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

早产儿的阅读能力差：神经基础、预测、

• 批准号: 8510701
• 负责人: Heidi M. Feldman
• 金额: $ 32.26万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-25 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8510701
• 关键词: 6 year old; 8 year old; Access to Information; Address; Affect; Age; Anisotropy; Area; Attention; Awareness; Behavior assessment; Behavioral; Biological; Birth; Caring; Cerebrum; Characteristics; Child; Clinical; Clinical Treatment; Cognitive; Comprehension; Corpus Callosum; Development; Diffusion; Diffusion Magnetic Resonance Imaging; Disease; Early Diagnosis; Education; Educational Curriculum; Educational Intervention; Enrollment; Family; Future; Goals; Gold; Imaging Techniques; Intelligence; Intervention; Language; Language Development; Learning; Learning Disorders; Left; Lesion; Linguistics; Magnetic Resonance Imaging; Measures; Medical; Memory; Names; Neurocognitive; Neuronal Plasticity; Newborn Infant; Oral; Outcome; Parietal; Pathogenesis; Pattern; Performance; Perinatal; Phase; Pilot Projects; Play; Population; Positioning Attribute; Premature Birth; Preparation; Primary Prevention; Problem-Based Learning; Property; Public Health; Randomized Clinical Trials; Reader; Reading; Reading Disabilities; Recruitment Activity; Research; Role; Sampling; School-Age Population; Students; Testing; Time; Work; base; behavior measurement; behavior test; design; elementary school; evidence base; executive function; experience; forging; group intervention; high risk; improved; injured; innovation; kindergarten; peer; performance tests; phonology; premature; processing speed; programs; public health relevance; relating to nervous system; repaired; response; skills; white matter; white matter injury

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.

早产影响约13%的美国出生，其公共卫生后果远远超出新生儿期。大约一半的早产儿会出现认知、语言和学习问题，对他们的长期结果产生不利影响。一旦这些儿童达到上学年龄，教育计划就取决于他们在学术领域的功能水平，而不管任何学习困难的潜在发病机制。为了改善结果，我们必须确定早产儿（PT）的学习问题是否具有与足月儿（FT）的学习问题相似的认知特征、神经基础和/或发展过程。我们还必须调查PT儿童是否对同样的干预措施反应良好，这些干预措施在教育患有学习障碍的FT儿童方面是有效的。由于阅读在教育和长期成果中发挥着关键作用，我们已经组建了一支跨学科的团队，专注于PT儿童的阅读技能。本研究的具体目的是（1）使用行为测量和扩散张量成像（DTI）（一种评估大脑白色物质微观结构的磁共振成像技术）比较PT和FT儿童阅读技能的认知概况和神经基础，（2）确定哪些行为或神经特征预测两组中持续良好或较差的阅读技能;（3）对PT不良阅读者进行干预以提高其阅读技能的试点试验。我们将招募6岁的幼儿园学生（PT n=50，FT n=50），对他们进行一系列阅读和认知测量，获得DTI，并随访他们直到8岁，此时我们重复扩展电池和DTI。我们假设PT组比FT组表现更差。我们将评估PT组与FT组儿童相比，是否具有独特的测试表现或白色物质微结构模式，等同于单个单词阅读水平。两年后，我们将确定哪些行为和/或神经特征与持续性阅读困难相关。在第4年和第5年，我们将招募另一个阅读分数低于年龄第25百分位数的PT儿童样本。我们将使用两种基于证据的课程对为期6周的暑期辅导计划进行试点测试，一种侧重于音位意识，另一种更广泛地侧重于其他方面，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在3人小组中工作90分钟，每周5天，持续6周。这项创新性研究将对理解（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，即白色物质随时间和教育干预而变化的能力产生持续影响。这将使我们能够在后续阶段对早产儿进行阅读干预的随机临床试验。