The Developmental-Behavioral Pediatrics Research Group  

Current Studies

The Therapeutic Potential of Deep Massage (Rolfing / Myofascial Structural Integration) in Children with Cerebral Palsy Study (closed to enrollment)

Cerebral palsy (CP) is the diagnosis of the most prevalent physical disability in childhood. Spasticity is the most common type of CP. In the past, spasticity was attributed solely to neural mechanisms related to central nervous system injury. However, recent evidence implicates structural changes in the muscle and connective tissue or fascia as important contributors to the increased muscle tone and stiffness in CP. Targeting the local structural changes specifically and directly could be a potential mechanism to reduce spasticity and resultant contractures and to improve motor function in children with CP.

Myofascial Structural Integration (MSI) therapy, also known as rolfing, is a specific technique that manipulates muscle and fascia to put the body into proper alignment and facilitate improved motor patterns. Currently classified as a manipulative and movement-based complementary medicine practice, MSI may be a safe and effective treatment for improving motor functions in children with spastic CP. We are currently running a trial of 24 children funded by the Gerber Foundation evaluating the potential functional benefits of MSI.

 

The Executive Function in Preschool Children at Risk for Inattention and Hyperactivity Study

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Executive function (EF) is an umbrella term that refers to multiple interrelated abilities used to guide and control goal-oriented behavior. Component skills may include response inhibition, working memory, cognitive flexibility, and organization and planning. EF skills are linked to academic achievement, adaptive function, and social skills. EF impairments are found in several clinical populations, including children with Attention-Deficit/Hyperactivity Disorder (ADHD), autism, learning disabilities, and preterm birth.

The goal of this project is to evaluate two highly prevalent populations at risk for EF impairment: (1) preterm children (preterm-risk) and (2) children with ADHD or first-degree family member with ADHD (family-risk).  

Part 1 of the study, Executive Function Characteristics/Executive Function Profiles study, is designed to compare EF skills in groups with (1) preterm-risk, (2) family-risk, and (3) matched full-term controls. We compare groups to each other directly, hypothesizing differences in EF and behavioral profiles in preterm-risk and family-risk groups.

Part 2 of the study, Response to Treatment study, is a randomized trial of home-based computerized training for preterm preschoolers with EF impairment. The training targets working memory skills. We are interested in whether the training improves performance on trained and untrained working memory tasks as well as other EF tasks.

The significance of this project is that it will help us understand how different risk factors contribute to impairments in EF skills and whether training can improve EF skills. EF skills may serve as important markers or predictors of outcome, as well as targets for intervention to improve outcomes. Effective interventions for EF impairments in preschool children capitalize on potential neural plasticity and could lead to improved functional outcomes.

 

The Reading in Preterm and Full Term Children Study

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The purpose of this study is to understand reading abilities of children born preterm (i.e. their cognitive profiles, the neural basis of good and poor reading abilities, and the behavioral and neural factors that predict persistent difficulties).

We aim:

1) to compare and contrast the cognitive and behavioral characteristics (including phonemic awareness, processing speed, memory, language abilities, executive functions skills, and attentional capacity) and the neural basis of reading skills in preterm and full-term 6-year old children using behavioral assessments and diffusion tensor imaging (DTI).

2) to predict reading skills at age 8 years in children born preterm and full term based on their cognitive profile and DTI measures at age 6 years.

The long-term significance of this project is that it will determine if preterm poor readers have distinctive cognitive or neural profiles, issues of high relevance to understanding of the long-term sequelae of prematurity and the neural basis of reading. Currently, we create educational programs for children based solely on their level of functioning in academic areas.  We need to know whether educational programs should be designed solely on the basis of academic performance or whether programs must be tailored to specific clinical groups and causes of learning disorders. These findings will have a lasting impact on the field of education. In addition, establishing whether white matter characteristics predict or respond to experience will contribute to our understanding of plasticity.

 

The Predicting Language Outcomes From Early Processing Efficiency in Preterm Children Study

Each year in the U.S., one in 8 children is born prematurely and the rate of preterm birth continues to rise. Children born preterm are at substantial risk for language-based learning disabilities that may not be identified until the child enters kindergarten, a delay that precludes opportunities for early intervention. Early behavioral indicators of adverse language and cognitive outcomes are urgently needed, particularly methods that identify underlying deficits amenable to effective interventions. To meet these pressing needs, we have forged an experienced interdisciplinary team with complementary expertise in pediatrics and developmental psycho-linguistics.

Our mutual long-term goals are to develop reliable and robust predictors of later outcomes for children born preterm (PT) that allow us to design effective early interventions and to elucidate the neural basis of disorders associated with prematurity and with atypical language development. This innovative translational project adopts a developmental psycholinguistic approach to explain individual variation in outcomes in a clinical population at high risk for language disorders, and is poised to inform future theory- and empirically-driven intervention research as well as studies of the neural basis of language disorders.

 

The Neurobiological Basis of Outcomes After Prematurity Study (closed to enrollment)

Children born prematurely are at risk white matter damage within the brain, particularly in periventricular regions. Children born preterm are also at risk for neurodevelopmental disabilities. The goal of this study is to relate the degree and patterns of white matter injury to linguistic, cognitive outcomes, academic, and behavioral outcomes. Two sophisticated MRI procedures will complement behavioral testing. (1) Diffusion Tensor Imaging (DTI) provides detailed voxel-based quantitative information on the integrity of white matter microstructure. We used multiple analytic strategies to analyze the DTI data, including tract-based spatial statisitcs and tractography. (2) Functional Magnetic Resonance Imaging (fMRI) was used to characterize the patterns of neural activity underlying cognitive skills. fMRI tasks assessed domains known to be supported in mature functioning by widely distributed brain circuitry that may be impaired after white matter injury—comprehension of syntactically complex sentences, which relies on interhemispheric integration, and oculomotor response inhibition and spatial working memory, which rely on occipital-frontal and cortical-subcortical integration.

The combination of methods will allow us to link brain structure, brain functioning, and behavioral outcomes. Participants were a group of children and adolescents, 9 to 16 years old who were born preterm and a matched group born at term. Results thus far have replicated other studies of the preterm population, confirming mild to moderate deficits in multiple domains through to adolescence. We did not find consistent differences in white matter properties comparing the preterm and full term groups. However, within the preterm group we demonstrated strong correlations of white matter properties and behavioral outcomes. Functional imaging results showed that children activate frontal brain regions when processing difficult as compared to simple sentences and the areas differ comparing preterm and full term participants.

Updated on 11/4/13

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