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This study examined associations of a caregiver-based diagnosis of attention deficit hyperactivity disorder (ADHD) in kindergarten with early learning progress in 139 extremely preterm/extremely low birth weight (EPT/ELBW, gestational age

OBJECTIVE The study was designed to investigate the effect of extreme prematurity on growth in academic achievement across the early school years and the validity of kindergarten neuropsychological skills as predictors of achievement. METHOD A 2001-2003 birth cohort of 145 extremely preterm/extremely low birth weight (EPT/ELBW) children from a single medical center, along with 111 normal birth weight (NBW) classmate controls, were recruited during their first year in kindergarten and followed annually across the next 2 years in school. Mixed model analysis was conducted to compare the groups on growth in achievement across years and examine kindergarten neuropsychological skills as predictors of growth. RESULTS The EPT/ELBW group scored significantly below NBW controls on all achievement tests across years and had higher rates of special education placement and grade repetition. Despite limited catch-up of the EPT/ELBW group to the NBW controls in spelling, group differences were generally stable. Differences in spelling and mathematics achievement remained significant when controlling for global intelligence or excluding children who had intellectual or neurosensory impairments or repeated a grade. Higher scores on kindergarten tests of multiple neuropsychological ability domains predicted higher achievement levels and steeper growth in achievement. CONCLUSIONS The findings document persistent academic weaknesses in EPT/ELBW children across the early school years. Results point to the need for preschool interventions to enhance academic readiness and suggest that neuropsychological skills assessed in kindergarten are useful in identifying individual differences in early learning progress. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

To examine parent protection and its correlates among 8-year-old ELBW children compared with normal birth weight (NBW) controls.The population included 217 eight-year-old ELBW children born 1992-1995 (92% of the surviving birth cohort; mean birth weight, 811 g; mean gestational age, 26.4 weeks) and 176 NBW controls. The primary outcome measure, the Parent Protection Scale (PPS), included a total score and four domains including Supervision, Separation, Dependence, and Control. Multivariate analyses were performed to examine the predictors of parental protection and overprotection.After adjusting for socioeconomic status (SES), race, sex, and age of the child, parents of ELBW children reported significantly higher mean total Parent Protection Scale scores (31.1 vs 29.7, p = .03) than parents of NBW children and higher scores on the subscale of Parent Control (8.0 vs 7.5, p = .04). These differences were not significant when the 36 children with neurosensory impairments were excluded. Parents of ELBW children also reported higher rates of overprotection than controls (10% vs 2%, p = .001), findings that remained significant even after excluding children with neurosensory impairments (8% vs 2%, p = .011). Multivariate analyses revealed lower SES to be associated with higher total Parent Protection Scale scores in both the ELBW (p.001) and NBW (p.05) groups. Additional correlates included neurosensory impairment (p.05) and functional limitations (p.001) in the ELBW group and black race (p.05) and maternal depression (p.01) in the NBW group. Lower child IQ was significantly associated with higher PPS scores only in the neurosensory impaired subgroup of ELBW children.Longer term follow-up will be necessary to examine the effects of the increased parent protection on the development of autonomy and interpersonal relationships as the children enter adolescence.

To investigate the effects of very low birth weight (VLBW, JINS, 2004,10, 149–163.)

Cognitive, behavioral, and learning problems are evident in extremely preterm/extremely low birth weight (EPT/ELBW,28 weeks gestational age or1000 g) children by early school age. However, we know little about how they function within the classroom once they start school.To determine how EPT/ELBW children function in kindergarten classrooms compared to termborn normal birth weight (NBW) classmates and identify factors related to difficulties in classroom functioning.A 2001-2003 birth cohort of 111 EPT/ELBW children and 110 NBW classmate controls were observed in regular kindergarten classrooms during a 1-hour instructional period using a time-sample method. The groups were compared on frequencies of individual teacher attention, competing or offtask behaviors, task management/preparation, and academic responding. Regression analysis was also conducted within the EPT/ELBW group to examine associations of these measures with neonatal and developmental risk factors, kindergarten neuropsychological and behavioral assessments, and classroom characteristics.The EPT/ELBW group received more individual teacher attention and was more often off-task than the NBW controls. Poorer classroom functioning in the EPT/ELBW group was associated with higher neonatal and developmental risk, poorer executive function skills, more negative teaching ratings of behavior and learning progress, and classroom characteristics.EPT/ELBW children require more teacher support and are less able to engage in instructional activities than their NBW classmates. Associations of classroom functioning with developmental history and cognitive and behavioral traits suggest that these factors may be useful in identifying the children most in need of special educational interventions.

Most previous studies of children with birthweight

The school-age outcomes of children born at the lowest birthweights and gestational ages since the initiation of aggressive neonatal intensive care have only recently begun to appear in the literature. This paper summarizes the information available from reports of birthweight- and gestational age-based school-age studies. The results reveal relatively high rates of growth, neurosensory and cognitive impairment, together with more subtle neuropsychological and behavioural problems. Evaluation of outcomes has, however, been hampered by the small numbers of children who have reached school age, as well as by the heterogeneity of the population which includes differences in socio-demographic backgrounds, multiple births, small-for-gestational-age children, preferential survival of females and varying rates of neonatal risk factors such as severe periventricular haemorrhage and chronic lung disease. Future studies are needed to confirm present outcomes, to further elucidate the aetiology and pathogenesis of the problems revealed, as well as to evaluate the effects of early intervention in this population.

Although very-low-birth-weight (VLBW) infants, those weighing less than 1500 g, gained significantly better outcomes when neonatal intensive care became available in the 1960s, studies of later mental development have given mixed results. This longitudinal study enrolled 242 VLBW infants born in the years 1977-1979 who survived and 233 control infants of normal birth weight from the same population. The mean gestational age of the VLBW group at birth was 29.7 weeks. Intelligence testing was performed at age 20 with the Vocabulary and Block Design subtests of the Short Form of the Wechsler Adult Intelligence Scale-Revised. These tests measure verbal comprehension and perceptual-organizational skills, respectively. Academic skills were evaluated using the Letter-Word Identification and Applied Problems subtests of the Woodcock-Johnson Psycho-Educational Battery-Revised. The VLBW and normal-weight groups were sociodemographically similar, but the former group had significantly more chronic conditions than did control group. The major differences were in neurosensory impairment and subnormal height. Fewer subjects in the VLBW group had graduated from high school or obtained a general equivalency diploma by age 20. Although 40% of the VLBW group had repeated a grade, the figure for control subjects was 27%. Fewer VLBW subjects were enrolled in post-secondary studies. These differences remained significant when analysis was limited to those of normal IQ who had no neurosensory impairment. Mean IQ scores were significantly lower in the VLBW group (87 vs. 92, P

As part of a longitudinal study of the outcomes of very low birth weight children (

Objective. Information on the mental health of very low birth weight (VLBW; Methods. We compared a cohort of 241 survivors among VLBW infants who were born between 1977 and 1979 (mean birth weight: 1180 g; mean gestational age at birth: 29.7 weeks), 116 of whom were men and 125 of whom were women, with 233 control subjects from the same population in Cleveland who had normal birth weights (108 men and 124 women). Young adult behavior was assessed at 20 years of age with the Achenbach Young Adult Self-Report and the Young Adult Behavior Checklist for parents. In addition, the young adults and parents completed the ADHD Rating Scale for Adults. Gender-specific outcomes were adjusted for sociodemographic status.Results. VLBW men reported having significantly fewer delinquent behaviors than normal birth weight (NBW) control subjects, but there were no differences on the Internalizing, Externalizing, or Total Problem Behavior scales. Parents of VLBW men reported significantly more thought problems for their sons than did parents of control subjects. VLBW women reported significantly more withdrawn behaviors and fewer delinquent behavior problems than control subjects. Their rates of internalizing behaviors (which includes anxious/depressed and withdrawn behaviors) above the borderline clinical cutoff were 30% versus 16% (odds ratio: 2.2; 95% confidence interval [CI]: 1.2-4.1). Parents of VLBW women reported significantly higher scores for their daughters on the anxious/depressed, withdrawn, and attention problem subscales compared with control parents. The odds ratios for parent-reported rates above the borderline-clinical cutoff among women for the anxious/depressed subscale was 4.4 (95% CI: 1.4-13.5), for thought problems was 3.7 (95% CI: 1.2-11.6), and for attention problems was 2.4 (95% CI: 1.0-5.5). There were no differences in the young adult self-report of attention-deficit/hyperactivity disorder (ADHD). Parents of VLBW men reported higher mean scores on the attention subtype of ADHD but not higher rates of ADHD.Conclusion. The increase in psychopathology among VLBW survivors in young adulthood indicates a need for anticipatory guidance and early intervention that might help to prevent or ameliorate potential psychopathology.

A prospective follow-up of very low birth weight infants (VLBW) with (n=89) and without (n=71) bronchopulmonary dysplasia (BPD) and Term control children (n=93) was conducted at 8 years of age. Groups were compared on measures of articulation, receptive and expressive language, verbal and performance IQ, oral motor skills and gross and fine motor skills. The BPD group demonstrated reduced articulation, receptive language skills, performance IQ, and overall gross and fine motor skills when compared to VLBW and Term groups. The BPD and VLBW groups did not differ on expressive language, oral motor skills, or verbal IQ. The groups also differed in enrolment in special classes and speech–language therapy, with almost half (48%) of the BPD group enrolled in speech–language therapy compared to 21% of the VLBW group, and 9% of the Term group. These results suggest that BPD may have adverse effects on speech development as well as on performance IQ, motor skills, and receptive language over and above the effects of VLBW. Learning outcomes (1) As a result of this activity the reader will be able to describe what BPD is and how it impacts speech and language. (2) As a result of this activity the reader will be able to discuss how children with VLBW with BPD differ from children with VLBW without BPD in their developmental outcomes.

CONTEXT: Because of methodological limitations, the results of the few prospective studies assessing long-term cognitive effects of prenatal cocaine exposure are inconsistent. OBJECTIVE: To assess effects of prenatal cocaine exposure and quality of caregiving environment on 4-year cognitive outcomes. DESIGN: Longitudinal, prospective, masked comparison cohort study from birth (September 1994-June 1996) to 4 years. SETTING: Research laboratory of a US urban county teaching hospital. PARTICIPANTS: A total of 415 consecutively enrolled infants identified from a high-risk population screened for drug use through clinical interview, urine, and meconium screens. Ninety-three percent retention for surviving participants at 4 years of age resulted in 376 children (190 cocaine-exposed and 186 nonexposed). MAIN OUTCOME MEASURE: The Wechsler Preschool and Primary Scales of Intelligence-Revised. RESULTS: After control for covariates, prenatal cocaine exposure was not related to lower full-scale IQ (cocaine exposed [80.7] vs nonexposed [82.9]; P=.09) scores or summary verbal (cocaine exposed [79.9] vs nonexposed [81.9]; P=.11) or performance (cocaine exposed [85.5] vs nonexposed [87.5]; P=.18) IQ scores at age 4 years. However, prenatal cocaine exposure was related to small but significant deficits on several subscales (mean [SE]): visual-spatial skills (cocaine exposed [7.3 (0.22)] vs nonexposed [8.2 (0.22)]; P=.01), general knowledge (cocaine exposed [6.1 (0.18)] vs nonexposed [6.7 (0.17)]; P=.04), and arithmetic skills (cocaine exposed [6.2 (0.20)] vs nonexposed [6.8 (0.20)]; P=.05). Prenatal cocaine exposure was also associated with a lower likelihood of achievement of IQ above normative means (odds ratio, 0.26 [95% confidence interval, 0.10-0.65]; P=.004). The quality of the caregiving environment was the strongest independent predictor of outcomes. Cocaine-exposed children placed in nonrelative foster or adoptive care lived in homes with more stimulating environments and had caregivers with better vocabulary scores, and they attained full-scale and performance IQ scores (83 and 87, respectively) similar to nonexposed children in biological maternal or relative care (full-scale IQ, 82; performance IQ, 88) and higher than cocaine-exposed children in biological maternal or relative care (full-scale IQ, 79; performance IQ, 84). CONCLUSIONS: Prenatal cocaine exposure was not associated with lower full-scale, verbal, or performance IQ scores but was associated with an increased risk for specific cognitive impairments and lower likelihood of IQ above the normative mean at 4 years. A better home environment was associated with IQ scores for cocaine-exposed children that are similar to scores in nonexposed children.

Objectives To assess learning problems among kindergarten students with extremely preterm birth and to identify risk factors. Design Cohort study. Setting Children's hospital. Participants A cohort of 148 children born between January 1, 2001, and December 31, 2003, with extremely preterm birth, defined as less than 28 weeks' gestation or having a birth weight of less than 1000 g, and 111 classmate control individuals born at term with normal birth weight. Interventions The children were enrolled in the study during their first year in kindergarten and were assessed on measures of learning progress. Main Outcome Measures Achievement testing, teacher ratings of learning progress, and individual educational assistance. Results Children with extremely preterm birth had lower mean standard scores than controls on achievement tests of spelling (8.52; 95% confidence interval, 4.58-12.46) and applied mathematics (11.02; 6.76-15.28). They had higher rates of substandard learning progress by teacher report in written language (odds ratio, 4.23; 95% CI, 2.32-7.73) and mathematics (7.08; 2.79-17.95). Group differences in mathematics achievement and in teacher ratings of learning progress were statistically significant even in children without neurosensory deficits or low global cognitive ability. Neonatal risk factors, early childhood neurodevelopmental impairment, and socioeconomic status predicted learning problems in children with extremely preterm birth; however, many children with problems were not enrolled in a special education program. Conclusions Learning problems in children with extremely preterm birth are evident in kindergarten and are associated with neonatal and early childhood risk factors. Our findings support efforts to provide more extensive monitoring and interventions before and during the first year of school.

To determine the impact of very low birth weight (VLBW) on medical outcomes during childhood, we compared the health of 249 VLBW children born from 1977 through 1979 with that of 363 normal birth weight (NBW) control children at 8 years of age. Measures included the rates of specific illnesses, surgical procedures and accidents, growth, and other physical findings. The number of medical conditions and surgical procedures was significantly greater in the VLBW children than in the NBW control children. Eighteen percent of VLBW versus 5% of NBW children had had respiratory conditions (p0.001), mainly before 3 years of age. Surgical procedures were more common both before and after 3 years of age, but accidents occurred with similar frequency. The VLBW children had significantly lower weight, height, and head circumference and more minor physical stigmata. Thus medical illness, surgical interventions, and poor growth attainment are part of the ongoing morbidity of VLBW children during childhood.

To examine the self-perceived health of very low birth weight (VLBW;1.5 kg) infants during young adulthood.The population included 241 VLBW and 232 normal birth weight (NBW) controls who completed the Child Health and Illness Profile: Adolescent Edition (CHIP-AE) at 20 years of age. The CHIP-AE includes six domains: Satisfaction, Comfort, Resilience, Achievement, Risk Avoidance, and Disorders, and 13 profiles that characterize patterns of health. Results were compared between VLBW and NBW subjects adjusting for sex and sociodemographic status.VLBW subjects did not differ from NBW controls in the domains of Satisfaction or Comfort but reported less Resilience (effect size [ES] -0.19, P.05), specifically in physical activity and family involvement. They reported better Achievement, specifically in work performance (ES 0.28, P.05), more Risk Avoidance (ES 0.43, P.001), and significantly more long-term medical, surgical, and psychosocial disorders. Similar proportions of VLBW and NBW subjects reported Excellent (15% vs 11%), Average (27% vs 34%), and Poor (12% vs 13%) profiles of health.VLBW subjects report similar health, well-being, and functioning compared with NBW controls and greater risk avoidance. However, we are concerned that their lesser resilience may prove detrimental to their future adult health.

This study tested the hypothesis that infants with iron-deficiency anemia show behaviors, such as increased proximity to caregivers, increased wariness or hesitance, and decreased activity, that could contribute to "functional isolation." The behavior of 52 Costa Rican 12- to 23-month-old infants with iron-deficiency anemia was contrasted with that of 139 comparison group infants with better iron status during free play and mental and motor testing and in the home. Infants with iron-deficiency anemia maintained closer contact with caregivers; showed less pleasure and delight; were more wary, hesitant, and easily tired; made fewer attempts at test items; were less attentive to instructions and demonstrations; and were less playful. Adult behavior also differed. The results indicate that iron-deficiency anemia in infancy is associated with alterations in affect and activity, suggesting that functional isolation is a useful framework for understanding poorer developmental outcome in iron-deficiency anemia, the world's most common single nutrient deficiency.

We tested the hypothesis that very low birth weight (VLBW > 1.5 kg) children would have significantly poorer neurocognitive abilities at school age than would normal birth weight full-term age mates, that differences would persist after control for neurologic impairment and social risk, and that VLBW would interact with social risk. Two hundred forty-nine VLBW children and a randomly selected sample of 363 normal birth weight age mates born 1977 through 1979 were tested at 8 years. A neurologic examination and tests of intelligence, language, speech, reading, mathematics, spelling, visual and fine motor abilities, and behavior were performed. Twenty-four (10%) VLBW had a major neurologic abnormality compared with none of the controls. VLBW had significantly poorer scores on all tests, with the exception of speech and the total behavior score. These differences persisted among VLBW children without major neurologic abnormality, with the exception of social competence, reading, and spelling. Even normal IQ, neurologically normal VLBW had significantly poorer scores than did controls in expressive language, memory, visuomotor, and fine motor function, and measures of hyperactivity. When social risk was controlled in multiple regression analyses, VLBW still had an adverse effect on all outcome measures with the exception of speech. Social risk was, however, the major determinant of outcome. We found an interaction between VLBW and social risk only in verbal IQ and in the opposite direction than hypothesized.

emphasis, however, on a systematic approach to content analysis, curriculum, and the process of education for handicapped students. Bruner (1968), in his book Toward a Theory of Instruction, defines instruction as "leading the learner through a sequence of statements and restatements of a problem or body of knowledge that increases the learner's ability to grasp, transform, and transfer what he is learning" (p. 45). Thus, from this perspective, instruction entails more than the mere transmission of skills and knowledge from teacher to student. The organization and transformation of information to be taught is a complex arrangement that we refer to as an instructional model.

The developmental theory of Jean Piaget describes intellectual growth, from sensorimotor intelligence through adult logic. Although Piaget has not dealt with mentally retarded (MR) persons per se, his theory has been applied to that population by many researchers. Results of investigations into this application of Paget's stage theory of development indicate that the stages of development in the MR parallel those described by Piaget but appear at later chronological periods. Because of the tremendous variability in cognitive MR task performance within IQ categories, identification of specific aspects of concept learning holds promise for enhancing the school performance of MR children through individualized instruction.

Sixty-two children who were born very low birthweight (VLBW; < 1,500 grams) in 1976 are now reaching school age, and their ability to meet the demands of school can be evaluated. These children, enrolled in regular classrooms, were matched by race and sex to full-term classmates at 5 years of age. Measures of cognitive abilities and visual motor integration were administered and teachers rated their classroom behavior. VLBW children scored significantly lower on measures of visual perceptual and visual motor function. Teachers rated VLBW children as having significantly more problems including attending to tasks, following directions, and being passive. These data suggest the need for early intervention programs. Furthermore, these data underscore the need for longitudinal follow-up into the elementary school years.

The dramatic increase in the number of mothers of young children currently in the work force has resulted in an increased demand for child care outside the home, including care for handicapped children. To meet this need, we propose the integration of handicapped children into community child care centers as adjunct services to specialized early intervention programs. The successful integration of handicapped children into day care settings requires a planned program of staff development. Several models of staff development are presented that have been found effective for teachers of school-age children in mainstreamed settings. Several features of these models are incorporated in the special education consultation model described here. This model provides on-site consultation to day care providers as they acquire the skills to adapt and modify activities to facilitate the social integration of handicapped children in all activities of the center. And, finally, case studies are presented that document the staff development process.

Nancy K. Klein Department of Specialized Instructional Programs Cleveland State University Cleveland, Ohio A great journalist, Henry L. Mencken, once remarked that for every complex problem there was a simple solution. And that solution was probably wrong. Perhaps no where is this more true than in the field of special education, a technique developed to deal with those children euphemistically called "exceptional." While a few of these children vary from the norm by being of superior intellect, most suffer from limitations of learning ability or have sensory, physical and /or emotional problems. For a great many years our society chose to avert its attention from backward children, to shut them up in back rooms or even to pretend they did not exist. It is only quite recently that a growing awareness of this segment of our population has come to national attention. It has slowly sunk into our collective minds that such babies arrive at the homes of the well-born as well as in the slums, and that they, too, are citizens.