Petrou, S., Johnson, S., Wolke, D., Hollis, C., Kochhar, P., & Marlow, N.
(2010). Economic costs and preference-based health-related quality of
life outcomes associated with childhood psychiatric disorders. The
British Journal of Psychiatry: The Journal of Mental Science, 197(5),
BACKGROUND: Childhood psychiatric disorders may have deleterious consequences through childhood and into adulthood.
AIMS: To estimate costs and preference-based health-related quality of life outcomes (health utilities) associated with a broad range of childhood psychiatric disorders during the eleventh year of life.
METHOD: Participants in a whole-population study of extremely preterm children and term-born controls (EPICure) undertook psychiatric assessment using the Development and Well Being Assessment (DAWBA) and the Kaufman-Assessment Battery for Children. Questionnaires completed by parents and teachers described the children's utilisation of health, social and education services during the eleventh year of life. Parents also described their child's health status using the Health Utilities Index Mark 2 and Mark 3 health status classification systems. Descriptive and multiple regression techniques were used to explore the association between psychiatric disorders and economic outcomes.
RESULTS: The study presents detailed costs and health utilities associated with psychiatric disorders for the preterm population, term-born population and pooled study population, following appropriate controls.
CONCLUSIONS: The results of this study should be used to inform future economic evaluations of interventions aimed at preventing childhood psychiatric disorders or alleviating their effects. Further research is required that identifies, measures and values the longer-term economic impacts of these disorders in a valid and reliable manner.
Farooqi, A. (2009). Pervasive behavioural problems are common in children
born at less than 26 weeks of gestation. Evidence Based Mental Health,
QUESTION: Does being born at less than 2 weeks of gestation (extremely preterm) increase pervasive behavioural problems at 6 years of age?
POPULATION: All children born </= 25 weeks of gestation in UK and Ireland between March and December 1995. 241 of 308 eligible children responded; of these 200 had complete reports from teachers and parents. They were compared with reports for 148 age matched control children.
SETTING: UK and Ireland; children born between March and December 1995.
ASSESSMENT: Behavioural problems, including emotional symptoms, conduct problems, hyperactivity, peer problems and prosocial behaviours, were assessed at age 6 years by teacher and parent completed Strengths and Difficulties Questionnaires (SDQ). Clinical pervasive behaviour was defined as behaviour in the clinical range reported by both the parent and teacher. Cognitive ability was assessed using the Kaufman Assessment Battery for Children unless the child had disability or cognitive impairment, in which case the Griffiths Scale of Mental Development or NEPSY neuropsychology assessment was used. Children were also classified into four groups according to overall functional disability, ranging from severe overall disability to none.
OUTCOMES: Pervasive behavioural problems defined as scoring >90th percentile on parent and teacher reports of SDQ.
METHODS DESIGN: Comparative cross sectional study.
MAIN RESULTS: At age 6 years, 19% of extremely pre term children had pervasive behavioural problems compared with 3% of control children (boys 23% vs 5%; girls 16% vs 3%). Extremely preterm children were more likely to have (Table 1 Extremely preterm children versus age matched controls at age 6 years Behavioural problem Boys Girls Total Hyperactivity: 42% vs 11%, 19% vs 7%, 31% vs 9%; Conduct: 16% vs 9%, 9% vs 3%, 13% vs 5%; Attention: 44% vs 11%, 22% vs 4%, 33% vs 7%; Peer: 31% vs 5%, 20% vs 6%, 25% vs 5%; Emotional: 10% vs 0%, 17% vs 7%, 14% vs 4%; Prosocial: 12% vs 0%, 2% vs 0%, 7% vs 0%) problems with pervasive hyperactivity, conduct, attention, poor peer relationships, emotions and prosocial behaviour than control children (see table 1). Hyperactivity and conduct problems, but not emotional peer or attention problems, could be accounted for by cognitive deficits (emotional: adjusted odds ratio (OR) 4.2, 95% CI 1.5 to 11.8; peer: adjusted OR 2.5, 95% CI 1.0 to 6.1; attention: adjusted OR 3.8, 95% CI 1.7 to 8.3). Behavioural problems had a significant impact on home or school life for 23% of early preterm children compared with 7% of control children (OR 4.0, 95% CI 1. to 8.3). Extremely preterm boys were more likely to have hyperactivity (p<0.001), prosocial problems (p<0.01), attention problems (p<0.001) and higher parent/teacher impact scores (p<0.05) than extremely preterm girls.
CONCLUSIONS: Pervasive behavioural problems are common in children aged 6 years who were born at less than 26 weeks of gestation. These problems are more common in preterm boys than preterm girls.
Marlow, N., Hennessy, E. M., Bracewell, M. A., Wolke, D., & EPICure
Study Group (2007). Motor and executive function at 6 years of age
after extremely preterm birth. Pediatrics, 120(4), 793-804.
BACKGROUND: Studies of very preterm infants have demonstrated impairments in multiple neurocognitive domains. We hypothesized that neuromotor and executive-function deficits may independently contribute to school failure.
METHODS: We studied children who were born at < or = 25 completed weeks' gestation in the United Kingdom and Ireland in 1995 at early school age. Children underwent standardized cognitive and neuromotor assessments, including the Kaufman Assessment Battery for Children and NEPSY, and a teacher-based assessment of academic achievement.
RESULTS: Of 308 surviving children, 241 (78%) were assessed at a median age of 6 years 4 months. Compared with 160 term classmates, 180 extremely preterm children without cerebral palsy and attending mainstream school performed less well on 3 simple motor tasks: posting coins, heel walking, and 1-leg standing. They more frequently had non-right-hand preferences (28% vs 10%) and more associated/overflow movements during motor tasks. Standardized scores for visuospatial and sensorimotor function performance differed from classmates by 1.6 and 1.1 SDs of the classmates' scores, respectively. These differences attenuated but remained significant after controlling for overall cognitive scores. Cognitive, visuospatial scores, and motor scores explained 54% of the variance in teachers' ratings of performance in the whole set; in the extremely preterm group, additional variance was explained by attention-executive tasks and gender.
CONCLUSIONS: Impairment of motor, visuospatial, and sensorimotor function, including planning, self-regulation, inhibition, and motor persistence, contributes excess morbidity over cognitive impairment in extremely preterm children and contributes independently to poor classroom performance at 6 years of age.
Allin, M., Matsumoto, H., Santhouse, A. M., Nosarti, C., AlAsady, M. H.,
Stewart, A. L., Rifkin, L., & Murray, R. M. (2001). Cognitive and
motor function and the size of the cerebellum in adolescents born
very pre-term. Brain, 124(1), 60-66.
ABSTRACT: Individuals born before 33 weeks' gestation are at risk of brain lesions, which have the potential to disrupt subsequent neurodevelopment. As a result they manifest an increased incidence of neuromotor signs and cognitive deficits, which can still be detected in adolescence. The cerebellum is known to be involved in both the co-ordination of movement and in cognitive processes. We therefore set out to establish whether cognitive and motor impairments in adolescents born very pre-term are associated with abnormalities of the cerebellum as revealed by volumetric analysis of brain MRI scans. The volume of the whole cerebellum was determined manually using a PC-based Cavalieri procedure in 67 adolescents born very pre-term and 50 age-matched, full-term born controls. Cognitive and neurological assessments were performed at 1, 4, 8 and 14-15 years of age as part of the long-term follow-up of the pre-term subjects. The pre-term-born subjects had significantly reduced cerebellar volume compared with term-born controls (P<0.001). This difference was still present after controlling for potential confounders. There was no association between cerebellar volume and motor neurological signs. However, there were significant associations between cerebellar volume and several cognitive test scores, in particular the Wechsler Intelligence Scale for Children-Revised, the Kaufman Assessment Battery for Children and the Schonnel reading age. This provides further evidence implicating the cerebellum in cognition and suggests that cerebellar abnormalities may underlie some of the cognitive deficits found in individuals born very pre-term.
Full Text: Allin et. al, 2001.pdf
Hogg, J. & Moss, S. (1995). The applicability of the Kaufman Assessment
Battery for Children (K-ABC) with older adults (50 + years) with
moderate, severe and profound intellectual impairment. Journal of
Intellectual Disability Research, 39(3), 167-176.
ABSTRACT: To define the intellectual characteristics of a population of older people ( 50 + years) with severe intellectual impairment who were the focus of a wider demographic study, participants were assessed on the Kaufman Assessment Battery for Children (K-ABC). Test material was modified to make it age-appropriate and culturally suitable. Of the 122 people in the population [chronological age (CA) - 63.5 years; rang 50-90 years), 61 were successfully tested on the K-ABC (ca = 60.9 years; range 51-81 years). Factor analysis closely replicated the factorial structure demonstrated for younger children. Separate Sequential and Simultaneous Mental Processing factors were identified, with subtests from the Achievement Scale loading on these factors and not constituting a separate factor. Application of hierarchical cluster analysis confirmed the factor structures. Inferences in relation to cognitive development from a Piagetian perspective are drawn, and the utility of information on mental processing for educational intervention with older persons with severe intellectual impairment is noted.