Prenatal and Perinatal Factors Associated with Intellectual Disability
American Journal on Intellectual and Developmental Disabilities (Impact Factor: 2.08). 03/2013; 118(2):156-76. DOI: 10.1352/1944-7558-118.2.156
Abstract Prenatal and perinatal risk factors associated with intellectual disability (ID) were studied in 8-year-old Utah children from a 1994 birth cohort (N = 26,108) using broad ascertainment methods and birth records following the most current recording guidelines. Risk factor analyses were performed inclusive and exclusive of children with a known or suspected underlying genetic disorder. Risk factors identified were poly/oligohydramnios, advanced paternal/maternal age, prematurity, fetal distress, premature rupture of membranes, primary/repeat cesarean sections, low birth weight, assisted ventilation greater than 30 min, small-for-gestational age, low Apgar scores, and congenital infection. Although several risk factors lost significance once children with underlying genetic disorders were excluded, socioeconomic variables were among those that maintained a prominent association with increased ID risk.
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ABSTRACT: Mechanical ventilation for preterm infants independently contributes to poor neurodevelopmental performance. However, few studies have investigated the association between the duration of mechanical ventilation and the risk for various developmental disorders in extremely low birth weight (ELBW) (<1000g) infants. Using a large nationwide database, we did a 10-year retrospective follow-up study to explore the effect of mechanical ventilation on the incidence of cerebral palsy (CP), autism spectrum disorder (ASD), intellectual disability (ID), and attention-deficit/hyperactivity disorder (ADHD) in ELBW infants born between 1998 and 2001. Seven hundred twenty-eight ELBW infants without diagnoses of brain insults or focal brain lesions in the initial hospital stay were identified and divided into three groups (days on ventilator: ≦2, 3-14, ≧15 days). After adjusting for demographic and medical factors, the infants in the ≧15 days group had higher risks for CP (adjusted hazard ratio: 2.66; 95% confidence interval: 1.50-4.59; p<0.001) and ADHD (adjusted hazard ratio: 1.95; 95% confidence interval: 1.02-3.76; p<0.05), than did infants in the ≦2 days group. The risk for ASD or ID was not significantly different between the three groups. We conclude that mechanical ventilation for ≧15 days increased the risk for CP and ADHD in ELBW infants even without significant neonatal brain damage. Developing a brain-protective respiratory support strategy in response to real-time cerebral hemodynamic and oxygenation changes has the potential to improve neurodevelopmental outcomes in ELBW infants.Research in developmental disabilities 04/2014; 35(7):1544-1550. DOI:10.1016/j.ridd.2014.03.048 · 4.41 Impact Factor
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ABSTRACT: Background Hypospadias (aberrant opening of the urethra on the underside of the penis) occurs in 1 per 300 newborn boys. It has been previously unknown whether this common malformation is associated with increased psychiatric morbidity later in life. Studies of individuals with hypospadias also provide an opportunity to examine whether difference in androgen signaling is related to neurodevelopmental disorders. To elucidate the mechanisms behind a possible association, we also studied psychiatric outcomes among brothers of the hypospadias patients.Methods Registry study within a national cohort of all 9,262 males with hypospadias and their 4,936 healthy brothers born in Sweden between 1973 and 2009. Patients with hypospadias and their brothers were matched with controls by year of birth and county. The following outcomes were evaluated (1) any psychiatric (2) psychotic, (3) mood, (4) anxiety, (5) eating, and (6) personality disorders, (7) substance misuse, (8) attention-deficit hyperactivity disorder (ADHD), (9) autism spectrum disorders (ASD), (10) intellectual disability, and (11) other behavioral/emotional disorders with onset in childhood.ResultsPatients with hypospadias were more likely to be diagnosed with intellectual disability (OR 3.2; 95% CI 2.8-3.8), ASD (1.4; 1.2-1.7), ADHD (1.5; 1.3-1.9), and behavioral/emotional disorders (1.4; 1.2-1.6) compared with the controls. Brothers of patients with hypospadias had an increased risk of ASD (1.6; 1.3-2.1) and other behavioral/emotional disorders with onset in childhood (1.2; 0.9-1.5) in comparison to siblings of healthy individuals. A slightly higher, although not statistically significant, risk was found for intellectual disability (1.3; 1.0-1.9). No relation between other psychiatric diagnosis and hypospadias was found.Conclusions This is the first study to identify an increased risk for neurodevelopmental disorders in patients with hypospadias, as well as an increased risk for ASD in their brothers, suggesting a common familial (genetic and/or environmental) liability.Journal of Child Psychology and Psychiatry 07/2014; 56(2). DOI:10.1111/jcpp.12290 · 6.46 Impact Factor
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ABSTRACT: Background We may improve our understanding of the role of common versus unique risk factors in attention-deficit/hyperactivity disorder (ADHD) by examining ADHD-related cognitive deficits in single- (SPX), and multi-incidence (MPX) families. Given that individuals from multiplex (MPX) families are likely to share genetic vulnerability for the disorder, whereas simplex (SPX) ADHD may be the result of sporadic (non-)genetic causes unique to the patient, we hypothesized that cognitive impairments may be different in SPX and MPX ADHD as indicated by (a) the presence of cognitive deficits in MPX, but not SPX unaffected siblings and (b) dissimilar cognitive profiles in SPX and MPX ADHD patients.Methods Tasks measuring total IQ, verbal attention, executive functioning, motor functioning, and time estimation were administered to 31 SPX/264 MPX ADHD probands, 47 SPX/123 MPX unaffected siblings, and 263 controls, aged 6–19 years.ResultsSPX unaffected siblings were unimpaired compared to controls, except for verbal working memory, whereas MPX unaffected siblings showed impairments on most cognitive domains. The cognitive profiles of SPX and MPX probands were highly similar, except that verbal attention, response inhibition and motor control deficits were more pronounced in MPX probands, and -compared to their unaffected siblings- impairments in IQ, visual working memory and timing abilities were more pronounced in SPX cases.Conclusions Our results support the hypothesis that a partly different cognitive architecture may underlie SPX and MPX forms of ADHD, which becomes evident when contrasting cognitive performances within families. Cognitive factors underlying MPX forms of ADHD are familial, whereas nonfamilial in SPX ADHD. SPX-MPX stratification may be a step forward in unraveling diverse causal pathways.Journal of Child Psychology and Psychiatry 10/2014; 56(7). DOI:10.1111/jcpp.12349 · 6.46 Impact Factor
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