| 1. |
- Aiko, Lundequist, 1973-, et al.
(author)
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The Stockholm Neonatal Project : Cognitive and executive functioning in adolecents born preterm
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Other publication (other academic/artistic)abstract
- Objective: Research has shown that premature birth poses a risk for later cognitive development, particularly in the executive domain, but few studies extend beyond the early school years. Adolescence is a critical period for cognitive maturation, and this study investigated the cognitive outcome in a Swedish cohort of prematurely born 18-year olds, in relation to gestational age at birth and medical risks in the perinatal period.Participants and Methods: As part of Stockholm Neonatal Project, 134 adolescents born preterm with very low birth weight (< 1500g) and 94 matched controls born at term, participated in a follow-up study at age 18. General intelligence, as well as executive, memory, language and visual motor functions were measured by WISC-III, Delis-Kaplan Executive Function System, naming tests, Rey Auditory Verbal Learning test, face recognition, and Visual Motor Integration test.Results: Extremely preterm adolescents (EPT, GA 23-27, n=74) performed worse than adolescents born either very preterm or at term, on all cognitive tasks and particularly on executive measures. 50% of the EPT group had suffered perinatal medical complications, and had more pervasive cognitive deficits than EPTs with low medical risk. By contrast, very preterm adolescents (GA 28-31; n=36) performed consistently on a par with the controls. Moderately preterm with very low birth weight (GA 32-36; n=25), who had experienced varying degrees of intrauterine growth retardation, tended to score lower than very preterm and control adolescents, particularly on complex cognitive measures.Conclusions: Extremely preterm birth per se poses a risk for long-term cognitive outcome, particularly in executive functions. These risks may be exacerbated by medical complications. Children born after 28 weeks of gestation or later, with normal birth weight and no perinatal complications, do not have an elevated risk for cognitive deficits at age 18.
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| 2. |
- Böhm, Birgitta, et al.
(author)
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Visual-motor and executive functions in children born preterm : The Bender Visual Motor Gestalt Test revisited
- 2010
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In: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 51:5, s. 376-384
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Journal article (peer-reviewed)abstract
- Visual-motor development and executive functions were investigated with the Bender Test at age 51/2 years in 175 children born preterm and 125 full-term controls, within the longitudinal Stockholm Neonatal Project. Assessment also included WPPSI-R and NEPSY neuropsychological battery for ages 4-7 (Korkman, 1990). Bender protocols were scored according to Brannigan & Decker (2003), Koppitz (1963) and a complementary neuropsychological scoring system (ABC), aimed at executive functions and developed for this study. Bender results by all three scoring systems were strongly related to overall cognitive level (Performance IQ), in both groups. The preterm group displayed inferior visual-motor skills compared to controls also when controlling for IQ. The largest group differences were found on the ABC scoring, which shared unique variance with NEPSY tests of executive function. Multiple regression analyses showed that hyperactive behavior and inattention increased the risk for visual-motor deficits in children born preterm, whereas no added risk was seen among hyperactive term children. Gender differences favoring girls were strongest within the preterm group, presumably reflecting the specific vulnerability of preterm boys. The results indicate that preterm children develop a different neurobehavioral organization from children born at term, and that the Bender test with a neuropsychological scoring is a useful tool in developmental screening around school start.
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| 3. |
- de Schipper, Elles, et al.
(author)
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A comprehensive scoping review of ability and disability in ADHD using the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY)
- 2015
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In: European Child and Adolescent Psychiatry. - : Springer. - 1018-8827 .- 1435-165X. ; 24:8, s. 859-872
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Research review (peer-reviewed)abstract
- This is the first in a series of four empirical investigations to develop International Classification of Functioning, Disability and Health (ICF) Core Sets for Attention Deficit Hyperactivity Disorder (ADHD). The objective here was to use a comprehensive scoping review approach to identify the concepts of functional ability and disability used in the scientific ADHD literature and link these to the nomenclature of the ICF-CY. Systematic searches were conducted using Medline/PubMed, PsycINFO, ERIC and Cinahl, to extract the relevant concepts of functional ability and disability from the identified outcome studies of ADHD. These concepts were then linked to ICF-CY by two independent researchers using a standardized linking procedure. Data from identified studies were analysed until saturation of ICF-CY categories was reached. Eighty studies were included in the final analysis. Concepts contained in these studies were linked to 128 ICF-CY categories. Of these categories, 68 were considered to be particularly relevant to ADHD (i.e., identified in at least 5 % of the studies). Of these, 32 were related to Activities and participation, 31 were related to Body functions, and five were related to environmental factors. The five most frequently identified categories were school education (53 %), energy and drive functions (50 %), psychomotor functions (50 %), attention functions (49 %), and emotional functions (45 %). The broad variety of ICF-CY categories identified in this study underlines the necessity to consider ability and disability in ADHD across all dimensions of life, for which the ICF-CY provides a valuable and universally applicable framework. These results, in combination with three additional preparatory studies (expert survey, focus groups, clinical study), will provide a scientific basis to define the ICF Core Sets for ADHD for multi-purpose use in basic and applied research, and every day clinical practice.
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| 4. |
- de Schipper, Elles, et al.
(author)
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Ability and Disability in Autism Spectrum Disorder : A Systematic Literature Review Employing the International Classification of Functioning, Disability and Health-Children and Youth Version.
- 2015
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In: Autism Research. - : Wiley. - 1939-3792 .- 1939-3806. ; 8:6, s. 782-94
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Journal article (peer-reviewed)abstract
- OBJECTIVE: This study is the first in a series of four empirical investigations to develop International Classification of Functioning, Disability and Health (ICF) Core Sets for Autism Spectrum Disorder (ASD). The objective was to use a systematic review approach to identify, number, and link functional ability and disability concepts used in the scientific ASD literature to the nomenclature of the ICF-CY (Children and Youth version of the ICF, covering the life span).METHODS: Systematic searches on outcome studies of ASD were carried out in Medline/PubMed, PsycINFO, ERIC and Cinahl, and relevant functional ability and disability concepts extracted from the included studies. These concepts were then linked to the ICF-CY by two independent researchers using a standardized linking procedure. New concepts were extracted from the studies until saturation of identified ICF-CY categories was reached.RESULTS: Seventy-one studies were included in the final analysis and 2475 meaningful concepts contained in these studies were linked to 146 ICF-CY categories. Of these, 99 categories were considered most relevant to ASD (i.e., identified in at least 5% of the studies), of which 63 were related to Activities and Participation, 28 were related to Body functions, and 8 were related to Environmental factors. The five most frequently identified categories were basic interpersonal interactions (51%), emotional functions (49%), complex interpersonal interactions (48%), attention functions (44%), and mental functions of language (44%).CONCLUSION: The broad variety of ICF-CY categories identified in this study reflects the heterogeneity of functional differences found in ASD--both with respect to disability and exceptionality--and underlines the potential value of the ICF-CY as a framework to capture an individual's functioning in all dimensions of life. The current results in combination with three additional preparatory studies (expert survey, focus groups, and clinical study) will provide the scientific basis for defining the ICF Core Sets for ASD for multipurpose use in basic and applied research and every day clinical practice of ASD.
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| 5. |
- Lundequist, Aiko, 1973-, et al.
(author)
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Cognitive outcome varies in adolescents born preterm, depending on gestational age, intrauterine growth and neonatal complications
- 2015
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 104:3, s. 292-299
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Journal article (peer-reviewed)abstract
- Aim: The aim of this study was to investigate long-term cognitive outcome in a cohort of 18-year-olds born preterm and previously assessed at the age of 5.5.Methods: We tested 134 adolescents born preterm with a very low birthweight of <1500g and 94 term-born controls with a comprehensive cognitive battery at 18years of age. The cohort was subdivided into 73 extremely preterm, 42 very preterm and 19 moderately preterm infants with gestational ages of 23-27, 28-31 and 32-36weeks, respectively. The moderately preterm group was dominated by adolescents born small for gestational age.Results:Very preterm adolescents performed on a par with term-born controls. In contrast, extremely preterm adolescents displayed inferior results on all cognitive tests, more so if they had suffered neonatal complications. Moderately preterm adolescents scored lower than very preterm and full-term born adolescents, particularly on complex cognitive tasks.Conclusion: Adolescents born at 28weeks of gestation or later, with appropriate birthweight and no perinatal complications, functioned like term-born peers at 18years of age. Extremely preterm birth per se posed a risk for long-term cognitive deficits, particularly executive deficits. Adolescents born moderately preterm but small for gestational age were at risk of general cognitive deficits.
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| 6. |
- Lundequist, Aiko, et al.
(author)
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Executive dysfunction in young adults born preterm : Neuropsychological test results and structural brain correlates
- 2010
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In: Journal of the International Neuropsychological Society, 16. - Cambridge, UK : Cambridge University Press. ; , s. 71-71
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Conference paper (peer-reviewed)abstract
- Preterm children appear to develop a different neurobehavioral organization from children born at term, and executive function (EF) has repeatedly been cited as an area of specific weakness. Likewise, neuroimaging studies have shown that the majority of very preterm infants display structural abnormalities, including white matter injury and volumetric differences (Nagy et al., 2003, 2009). Based on the analysis of the effects of lesion in adults, Stuss & Alexander (2007) have proposed a theoretical model, relating discrete categories of EF to regions within the frontal lobes. These EF categories and their coarse frontal localizations are: Executive cognition – dorsolateral prefrontal cortex (DLPFC), Behavioral / emotional self regulation – Ventral prefrontal cortex (VPFC) and Energization- superior medial frontal gyrus. The aim of this study was to identify preterm young adults’ strengths and weakness in terms of EF categories, and investigate their brain structural correlates. Preterm children appear to develop a different neurobehavioral organization from children born at term, and executive function (EF) has repeatedly been cited as an area of specific weakness. Likewise, neuroimaging studies have shown that the majority of very preterm infants display structural abnormalities, including white matter injury and volumetric differences (Nagy et al., 2003, 2009). Based on the analysis of the effects of lesion in adults, Stuss & Alexander (2007) have proposed a theoretical model, relating discrete categories of EF to regions within the frontal lobes. These EF categories and their coarse frontal localizations are: Executive cognition – dorsolateral prefrontal cortex (DLPFC), Behavioral / emotional self regulation – Ventral prefrontal cortex (VPFC) and Energization- superior medial frontal gyrus. The aim of this study was to identify preterm young adults’ strengths and weakness in terms of EF categories, and investigate their brain structural correlates. As a part of the longitudinal Stockholm Neonatal Project, 62 preterm and 38 term children were administered the Delis-Kaplan Executive Function System (D-KEFS) and behavioral self-reports (YSR and SDQ) as indices of EF at age 18. To investigate structural brain correlates, T1 and T2 weighted and diffusion weighted magnetic resonance images have been collected using a 1.5 T scanner. Results showed that preterm children had deficits primarily in Executive cognition and Energization, and less so in Behavioral self-regulation, with the extremely preterm children, born GA 23-28, having the most marked deficits also when controlling for overall cognitive level. Structural brain correlates are presently analyzed and preliminary findings are presented. Conclusion: A theory-based and interdisciplinary approach promotes our understanding of executive dysfunction in preterm children.
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| 7. |
- Lundequist, Aiko, et al.
(author)
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Executive function development in adolescents born very and extremely preterm
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Journal article (peer-reviewed)abstract
- Executive function deficits are often reported as being a specific weakness in preterm born children. Yet, stability in function and development over time is largely unknown. In a prospective longitudinal study, 115 participants born very or extremely preterm, ≤ 31 weeks of gestation, participated in neuropsychological assessments at ages 5½ years and 18 years. Executive functions were separated into working memory and cognitive flexibility. Gestational age at birth, intrauterine growth, sex, perinatal medical complications, and parental education were tested as predictors, and developmental stability was investigated using Structural Equation Modeling. Working memory and cognitive flexibility were highly stable from preschool age to late adolescence. Higher parental education, higher gestational age, and female sex were related to better outcome at 5½ years which in turn fully mediated outcome at age 18 years. Perinatal medical complications and restricted intrauterine growth negatively influenced cognitive flexibility in late adolescence. The study poses an argument for identification of executive deficits before school entry among children born preterm, as such deficits are unlikely to diminish as a consequence of maturation.
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| 8. |
- Lundequist, Aiko, 1973-, et al.
(author)
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Individual neuropsychological profiles at age 5 1/2 years in children born preterm in relation to medical risk factors
- 2013
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In: Child Neuropsychology. - : Informa UK Limited. - 0929-7049 .- 1744-4136. ; 19:3, s. 313-331
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Journal article (peer-reviewed)abstract
- Follow-up studies of preterm children have reported a range of cognitive deficits, particularly in executive functions, visuospatial abilities, and learning. However, few researchers have adopted a person-oriented approach, exploring individual neuropsychological profiles. The aim of this study was to identify typical neuropsychological profiles among preterm children and control children, respectively. A second aim was to investigate if neuropsychological profiles at age 51/2 might be associated with perinatal medical risk factors. As part of the longitudinal Stockholm Neonatal Project, NEPSY for 4- to 7-year-old children (Korkman, 1990), WPPSI-R, and Movement ABC were administered at age 51/2 years to 145 preterm (mean gestational age 28 weeks) and 117 control children born at term. For the present study, the NEPSY results of each child were transformed into summary z scores for each of 5 neuropsychological domains: attention, memory, sensory-motor, verbal, and visuospatial functions. Subsequently, Ward's cluster analysis was performed for the preterm and control groups separately, identifying 5 neuropsychological profiles in both groups explaining around 56% and 57% of the variance, respectively. Overall, preterm children had lower neuropsychological results but also more diverging profiles compared to controls. The variability in outcome could not be sufficiently explained by birth weight, gestational age, or medical risks. The results suggest that prematurity interacts dynamically with genetic, medical, and environmental factors in neuropsychological development.
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| 9. |
- Lundequist, Aiko, 1973-
(author)
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Longitudinal studies of executive and cognitive development after preterm birth
- 2012
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Doctoral thesis (other academic/artistic)abstract
- Stockholm Neonatal Project is a longitudinal population-based study of children born prematurely in 1988-93, with a very low birth weight (<1500 g), who have been followed prospectively from birth through adolescence. A matched control group was recruited at age 5 ½ years. The overall aim was to investigate long-term developmental outcome, paying particular attention to executive functions (EF) in relation to degree of prematurity, birth weight and medical risks. Study I showed a disadvantage in visuo-motor development at 5 ½ years, especially among the preterm boys. Visuo-motor skills were highly related to IQ, and also to EF. In Study II, neuropsychological profiles typical of preterm children and term born children, respectively, were identified through cluster analysis. The general level of performance corresponded well with IQ, motor functions and parental education in both groups, but preterm children had overall lower results and exhibited greater variability across domains. Study III showed that extremely preterm birth (w. 23-27) per se poses a risk for cognitive outcome at age 18, particularly for EF, and that perinatal medical complications add to the risk. By contrast, adolescents born very preterm (w. 28-31) performed just as well as term-born controls in all cognitive domains. However, adolescents born moderately preterm (w. 32-36) and small for gestational age showed general cognitive deficits. Study IV found that cognitive development was stable over time, with parental education and EF at 5 ½ years as significant predictors for cognitive outcome at age 18. Among preterm children, perinatal medical risks and being small for gestational age had a continued negative impact on cognitive development from 5 ½ to 18 years. Study V demonstrated that neuropsychological scoring of Bender drawings, developed in study I, predicted cognitive outcome in adolescence, indicating that the method may be useful in developmental screening around school entry.
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| 10. |
- Lundequist, Aiko, et al.
(author)
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Neuropsychological profiles in 5 1/2 year old children born preterm : Medical risk and long-term outcome
- 2009
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In: Abstracts Presented at the International Neuropsychological Society, Finnish Neuropsychological Society Joint Mid-Year Meeting July 29-August 1, 2009 Helsinki, Finland & Tallinn, Estonia. ; , s. 104-104
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Conference paper (other academic/artistic)abstract
- OBJECTIVE: Follow-up studies of preterm children have reported a range of cognitive deficits, particularly in visuo-spatial abilities, executive functions and learning. However, few researchers have adopted a person-oriented approach, exploring individual neuropsychological profiles. The aim of this study was to identify typical neuropsychological profiles among preterm children and control children, respectively. A second aim was to investigate if neuropsychological profile at age 5 1/2 might be related to perinatal medical risk factors, as well as later cognitive outcome. PARTICIPANTS AND METHODS: As part of the longitudinal Stockholm Neonatal Project, NEPSY for 4-7 year old children (Korkman 1990) was administered to 175 preterm and 125 control children at age 5 1/2 years. For the present study, the NEPSY-results of each child were transformed into summary z-scores for each of the five neuropsychological domains. Subsequently, Ward’s cluster analysis was performed for the preterm and control groups separately. RESULTS: Five neuropsychological profiles were identified in both groups, explaining around 60% of the variance among preterms and controls respectively. Overall, preterm children had lower results in all neuropsychological domains, but also more diverging profiles compared to controls. Subgroups with more diverging profiles tended to have experienced more medical risks, but this was not statistically significant and appeared to reflect cumulative risk more than specific mechanisms. CONCLUSIONS: The results suggest that prematurity in itself, in interaction with genetic and environmental factors, may affect preterm children’s neuropsychological development. In addition to these findings, preliminary results on the relation between early neuropsychological profiles and cognitive outcome at age 18 (WISC-III) will be presented.
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