Poor Reading in Preterms: Neural Basis, Prediction, & Response to Intervention

描述(由申请人提供)：早产影响了大约13%的美国新生儿，其公共健康后果远远超出了新生儿期。大约一半的早产儿会出现认知、语言和学习问题，对他们的长期结局产生不利影响。一旦这些孩子达到学龄，教育计划就由他们在学术领域的功能水平决定，而不考虑任何学习困难的潜在发病机制。为了改善结局，我们必须确定早产(PT)儿童的学习问题是否与足月出生(FT)儿童的学习问题具有相似的认知特征、神经基础和/或发展过程。我们还必须调查PT儿童是否对已知在教育患有学习障碍的FT儿童方面有效的相同干预措施做出积极反应。我们组建了一支成功的跨学科团队，专注于PT儿童的阅读技能，因为阅读在教育和长期结果中发挥着关键作用。本研究的具体目的是(1)使用行为测量和扩散张量成像(DTI)来比较PT和FT儿童阅读技能的认知特征和神经基础，扩散张量成像(DTI)是一种评估脑白质微结构的磁共振成像技术，(2)确定哪些行为或神经特征可以预测两组儿童阅读技能的持续良好或不良，以及(3)初步测试一种提高PT差读者阅读技能的干预措施。我们将招收6岁的幼儿园学生(PT n=50和FT n=50)，对他们进行一系列阅读和认知测试，获得DTI，并跟踪他们直到8岁，然后重复使用扩展电池和DTI。我们假设，PT组的表现将比FT组更差。我们将评估与单字阅读水平相同的FT儿童相比，PT组是否具有独特的测试成绩或白质微结构模式。我们将在两年后确定哪些行为和/或神经特征与持续性阅读困难有关。在四年级和五年级，我们将再招募一批阅读成绩低于年龄第25百分位数的PT儿童。我们将使用两门循证课程试行为期六周的暑期辅导计划，一门侧重于语音意识，另一门则侧重于其他方面，包括阅读理解。我们将确定家庭干预的可行性和可接受性，并评估早产儿是否有注意力和耐力，以3人小组形式工作90分钟，每周5天，连续6周。这项创新的研究将对理解产生持续的影响(1)PT儿童的阅读结果，(2)PT和FT儿童正常和异常阅读的神经基础，以及(3)神经可塑性，即白质随着时间和教育干预而变化的能力。这将使我们能够在接下来的阶段对早产儿童进行阅读干预的随机临床试验。 公共卫生相关性：这项研究计划旨在改善早产儿童的学习成绩，早产儿童是一大群患有严重学习障碍的高危儿童，而且还在不断增长。这项研究将确定早产儿阅读能力差的儿童是否具有与足月儿阅读能力差的儿童不同的认知和学习特征以及不同的神经特征。我们还将确定幼儿园的哪个因素可以预测每组中可能有长期阅读问题的儿童，以便可以针对适当的组进行早期精读干预。为了准备治疗的随机临床试验，这些研究还将就可行性、家庭可接受性和早产儿贫困读者的适宜性等方面对目前用于足月贫困读者的两种干预措施进行试点测试。

DESCRIPTION (provided by applicant): Prematurity affects about 13% of the US births and its public health consequences extend far beyond the newborn period. About half of children born preterm develop cognitive, language and learning problems that adversely impact their long-term outcomes. Once these children reach school age, educational programs are dictated by their level of function in academic domains, irrespective of the underlying pathogenesis of any learning difficulties. To improve outcomes, we must ascertain whether the learning problems of children born preterm (PT) have a similar cognitive profile, neural basis, and/or developmental course as learning problems in children born full term (FT). We must also investigate if PT children respond favorably to the same interventions known to be effective in educating FT children with learning disorders. We have forged an accomplished interdisciplinary team to focus on reading skills in PT children because of the pivotal role reading plays in education and long term outcomes. The specific aims of this study are to (1) compare the cognitive profiles and neural basis of reading skills in PT and FT children using behavioral measures and diffusion tensor imaging (DTI), an magnetic resonance imaging technique that evaluates cerebral white matter microstructure, (2) determine which behavioral or neural features predict persistent good or poor reading skills in both groups and (3) pilot test an intervention to improve reading skills n PT poor readers. We will enroll 6-year old kindergarten students (PT n=50 and FT n=50), test them on a battery of reading and cognitive measures, obtain DTIs, and follow them until age 8 years when we repeat an expanded battery and DTI. We hypothesize that the PT group will perform more poorly than the FT group. We will assess if the PT group has distinctive profiles of test performance or patterns of white matter microstructure compared to FT children equated for single word reading level. We will determine which behavioral and/or neural features are associated with persistent reading difficulties two years later. In Years 4 and 5 we will recruit another sample of PT children with reading scores below the 25th percentile for age. We will pilot test a 6-week summer tutoring program using two evidence-based curricula, one focused narrowly on phonemic awareness and one focused more broadly on other aspects, including reading comprehension. We will establish the feasibility and acceptability of the intervention for families and assess if the preterm children have the attentional capacity and endurance to work in small groups of 3 for 90 minutes 5 days/week for 6 weeks. This innovative study will make a sustained impact on understanding (1) reading outcomes in PT children, (2) the neural basis of normal and abnormal reading in both PT and FT children, and (3) neural plasticity, the ability of white matter to change over time and with educational interventions. It will position us to conduct a randomized clinical trial on reading intervention in children born preterm in the subsequent phase. PUBLIC HEALTH RELEVANCE: This research program is designed to improve academic outcomes for children born preterm, a large and growing population of children at high risk for significant learning disorders. The study will determine whether poor reading skills in children born preterm have distinctive cognitive and academic profiles and different neural characteristics than poor reading skills in full-term children. We will also determine which factor at kindergarten predict those children who are likely to have long-term reading problems in each group so that the appropriate group can be targeted for early intensive reading interventions. In preparation for a randomized clinical trial of treatments, the studies will also pilot-test two interventions currently used for full term poor readers in terms of feasibility, acceptability for families, and appropriateness for the preterm poor readers.