Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation.
Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation.
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妊娠不到26周的青春期儿童的执行功能和学习技能。
DOI：
10.1371/journal.pone.0151819
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Hägglöf B
中科院分区：
文献类型：
--
作者：
Farooqi A;Adamsson M;Serenius F;Hägglöf B
与 10 至 15 岁足月对照儿童相比，评估极早产儿 (EPT) 的执行功能 (EF) 和学习技能的认知和行为方面。对 1992 年至 1998 年间在瑞典两个地区三级护理中心出生的 134 名 EPT 儿童（占所有合格幸存者的 98%）中的 132 名（平均年龄 = 12 岁，平均出生体重 = 718 克，平均胎龄 = 24.4 周）和 103 名匹配的足月对照进行了评估。使用韦克斯勒儿童智力量表 (WISC-III-R) 评估一般智力，并使用 WISC-III-R 的 EF 敏感子量表和 Delis-Kaplan 执行功能量表 (D-KEFS) 的塔测试来分析 EF 的认知方面。使用“五到十五”问卷评估与 EF 和学习技能相关的行为，该问卷是经过验证的家长和教师工具。学校的学业成绩是根据教师在阿亨巴赫教师报告表上的回答来评估的。进行的分析包括协方差的多变量分析（ANCOVA 和 MANCOVA）和逻辑回归分析。与对照组相比，EPT 儿童在 EF 认知方面表现出显着缺陷，在言语概念推理、言语和非言语工作记忆、处理速度和计划能力等任务中表现出约 0.9 SD 至 1.2 SD 的下降（全部 P <0.001）。排除患有严重神经感觉障碍 (NSI) 或满量表智商 (FSIQ) < 70 的儿童后，所有测试均观察到显着差异。与对照组相比，EPT 儿童的家长和老师报告了更多与 EF 相关的行为问题。对 FSIQ >70 且无严重 NSI 的儿童的教师报告的学习技能进行 MANCOVA 分析，结果显示没有交互作用，但在行为综合执行功能评分、群体状态（EPT 与对照）和 FSIQ 方面观察到显着的主效应，其中所有效应大小均为中等到大。 MANCOVA 对家长报告的学习技能的相应发现非常相似。根据老师的评分，EPT孩子对学校环境的适应能力较差。即使排除了患有严重神经发育障碍的儿童，20 世纪 90 年代出生的、接受积极围产期护理的 EPT 儿童出现执行功能障碍的风险也会增加。即使是轻度至中度的执行功能障碍也会对学习技能产生重大影响。这些发现表明需要及时干预来解决特定的认知缺陷和执行功能障碍。
To assess the cognitive and behavioral aspects of executive functioning (EF) and learning skills in extremely preterm (EPT) children compared with term control children aged 10 to 15 years. A total of 132 of 134 (98% of all eligible survivors) EPT children born at the 2 Swedish regional tertiary care centers from 1992 to 1998 (mean age = 12 years, mean birth weight = 718 g, and mean gestational age = 24.4 weeks) and 103 matched term controls were assessed. General intelligence was assessed using the Wechsler Intelligence Scale for Children (WISC-III-R), and cognitive aspects of EF were analyzed using EF-sensitive subscales of the WISC-III-R and Tower test of the Delis-Kaplan Executive Function Scale (D-KEFS). Behaviors related to EF and learning skills were assessed using the Five to Fifteen questionnaire, which is a validated parent and teacher instrument. Academic performance in school was assessed by teachers’ responses on Achenbach’s Teachers Report Form. Analyses performed included multivariate analyses of covariance (ANCOVA and MANCOVA) and logistic regression analyses. The EPT children displayed significant deficits in cognitive aspects of EF compared with the controls, exhibiting decreases on the order of 0.9 SD to 1.2 SD for tasks of verbal conceptual reasoning, verbal and non-verbal working memory, processing speed and planning ability (P <0.001 for all). After excluding the children with major neurosensory impairment (NSI) or a Full Scale intelligence quotient (FSIQ) of < 70, significant differences were observed on all tests. Compared with controls, parents and teachers of EPT children reported significantly more EF-related behavioral problems. MANCOVA of teacher-reported learning skills in children with FSIQ >70 and without major NSI revealed no interactions, but significant main effects were observed for the behavioral composite executive function score, group status (EPT vs control) and FSIQ, for which all effect sizes were medium to large. The corresponding findings of MANCOVA of the parent-reported learning skills were very similar. According to the teachers’ ratings, the EPT children were less well adjusted to the school environment. EPT children born in the 1990s who received active perinatal care are at an increased risk of executive dysfunction, even after excluding children with significant neurodevelopmental disabilities. Even mild to moderate executive dysfunctions has a significant impact on learning skills. These findings suggest the need for timely interventions that address specific cognitive vulnerabilities and executive dysfunctions.