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Longitudinal Study of Executive Function and Low Birth Weight
Patricia M Blasco, Sybille Guy, Serra Acar The Research Institute at Western Oregon University
Sage N Saxton Oregon Health & Science University
Division for Early Childhood 33rd Annual International Conference Portland, OR
October 4 – 6, 2017
Expected Outcomes
• Participants will a) identify and recognize executive function (EF) and its importance in early learning
• Understand components of EF and how they can be measured in young children
• Discuss implications for practice/implementation of practice within early intervention.
Executive Function
Refers to a group of neurocognitive processes in the brain that direct, connect, and organize information that is manifested in planned behavior.
She’s the CEO of her brain
Neurocognitive Processes
• Self Regulation
• Inhibition
• Working Memory
• Cognitive Flexibility
• Goal Setting
• Planning and Organization
Self-Regulation
Self-regulation functions are developing from the
first years of life on throughout a person’s entire
lifetime.
Inhibit
Ability to control behavior and impulses
Redirect Activity
Stop, Think & Action
Challenging Behavior
Working Memory
• Ability to hold and process “stored” information!
• A not B tasks
Cognitive Flexibility
• Ability to shift between two different concepts or attributes and requests
Dimensional Change Card Sort- Separated Task
Rule: Sort by Shape
Rule: Sort by Color
Goal Setting
• Process that results in goal-directed behavior • Mastery Motivation – goal persistence
Planning and Organization
• Anticipate additional steps to maintain a task or order an event
• Toddler – Engages in multischeme play (first, I feed the baby, then burp the baby, then put the baby to bed)
• First Grade – Place the folder with my pencil in the backpack, take out my pencil, put the teacher’s note to mom and dad in my folder to go home.
What about Children born LBW and Preterm?
• Major medical conditions, such as cerebral palsy and other severe disabilities, are well known outcomes of low birth weight (LBW)(< 2500 grams) and preterm birth (< 37 weeks).
Research on LBW and Preterm
Retrospective research has shown that, although a large portion of this population did not have major disabilities, some may have lasting cognitive impairments, particularly in executive functions (EF).
(Anderson & Boyle, 2004; Vohr, Wright, Poole, & McDonald, 2005)
Research on LBW and Preterm
• Very LBW & Preterm children ( <1500g, <33 weeks gestation) scored lower on tasks of executive functioning than full-term peers.
• Outcomes include poor cognitive function, learning difficulties, and behavior problems.
(Aarnoudse- Moens et. al., 2009)
Research on LBW and Preterm
One researcher reported: • “At school age among very preterm children, key
processing skills and working memory seem to underpin problems both generally and in math” (Marlow, p. F442, 2014).
• Recent research also demonstrated that late preterm (34 to 36 weeks gestation) children had learning difficulties in the early school years (Chan & Quigley, 2014).
Project EF
• Current research funded by U. S. Department of Health and Human Services
Purpose of the Current Study
The purpose of Project EF: Executive Function in Infants and Toddlers Born Low Birth Weight (LBW) and Preterm is to examine whether traditional assessment methods that have components of EF in their structure can discern early indicators of executive function. a) children born LBW and preterm at low risk (>1500
grams), b) children born LBW and preterm at high risk (≤1500
grams), c) children born full term.
Project EF Research Questions
1. Are there differences in performance on cognitive, problem-solving, mastery motivation, self-regulation and social behavior between children who are LBW/preterm low risk, LBW/preterm high risk, and full-term?
2. Are there early indicators of EF that can be extrapolated from infant/toddler assessments?
Measures
• Dimensions of Mastery Questionnaire (DMQ 18) (Morgan, et. al. 2015)
• Bayley Scales of Infant & Toddler Development III (Bayley, 2005)
• Child Behavior Checklist (Achenbach & Rescorla (2001)
Dimensions of Mastery Questionnaire (DMQ 18) (Morgan et al., 2015)
• A parent-completed questionnaire that is designed to assess their children’s mastery motivation and mastery pleasure related behaviors.
• Mastery Motivation is the intrinsic drive to explore and master one’s environment through goal-directed behavior with challenging tasks.
Bayley Scales of Infant and Toddler Development III (BSID) (Bayley, 2005)
• Designed to measure physical, motor, sensory, and cognitive development in infants and toddlers from birth to age 42 months.
• Consist of one form that provides: • Cognitive Composite and Scaled Score • Language Composite
• Receptive and Expressive Scaled Scores • Motor Composite
• Fine and Gross Motor Scaled Scores
Figure. A copy of BSID materials.
Child Behavior Checklist
• Measures children's emotional, behavioral, and social development.
• The preschool checklist (CBCL/1½-5) is intended for use with children aged 18 months to 5 years.
Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P)
Ø Likert Scale Questionnaire that can be used by
parents and/or teachers
Ø Three broad indexes Ø Inhibitory Self-Control (Inhibit and Emotional Control) Ø Flexibility (Shift and Emotional Control) Ø Emergent Metacognition (Plan/Organize and Working
Memory)
EF touch
Ø Computerized-battery of EF tasks for children ages 3 to 6
Ø The tasks we are using are presented as fun activities that measure working memory and inhibitory control
Age
• ASSESSMENTS
• BSID III, DMQ 18
• BSID III, DMQ 18, CBC
• BSID III, DMQ 18, CBC, EF assessment
6 to 8 months corrected age 18 to 20 months corrected age 36 months
Current Data Analysis
Sample Demographics
Full Term (N = 41)
LBW (N = 100)
Gender
Male 51.2 52.0
Female 48.8 48.0
Race/Ethnicity
American Indian/Alaska Native -- 2.1
Asian 7.5 6.3
Black/African American -- 4.2
Hispanic/Latino 15.0 16.8
White, non-Hispanic 70.0 55.8
Other 7.5 14.7
*percentages
Sample Demographics
Full Term (N = 41)
LBW (N = 100)
Mother’s Education
Less than college 7.3 33.0
Some college 17.1 24.5
College grad+ 75.6 42.5
Father’s Education
Less than college 10.0 45.1
Some college 32.5 17.6
College grad+ 57.5 37.3
LBW Sample Demographics
Mean Ranges
Corrected Age (months) 6.6 5.7 – 8.9
Gestational Age (weeks) 32.9 25.0 – 37.0
Birth Weight (grams) 1813.7 620 - 2,466
DMQ Scales – Average Scores
Full Term (N = 41)
LBW (N = 100)
Object Oriented Persistence 3.29 3.25
Social Persistence with Adults 2.93 2.79
Social Persistence with Children 2.37 2.57
Gross Motor Persistence 3.80 3.41
Mastery Pleasure 4.05 3.86
Negative Reaction to Failure 2.53 2.63
General Competence 3.35 2.60
Full term and LBW children did not differ significantly on six DMQ scales with one exception:
Parents of children who were full term rated the child significantly higher on:
General Competence (t(134) = 4.19, p = .000) than parents of children with LBW.
Bayley III Scales – Average Scores
Full Term (N = 41)
LBW (N = 100)
Cognitive Scaled 10.10 10.54
Cognitive Composite 100.49 102.55
Receptive Scaled 9.02 8.93
Expressive Scaled* 9.90 9.07
Language Composite 96.95 94.27
Fine Motor Scaled 11.22 10.66
Gross Motor Scaled 10.76 9.87
Motor Composite 105.95 101.61
Children who were born full term scored significantly higher on: Expressive Scaled(t(139) = 2.42, p = .017) compared to children in the LBW group. However, this was not significant after adjusting for multiple comparisons.
BSID III Item components of EF
• Cognitive Scale • Emotional Control, Attention, Working Memory, Shift,
Plan/Organize • Language (both Receptive and Expressive)
• Emotional Control, Attention, Working Memory, RC – Inhibit, EX – Plan/Organize
• Fine Motor • Plan/Organize • Working Memory
• Gross Motor • Plan/Organize • Attention
Bayley III and EF Scales – Average Scores
Full Term (N = 41)
LBW (N = 100)
Attention* .90 .82
Working Memory .32 .31
Inhibit .38 .42
Plan/Organize* .60 .54
Shift - -
Emotional Control 1.00 .99
• Concern for item density at 6 months on the Bayley III.
• Correcting for age often inflates scores for children who are LBW in their standard scores.
Full Term children score statistically significantly higher on two scales: • Attention (t(139) = 4.94, p = .000) • Plan/Organize (t(139) = 3.08, p = .
003)
Data from 18 months
DMQ Scales – Average Scores – 18 months
Full Term (N = 25)
LBW (N = 47)
Object Oriented Persistence 3.33 3.31
Social Persistence with Adults* 3.68 3.12
Social Persistence with Children* 3.45 3.00
Gross Motor Persistence 3.98 3.56
Mastery Pleasure* 4.81 4.26
Negative Reaction to Frustration 3.19 3.18
Negative Reaction to Sadness 2.30 2.18
General Competence* 3.82 3.35
Full term and LBW children differed significantly on one DMQ scale after adjustment for multiple comparisons.
Master Pleasure(t(68) = 3.04, p = .003) higher for full term children compared to children in the LBW group
Bayley III Scales – Average Scores – 18 months
Full Term (N = 25)
LBW (N = 47)
Cognitive Scaled 10.48 10.77
Cognitive Composite 102.40 97.13
Receptive Scaled** 10.08 7.91
Expressive Scaled** 11.08 8.96
Language Composite**
103.48 91.06
Fine Motor Scaled 10.88 9.72
Gross Motor Scaled** 9.80 8.57
Motor Composite** 101.84 95.04
Children in the full term group scored statistically significantly higher on five scales: Receptive Scaled (t(70) = 3.67, p=.000) Expressive Scaled (t(70) = 3.72, p=.000) Language Composite(t(70) = 4.06, p=.000) Gross Motor Scaled (t(70) = 2.98, p=.004) Motor Composite(t(70) = 3.01, p = .004).
Bayley III and EF Components – Average Scores – 18 Months
• Given a still relatively small sample size, the trend is toward higher means for Full Term group.
Full Term children score statistically significantly higher on one scale:
• Emotional Control (t(70) = 2.71, p = .008)
Full Term (N = 25)
LBW (N = 47)
Attention .58 .55
Working Memory .57 .51
Inhibit .83 .76
Plan/Organize .68 .65
Shift .40 .36
Emotional Control* .88 .75
Average Difference Scores on the BSID III Between 6 and 18 Months
Multivariate analysis found significant difference in Language composite scores, expressive and receptive scaled scores.
Children who were full-term, showed a significantly larger, positive average difference score compared to children born with LBW.
Average scores decreased for those in the LBW group.
-2.81
8.72
-1.06
1.64
0.06
1.36
Expressive Scaled Receptive Scaled Language Composite
LBW
FT
FT, N = 25 LBW, N = 47
How do we advocate for infants and toddlers who are LBW and their families to ensure their needs are met early?
What do you see as the benefits of measuring EF skills?
