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Cognitive and neuropsychological outcomes: more than IQ scores
1Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, Illinois 62794-9658, USA. Gaylward@siumed.edu
Insights
Improved survival in preterm infants has led to increased learning disabilities and attention deficits. These subtle neurodevelopmental issues, including ADHD, require comprehensive follow-up evaluations beyond IQ scores.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Cognitive Psychology
Background:
- Improved survival rates for preterm infants have shifted focus to long-term cognitive and neuropsychological outcomes.
- While major disabilities remain stable, there's a rise in subtle, high-prevalence neurodevelopmental dysfunctions in this population.
- Existing follow-up literature presents methodological challenges impacting outcome generalizations.
Purpose of the Study:
- To analyze the cognitive and neuropsychological outcomes of preterm infants.
- To identify trends and specific deficits in neurodevelopment among survivors.
- To discuss methodological limitations in current follow-up research.
Main Methods:
- Review and discussion of existing follow-up literature on preterm infant outcomes.
- Analysis of cognitive assessments, including IQ and achievement testing.
- Examination of specific neurodevelopmental domains such as attention, language, and executive functions.
Main Results:
- Former very low birth weight (VLBW) infants show subtle deficits in visual-motor skills, language, academics, and attention.
- Increased incidence of non-verbal learning disabilities, need for special education, and behavioral disorders observed.
- Males exhibit a higher prevalence of problems, with outcomes potentially worsening over time due to increased demands.
Conclusions:
- Mean IQ scores for VLBW infants are in the low average range, masking specific functional deficits.
- Comprehensive neurodevelopmental evaluation, including executive functions and behavioral adjustment, is crucial for preterm survivors.
- Future research needs to address methodological issues to provide more reliable outcome data for preterm infants.
Abstract:
Improved survival in preterm infants has broadened interest in cognitive and neuropsychological outcomes. The incidence of major disabilities (moderate/severe mental retardation, neurosensory disorders, epilepsy, cerebral palsy) has remained consistent, but high prevalence/low severity dysfunctions (learning disabilities, ADHD, borderline mental retardation, specific neuropsychological deficits, behavioral disorders) have increased. The follow-up literature contains methodologic problems that make generalizations regarding outcome difficult, and these are discussed. Although mean IQs of former VLBW infants generally are in the low average range and are 3-9 points below normal birth weight peers, these scores mask subtle deficits in: visual-motor and visual-perceptual abilities, complex language functions, academics (reading, mathematics, spelling and writing), and attentional skills. There is an increased incidence of non-verbal learning disabilities, need for special educational assistance, and behavioral disorders in children born prematurely. Males have more problems, and there is a trend for worsening outcome over time, due to emergence of more subtle deficits in response to increased performance demands. In addition to IQ and achievement testing in follow-up, there should be evaluation of executive functions and attention, language, sensorimotor functions, visuospatial processes, memory and learning, and behavioral adjustment.