Longitudinal Effects of Spina Bifida on Learning

描述（由申请人提供）：脊柱裂脊髓脊膜膨出（SB）是一种与脊柱和大脑畸形相关的神经管缺陷，与运动、非语言认知、注意力、语言和适应性行为问题相关。虽然这些缺陷是有据可查的学龄儿童，他们的发展起源还没有得到很好的理解，因为很少有研究已经检查了认知发展的儿童与SB在幼儿期。对学龄儿童的研究表明，年龄较大的SB儿童有核心缺陷，涉及时间，注意力定向和运动控制/学习，以及视觉感知，注意力调节和涉及整合信息/应急学习（II/CL）的技能的功能缺陷：基于规则的问题解决，上下文语言和行为调节。这些缺陷贯穿于成果领域。在目前对SB婴儿的纵向研究中，已经检查了6 - 36个月的核心缺陷和6-36个月的功能缺陷（包括II/CL技能）的发展，以确定其起源以及与SB后期问题的可能联系。目前纵向研究的结果表明，SB婴儿确实表现出时间方面的核心缺陷，运动质量和组织，以及注意力定向。这些核心缺陷早在7个月大时就很明显，在幼儿期持续存在，并且似乎与3岁时出现的功能缺陷的增长有关，这表明它们作为以后SB问题的基础的重要性。为了将核心和功能缺陷与学龄期类似技能的评估以及传统的结果评估联系起来，拟议的研究将纵向研究参与我们当前研究的85名SB儿童和73名正常发育对照儿童的核心和功能缺陷。在拟议的扩展中，我们将看到这些儿童在7.5岁，8.5岁和9.5岁时检查核心和功能缺陷的增长，评估涉及智力，语言，学术，适应行为和社会功能的传统结果。我们期望儿童在核心和功能任务上的早期表现将预测他们在学龄早期的类似技能的发展，并解释传统结果的变化。然而，我们预测，随着时间的推移，技能之间的关系将被调节的性质和严重程度的中枢神经系统（脊柱和大脑）异常和重要的环境变量，包括并发和以前的母亲的互动风格。特别是，照顾者的能力，以保持儿童的注意力集中，应急和热情地响应儿童的信号，并提供认知丰富的口头输入可能会缓和的程度，早期核心缺陷导致功能缺陷和预测以后的能力，在这些技能。SB儿童在9.5岁时记录的特定CNS异常与发育轨迹之间的关系以及与该组技能的并发关系，应揭示有关年幼SB儿童大脑-行为关系的重要信息。这项研究是少数几项针对学龄前SB儿童的研究之一，也是唯一一项系统、全面的学龄期随访研究。完成这项研究将使人们能够与关于学龄儿童SB的大量研究联系起来。

DESCRIPTION (provided by applicant): Spina bifida myelomeningocele (SB), a neural tube defect associated with deformities of the spine and brain, is associated with motor, non-verbal cognitive, attention, language, and adaptive behavior problems. While these deficiencies are well documented in school-age children, their developmental origins are not well understood since few studies have examined cognitive development for children with SB in early childhood. Research with school- age children has demonstrated that older children with SB have core deficits involving timing, attention orientation, and motor control/learning, and functional deficits in visual perception, attention regulation, and skills involving the integration of information/contingency learning (II/CL): rule-based problem solving, contextual language, and behavioral regulation. These deficits cut across outcome domains. In the current longitudinal study of infants with SB, the development over 6 to 36 months of core deficits and functional deficits from 6-36 months of age, including II/CL skills, have been examined in order to determine their origins and possible links to the later problems identified for SB. Findings from the current longitudinal study show that infants with SB do exhibit core deficits in timing, motor quality and organization, and attention orientation. These core deficits are apparent as early as 7 months of age, persist across early childhood, and appear to be related to growth in emerging functional deficits at 3 years, which demonstrates their importance as a foundation for later SB problems. To link core and functional deficits with school age assessments of similar skills, and to traditional assessments of outcomes, the proposed research will examine longitudinally core and functional deficits for the same 85 children with SB and 73 children normally developing controls that have participated in our current study. In the proposed extension, we will see these children at 7.5, 8.5, and 9.5 years of age to examine growth of core and functional deficits, assess traditional outcomes involving intelligence, language, academics, adaptive behavior, and social functions. We expect that the children's early performance on core and functional tasks will predict their development of similar skills during the early school-age period, and explain variations in traditional outcomes. However, we predict that relations among skills over time will be moderated by the nature and severity of CNS (spine and brain) anomalies and by important environmental variables, including concurrent and previous maternal interactive style. In particular, the caregivers' abilities to maintain the children's attention focus, respond contingently and warmly to children's signals, and provide cognitively enriching verbal input are likely to moderate the degree to which early core deficits lead to functional deficits and predict later ability in these skills. Relations between specific CNS abnormalities documented at 9.5 years for children with SB and the developmental trajectories and concurrent relations with this group of skills, should reveal important information about brain- behavior relations for younger SB children. This study is 1 of few studies of children with SB in the preschool years, and would be the only systematic, comprehensive follow- up into the school- age years. Completion of the study would allow a link with a significant body of research on school- age children with SB.