Toddlers Using Tablets: They Engage, Play, and Learn.

Although very young children have unprecedented access to touchscreen devices, there is limited research on how successfully they operate these devices for play and learning. For infants and toddlers, whose cognitive, fine motor, and executive functions are immature, several basic questions are significant: (1) Can they operate a tablet purposefully to achieve a goal? (2) Can they acquire operating skills and learn new information from commercially available apps? (3) Do individual differences in executive functioning predict success in using and learning from the apps? Accordingly, 31 2-year-olds (M = 30.82 month, SD = 2.70; 18 female) were compared with 29 3-year-olds (M = 40.92 month, SD = 4.82; 13 female) using two commercially available apps with different task and skill requirements: (1) a shape matching app performed across 3 days, and (2) a storybook app with performance compared to that on a matched paper storybook. Children also completed (3) the Minnesota Executive Functioning Scale. An adult provided minimal scaffolding throughout. The results showed: (1) toddlers could provide simple goal-directed touch gestures and the manual interactions needed to operate the tablet (2) after controlling for prior experience with shape matching, toddlers' increased success and efficiency, made fewer errors, decreased completion times, and required less scaffolding across trials, (3) they recognized more story content from the e-book and were less distracted than from the paper book, (4) executive functioning contributed unique variance to the outcome measures on both apps, and (5) 3-year-olds outperformed 2-year-olds on all measures. The results are discussed in terms of the potential of interactive devices to support toddlers' learning.

A pseudoisochromatic test of color vision for human infants.

Despite the development of experimental methods capable of measuring early human color vision, we still lack a procedure comparable to those used to diagnose the well-identified congenital and acquired color vision anomalies in older children, adults, and clinical patients. In this study, we modified a pseudoisochromatic test to make it more suitable for young infants. Using a forced choice preferential looking procedure, 216 3-to-23-mo-old babies were tested with pseudoisochromatic targets that fell on either a red/green or a blue/yellow dichromatic confusion axis. For comparison, 220 color-normal adults and 22 color-deficient adults were also tested. Results showed that all babies and adults passed the blue/yellow target but many of the younger infants failed the red/green target, likely due to the interaction of the lingering immaturities within the visual system and the small CIE vector distance within the red/green plate. However, older (17-23 mo) infants, color- normal adults and color-defective adults all performed according to expectation. Interestingly, performance on the red/green plate was better among female infants, well exceeding the expected rate of genetic dimorphism between genders. Overall, with some further modification, the test serves as a promising tool for the detection of early color vision anomalies in early human life.

The development of prospective memory in preschool children using naturalistic tasks.

The development of prospective memory (PM) in 3-, 4-, and 5-year-old children (N=123) was assessed in two experiments using several naturalistic game-like tasks that varied in the explicitness of the cues for retrieval that they provided. The goals of the study were to evaluate age differences in PM (a) with the effects of retrospective memory (RM) factored out and (b) as a function of increasing retrieval cue specificity. Results from Experiment 1 showed that there were age differences in PM on a simulated Shopping Trip task that favored older children after age differences attributable to RM were identified in a hierarchical regression. PM and RM components followed the same developmental trajectory. Because the Shopping Trip task provided a visual cue for retrieval, a second naturalistic PM task that was incidental to the Shopping Trip task (i.e., to ask for stickers at the end of the shopping trip) was included but provided no explicit cue other than the end of Shopping Trip task itself. A binary logistic regression showed that age did not predict children who succeeded and those who did not succeed. Because the end of the Shopping Trip task might have cued PM, two new tasks without any explicit cues for retrieval were examined in Experiment 2. Logistic regressions revealed that age predicted PM success on both tasks. With additional cues following failure to retrieve the PM intention, nearly all children succeeded, but the number of cues needed increased with age. The joint and separate contributions of PM and RM to successful task performance are discussed.

Comparison of Patti Pics and Lea Symbols optotypes in children and adults.

PURPOSE: Although a great variety of pediatric tests of visual acuity exist, few have been compared directly within the same patients or have been evaluated directly against an adult gold standard. METHODS: Right eyes from 80 3- to 5-year-old preschoolers were tested at 3 m with the two current pediatric optotype tests-the Patti Pics and the Lea Symbols (Mass VAT versions)-that best adhere to the international standard for early eye and vision screening. For comparison, right eyes from 52 adults were tested under the same conditions with both pediatric tests and with a gold standard Mass VAT Sloan letter test. RESULTS: Compared with the Patti Pics, both children and adults showed relatively better and finer levels of visual acuity with Lea Symbols (0.07-0.11 logMAR better). Compared with Sloan letters, adults' acuity was also 0.09 logMAR better with the Lea Symbols but was virtually identical and also showed good statistical agreement with Patti Pics acuity. CONCLUSIONS: Although both pediatric tests show excellent testability, our data suggest that acuity values obtained with the Patti Pics optotypes are more consistent with those obtained with a gold standard visual acuity test used for older children and adults.

Children with fetal alcohol spectrum disorder show an amblyopia-like pattern of vision deficit.

AIM: The aim of the study was to assess and characterize visual functioning in children with fetal alcohol spectrum disorder (FASD) using a broader and more inclusive range of measures than has been reported previously. METHOD: Standard tests of visual functioning were used to assess 21 children (11 females, 10 males) with FASD and 21 sex- and age-matched comparison children without FASD. The age of the children ranged from 6 years 9 months to 11 years 11 months (mean 9y 6mo). Children were tested individually under standardized conditions for visual acuity, stereoacuity, contrast sensitivity, ocular alignment/motility, color vision, and refractive error. RESULTS: Compared with non-affected children, children with FASD showed deficits in visual acuity, contrast sensitivity, and stereoacuity. Ocular alignment/motility, refractive error, and color vision measures were normal. Among children with FASD, 62% met the criteria for referral to an eye specialist, compared with 20% of children without FASD. INTERPRETATION: Children with FASD showed an amblyopia-like pattern of vision deficit in the absence of the optical and oculomotor disruptions of early experience that usually precede this condition. Evidence from animal models suggests that the deficits in spatial vision may be due to alterations in the functional architecture of the neocortex that occurs following prenatal alcohol exposure.

Background Television and Infants' Allocation of Their Attention During Toy Play.

The effect of background television on 6- and 12-month-olds' attention during 20 min of toy play was examined. During the first or second half of the session, a clip from a variety of commonly available television programs was presented. The duration and frequency of infants' looks to the toys and to the television indicated that regardless of age or program content, background television frequently got, but did not hold the infants' attention. An order effect indicated that infants looked longer at the television when it was available in the second half of the session. Examination of infants' focused attention to the toys showed a reduction in the mean length of focused episodes when the television was on. A follow-up of the infants at 24 months indicated greater resistance to distraction by the television during play. Data from the three ages showed that individual differences in the amount of viewing were moderately stable across age and across home and lab contexts.

Infant attention and visual preferences: converging evidence from behavior, event-related potentials, and cortical source localization.

In this study, we had 3 major goals. The 1st goal was to establish a link between behavioral and event-related potential (ERP) measures of infant attention and recognition memory. To assess the distribution of infant visual preferences throughout ERP testing, we designed a new experimental procedure that embeds a behavioral measure (paired comparison trials) in the modified-oddball ERP procedure. The 2nd goal was to measure infant ERPs during the paired comparison trials. Independent component analysis (ICA) was used to identify and to remove eye-movement components from the electroencephalographic data, thus allowing for the analysis of ERP components during paired comparison trials. The 3rd goal was to localize the cortical sources of infant visual preferences. Equivalent current dipole analysis was performed on the ICA components related to experimental events. Infants who demonstrated novelty preferences in paired comparison trials demonstrated greater amplitude Negative central ERP components across tasks than infants who did not demonstrate novelty preferences. Visual preference also interacted with attention and stimulus type. The cortical sources of infant visual preferences were localized to inferior and superior prefrontal cortex and to the anterior cingulate cortex.

The Neural Bases of Infant Attention.

The development of attention in the infant can be characterized by changes in overall arousal (attentiveness) and by changes in attention's effect on specific cognitive processes (e.g., stimulus orienting, spatial selection, recognition memory). These attention systems can be identified using behavioral and psychophysiological methods. The development of infant attention is thought to be closely related to changes in the neural systems underlying attention control. The recent application of cortical source analysis of event-related potentials (ERP) and structural magnetic resonance imaging (MRI) has led to the identification of some of these the neural systems.

When the television is on: the impact of infant-directed video on 6- and 18-month-olds' attention during toy play and on parent-infant interaction.

The pattern of 6- and 18-month-old infants' and their parents' attention to toys, a commercially available infant-directed video, and each other were examined in a 20 min free-play context as a function of whether the television was on or off. The results indicated that infants at both ages directed significantly more of their attention to the toys than the video when the toys were novel. Attention to the parent was low across the session. Parents directed most of their attention to the infants and the toys and relatively little to the video. They also talked to and played with their infants less when the video was on than when it was off. These results are discussed in terms of Cohen's (1972) model of attention-getting and attention-holding and the implications of this for learning and distractibility.

Prevalence of amblyopia and other vision disorders in young Newfoundland and Labrador children.

BACKGROUND: Currently, there is a lack of adequate data on pediatric eye and vision disorders in Canada, particularly in the province of Newfoundland and Labrador. In the present study, we estimate the prevalence of eye and vision disorders among young children who participated in a vision screening program in the St. John's, Newfoundland, metropolitan region. METHODS: In daycare settings, 946 children (mean age 4.2 years) were screened with the latest tests of optics and functional vision. Those with suspected vision disorders were referred to an optometrist for a complete eye examination. From the results of these examinations, prevalence rates were estimated for several categories of vision disorders. RESULTS: Overall, we estimate that 14.0% of the children possessed significant vision disorders, the most prevalent of which were hyperopia, amblyopia, and strabismus (4.8%, 4.7%, and 4.3%, respectively). Myopia and anisometropia, on the other hand, were relatively rare (1.1% and 1.4%, respectively). In general, prevalence estimates are within the range of existing estimates from other developed nations. INTERPRETATION: Although the prevalence rates reported here must be interpreted cautiously because of methodological limitations, it appears that children in the present study do not possess an abnormally high prevalence of visual dysfunction. Nevertheless, because an estimated 14.0% of children tested had treatable vision disorders, early screening is clearly warranted in Newfoundland and Labrador.

Randot Preschool Stereoacuity Test: normative data and validity.

INTRODUCTION: The Randot Preschool Stereoacuity Test is a widely used three-book test for the assessment of binocular status. Using a prototype, we previously reported high testability in children as young as 3 years, validity data, and some normative data. Here we report extensive normative and validity data for the final version of the test. In addition, we report normative data for a new, fourth book that adds finer disparities. METHODS: The Randot Preschool Stereoacuity Test was administered to 4355 normal children aged 3 to 18 years and 39 adults in multiple settings. In addition, the Randot Preschool Stereoacuity Test along with the new, fourth book that added 30 arcsec and 20 arcsec disparity levels was administered to 1402 normal children aged 3 to 18 years and 33 normal adults. Both the four-book Randot((R)) Preschool Stereoacuity Test and the Randot circles were administered to 242 patients with amblyogenic conditions aged 3 to 18 years. RESULTS: Mean normal stereoacuity improved from 100 arcsec at 3 years of age to 60 arcsec by 5 years and 40 arcsec by 7 years. The lower limit of normal was 400 arcsec at 3 years, 200 arcsec at 4 years, and 60 arcsec at 7 years. Using the new four-book version, further improvement in mean stereoacuity could be appreciated beyond 7 years of age to 30 arcsec in the 11- to 18-year-old and adult groups. Among the 242 patients, Randot Preschool Stereoacuity Test stereoacuity was strongly associated with Randot circle stereoacuity (chi(2) = 261.0, p < 0.001). CONCLUSIONS: Normative data for the Randot Preschool Stereoacuity Test show a monotonic improvement of stereoacuity from age 3 years through the teen years. Patient data support the validity of the Randot Preschool Stereoacuity Test.

Multi-class classification of cancer stages from free-text histology reports using support vector machines.

Multi-class machine learning techniques using support vector machines (SVM) are proposed to classify the TNM stage of lung cancer patients from analysis of their free-text histology reports. Stages obtained automatically can be used for retrospective population-level studies of lung cancer outcomes. While the system could in principle be applied to stage different cancer types, the paper focuses on staging lung cancer due to data availability. Experiments have quantified system performance on a corpus of reports from 710 lung cancer patients using four different SVM architectures for multi-class classification. Results show that a system based on standard binary SVM classifiers organised in a hierarchical architecture show the most promise with overall accuracy results of 0.64 and 0.82 across T and N stages, respectively.

Obesity in a provincial population of Canadian preschool children: differences between 1984 and 1997 birth cohorts.

OBJECTIVE: To determine whether trends of increasing overweight and obesity reported for older children and adults are evident in Canadian preschoolers. METHODS: A sample of 3857 preschool-aged children (51.1% boys) in the Province of Newfoundland and Labrador, born in 1984 and measured in 1987-1989, was selected from government archival records. The sample of 4161 children (50.1% boys), born in 1997 and measured in 2000-2002, was obtained from regional health authority records. Body mass index (BMI) was calculated using heights and weights measured by nurses. Overweight and obesity prevalence was estimated according to the International Obesity Task Force (IOTF) and the Centres for Disease Control (CDC) methods. RESULTS: Combined rates of overweight and obesity were significantly higher in preschoolers born in 1997 (25.6% IOTF and 36.0% CDC) than in 1984 (16.9% IOTF and 25.1% CDC), when levels were already high. There were some differences between sexes and classification systems. CONCLUSION: The relatively rapid rise in overweight and obesity in children as young as 3.5 years, in little more than a decade, underscores the immediate need for monitoring, and implementation of effective interventions. Overweight and obesity in preschool children is not new, but has become increasingly prevalent, and requires population-based strategies.

Infants' attention to patterned stimuli: developmental change from 3 to 12 months of age.

To examine the development of look duration as a function of age and stimulus type, 14- to 52-week-old infants were shown static and dynamic versions of faces, Sesame Street material, and achromatic patterns for 20 s of accumulated looking. Heart rate was recorded during looking and parsed into stimulus orienting, sustained attention, and attention termination phases. Infants' peak look durations indicated that prior to 26 weeks there was a linear decrease with age for all stimuli. Older infants' look durations continued to decline for patterns but increased for Sesame Street and faces. Measures of heart rate change during sustained attention and the proportion of time spent in each phase of attention confirmed infants' greater engagement with the more complex stimuli.

Accuracy of the contrast sensitivity card test for infants: retest variability and prediction of spatial resolution.

PURPOSE: We assessed the retest variability of a new contrast sensitivity (CS) card procedure and its ability to predict spatial resolution. METHODS: Twenty-four 3-month-olds were tested twice with the CS cards and once with the Teller acuity cards (TAC) within a single session. RESULTS: Coefficient of repeatability (COR) analysis revealed that retest variability of the new cards is superior to that of an earlier prototype at low to mid spatial frequencies. Furthermore, retest variability is comparable to that of infant visual evoked potential studies and the Vistech 6500, a chart commonly used to measure CS in adults. Finally, estimates of visual acuity based on the CS cards were consistent with those provided by the TAC (although CS-based estimates were generally lower overall). CONCLUSIONS: Given its reliability and accuracy, the new CS card procedure has good potential as a clinical tool for assessing spatial vision in infants and toddlers.

Long-term visual pathology in children with significant perinatal complications.

Eye research in infants who experience significant perinatal complications has been restricted to evaluation of structural ocular disease and spatial vision, and results show that these aspects of vision are at increased risk for abnormal or delayed development. To expand upon previous work, a battery of 17 vision tests was employed to assess, comprehensively, long-term outcome of functional vision. Seventy-six children (38 males, 38 females), between the corrected ages of 2 years 11 months and 10 years 2 months (mean 6y 6mo) with various significant complications (e.g. very preterm birth, bronchopulmonary dysplasia, intraventricular hemorrhage) were compared to normally developing, age-matched control children (n = 61; mean age 7y 1mo) on measures of visual acuity, contrast sensitivity, stereoacuity, peripheral vision, color vision, astigmatism, and binocular alignment. Results showed that at-risk children had more test results that fell within the suspect or abnormal range. At-risk children also had a slightly higher incidence of ocular disorders (e.g. strabismus) and refractive error. These data imply that children who experienced significant perinatal risk factors are at risk for long-term deficits of functional vision. However, most of these deficits appear to be relatively mild.

Prevalence of overweight and obesity in a provincial population of Canadian preschool children.

BACKGROUND: More and more school-aged children in Canada and elsewhere are becoming overweight or obese. Many countries are now reporting a similar trend among preschool children. However, little information is available on the prevalence of overweight and obesity among preschool children in Canada. In addition, available data are based on reported rather than measured heights and weights. We conducted this study to determine the prevalence of overweight and obesity, using measured heights and weights, in the 1997 cohort of children aged 3-5 years born in Newfoundland and Labrador. METHODS: We calculated the body mass indices (BMIs) using heights and weights measured by public health nurses during the province-wide Preschool Health Check Program conducted between October 2000 and January 2003. Descriptive data on the children's BMIs and prevalence estimates were generated and analyzed by sex and age with the use of the classification system recommended by the International Obesity Task Force. RESULTS: Data were available for 4161 of the 5428 children born in 1997; boys and girls were equally represented (50.1% and 49.9% respectively). Overall, 25.6% of the preschool children in the cohort were overweight or obese. The rates did not differ significantly by sex or age group. INTERPRETATION: These results indicate that a high proportion of children aged 3-5 years in Newfoundland and Labrador are overweight or obese. It appears that prevention measures should begin before the age of 3 years.

A double-masked, randomized control trial of iron supplementation in early infancy in healthy term breast-fed infants.

OBJECTIVES: To test whether iron supplementation affects hematologic, biochemical, and developmental status in term breast-fed infants. STUDY DESIGN: Term breast-fed infants (n=77) were randomly selected to receive either 7.5 mg per day of elemental iron as ferrous sulfate or placebo from 1 to 6 months of age. Investigators and families were unaware of group assignment. Complete blood count and ferritin, red cell superoxide dismutase, catalase, plasma ferric reducing antioxidant power, and zinc and copper levels were analyzed at 1, 3.5, 6, and 12 months of age. Bayley mental and psychomotor developmental indexes (MDI and PDI) and visual acuity (with the use of Teller acuity cards) were assessed from 12 to 18 months of age. Analysis performed by analysis of variance and t tests was by intention to treat. RESULTS: Iron supplementation resulted in higher hemoglobin and mean corpuscular volume at 6 months of age and significantly higher visual acuity and PDI at 13 months of age (100+/-12 vs 93+/-9 [+/-SD]). Treatment and placebo groups did not differ in anthropometric indexes, compliance, biochemical status, or demographic characteristics. CONCLUSIONS: Iron supplementation of breast-fed infants appears safe and might have beneficial hematologic and developmental effects for some infants.