Longitudinal Effects of Spina Bifida on Learning

描述(申请人提供)：脊柱裂脊髓膜脊膜膨出(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有关。虽然这些缺陷在学龄儿童中得到了很好的记录，但它们的发展起源并不是很清楚，因为很少有研究考察患有SB的儿童在童年早期的认知发展。对学龄儿童的研究表明，年龄较大的SB儿童在计时、注意定向和运动控制/学习方面存在核心缺陷，在视觉感知、注意调节和涉及信息/应急学习(II/CL)整合的技能(基于规则的问题解决、上下文语言和行为调节)方面存在功能缺陷。这些赤字跨越了结果领域。在目前对SB婴儿的纵向研究中，对6-36个月的核心缺陷和6-36个月大的功能缺陷(包括II/CL技能)的发展进行了检查，以确定它们的起源以及与后来发现的SB问题的可能联系。目前的纵向研究结果表明，患有SB的婴儿确实在时间、运动质量和组织以及注意力定向方面表现出核心缺陷。这些核心缺陷在7个月大的时候就很明显，并持续到儿童早期，而且似乎与3岁时新出现的功能缺陷的增长有关，这表明它们作为后来SB问题的基础的重要性。为了将核心和功能缺陷与类似技能的学龄评估以及传统的结果评估联系起来，拟议的研究将纵向检查85名儿童的核心和功能缺陷，其中SB和73名儿童正常发展控制，参与了我们目前的研究。在拟议的延期中，我们将看到这些儿童在7.5、8.5和9.5岁时检查核心和功能缺陷的发育，评估涉及智力、语言、学业、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期早期类似技能的发展，并解释传统结果的差异。然而，我们预测，随着时间的推移，技能之间的关系将受到中枢神经系统(脊柱和大脑)异常的性质和严重程度以及重要环境变量的调节，包括同时存在的和以前的母亲互动方式。特别是，照顾者保持儿童注意力集中的能力，对儿童信号的应急和热情反应，以及提供丰富认知的语言输入的能力，可能会缓和早期核心缺陷导致功能缺陷的程度，并预测这些技能的未来能力。在9.5岁的SB儿童中记录的特定中枢神经系统异常与发育轨迹以及与这组技能的同时关系之间的关系，应该可以揭示关于年幼SB儿童的大脑-行为关系的重要信息。这项研究是对学龄前儿童SB的少数研究之一，也是对学龄期唯一系统、全面的跟踪调查。这项研究的完成将允许与大量关于患有SB的学龄儿童的研究建立联系。

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.