Akshoomoff Natacha, Joseph Robert M, Taylor H Gerry, Allred Elizabeth N, Heeren Timothy, OʼShea Thomas M, Kuban Karl C K
*Department of Psychiatry and Center for Human Development, University of California, San Diego, La Jolla, CA; †Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA; ‡Department of Pediatrics, Case Western Reserve University and Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Cleveland, OH; §Department of Neurology, Harvard Medical School, Boston, MA; ‖Neuroepidemiology Unit, Department of Neurology, Boston Children's Hospital, Boston, MA; ¶Department of Biostatistics, Boston University School of Public Health, Boston, MA; **Department of Pediatrics, University of North Carolina, Chapel Hill, NC; ††Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, Boston, MA.
J Dev Behav Pediatr. 2017 Oct;38(8):627-637. doi: 10.1097/DBP.0000000000000479.
The purpose of this study was to examine the risks associated with learning disabilities (LDs) in a large sample of children born extremely preterm. We predicted higher than expected rates of LD, particularly in math, and children with LD in math, reading, or both would have lower intelligence quotients (IQs) and specific patterns of neuropsychological deficits.
We evaluated academic achievement, rates of LD, and their neuropsychological correlates in the Extremely Low Gestational Age Newborns (ELGANs) Study cohort of 10-year-old children born at 23 to 27 weeks gestational age. Primary analyses focused on children without intellectual disability (verbal IQ > 70 and nonverbal IQ > 70; N = 668). Low achievement was defined as a standard score ≤85 on the reading or math measures.
The risk of low math achievement scores (27%) was 1.5 times higher than the risk of low reading achievement scores (17%). Children were classified as having LD based on low achievement criteria in reading only (RD, 6.4% of sample), math only (MD, 16.2%), both reading and math (RD/MD, 8.3%), or no reading or math disabilities (No LD, 69.1%). Although all 3 LD groups had multiple neuropsychological weaknesses compared with the No LD group, the RD and MD groups had different patterns of neuropsychological impairment.
These children from the ELGAN cohort had higher than expected rates of LD, particularly in mathematics, even after taking socioeconomic status into consideration. These results indicate specific cognitive weaknesses that differ between extremely preterm children with RD and MD.
本研究旨在调查极早产出生的大量儿童中与学习障碍（LD）相关的风险。我们预测LD发生率会高于预期，尤其是在数学方面，且数学、阅读或两者都有LD的儿童智商（IQ）会较低，并有特定模式的神经心理缺陷。
我们在极早早产新生儿（ELGANs）研究队列中评估了孕23至27周出生的10岁儿童的学业成绩、LD发生率及其神经心理相关性。主要分析集中在无智力障碍的儿童（言语智商>70且非言语智商>70；N = 668）。低学业成绩定义为阅读或数学测试中的标准分数≤85。
数学低学业成绩分数的风险（27%）比阅读低学业成绩分数的风险（17%）高1.5倍。根据低学业成绩标准，儿童被分类为仅阅读方面有LD（RD，占样本的6.4%）、仅数学方面有LD（MD，16.2%）、阅读和数学方面都有LD（RD/MD，8.3%）或无阅读或数学障碍（无LD，69.1%）。尽管与无LD组相比，所有3个LD组都有多种神经心理弱点，但RD组和MD组有不同的神经心理损伤模式。
即使考虑了社会经济地位，ELGAN队列中的这些儿童LD发生率仍高于预期，尤其是在数学方面。这些结果表明，极早产的RD儿童和MD儿童存在不同的特定认知弱点。
