Perceptions of Parent Stressors in the Neonatal Intensive Care Unit Among the General Public and Healthcare Professionals.

OBJECTIVES: Intervention efforts to improve the psychosocial well-being of parents with an infant in the neonatal intensive care unit (NICU) are high priority. This study assessed public and healthcare professionals' perceptions of prominent NICU stressors to highlight areas where NICU parents are in need of further support. Relations with sample characteristics were also examined to establish the generalizability of known parent demographic/sociofamilial risk factors. METHODS: A cross-sectional design was used to assess public (n = 96) and staff (n = 55) responses on the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU). RESULTS: The public perceived parental stress as being low to moderate. This was significantly lower than the staff estimate and highly comparable with past parent reports. Staff communication was perceived as most stressful by the public with this influenced by gender and education. Staff with more NICU experience were more likely to overestimate parental stress, particularly those working at the highest care level. CONCLUSIONS: Collectively, these findings highlight preconceived anxiety around staff communication and behaviors and indicate that education on the potential for traumatic unit experiences to influence staff-parent communication may be important.

Separable effects of the approximate number system, symbolic number knowledge, and number ordering ability on early arithmetic development.

There is evidence that early variations in the development of an approximate number system (ANS) and symbolic number understanding are both influences on the later development of formal arithmetic skills. We report a large-scale (N = 552) longitudinal study of the predictors of arithmetic spanning a critical developmental period (the first 3 years of formal education). Variations in early knowledge of symbolic representations of number and the ordinal associations between them are direct predictors of later arithmetic skills. The development of number ordering ability is in turn predicted by earlier variations in arithmetic, the ANS (numerosity judgments), and rapid automatized naming (RAN). These findings have important implications for theories of numerical and arithmetical development and potentially for the teaching of these skills.

The Production Effect Improves Memory in 7- to 10-Year-Old Children.

The production effect-whereby reading words aloud improves memory for those words relative to reading them silently-was investigated in two experiments with 7- to 10-year-old children residing in Brisbane, Australia. Experiment 1 (n = 41) involved familiar printed words, with words read aloud or silently appearing either in mixed- or blocked-list formats in a within-subject design. Recognition for words read aloud was better than for those read silently, an effect consistent across both list formats. These results were confirmed in Experiment 2 (n = 40) using longer lists of printed novel nonwords. Final analyses indicated that the production effect was comparable for words and nonwords. Findings are discussed in relation to the distinctiveness account and the use of production as a mnemonic in children.

Health and Neurodevelopment of Children Born to Opioid-Dependent Mothers at School Entry.

OBJECTIVE: To examine the school readiness of a regional cohort of prenatally methadone-exposed children across 5 domains and to examine factors contributing to impairment risk. METHODS: Data were drawn from a single-center, prospective longitudinal study. One hundred children born to women in methadone maintenance treatment and 110 randomly identified non-methadone-exposed children were studied from birth (2003-2008) to age 4.5 years. At 4.5 years, children underwent comprehensive assessment of their physical/motor development, social-emotional skills, approaches to learning, language development, and cognitive functioning. Predictors of children's overall school readiness were examined, including the extent of prenatal substance exposure (number and quantity of different substances), social risk, maternal mental health, infant clinical factors, and the quality of the home environment at age 18 months Home Observation for Measurement of the Environment (HOME) score. RESULTS: Methadone-exposed children had higher rates of delay/impairment across all outcome domains (odds ratios 4.0-5.3), with 72% impaired in at least 1 domain. Multiple problems were also common, affecting 48% of methadone-exposed children compared with 15% of control children. The mean number of school readiness domains impaired increased, with increasing prenatal substance exposure (rate ratio [RR] = 1.05 [1.01-1.11]), higher social risk (RR = 1.35 [1.20-1.53]), male sex (RR = 1.69 [1.27-2.25]), and lower HOME scores indicating a poorer quality postnatal environment (RR = 0.96 [0.94-0.99]). CONCLUSION: Children born to opioid-dependent mothers are at high risk of impaired school readiness, with multiple domain problems being common. Impaired school readiness was associated with greater maternal prenatal substance use, higher social risk, male sex, and lower-quality caregiving environments.

Data on numerosity discrimination, inhibition and arithmetic during the early school years.

Participants consisted of 496 children (mean age = 6 years; 9 months) recruited from 11 schools in Brisbane, Australia. Children were assessed on the addition and subtraction subtests of the Test of Basic Arithmetic and Number Skills (TOBANS), an adapted version of the Head-Toes-Knees-Shoulders task to measure inhibition, numerosity discrimination using eight subtests varying ratio (2:3 or 5:6) and congruency, and non-verbal cognitive ability using an adapted version of Raven's Coloured Progressive Matrices. Information on children's demographics (gender, English as an additional language, and learning difficulty status) is also provided. All assessments were administered during the second year of formal schooling (i.e. Grade 1). Findings regarding the impact of inhibition on the relation between numerosity discrimination and arithmetic are reported elsewhere [1].

Stage 2 Registered Report: There is no appreciable relationship between strength of hand preference and language ability in 6- to 7-year-old children.

Background: Weak or inconsistent hand preference has been postulated to be a risk factor for developmental language delay. Following on from our Registered Stage 1 report this study assessed the extent to which variations in language skills are associated with the strength of hand preference. Methods: Data are drawn from a large sample ( N = 569) of 6- to 7-year-old children unselected for ability, assessed at two time points, 6 months apart. Hand preference was assessed using the Quantitative Hand Preference (QHP) task and five uni-manual motor tasks. Language skills (expressive and receptive vocabulary, receptive grammar, and morphological awareness) were assessed with standardized measures. Results: We found QHP scores did not distinguish children with weaker language skills from those with stronger language skills and the correlation between QHP scores and language ability was negligible in this study. Hand preference on the QHP task was significantly stronger among right-handed than left-handed children and left-handed children were typically inconsistent in the hand used across different tasks.  Conclusions: The findings presented here fail to provide any support for the theory that weak cerebral lateralisation (as assessed here by the QHP task) places children at risk of language difficulties . Stage 1 report:  https://doi.org/10.12688/wellcomeopenres.15077.1.

The relationship between numerosity discrimination and arithmetic skill reflects the approximate number system and cannot be explained by inhibitory control.

Numerosity discrimination tasks (judging which of two random dotarrays contains the larger number) have been widely used as a measure of the efficiency of an approximate number system (ANS) and are a correlate of early arithmetic skills. Recently, it has been suggested that the relationship between numerosity discrimination and arithmeticis explained by inhibition rather than the ANS. We assessed this hypothesis in astudy of 496 children (mean age = 81.23 months) using numerosity discrimination tasks that manipulated the congruency between surface area and numerosity. Numerosity discrimination for incongruent arrays (which are postulated to require inhibition due to a conflict between judgments based on surface area rather than numerosity) was more difficult than that for congruent arrays. However, all numerosity discrimination tasks showed substantial correlations with each other and correlated with arithmetic. A latent variable path model showed that a general numerosity judgment factorcorrelated witharithmetic even after controlling for a measure of response inhibition. In contrast, numerosity discrimination for incongruent arrays showed no unique relationship with arithmetic ability. Our results do not support the view that the relationship between numerosity discrimination and arithmetic is largely attributable to inhibition; rather, theyare consistent withthe view that numerosity discrimination tasks tap the operation of an ANS.

Stage 1 Registered Report: The relationship between handedness and language ability in children.

Weak or inconsistent hand preference may be a risk factor for developmental language delay.  This study will test the extent to which variations in language skills are associated with the strength of hand preference. Data are drawn from a large sample (n = 569) of 6- to 7-year-old children unselected for ability, assessed at two time points, 6 months apart. Hand preference is assessed using the Quantitative Hand Preference task (QHP) and five uni-manual motor tasks. Language skills (expressive and receptive vocabulary, receptive grammar, and morphological awareness) are assessed with standardized measures. If weak cerebral lateralisation (as assessed by the QHP task) is a risk factor for language difficulties, it should be possible to detect such effects in the large representative sample of children examined here.

A comparison of parent and staff perceptions of setting-specific and everyday stressors encountered by parents with very preterm infants experiencing neonatal intensive care.

BACKGROUND: Stress responses among parents of premature infants experiencing the neonatal intensive care unit (NICU) environment are widely reported. However, less is known about how nurses perceive parents' experiences or how stressors relating to demands on family finances and practical challenges associated with infant hospitalization contribute to parental stress levels in the NICU. OBJECTIVE: 1) To compare parent and staff perceptions of the stressors facing parents experiencing neonatal intensive care; and 2) to develop a scale suitable for identifying stressors outside the NICU setting. METHODS: At infant 34 weeks, parents (n=21) of very preterm infants (≤ 32 weeks GA) and NICU nurses (n=23) completed the Parental Stressor Scale: NICU (PSS: NICU) and a custom-made External Stressor Scale (ESS: NICU). RESULTS: Nurses perceived parents to experience higher stress in the NICU than parents themselves (ps<0.00001), with parents reporting low-to-moderate stress and staff rating parental stress as moderate-to-high. Parents reported slightly lower levels of stress on the ESS: NICU, with nurses again overestimating the level of parental stress (ps<0.00001). Consideration of the extent of nurses' medical experience did not alter results. The ESS: NICU showed good internal reliability, with PCAs revealing all items to load onto a single component. Additional analyses demonstrated divergent validity, with no relation evident with stress responses on the PSS: NICU. CONCLUSIONS: Periodic reassessments of staff and parent perceptions should be encouraged along with research dedicated to a fuller understanding of the range of stressors facing parents experiencing neonatal intensive care in attempts to reduce stress levels and aid integration into the unit.

Identifying very preterm children at educational risk using a school readiness framework.

OBJECTIVES: Children born very preterm (VPT) are at high risk of educational delay, yet few guidelines exist for the early identification of those at greatest risk. Using a school readiness framework, this study examined relations between preschool neurodevelopmental functioning and educational outcomes to age 9 years. METHODS: The sample consisted of a regional cohort of 110 VPT (≤ 32 weeks' gestation) and 113 full-term children born during 1998-2000. At corrected age 4 years, children completed a multidisciplinary assessment of their health/motor development, socioemotional adjustment, core learning skills, language, and general cognition. At ages 6 and 9, children's literacy and numeracy skills were assessed using the Woodcock-Johnson III Tests of Achievement. RESULTS: Across all readiness domains, VPT children were at high risk of delay/impairment (odds ratios 2.5-3.5). Multiple problems were also more common (47% vs 16%). At follow-up, almost two-thirds of VPT children were subject to significant educational delay in either literacy, numeracy or both compared with 29% to 31% of full-term children (odds ratios 3.4-4.4). The number of readiness domains affected at age 4 strongly predicted later educational risk, especially when multiple problems were present. Receiver operating characteristic analysis confirmed ≥ 2 readiness problems as the optimal threshold for identifying VPT children at educational risk. CONCLUSIONS: School readiness offers a promising framework for the early identification of VPT children at high educational risk. Findings support the utility of ≥ 2 affected readiness domains as an effective criterion for referral for educational surveillance and/or additional support during the transition to school.

Neonatal cerebral morphometry and later risk of persistent inattention/hyperactivity in children born very preterm.

BACKGROUND: Attention problems are among the most prevalent neurobehavioral morbidities affecting very preterm (VPT) born children. The first study aim was to document rates of persistent attention/hyperactivity problems from ages 4 to 9 years in a regional cohort of VPT born children. The second aim was to examine the extent to which persistent problems were related to cerebral white matter abnormality and structural development on neonatal MRI. METHODS: Data were drawn from a prospective longitudinal study of 110 VPT (≤32 weeks gestation) and 113 full-term (FT) children born from 1998 to 2000. At term equivalent, all VPT and 10 FT children underwent cerebral structural MRI, with scans analyzed qualitatively for white matter abnormalities and quantitatively for cortical and subcortical gray matter, myelinated and unmyelinated white matter, and cerebrospinal fluid volumes. At ages 4, 6, and 9 years, each child's parent and teacher completed the Inattention/Hyperactivity subscale of the Strengths and Difficulties Questionnaire. RESULTS: VPT born children had a fivefold increased risk of persistent attention/hyperactivity problems compared with FT children (13.1% vs. 2.8%; p = .002). No association was found between neonatal white matter abnormalities and later persistent inattention/hyperactivity risk (p ≥ .24). In contrast, measures of cerebral structural development including volumetric estimates of total cerebral tissue and cerebrospinal fluid relative to intracranial volume were associated with an increased risk of persistent attention/hyperactivity problems in VPT born children (p = .001). The dorsal prefrontal region showed the largest volumetric reduction (↓3.2-8.2 mL). These brain-behavior associations persisted and in some cases, strengthened after covariate adjustment for postmenstrual age at MRI, gender, and family socioeconomic status. CONCLUSIONS: Just over one in 10 VPT born children are subject to early onset and persistent attention/hyperactivity problems during childhood. These problems appear to reflect, at least in part, neonatal disturbances in cerebral growth and development rather than the effects of white matter injury.

Emotional and behavioural adjustment of children born very preterm at early school age.

AIMS: This paper describes the emotional and behavioural adjustment of children born very preterm (VPT) at early school age. Of particular interest was the degree of agreement between parents and teachers, and the extent of situational (parent or teacher) and pervasive (parent and teacher reported) adjustment problems. METHODS: A regionally representative cohort of 104 VPT (≤33 weeks gestation) and 108 full-term (FT) children born during 1998-2000 was studied prospectively to age six. At corrected age six, child emotional and behavioural adjustment was assessed using the parent and teacher rated strengths and difficulties questionnaires. RESULTS: According to parents, 6-year-old VPT children had odds of emotional, inattention/hyperactivity and peer problems that were 2.7 to 3.8 times higher than their FT peers. Similar difficulties were identified by teachers, but odds were much lower and nonsignificant (1.1-1.8). Agreement between parents and teachers was lower in the VPT than the FT group (mean alternative chance-correlated coefficient , AC(1) = 0.63 vs. 0.80). Examination of the extent of pervasively identified adjustment problems showed that VPT children had higher rates of emotional (6% vs. 1%) and inattention/hyperactivity problems (12% vs. 6%) than FT children. CONCLUSIONS: Early school age, VPT children are at increased risk of pervasive emotional problems and inattention/hyperactivity, although these risks are relatively modest. The use of multiple informants to assess VPT children's well-being is important to minimise the effects of report source bias and the over-identification of adjustment problems in children born VPT.

Preschool executive control on the Shape School task: measurement considerations and utility.

Executive functions (EF) necessary for purposeful goal-directed activities undergo rapid change and development during the preschool years. However, of the few psychometrically valid measures of EF suitable for use with preschoolers, information on task sensitivity and predictive validity is scant. The neurodevelopmental correlates of early executive difficulties are also largely unknown. In this study, the discriminant and predictive validity of the recently developed Shape School task (Espy, Bull, Martin, & Stroup, 2006) was examined with data from a regional sample of 209 preschool children at age 4 years. A 2-tiered measurement approach was used, with task completion examined in addition to efficiency. Children's performance was also examined in relation to functioning in a range of neurodevelopmental domains. The Shape School task showed some usefulness in capturing expected differences between at-risk and typically developing children. Performance loaded heavily on language and global cognitive abilities. However, several other factors were also implicated, including attention, motor skills, and ocular control. In addition, task completion and efficiency scores appeared to reflect different aspects of performance, and their associations with neurodevelopmental function and later academic achievement on the Woodcock-Johnson Tests of Achievement at age 6 years also differed. Implications for the application of the Shape School task are discussed.

Neonatal white matter abnormalities predict global executive function impairment in children born very preterm.

Using prospective longitudinal data from 110 very preterm and 113 full term children, this article describes the executive functioning abilities of very preterm children at age 4, and examines relations between the extent of white matter abnormality on neonatal magnetic resonance imaging (MRI) and later executive function outcomes. Very preterm children performed less well than full term children on measures of planning ability, cognitive flexibility, selective attention, and inhibitory control. Executive impairments at age 4 were confined to preterm children with mild or moderate-severe white matter abnormalities on MRI. Findings support the importance of cerebral white matter integrity for later executive function.

Classic Stroop Negative Priming effects for children and adults diverge with less-conflicting and nonconflicting conditions.

Negative priming indexes an inhibition process that aids target selection by reducing distractor interference. To date, children have produced negative priming only in tasks where distractor response tendencies are consistently greater than or equal to targets and not in tasks containing a substantial proportion of low-conflict distractors. To establish the exact parameters under which children's negative priming attenuates relative to adults, we varied processing demands across 2 experiments involving children and adults. Negative priming was comparable when 100% high-conflict conditions were encountered (Experiment 1) and was intact in adults but not children when a ratio of 50:50 high- to low-conflict conditions was encountered (Experiment 2). Compared with adults, children seem induced to divide attention more generally when low-conflict attentional conditions are included, attenuating negative priming.

Preschool executive functioning abilities predict early mathematics achievement.

Impairments in executive function have been documented in school-age children with mathematical learning difficulties. However, the utility and specificity of preschool executive function abilities in predicting later mathematical achievement are poorly understood. This study examined linkages between children's developing executive function abilities at age 4 and children's subsequent achievement in mathematics at age 6, 1 year after school entry. The study sample consisted of a regionally representative cohort of 104 children followed prospectively from ages 2 to 6 years. At age 4, children completed a battery of executive function tasks that assessed planning, set shifting, and inhibitory control. Teachers completed the preschool version of the Behavior Rating Inventory of Executive Function. Clinical and classroom measures of children's mathematical achievement were collected at age 6. Results showed that children's performance on set shifting, inhibitory control, and general executive behavior measures during the preschool period accounted for substantial variability in children's early mathematical achievement at school. These associations persisted even after individual differences in general cognitive ability and reading achievement were taken into account. Findings suggest that early measures of executive function may be useful in identifying children who may experience difficulties learning mathematical skills and concepts. They also suggest that the scaffolding of these executive skills could potentially be a useful additional component in early mathematics education.

Avoiding the potential pitfalls of using negative priming tasks in developmental studies: assessing inhibitory control in children, adolescents, and adults.

Despite being ignored, visual distractors often produce traceable negative priming (NP) effects that can be used to investigate inhibitory processes. Robust NP effects are typically found with young adults, but not with children. Using 2 different NP tasks, the authors compared NP in 5 different age groups spanning 5 to 25 years of age. The 1st task revealed comparable NP between all age groups, but a linear decrease in NP through childhood to early adulthood. In the 2nd task, NP decreased linearly into adulthood, with children actually showing larger NP than adults. This Age Group ? NP interaction was eliminated, however, when reaction time data were log transformed to control for age differences in overall processing speed. When appropriately transformed data were used, both experiments showed that NP was intact and comparable between children, adolescents, and adults, and suggested that an inhibitory process is fully developed by early childhood. The results highlight how potential pitfalls might be avoided when comparing NP in children and adults.

Early school-based learning difficulties in children born very preterm.

BACKGROUND: Educational underachievement is a major morbidity associated with very preterm (VPT) birth. However, few studies have examined early school outcomes with most employing global, clinic based measures. OBJECTIVE: To examine the early school achievement in a cohort of children born VPT and studied to age 6 years. METHODS: A regional cohort of 102 VPT children (

Selective attention and inhibitory deficits in ADHD: does subtype or comorbidity modulate negative priming effects?

Selective attention has durable consequences for behavior and neural activation. Negative priming (NP) effects are assumed to reflect a critical inhibitory component of selective attention. The performance of adolescents with Attention Deficit/Hyperactivity Disorder (ADHD) was assessed across two conceptually based NP tasks within a selective attention procedure. Comorbidity (non-comorbid ADHD vs. comorbid ADHD) and subtype (ADHD combined vs. ADHD inattentive) were considered key issues. Results found NP effects to differ as a function of comorbidity but not subtype. Findings are discussed in light of functional neuroimaging evidence for neuronal enhancement for unattended stimuli relative to attended stimuli that strongly complements an inhibitory-based explanation for NP. Implications for the 'AD' in ADHD and contemporary process models of the disorder are considered.

Interference and negative priming effects in adolescents with attention deficit hyperactivity disorder.

Three visual selective attention tasks were used to measure potential differences in susceptibility to interference and inhibitory cognitive control processes in 16 adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) and 45 similar-aged controls. Susceptibility to interference was assessed using the Stroop color and word naming test. Efficiency of distractor inhibition was assessed in two conceptual negative priming tasks. The majority of studies in this area indicate that people with ADHD demonstrate higher levels of interference and lower negative priming effects in comparison with age-matched peers. However, we found that although the ADHD group was consistently slower to name target stimuli than the control group, there were no differences in interference or negative priming between the two groups.