Internalizing and externalizing syndromes in children with dyslexia

An einer Klinikstichprobe (n = 77) von Regelschülern mit einer Lese- und Rechtschreibstörung (LRS) wurde die Prävalenz und Komorbidität psychischer Störungen untersucht. Im Breitbandscreening mit der Child Behavior Checklist (CBCL) zeigten sich viermal mehr Verhaltensauffälligkeiten als in der Normpopulation. Dabei wurden infolge einer besonderen administrativen Prävalenz anders als in prospektiven Studien mehr internalisierende als externalisierende Symptome festgestellt. Bei 66,2 Prozent der Stichprobe waren psychiatrische Syndrome nach ICD10 zu diagnostizieren: wegen der kaum zu bewältigenden Leistungsanforderungen besonders häufig Anpassungsstörungen, gefolgt von hyperkinetischen und Angststörungen. Die Durchschnittswerte in beiden Sekundärskalen der CBCL lagen zumeist im klinisch auffälligen Bereich, unabhängig davon, welche Diagnose gestellt wurde, jedoch waren die Schwerpunkte unterschiedlich. Die hohe Rate an Verhaltens- bzw. psychiatrischen Störungen weist auf den großen Bedarf an psychotherapeutischer Unterstützung bei LRS hin; Maßnahmen zur Leistungsförderung allein reichen vielfach nicht aus.(DIPF/Orig.)The prevalence and comorbidity of internalizing and externalizing syndromes was investigated in a clinical sample of children (n = 77) with dyslexia. In the normoriented broadband-screening of the Child Behavior Checklist (CBCL) the rate of behavioral disorders is four times higher than in the standardisation sample. As a consequence of specific administrative prevalence the children have – in contrast to prospective studies – more internalizing than externalizing problems (according to the secondary scales of the CBCL). Psychiatric syndromes have been diagnosed in 66,2 percent: most frequently adjustment disorders, because of nonconformity to performance standards, followed by hyperkinetic disorders and anxiety. In all different diagnosis groups the scores of both secondary scales of the CBCL lie within or near the clinical range, only the priority was different. The high rate of psychiatric disorders indicates a great demand of personal or psychotherapeutic support in referred children with dyslexia, that has to be provided – besides interventions focusing on performance deficits.(DIPF/Orig.

Growth variables and obstetrical risk factors in newborns are associated with psychomotor development at preschool ageAJOG Global Reports at a Glance

BACKGROUND: Low birthweight resulting from preterm birth or fetal growth restriction is associated with poor neurocognitive development and child psychopathology affecting school performance and educational success. Prediction of developmental performance may therefore serve as a basis for early intervention strategies to improve educational success and mental health of our children in a timely manner. OBJECTIVE: This study aimed to explore the predictive capacity of morphometric variables taken at birth and that of obstetrical risk factors to predict developmental performance at 4.3 (standard deviation, 0.8) years preschool age. We examined predicted Total psychomotor development score, predicted Developmental disability index, calculated Morphometric vitality index, and predicted Intelligence quotient, Maze test, and Neurologic examination optimality score in a large prospective screening (cranial ultrasound screening, n=5,301) and validation cohort (n=508,926). STUDY DESIGN: In a single-center cohort observational study design (data collection done from 1984–1988, analysis done in 2022), a prospective cranial ultrasound screening study (1984–1988) was carried out on 5,301 live-born infants, including 571 (10.8%) preterm infants (≤36 weeks gestation), on the day of discharge of the mother at 5 to 8 days postpartum from a level 3 perinatal center. Predicted psychomotor development as assessed by predicted Total psychomotor development score, predicted Developmental disability index, calculated Morphometric vitality index, and predicted Intelligence quotient, Maze test, and Neurologic examination optimality score, was calculated. We related growth variables and obstetrical risk factors to Psychomotor development indices, and calculated Morphometric vitality index using odds ratios, receiver operating characteristics, analysis of variance, and multivariate analysis of variance. RESULTS: The key result of our study is the observation that simple morphometric measures from newborns at birth like weight/head circumference ratio predict overall psychomotor development at 4.3 years (standard deviation, 0.8) of preschool age. Psychomotor development was assessed by predicted Total psychomotor development score, predicted Intelligence quotient, Maze test, and Neurologic examination optimality score, and related to weight/head circumference ratio in linear regression (P<.001) and ROC curve analyses (P<.001). Further, white matter damage strongly predicted adverse outcome in predicted Developmental disability index (P<.001). There was also a close correlation between calculated Morphometric vitality index and predicted Developmental disability index (P<.001). Finally, brain body weight ratio, weight/head circumference ratio, preterm birth, reduced Apgar at 10 minutes, weight/length ratio, and white matter damage yielded highest odds ratios for adverse outcome in predicted Total psychomotor development score and in predicted Developmental disability index (P<.001) and high effect sizes in reduced predicted Intelligence quotient, Maze test, and Neurologic examination optimality scores. CONCLUSION: Simple morphometric data, birth variables, and obstetrical risk factors bear predictive capacity for neurocognitive performance in children at 4.3 years (standard deviation, 0.8) of age and hence provide a basis for parental consultation and early intervention to improve school performance, educational success, and mental health in developed and developing countries

Differential effects of growth restriction and immaturity on predicted psychomotor development at 4 years of age in preterm infantsAJOG Global Reports at a Glance

BACKGROUND: Fetal growth restriction and immaturity are associated with poor neurocognitive development and child psychopathology affecting educational success at school and beyond. However, the differential effects of either obstetrical risk factor on predicted psychomotor development have not yet been deciphered. OBJECTIVE: This study aimed to separately study the impact of growth restriction and that of immaturity on predicted psychomotor development at the preschool age of 4.3 (standard deviation, 0.8) years using birthweight percentiles in a prospective cohort of preterm infants born at ≤37+6/7 weeks of gestation. Differences between small for gestational age newborns with intrauterine growth restriction and those without were described. We examined predicted total psychomotor development score, predicted developmental disability index, calculated morphometric vitality index, and predicted intelligence quotient, Porteus Maze test score, and neurologic examination optimality score in 854 preterm infants from a large prospective screening cohort (cranial ultrasound screening, n=5,301). STUDY DESIGN: This was a prospective cranial ultrasound screening study with a single-center cohort observational design (data collection done from 1984–1988, analysis done in 2022). The study included 5,301 live-born infants, of whom 854 (16.1%) were preterm infants (≤37+6/7 weeks’ gestation), and was conducted on the day of discharge of the mother at 5 to 8 days postpartum from a level 3 perinatal center. Predicted psychomotor development, as assessed by the predicted total psychomotor development score, predicted developmental disability index, calculated morphometric vitality index, predicted intelligence quotient, Porteus Maze test score, and neurologic examination optimality score were calculated. We related psychomotor development indices and measures to gestational age in 3 groups of birthweight percentiles (ie, 10%, 50%, and 90% for small, appropriate, and large for gestational age newborns, respectively) using linear regression analysis, analysis of variance, multivariate analysis of variance, and t test procedures. RESULTS: The key result of our study is the observation that in preterm infants born at ≤37+6/7 weeks of gestation, growth restriction as compared with immaturity is the prime risk factor for impairment of overall predicted psychomotor development, intelligence quotient, Porteus Maze test results, and neurologic examination optimality score at the preschool age of 4.3 (standard deviation, 0.8) years (P<.001). This is particularly true for intrauterine growth restriction. These detrimental effects of growth restriction become more prominent with decreasing gestational age (P<.001). As expected, growth restriction in preterm infants born at ≤37+6/7 weeks of gestation was associated with a number of obstetrical risk factors, including hypertension in pregnancy (P<.001), multiple pregnancy (P<.001), pathologic cardiotocography (P=.001), and low pH (P=.007), increased pCO2 (P=.009), and poor pO2 (P<.001) in umbilical arterial blood. Of note, there were no differences in cerebral hemorrhage or white matter damage among small, appropriate, and large for gestational age birthweight percentile groups, suggesting an independent mechanism of brain injury caused by preterm growth restriction resulting in poor psychomotor development. CONCLUSION: Compared with immaturity, growth restriction in preterm infants has more intense detrimental effects on psychomotor development, necessitating improved risk stratification. This finding has implications for clinical management, parental consultation, and early intervention strategies to improve school performance, educational success, and mental health in children. The mechanisms of brain injury specific to growth restriction in preterm infants require further elucidation