 very preterm (VPT, gestational age ≤30 weeks) 4-year-old children compared to a group of 35 term-born (Term) children of the same age. Methods: Adaptive competence, or "resilience" in the VPT group, was defined as age-appropriate scores on tests of early literacy and numeracy and an absence of clinical elevations on parent ratings of problems in behavior and development. Analyses were conducted to compare groups in the prevalence of adaptive competence, determine how adaptively competent VPT children differed from children who were not adaptively competent (i.e. the "maladaptive" subset) and from adaptively competent Term children, and identify family factors related to competence independent of group. Results: Controlling for sociodemographic background, fewer VPT children compared to Term participants (31% vs. 71%) were adaptively competent (p = .026). Compared to the maladaptive subset of the VPT group, adaptive VPT children had higher scores on cognitive tests and more positive parent ratings of executive function and self-regulation. The adaptive VPT subset had outcomes similar to adaptive Term children on many measures but poorer outcomes in specific domains. Higher home stimulation for learning and lower parent distress were also related to adaptive competence. Conclusion: Although a substantial minority of VPT children display adaptive competence, these children may have weaknesses in cognitive skills and executive functioning that present developmental challenges. Associations of adaptive competence with supportive home environments suggest that early family intervention may improve outcomes in this population.

Interrelatedness of Children's Psychological and Physiological Responses to Interparental Conflict: A Moderating Role of Harsh Parenting.

Children's psychological and physiological responses to interparental conflict have received considerable attention due to their implications for later adjustment, yet limited research has investigated the interplay between these two response systems. This study investigates patterns of association between children's psychological responses (e.g., emotional distress) and cortisol reactivity to interparental conflict, including possible moderations by negative caregiving environment. Participants included 193 families (mother, father, and child). Parents completed questionnaires relating to their caregiving behaviors toward the child (107 girls and 86 boys, M age = 7.99 years, SD = 0.53 years) and children's psychological responses to interparental conflict. Children provided three saliva samples over the course of watching videos depicting conflicts between two adults, whom children were asked to pretend were their parents. Based on a series of Latent Growth Curve Models, only children's emotional responses to interparental conflict (indicated by increased distress) were associated with greater cortisol reactivity. Additionally, fathers' harsh parenting behavior moderated the relation between children's emotional reactivity and cortisol reactivity, yet the moderation effect was not found for mothers' parenting. Findings are discussed in terms of the importance of exploring both psychological and physiological reactivity to conflict and the possible moderating role of harsh parenting.