Handbook of Life Course Health Development by Neal Halfon Christopher B. Forrest Richard M. Lerner & Elaine M. Faustman

Author:Neal Halfon, Christopher B. Forrest, Richard M. Lerner & Elaine M. Faustman
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

4.2 Cognitive Outcomes

The assessment of cognitive outcomes can focus on three related domains: intelligence testing , achievement testing , and neuropsychological testing . The latter includes evaluation of specific higher cortical processes such as executive function, working memory, and information processing. Assessment of toddlers and young children combines precursors of verbal and nonverbal intelligence and cognitive processes (e.g., object permanency, symbolic play), whereas school-age assessment and beyond require more complex testing to assess problem-solving, literacy, and numeracy. There is increased recognition that Bayley II and III scores <70 predict complex cognitive and learning challenges among school-age children. However, among children with 2-year Bayley scores of 71–84 (1–2 standard deviations below the mean), they may be uniquely vulnerable to the lack of quality early childhood education and preschool experiences, especially in socially disadvantaged families (Patrianakos-Hoobler et al. 2009). Therefore, one needs to be cautious in using developmental assessments in the first 2 years of life to fully assess the spectrum of cognitive and learning disorders in all children, not only those preterm and growing up in vulnerable circumstances. The limitations in Bayley assessments are due to the dynamic processes of higher cortical functioning in childhood. Additionally, the assessment of developmental delay is intertwined with perceptual and sensory skills as well as early learning experiences and neuroplasticity. Learning, communication, and social challenges may not be apparent until there is increased complexity of tasks for academic skills and behavioral/attention regulatory capacity required by school environments.

In order to address higher-level skills at school entry, one strategy is to examine children’s status at kindergarten entry. EPI cohorts born in the 1980s from Hamilton, Ontario, Melbourne, Australia, Buffalo, New York, and Chicago, Illinois, have demonstrated that 44–56% require special education resources and 21–29% have major neurodevelopmental impairments (Baek et al. 2002; Vohr and Msall 1997). These studies indicate that, in addition to planning for major developmental disabilities, resources are required to ensure success with peers in the classroom.

Gross and colleagues followed infants born very preterm and found that 41% of preterm infants were performing at grade level versus 70% of term children. These preterm children were more likely to receive special education services and three times as likely to be diagnosed with learning disabilities. In this cohort, parental marital status and educational attainment were significantly related to educational outcomes (Gross et al. 2001). Nearly three times as many preterm children achieved grade-level performance if parents were married as compared to children from single-parent homes. Thus, preterm survivors with limited family resources are further disadvantaged and vulnerable.

In Cleveland, Litt and colleagues prospectively followed 219 surviving ELBW children born between 1992 and 1995 through middle childhood and adolescence. Surviving children had a mean birth weight of 815 g, a mean GA of 26.4 weeks; and almost 1 in 5 was from multiple birth gestations. Neonatal morbidities included bronchopulmonary dysplasia in 41%, sepsis in 29%, and sonographic parenchymal brain injury in 24% (IVH3–IVH4/PVL by cranial ultrasound). Importantly, 115 term controls from the extremely preterm survivor’s community classroom were assessed at 14 years.

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