Bio

Clinical Focus


  • Pediatrics
  • Developmental-Behavioral Pediatrics

Academic Appointments


Administrative Appointments


  • Medical Director, Developmental and Behavioral Pediatric Programs at Lucile Packard Children's Hospital (2006 - Present)

Honors & Awards


  • C. Anderson Aldrich Award, American Academy of Pediatrics (2012)
  • Honor Roll for Teaching, Core Pediatric Clerkship, Stanford University (2008, 2009, 2011, 2012)
  • Service Above Self Award, San Andreas Regional Center, California (2010)
  • Best Doctors in America, Best Doctors (2009, 2012, 2013)
  • Ballinger-Swindells Endowed Professorship in Developmental and Behavioral Pediatrics, Stanford University School of Medicine (2006 - present)
  • Academy of Master Educators, University of Pittsburgh School of Medicine (2006)
  • Outstanding Alumna, University of California San Diego (2003)
  • Ronald L and Patricia M Violi Professor of Pediatrics and Child Development, Children's Hospital of Pittsburgh, University of Pittsburgh (2001-2006)
  • Excellence in Education Award, University of Pittsburgh School of Medicine (2000)
  • Chancellor’s Distinguished Teaching Award, University of Pittsburgh (1999)
  • National Pediatric Faculty Scholars Program, Ambulatory Pediatric Association and Health Resources and Services Administration (1998-2000)
  • Member, American Pediatrics Society (1998-present)
  • Senior Member, Society for Pediatric Research (1996-present)
  • Member, Society for Pediatric Research (1992-1996)
  • Mortar Board Senior Women's Honor Society, Chapter President, University of PA (1969-1970)
  • Miles S. Murphy Award for Distinction in Psychology, University of PA (1970)
  • Phi Beta Kappa, University of PA (1970)

Boards, Advisory Committees, Professional Organizations


  • Board Member, President of the Board, Abilities United (2009 - Present)
  • Executive Committee and Steering Committee, DBPNet: A research network in developmental-behavioral pediatrics (2010 - Present)

Professional Education


  • Board Certification: Pediatrics, American Board of Pediatrics (1985)
  • Residency:University of California San Diego (06/1982) CA
  • Internship:University of California San Diego (06/1980) CA
  • Fellowship:Children's Hospital Boston (06/1984) MA
  • Board Certification: Developmental Behavioral Pediatrics, American Board of Pediatrics (2002)
  • Fellowship:Children's Hospital Boston (06/1983) MA
  • Medical Education:University of California San Diego (1979) CA
  • MD, University of CA San Diego, Medicine (1979)
  • PhD, University of PA, Developmental Psychology (1975)

Community and International Work


  • International Collaborative Office Rounds

    Topic

    Developmental-Behavioral Pediatrics

    Partnering Organization(s)

    Yale University and National University and Hospital System Singapore

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Board of Directors, Abilities United

    Topic

    Children and Adults with Disabilities

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • Watch Me Grow: Special Needs Project of First 5 San Mateo County

    Partnering Organization(s)

    First 5 San Mateo County, Golden Gate Regional Center, and many other agencies in the County

    Populations Served

    Chidlren birth to 5

    Location

    Bay Area

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


I am a developmental-behavioral pediatrician. I became interested in the development of language as a graduate student in psycholgoy. Language development in young children becomes central to their abilities to learn, acquire information, communicate, and participate fully in the human social experience. A variety of clinical conditions put language learning at risk.

Chronic ear infections are associated with conductive hearing loss that may alter access to the verbal environment. I was part of an interdisciplinary team that investigated the long-term developmental consequences of otitis media with effusion. This research has documented that early placement of tympanostomy tubes restores normal hearing but does not confer any developmental advantages over watchful waiting in children with chronic middle ear effusions. Because the design of the study was a randomized clinical trial, the strong implication is that middle ear effusion does not cause developmental compromise in speech, language, cognition, or reading. The results have major clinical significance and have been cited in the revisions of practice guidelines for management of otitis media with effusion.

Early focal injuries to the left hemisphere damage what have been considered classic language areas of the brain. Children with such injuries learn to understand and speak competently during the preschool years, though some show mild to moderate developmental delays. Differences between children with left and right hemisphere damage are minimal even though the hemispheres seem to function very differently in adults. Children with focal injuries continue to perform only mildly below the level of their age-matched peers into school age, though both groups show improvements in performance at least through at 12 years. Functional magnetic resonance imaging document increased right hemisphere activation during language processing after focal left hemisphere injury. These studies provide an insight into the mechanisms of plasticity in the neural systems of language development.

My current research focuses on language and cognition after prematurity. A substantial proportion of children born prematurely have injury to the white matter of the brain. The study seeks to determine if the integrity of white matter tracks can explain developmental outcomes after prematurity. Results to date have found that some aspects of language function after prematurity seem to be explained by general intellectual function and other aspects, including linguistic speed and memory and reading comprehension, are explained in part by the degree of prematurity. We have found that the degree of white matter injury in various locations correlates with reading comprehension and also with memory, executive functions, and behavioral characteristics. Through case studies we have begun to find examples of injury to specific white matter tracts that link language areas in healthy adults. We have found that alternative pathways seem to carry language information from posterior to anterior language processing regions.

I am also extremely interested in improving the delivery of health care to children with developmental and behavioral disorders. To this end, I have been involved in studies that apply the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF), to care coordination and long-term planning for young adults with developmental disorders who transitioning into adult health care systems. The ICF may also prove a valuable tool within the medical home for children with developmental disorders.

Clinical Trials


  • Outcomes In Children With Developmental Delay And Deafness Recruiting

    Children with special needs require complex, individualized therapy to maximize their long-term quality of life. One subset of children with special needs includes those with both developmental delays and deafness. Currently, there is little compelling evidence supporting the idea that cochlear implantation provides benefit to children that don't have the cognitive potential to develop normal speech and language. We will perform a prospective, randomized clinical trial to answer the question of which intervention provides more benefit to this population of children using validated, norm-referenced tests. Our long-term goal is to develop guidelines that may help when selecting a treatment for hearing loss in a child with developmental delays. This proposal is significant because children with special needs are deserving of evidence upon which to base treatment decision-making, but remain under-represented in the medical literature and are often not studied. This research is designed to meet the criteria for the National Institutes of Health road map because it will generate this type of objective evidence that can directly improve patient care.

    View full details

Teaching

2013-14 Courses


Graduate and Fellowship Programs


  • Developmental-Behavioral Pediatrics (Fellowship Program)

Publications

Journal Articles


  • Clinical practice. Attention deficit-hyperactivity disorder in children and adolescents. New England journal of medicine Feldman, H. M., Reiff, M. I. 2014; 370 (9): 838-846

    View details for DOI 10.1056/NEJMcp1307215

    View details for PubMedID 24571756

  • Diagnostic and statistical manual of mental disorders: the solution or the problem? Journal of developmental and behavioral pediatrics Reiff, M. I., Feldman, H. M. 2014; 35 (1): 68-70

    View details for DOI 10.1097/DBP.0000000000000017

    View details for PubMedID 24399102

  • Case series: fractional anisotropy along the trajectory of selected white matter tracts in adolescents born preterm with ventricular dilation. Journal of child neurology Myall, N. J., Yeom, K. W., Yeatman, J. D., Gaman-Bean, S., Feldman, H. M. 2013; 28 (6): 774-780

    Abstract

    This case series assesses white matter microstructure in 3 adolescents born preterm with nonshunted ventricular dilation secondary to intraventricular hemorrhage. Subjects (ages 12-17 years, gestational age 26-29 weeks, birth weight 825-1624 g) were compared to 3 full-term controls (13-17 years, 39-40 weeks, 3147-3345 g) and 3 adolescents born preterm without ventricular dilation (10-13 years, 26-29 weeks, 630-1673 g). Tractography using a 2 region of interest method reconstructed the following white matter tracts: superior longitudinal/arcuate fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, and corticospinal tract. Subjects showed increased fractional anisotropy and changes in the pattern of fractional anisotropy along the trajectory of tracts adjacent to the lateral ventricles. Tensor shape at areas of increased fractional anisotropy demonstrated increased linear anisotropy at the expense of planar and spherical anisotropy. These findings suggest increased axonal packing density and straightening of fibers secondary to ventricular enlargement.

    View details for DOI 10.1177/0883073812449693

    View details for PubMedID 22859695

  • Attention and Internalizing Behaviors in Relation to White Matter in Children Born Preterm JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Loe, I. M., Lee, E. S., Feldman, H. M. 2013; 34 (3): 156-164

    Abstract

    Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that provides quantitative characterization of white matter tracts in the brain. This study used DTI to examine the degree of association between parent-rated scores of attention, internalizing behaviors including anxiety symptoms, and externalizing behaviors and white matter fractional anisotropy (FA) in children born preterm.Participants were aged 9 to 16 years; 25 were born at <36 weeks of gestation (mean = 28.6 wk, birth weight = 1191 g) and 20 were full term. The authors analyzed the results using Tract-Based Spatial Statistics, a technique that generates a skeleton representing the core of white matter tracts throughout the brain. The authors examined the correlations between behavior scores and FA of (1) the whole skeleton and (2) the specific regions of interest.In preterm children, scores on attention and internalizing behavior scales were each associated with whole skeleton FA and several regions of interest; unfavorable scores were consistently associated with lower FA. Externalizing behaviors were not associated with whole skeleton FA, but significant associations were found within a few regions of interest. The network of significant regions for attention and internalizing symptoms was widely distributed and overlapping. In full-term children, no associations of FA and behavior were significant.Attention and internalizing behaviors in preterm children were associated with FA in a widely distributed overlapping network of white matter tracts, suggesting common underlying neurobiology. DTI contributes to understanding individual differences in attention and behavior characteristics in children born preterm.

    View details for DOI 10.1097/DBP.0b013e3182842122

    View details for Web of Science ID 000317483400002

    View details for PubMedID 23572166

  • Hospitalizations of Children with Autism Increased from 1999-2009. Journal of Autism and Developmental Disorders Nayfack, A. M., Huffman, L. C., Feldman, H. M., Chan, J., Saynina, O., Wise, P. H. 2013; on line
  • Neural plasticity after pre-linguistic injury to the arcuate and superior longitudinal fasciculi CORTEX Yeatman, J. D., Feldman, H. M. 2013; 49 (1): 301-311

    Abstract

    We describe the case of girl who was born prematurely and diagnosed periventricular leukomalacia, a condition characterized by severe injury to the white matter tracts primarily surrounding the ventricles. At 12 years of age, we obtained diffusion tensor imaging (DTI) data on this child as part of a research protocol. Multiple analyses of DTI data, including tractography, showed that the left and right arcuate and superior longitudinal fasciculi were missing in the child though all other major white matter tracts were present. Standardized psychometric tests at age 12 years revealed that despite early language delays, she had average scores on expressive language, sentence repetition, and reading, functions that have been hypothesized to depend on signals carried by the arcuate fasciculus. We identified intact ventral connections between the temporal and frontal lobes through the extreme capsule fiber system and uncinate fasciculus. Preserved language and reading function after serious injury to the arcuate fasciculus highlights the plasticity of the developing brain after severe white matter injury early in life.

    View details for DOI 10.1016/j.cortex.2011.08.006

    View details for Web of Science ID 000314323600026

    View details for PubMedID 21937035

  • Effects of early language, speech, and cognition on later reading: a mediation analysis. Frontiers in psychology Durand, V. N., Loe, I. M., Yeatman, J. D., Feldman, H. M. 2013; 4: 586-?

    Abstract

    This longitudinal secondary analysis examined which early language and speech abilities are associated with school-aged reading skills, and whether these associations are mediated by cognitive ability. We analyzed vocabulary, syntax, speech sound maturity, and cognition in a sample of healthy children at age 3 years (N = 241) in relation to single word reading (decoding), comprehension, and oral reading fluency in the same children at age 9-11 years. All predictor variables and the mediator variable were associated with the three reading outcomes. The predictor variables were all associated with cognitive abilities, the mediator. Cognitive abilities partially mediated the effects of language on reading. After mediation, decoding was associated with speech sound maturity; comprehension was associated with receptive vocabulary; and oral fluency was associated with speech sound maturity, receptive vocabulary, and syntax. In summary, all of the effects of language on reading could not be explained by cognition as a mediator. Specific components of language and speech skills in preschool made independent contributions to reading skills 6-8 years later. These early precursors to later reading skill represent potential targets for early intervention to improve reading.

    View details for DOI 10.3389/fpsyg.2013.00586

    View details for PubMedID 24027549

  • Language and reading skills in school-aged children and adolescents born preterm are associated with white matter properties on diffusion tensor imaging NEUROPSYCHOLOGIA Feldman, H. M., Lee, E. S., Yeatman, J. D., Yeom, K. W. 2012; 50 (14): 3348-3362

    Abstract

    Children born preterm are at risk for deficits in language and reading. They are also at risk for injury to the white matter of the brain. The goal of this study was to determine whether performance in language and reading skills would be associated with white matter properties in children born preterm and full-term. Children born before 36 weeks gestation (n=23, mean±SD age 12.5±2.0 years, gestational age 28.7±2.5 weeks, birth weight 1184±431 g) and controls born after 37 weeks gestation (n=19, 13.1±2.1 years, 39.3±1.0 weeks, 3178±413 g) underwent a battery of language and reading tests. Diffusion tensor imaging (DTI) scans were processed using tract-based spatial statistics to generate a core white matter skeleton that was anatomically comparable across participants. Fractional anisotropy (FA) was the diffusion property used in analyses. In the full-term group, no regions of the whole FA-skeleton were associated with language and reading. In the preterm group, regions of the FA-skeleton were significantly associated with verbal IQ, linguistic processing speed, syntactic comprehension, and decoding. Combined, the regions formed a composite map of 22 clusters on 15 tracts in both hemispheres and in the ventral and dorsal streams. ROI analyses in the preterm group found that several of these regions also showed positive associations with receptive vocabulary, verbal memory, and reading comprehension. Some of the same regions showed weak negative correlations within the full-term group. Exploratory multiple regression in the preterm group found that specific white matter pathways were related to different aspects of language processing and reading, accounting for 27-44% of the variance. The findings suggest that higher performance in language and reading in a group of preterm but not full-term children is associated with higher fractional anisotropy of a bilateral and distributed white matter network.

    View details for DOI 10.1016/j.neuropsychologia.2012.10.014

    View details for Web of Science ID 000313142700020

    View details for PubMedID 23088817

  • Tract Profiles of White Matter Properties: Automating Fiber-Tract Quantification PLOS ONE Yeatman, J. D., Dougherty, R. F., Myall, N. J., Wandell, B. A., Feldman, H. M. 2012; 7 (11)

    Abstract

    Tractography based on diffusion weighted imaging (DWI) data is a method for identifying the major white matter fascicles (tracts) in the living human brain. The health of these tracts is an important factor underlying many cognitive and neurological disorders. In vivo, tissue properties may vary systematically along each tract for several reasons: different populations of axons enter and exit the tract, and disease can strike at local positions within the tract. Hence quantifying and understanding diffusion measures along each fiber tract (Tract Profile) may reveal new insights into white matter development, function, and disease that are not obvious from mean measures of that tract. We demonstrate several novel findings related to Tract Profiles in the brains of typically developing children and children at risk for white matter injury secondary to preterm birth. First, fractional anisotropy (FA) values vary substantially within a tract but the Tract FA Profile is consistent across subjects. Thus, Tract Profiles contain far more information than mean diffusion measures. Second, developmental changes in FA occur at specific positions within the Tract Profile, rather than along the entire tract. Third, Tract Profiles can be used to compare white matter properties of individual patients to standardized Tract Profiles of a healthy population to elucidate unique features of that patient's clinical condition. Fourth, Tract Profiles can be used to evaluate the association between white matter properties and behavioral outcomes. Specifically, in the preterm group reading ability is positively correlated with FA measured at specific locations on the left arcuate and left superior longitudinal fasciculus and the magnitude of the correlation varies significantly along the Tract Profiles. We introduce open source software for automated fiber-tract quantification (AFQ) that measures Tract Profiles of MRI parameters for 18 white matter tracts. With further validation, AFQ Tract Profiles have potential for informing clinical management and decision-making.

    View details for DOI 10.1371/journal.pone.0049790

    View details for Web of Science ID 000311151900195

    View details for PubMedID 23166771

  • White matter microstructure on diffusion tensor imaging is associated with conventional magnetic resonance imaging findings and cognitive function in adolescents born preterm DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Feldman, H. M., Lee, E. S., Loe, I. M., Yeom, K. W., Grill-Spector, K., Luna, B. 2012; 54 (9): 809-814

    Abstract

    Diffusion tensor imaging (DTI) was used to evaluate white matter architecture after preterm birth. The goals were (1) to compare white matter microstructure in two cohorts of preterm- and term-born children; and (2) within preterm groups, to determine if sex, gestational age, birthweight, white matter injury score from conventional magnetic resonance imaging (MRI), or IQ was associated with DTI measures.Participants (n=121; 66 females, 55 males) were aged 9 to 16 years. They comprised 58 preterm children (site 1, n=25; and site 2, n=33) born at less than 36 weeks' gestation (mean 29.4 wks; birthweight 1289g) and 63 term children (site 1, n=40; site 2, n=23) born at more than 37 weeks' gestation. DTI was analyzed using tract-based spatial statistics. Diffusion measures were fractional anisotropy, axial, radial, and mean diffusivity.In no region of the white matter skeleton was fractional anisotropy lower in the preterm group at either site. Within the preterm groups, fractional anisotropy was significantly associated with white matter injury score, but not sex, gestational age, or birthweight. At site 1, fractional anisotropy was associated with IQ.DTI contributes to understanding individual differences after preterm birth but may not differentiate a relatively high-functioning group of preterm children from a matched group of term-born children.

    View details for DOI 10.1111/j.1469-8749.2012.04378.x

    View details for Web of Science ID 000307468700011

    View details for PubMedID 22803787

  • Oculomotor Assessments of Executive Function in Preterm Children JOURNAL OF PEDIATRICS Loe, I. M., Luna, B., Bledsoe, I. O., Yeom, K. W., Fritz, B. L., Feldman, H. M. 2012; 161 (3): 427-?

    Abstract

    To use objective, nonverbal oculomotor tasks to assess executive function and infer the neural basis of impairments in preterm children.Cross-sectional study of preterm children age 9-16 years (n = 69; mean gestational age 29 weeks) and full-term controls (n = 43). Tasks assessed sensorimotor function (reflexive prosaccades); resistance to peripheral distracters (fixation); response inhibition, response preparation, and execution of a voluntary saccade (antisaccades); and spatial working memory (memory-guided saccades). Group differences were analyzed using ANOVA. We used linear regression to analyze the contributions of age, sex, gestational age, and white matter category to task performance.Preterm children did not differ from controls on basic sensorimotor function, response inhibition, and working memory. Compared with controls, preterm children showed greater susceptibility to peripheral distracters (P = .008) and were slower to initiate an inhibitory response (P = .003). Regression models showed contributions of age and white matter category to task performance.Preterm children show intact basic sensorimotor function and demonstrate difficulties in processes underlying executive control, including increased distractibility and prolonged response preparation. These limitations may reflect specific neural abnormalities in fronto-subcortical executive control of behavior.

    View details for DOI 10.1016/j.jpeds.2012.02.037

    View details for Web of Science ID 000308141700015

    View details for PubMedID 22480696

  • Research Priorities for Developmental-Behavioral Pediatrics: A DBPNet Consensus Study JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Blum, N. J., Feldman, H. M., Barbaresi, W. J., Schonfeld, D. J., Hansen, R. L., Forrest, C. B. 2012; 33 (6): 509-516

    Abstract

    To achieve consensus regarding important clinical, translational, and health services research questions for the field of developmental-behavioral pediatrics (DBP).Twenty-seven developmental-behavioral pediatricians, 16 psychologists, and 12 parents participated in a 3-round Delphi survey. Participation was 100% in Rounds I and III and 96% in Round II. In Round I, each participant suggested up to 10 research questions important for DBP in the next 5 years. In Round II, participants rated the importance of each unique question on a 9-point Likert scale. Questions were rated as consensus important questions if they had a median score of 7 and the 25th percentile was at least 6 or the coefficient of variation ?30 (suggesting consensus). Questions were rated as potentially important if they had a median of 7, but a coefficient of variation >30 or if specific stakeholder group ratings suggested importance. After providing participants the Round II results, potentially important questions were rated a second time (Round III).In Round I, 216 unique research questions were identified. In Round II, 29 of these questions met the criteria for a consensus important question and 60 questions were rated as potentially important. In Round III, 10 additional questions were rated as consensus important questions. Of the 39 consensus important questions, 20 were efficacy or comparative effectiveness studies and 40% related to autism spectrum disorders.This Delphi process identified a set of high priority clinical, translational, and health services research topics for DBP that can guide research to advance the field and improve care and outcomes for children with DBP conditions.

    View details for DOI 10.1097/DBP.0b013e31825a7101

    View details for Web of Science ID 000306281500011

    View details for PubMedID 22710856

  • Missed Opportunities in the Referral of High-Risk Infants to Early Intervention PEDIATRICS Tang, B. G., Feldman, H. M., Huffman, L. C., Kagawa, K. J., Gould, J. B. 2012; 129 (6): 1027-1034

    Abstract

    Using a statewide population-based data source, we describe current neonatal follow-up referral practices for high-risk infants with developmental delays throughout California.From a cohort analysis of quality improvement data from 66 neonatal follow-up programs in the California Children's Services and California Perinatal Quality Care Collaborative High-Risk Infant Follow-Up Quality of Care Initiative, 5129 high-risk infants were evaluated at the first visit between 4 and 8 months of age in neonatal follow-up. A total of 1737 high-risk infants were evaluated at the second visit between 12 and 16 months of age. We calculated referral rates in relation to developmental status (high versus low concern) based on standardized developmental testing or screening.Among infants with low concerns (standard score >70 or passed screen) at the first visit, 6% were referred to early intervention; among infants with high concerns, 28% of infants were referred to early intervention. Even after including referrals to other (private) therapies, 34% infants with high concerns did not receive any referrals. These rates were similar for the second visit.In spite of the specialization of neonatal follow-up programs to identify high-risk infants with developmental delays, a large proportion of potentially eligible infants were not referred to early intervention.

    View details for DOI 10.1542/peds.2011-2720

    View details for Web of Science ID 000304707000036

    View details for PubMedID 22614772

  • Differences in neural activation between preterm and full term born adolescents on a sentence comprehension task: Implications for educational accommodations DEVELOPMENTAL COGNITIVE NEUROSCIENCE Barde, L. H., Yeatman, J. D., Lee, E. S., Glover, G., Feldman, H. M. 2012; 2: S114-S128

    Abstract

    Adolescent survivors of preterm birth experience persistent functional problems that negatively impact academic outcomes, even when standardized measures of cognition and language suggest normal ability. In this fMRI study, we compared the neural activation supporting auditory sentence comprehension in two groups of adolescents (ages 9-16 years); sentences varied in length and syntactic difficulty. Preterms (n=18, mean gestational age 28.8 weeks) and full terms (n=14) had scores on verbal IQ, receptive vocabulary, and receptive language tests that were within or above normal limits and similar between groups. In early and late phases of the trial, we found interactions by group and length; in the late phase, we also found a group by syntactic difficulty interaction. Post hoc tests revealed that preterms demonstrated significant activation in the left and right middle frontal gyri as syntactic difficulty increased. ANCOVA showed that the interactions could not be attributed to differences in age, receptive language skill, or reaction time. Results are consistent with the hypothesis that preterm birth modulates brain-behavior relations in sentence comprehension as task demands increase. We suggest preterms' differences in neural processing may indicate a need for educational accommodations, even when formal test scores indicate normal academic achievement.

    View details for DOI 10.1016/j.dcn.2011.10.002

    View details for Web of Science ID 000315317400011

    View details for PubMedID 22682901

  • Executive function skills are associated with reading and parent-rated child function in children born prematurely EARLY HUMAN DEVELOPMENT Loe, I. M., Lee, E. S., Luna, B., Feldman, H. M. 2012; 88 (2): 111-118

    Abstract

    Preterm children are at risk for executive function (EF) problems, which have been linked to behavior and learning problems in full term children. In this study, we examine the relationship between EF and functional outcomes in preterm children.To evaluate (1) EF skills of 9- to 16-year-old children born across the spectrum of gestational age (GA), (2) relationship of degree of prematurity to EF skills, and (3) contributions of EF skills to two functional outcomes - reading scores and parent-rated child function.Preterm children <36 weeks gestation (n=72) were compared to full term children (n=42) of similar age, gender and SES, on measures of EF, reading, and parent-ratings of child function. Multiple regression models evaluated contributions to EF skills and functional outcomes.Compared to full term controls, preterm children had poorer EF performance on a complex planning and organization task and did not increase planning time as task difficulty increased. Their spatial memory capacity was not different. GA contributed to EF skills, but was mediated by IQ. EF contributed to the variance in reading skills but did not add to the variance in reading when IQ was considered. EF skills significantly contributed to the variance in parent-rated child function, but IQ did not.EF skills contribute to measures of functional outcome in this high-risk population. The use of EF skills as an early marker for learning and functional problems and as a target for intervention in children born preterm warrants future study.

    View details for DOI 10.1016/j.earlhumdev.2011.07.018

    View details for Web of Science ID 000301474900012

    View details for PubMedID 21849240

  • The Developmental-Behavioral Pediatrics Research Network (DBPNet): Another Step in the Development of the Field. Journal of Developmental and Behavioral Pediatrics Blum, N. J. 2012; 33 (1): 78-83
  • Myofascial structural integraton: A promising complementary therapy for young children with spastic cerebral palsy Journal of Evidence-Based Complementary and Alternative Medicine Hansen AB, Price KS, Feldman HM 2012; 17 (2): 131-135
  • ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents PEDIATRICS Wolraich, M., Brown, L., Brown, R. T., DuPaul, G., Earls, M., Feldman, H. M., Ganiats, T. G., Kaplanek, B., Meyer, B., Perrin, J., Pierce, K., Reiff, M., Stein, M. T., Visser, S. 2011; 128 (5): 1007-1022

    Abstract

    Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of children; the American Academy of Pediatrics first published clinical recommendations for the diagnosis and evaluation of ADHD in children in 2000; recommendations for treatment followed in 2001.

    View details for DOI 10.1542/peds.2011-2654

    View details for Web of Science ID 000296714000069

    View details for PubMedID 22003063

  • Behavior problems of 9-16 year old preterm children: Biological, sociodemographic, and intellectual contributions EARLY HUMAN DEVELOPMENT Loe, I. M., Lee, E. S., Luna, F., Feldman, H. M. 2011; 87 (4): 247-252

    Abstract

    Preterm children are at risk for behavior problems. Studies examining contributions of intellectual and environmental factors to behavior outcomes in preterm children are mixed.(1) To identify the nature of maladaptive behaviors in preterm children age 9 to 16 years born across the spectrum of gestational age and birth weight (BW). (2) To examine contributions of BW as a biological factor, socioeconomic status as an environmental factor, and intelligence quotient (IQ) as indicative of intellectual ability to behavior outcomes.Using the Child Behavior Checklist, parent reports of behavior for 63 preterm children (gestational age 24 to <36 weeks) were compared to 29 full term children of similar age, gender and socioeconomic status. Multiple regression models evaluated effects of prematurity, socioeconomic status, and intellectual ability on behavioral symptom scores.Preterm children had higher total and internalizing problem scores compared to full term children. They also had lower IQ. BW was a significant predictor of total and internalizing behavior problems. Among the syndrome scales, anxious/depressed and attention problems were elevated. Socioeconomic status did not contribute to behavior scores. IQ contributed to total, but not to internalizing or externalizing, scores. IQ contributed to attention problems, but not to anxious/depressed scores.Preterm children had increased behavior problems, especially symptoms of inattention and anxiety. Lower BW predicted more behavior problems. IQ acted as a mediator between BW and attention scores, but not anxiety scores. These findings alert health care providers to assess anxiety in all preterm children regardless of intellectual ability and additional study on the influence of intellectual ability on behavioral outcomes in preterm children is needed.

    View details for DOI 10.1016/j.earlhumdev.2011.01.023

    View details for Web of Science ID 000289605500002

    View details for PubMedID 21316875

  • Specific language and reading skills in school-aged children and adolescents are associated with prematurity after controlling for IQ NEUROPSYCHOLOGIA Lee, E. S., Yeatman, J. D., Luna, B., Feldman, H. M. 2011; 49 (5): 906-913

    Abstract

    Although studies of long-term outcomes of children born preterm consistently show low intelligence quotient (IQ) and visual-motor impairment, studies of their performance in language and reading have found inconsistent results. In this study, we examined which specific language and reading skills were associated with prematurity independent of the effects of gender, socioeconomic status (SES), and IQ. Participants from two study sites (N=100) included 9-16-year old children born before 36 weeks gestation and weighing less than 2500 grams (preterm group, n=65) compared to children born at 37 weeks gestation or more (full-term group, n=35). Children born preterm had significantly lower scores than full-term controls on Performance IQ, Verbal IQ, receptive and expressive language skills, syntactic comprehension, linguistic processing speed, verbal memory, decoding, and reading comprehension but not on receptive vocabulary. Using MANCOVA, we found that SES, IQ, and prematurity all contributed to the variance in scores on a set of six non-overlapping measures of language and reading. Simple regression analyses found that after controlling for SES and Performance IQ, the degree of prematurity as measured by gestational age group was a significant predictor of linguistic processing speed, ?=-.27, p<.05, R(2)=.07, verbal memory, ?=.31, p<.05, R(2)=.09, and reading comprehension, ?=.28, p<.05, R(2)=.08, but not of receptive vocabulary, syntactic comprehension, or decoding. The language and reading domains where prematurity had a direct effect can be classified as fluid as opposed to crystallized functions and should be monitored in school-aged children and adolescents born preterm.

    View details for DOI 10.1016/j.neuropsychologia.2010.12.038

    View details for Web of Science ID 000290649200016

    View details for PubMedID 21195100

  • Management of Symptoms in Children With Autism Spectrum Disorders: A Comprehensive Review of Pharmacologic and Complementary-Alternative Medicine Treatments JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Huffman, L. C., Sutcliffe, T. L., Tanner, I. S., Feldman, H. M. 2011; 32 (1): 56-68

    Abstract

    In the care of children with autism spectrum disorders (ASD), medical treatment is typically considered an adjunct to educational and behavioral interventions. Nonetheless, large proportions of children with ASD are managed medically and receive both pharmacologic and complementary-alternative medicine (CAM) treatments. Although many medical treatments have been studied in children with ASD, studies vary widely in terms of the sample, sample size, research design, purposes of treatment, and measurements of change. Surprisingly, comprehensive reviews of the options for medical management in ASD are lacking, particularly reviews that address both pharmacologic and CAM treatments. Furthermore, reviews to date tend to emphasize general effects of medication; this perspective contradicts medical practice, which targets particular symptoms during treatment selection and monitoring. This review of 115 studies adds to the ASD treatment literature by (1) including studies of individuals 0 to 22 years of age; (2) aggregating studies of pharmacologic treatments and CAM treatments; and importantly, (3) organizing treatment response by ASD symptoms, differentiating core and associated symptoms.

    View details for DOI 10.1097/DBP.0b013e3182040acf

    View details for Web of Science ID 000285914200011

    View details for PubMedID 21160435

  • Individual differences in auditory sentence comprehension in children: An exploratory event-related functional magnetic resonance imaging investigation BRAIN AND LANGUAGE Yeatman, J. D., Ben-Shachar, M., Glover, G. H., Feldman, H. M. 2010; 114 (2): 72-79

    Abstract

    The purpose of this study was to explore changes in activation of the cortical network that serves auditory sentence comprehension in children in response to increasing demands of complex sentences. A further goal is to study how individual differences in children's receptive language abilities are associated with such changes in cortical responses. Fourteen children, 10-16 years old, participated in an event-related functional magnetic resonance imaging experiment using a cross modal sentence-picture verification paradigm. We manipulated sentence difficulty and length in a 2x2 factorial design. Task-related activation covered large regions of the left and right superior temporal cortex, inferior parietal lobe, precuneous, cingulate, middle frontal gyrus and precentral gyrus. Sentence difficulty, independent of length, led to increased activation in the left temporal-parietal junction and right superior temporal gyrus. Changes in activation in frontal regions positively correlated with age-standardized receptive vocabulary scores and negatively correlated with reaction time on a receptive grammar test outside the scanner. Thus, individual differences in language skills were associated with changes in the network in response to changing task demands. These preliminary findings in a small sample of typically developing children suggest that the investigation of individual differences may prove useful in elucidating the underlying neural mechanisms of language disorders in children.

    View details for DOI 10.1016/j.bandl.2009.11.006

    View details for Web of Science ID 000280975600003

    View details for PubMedID 20053431

  • Reading performance correlates with white-matter properties in preterm and term children DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY Andrews, J. S., Ben-Shachar, M., Yeatman, J. D., Flom, L. L., Luna, B., Feldman, H. M. 2010; 52 (6): E94-E100

    Abstract

    We used diffusion tensor imaging to investigate the association between white-matter integrity and reading ability in a cohort of 28 children. Nineteen preterm children (14 males, five females; mean age 11 y 11 mo [SD 1 y 10 mo], mean gestational age 30.5 wks (SD 3.2), mean birthweight was 1455 g [SD 625]); and nine term children (five males, four females; mean age 12 y 8 mo [SD 2 y 5 mo], mean gestational age 39.6 wks (SD 1.2), and mean birthweight 3877 g [SD 473]).We tested whether fractional anisotropy in a left hemisphere temporoparietal region and in the corpus callosum correlates with birthweight and scores on the following three subtests of the Woodcock-Johnson III Tests of Achievement: word identification, word attack, and passage comprehension.Preterm children had lower reading scores than a comparison group for all reading subtests (p<0.05). We found significant correlations between birthweight and fractional anisotropy in the whole corpus callosum (p=0.001), and between fractional anisotropy and reading skill in the genu (p=0.001) and body (p=0.001) of the corpus callosum. The correlation between reading skill and fractional anisotropy in a left temporoparietal region previously associated with reading disability was not significant (p=0.095).We conclude that perinatal white-matter injury of the central corpus callosum may have long-term developmental implications for reading performance.

    View details for DOI 10.1111/j.1469-8749.2009.03456.x

    View details for Web of Science ID 000277524800023

    View details for PubMedID 19747208

  • Diffusion Tensor Imaging: A Review for Pediatric Researchers and Clinicians JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H. M., Yeatman, J. D., Lee, E. S., Barde, L. H., Gaman-Bean, S. 2010; 31 (4): 346-356

    Abstract

    Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that allows for the visualization and characterization of the white matter tracts of the brain in vivo. DTI does not assess white matter directly. Rather, it capitalizes on the fact that diffusion is isotropic (equal in all directions) in cerebral spinal fluid and cell bodies but anisotropic (greater in one direction than the other directions) in axons that comprise white matter. It provides quantitative information about the degree and direction of water diffusion within individual units of volume within the magnetic resonance image, and by inference, about the integrity of white matter. Measures from DTI can be applied throughout the brain or to regions of interest. Fiber tract reconstruction, or tractography, creates continuous 3-dimensional tracts by sequentially piecing together estimates of fiber orientation from the direction of diffusion within individual volume units. DTI has increased our understanding of white matter structure and function. DTI shows nonlinear growth of white matter tracts from childhood to adulthood. Delayed maturation of the white matter in the frontal lobes may explain the continued growth of cognitive control into adulthood. Relative to good readers, adults and children who are poor readers have evidence of white matter differences in a specific region of the temporo-parietal lobe, implicating differences in connections among brain regions as a factor in reading disorder. Measures from DTI changed in poor readers who improved their reading skills after intense remediation. DTI documents injury to white matter tracts after prematurity. Measures indicative of white matter injury are associated with motor and cognitive impairment in children born prematurely. Further research on DTI is necessary before it can become a routine clinical procedure.

    View details for DOI 10.1097/DBP.0b013e3181dcaa8b

    View details for Web of Science ID 000277769600015

    View details for PubMedID 20453582

  • Delayed Recognition of Profound Hearing Loss in a 7-Year-Old Girl With a Neurological Condition JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Tang, B. G., Feldman, H. M., Padden, C., Israeli, N., Stein, M. T. 2010; 31 (3): S42-S45

    Abstract

    Kelly is a 7-year-old girl with a complex medical history including asthma, mild spastic diplegia, and seizure disorder that is controlled with carbamazepine. She had a significant receptive and expressive language impairment and milder delays in gross and fine motor skills. Kelly is currently repeating first grade in a self-contained classroom; she receives speech, occupational, and physical therapy. At the 7-year-old well child visit, her mother is worried about Kelly's poor progress in school, and she expresses concern about her daughter's hearing. Her pediatrician observes that Kelly is withdrawn, uses minimal language, and is fearful of the examination. Kelly was born full-term by Cesarean section because of placental abruption. She was in the neonatal intensive care nursery for 2 weeks with metabolic acidosis because of acute tubular necrosis. One day after arriving home, she had a cardiopulmonary arrest followed by emergency open-heart surgery for critical pulmonary hypertension. Her postoperative course was significant for renal failure, extracorporal membrane oxygenation, ventilator dependency, tracheostomy, and gastrostomy. By 3 years of age her medical condition stabilized, and the tracheostomy and gastrostomy tubes were removed. A review of Kelly's previous audiological tests revealed a failed otoacoustic emission test at 5 months. An auditory brain stem response test at 8 months recorded normal hearing in the right ear. At 4 years, behavioral audiometry was attempted but not completed because Kelly cried throughout the session. At 5 years, testing with ear inserts showed normal hearing bilaterally. Because of the concerns raised by Kelly's mother at the pediatric visit, she was referred to audiology for a reevaluation. Testing at this time revealed moderate to profound sensorineural hearing loss in both the ears, which was confirmed on subsequent examinations. Kelly was promptly fitted for hearing aids. Her individual education plan was changed to reflect the diagnosis of hearing impairment, and hearing services were implemented in the classroom. On a recent follow-up visit, Kelly was talkative, engaging, and cheerful.

    View details for DOI 10.1097/DBP.0b013e3181d82efc

    View details for Web of Science ID 000277185500013

    View details for PubMedID 20414074

  • Delayed Recognition of Profound Hearing Loss in a 7-Year-Old Girl With a Neurological Condition JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Tang, B. G., Feldman, H. M., Padden, C., Israeli, N., Stein, M. T. 2009; 30 (4): 327-330

    Abstract

    Kelly is a 7-year-old girl with a complex medical history including asthma, mild spastic diplegia, and seizure disorder that is controlled with carbamazepine. She had a significant receptive and expressive language impairment and milder delays in gross and fine motor skills. Kelly is currently repeating first grade in a self-contained classroom; she receives speech, occupational, and physical therapy. At the 7-year-old well child visit, her mother is worried about Kelly's poor progress in school, and she expresses concern about her daughter's hearing. Her pediatrician observes that Kelly is withdrawn, uses minimal language, and is fearful of the examination.Kelly was born full-term by Cesarean section because of placental abruption. She was in the neonatal intensive care nursery for 2 weeks with metabolic acidosis because of acute tubular necrosis. One day after arriving home, she had a cardiopulmonary arrest followed by emergency open-heart surgery for critical pulmonary hypertension. Her postoperative course was significant for renal failure, extracorporal membrane oxygenation, ventilator dependency, tracheostomy, and gastrostomy. By 3 years of age her medical condition stabilized, and the tracheostomy and gastrostomy tubes were removed.A review of Kelly's previous audiological tests revealed a failed otoacoustic emission test at 5 months. An auditory brain stem response test at 8 months recorded normal hearing in the right ear. At 4 years, behavioral audiometry was attempted but not completed because Kelly cried throughout the session. At 5 years, testing with ear inserts showed normal hearing bilaterally.Because of the concerns raised by Kelly's mother at the pediatric visit, she was referred to audiology for a reevaluation. Testing at this time revealed moderate to profound sensorineural hearing loss in both the ears, which was confirmed on subsequent examinations. Kelly was promptly fitted for hearing aids. Her individual education plan was changed to reflect the diagnosis of hearing impairment, and hearing services were implemented in the classroom. On a recent follow-up visit, Kelly was talkative, engaging, and cheerful.

    View details for Web of Science ID 000269066000008

    View details for PubMedID 19672159

  • Using Diffusion Tensor Imaging and Fiber Tracking to Characterize Diffuse Perinatal White Matter Injury: A Case Report JOURNAL OF CHILD NEUROLOGY Yeatman, J. D., Ben-Shachar, M., Bammer, R., Feldman, H. M. 2009; 24 (7): 795-800

    Abstract

    Prematurity is associated with white matter injury. Diffusion tensor imaging, a new magnetic resonance imaging technique, identifies white matter fiber tracts and quantifies structural properties. We used diffusion tensor imaging fiber tracking to compare white matter characteristics in a 12-year-old born prematurely and full-term control. We divided fibers passing through the corpus callosum into 7 segments based on cortical projection zones and analyzed them for fractional anisotropy, axial diffusivity, and radial diffusivity. We also compared corticospinal and somatosensory tracts in the participant and control. The participant had decreased fractional anisotropy in every callosal segment, particularly in superior and posterior parietal projections. Fractional anisotropy of the corticospinal and somatosensory tracts was not lower in the participant than control. Fiber tracking allowed precise localization and visualization of white matter injuries of the corpus callosum associated with prematurity. Quantitative measures suggested myelin deficiencies across the corpus callosum, particularly in parietal projections.

    View details for DOI 10.1177/0883073808331080

    View details for Web of Science ID 000267347000002

    View details for PubMedID 19435729

  • Oculomotor Performance Identifies Underlying Cognitive Deficits in Attention-Deficit/Hyperactivity Disorder JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Loe, I. M., Feldman, H. M., Yasui, E., Luna, B. 2009; 48 (4): 431-440

    Abstract

    To evaluate cognitive control in children with attention-deficit/hyperactivity disorder (ADHD) using oculomotor tests of executive function.Cross-sectional study of children aged 8 to 13 years with ADHD (n = 26) and controls (n = 33) used oculomotor tasks to assess sensorimotor function (visually guided saccades), resistance to peripheral distractors (fixation), response inhibition (antisaccades), and spatial working memory (memory-guided saccades).All children had intact sensorimotor function and working memory. Children with ADHD showed susceptibility to peripheral distractors and deficits in response inhibition. Increased interstimulus (IS) fixation periods on the antisaccade task were associated with improved performance and decreased reaction times on correct trials for controls but not for children with ADHD. Attention-deficit/hyperactivity disorder-combined and inattentive subtypes showed different patterns of reaction time as a function of IS periods.Response inhibition deficits in ADHD on oculomotor tasks are consistent with other studies. The failure of children with ADHD to use IS time to decrease response inhibition errors and reaction time suggests that IS time is not used to prepare a response. These findings highlight the importance of considering cognitive processing components affected by ADHD in addition to core behavioral symptoms, particularly in designing new treatment strategies.

    View details for DOI 10.1097/CHI.0b013e31819996da

    View details for Web of Science ID 000264507800011

    View details for PubMedID 19238098

  • Otitis Media with Effusion and Child Development: Rethinking management. Contemporary Pediatrics Feldman, H. M., Paradise, J. L. 2009; 26 (5): 40-47
  • Functional characteristics of children diagnosed with Childhood Apraxia of Speech DISABILITY AND REHABILITATION Teverovsky, E. G., Bickel, J. O., Feldman, H. M. 2009; 31 (2): 94-102

    Abstract

    The purpose of this study was to describe the complex array of functional problems in children diagnosed by their treating speech/language pathologist with Childhood Apraxia of Speech (CAS), a poorly understood, severe speech sound disorder.We asked parents (n = 201) attending the first national parent conference on CAS to voluntarily complete a survey, which evaluated 43 functional domains from the International Classification of Functioning, Disability, and Health-Children and Youth version (ICF-CY). The survey also included questions about co-existing medical, developmental, and mental health conditions and about service utilization. Data were analyzed using descriptive statistics and exploratory factor analysis.The most prevalent functional problems in addition to communication were attention (focus), vestibular function, temperament, fine hand use, maintaining attention, and learning to write. Four orthogonal factors accounted for 23% of the variance in functional problems: Cognitive and Learning Problems, Social Communication Difficulties, Behavioral Dysregulation, and Other Oral Motor Problems. Over half the sample had health, mental health, and developmental conditions. Almost all of the children used early intervention and speech/language therapy services.The ICF-CY provided a systematic approach for describing and categorizing functional problems in children with CAS. The identified factors should guide the multidisciplinary team in conducting comprehensive evaluations, rehabilitation, and long-term follow-up of children with CAS.

    View details for DOI 10.1080/09638280701795030

    View details for Web of Science ID 000263007900004

    View details for PubMedID 18720114

  • Early Histories of School-Aged Children With Attention-Deficit/Hyperactivity Disorder CHILD DEVELOPMENT Loe, I. M., Balestrino, M. D., Phelps, R. A., Kurs-Lasky, M., Chaves-Gnecco, D., Paradise, J. L., Feldman, H. M. 2008; 79 (6): 1853-1868

    Abstract

    In a prospective study of developmental outcomes in relation to early-life otitis media, behavioral, cognitive, and language measures were administered to a large, diverse sample of children at 2, 3, 4, 6, and 9-11 years of age (N = 741). At 9-11 years of age, 9% of the children were categorized as having attention-deficit/hyperactivity disorder (ADHD) based on parent report. Compared to the non-ADHD group, the ADHD group had higher (i.e., less favorable) scores on parent and teacher versions of the Child Behavior Checklist at all ages. Children in the ADHD group also had lower scores on cognitive and receptive language measures in preschool. The findings support the concept that ADHD is a cognitive as well as a behavioral disorder.

    View details for DOI 10.1111/j.1467-8624.2008.01230.x

    View details for Web of Science ID 000261054900022

    View details for PubMedID 19037954

  • Academic and educational outcomes of children with ADHD JOURNAL OF PEDIATRIC PSYCHOLOGY Loe, I. M., Feldman, H. M. 2007; 32 (6): 643-654

    Abstract

    Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention. ADHD is also associated with increased use of school-based services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education. Children in community samples who show symptoms of inattention, hyperactivity, and impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes. Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment. Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.

    View details for DOI 10.1093/jpepsy/jsl054

    View details for Web of Science ID 000248086000003

    View details for PubMedID 17569716

  • Using the language characteristics of clinical populations to understand normal language development PEDIATRIC CLINICS OF NORTH AMERICA Feldman, H. M. 2007; 54 (3): 585-?

    Abstract

    The overall purpose of this article is to describe the speech and language abilities of children who have selected clinical conditions, not only to characterize the outcomes of those conditions, but also to understand fundamental requirements for language learning in typically developing children. This developmental cognitive neuroscience analysis conceptualizes the clinical conditions as naturalistic experimental manipulations, selectively altering factors in the language-learning situation that could not otherwise be ethically manipulated in a research study.

    View details for DOI 10.1016/j.pcl.2007.02.006

    View details for Web of Science ID 000247842800011

    View details for PubMedID 17543911

  • Tympanostomy tubes and developmental outcomes at 9 to 11 years of age NEW ENGLAND JOURNAL OF MEDICINE Paradise, J. L., Feldman, H. M., Campbell, T. F., Dollaghan, C. A., Rockette, H. E., Pitcairn, D. L., Smith, C. G., Colborn, D. K., Bernard, B. S., Kurs-Lasky, M., Janosky, J. E., Sabo, D. L., O'Connor, R. E., Pelham, W. E. 2007; 356 (3): 248-261

    Abstract

    Developmental impairments in children have been attributed to persistent middle-ear effusion in their early years of life. Previously, we reported that among children younger than 3 years of age with persistent middle-ear effusion, prompt as compared with delayed insertion of tympanostomy tubes did not result in improved cognitive, language, speech, or psychosocial development at 3, 4, or 6 years of age. However, other important components of development could not be assessed until the children were older.We enrolled 6350 infants soon after birth and evaluated them regularly for middle-ear effusion. Before 3 years of age, 429 children with persistent effusion were randomly assigned to undergo the insertion of tympanostomy tubes either promptly or up to 9 months later if effusion persisted. We assessed literacy, attention, social skills, and academic achievement in 391 of these children at 9 to 11 years of age.Mean (+/-SD) scores on 48 developmental measures in the group of children who were assigned to undergo early insertion of tympanostomy tubes did not differ significantly from the scores in the group that was assigned to undergo delayed insertion. These measures included the Passage Comprehension subtest of the Woodcock Reading Mastery Tests (mean score, 98+/-12 in the early-treatment group and 99+/-12 in the delayed-treatment group); the Spelling, Writing Samples, and Calculation subtests of the Woodcock-Johnson III Tests of Achievement (96+/-13 and 97+/-16; 104+/-14 and 105+/-15; and 99+/-13 and 99+/-13, respectively); and inattention ratings on visual and auditory continuous performance tests.In otherwise healthy young children who have persistent middle-ear effusion, as defined in our study, prompt insertion of tympanostomy tubes does not improve developmental outcomes up to 9 to 11 years of age. (ClinicalTrials.gov number, NCT00365092 [ClinicalTrials.gov].).

    View details for Web of Science ID 000243488100007

    View details for PubMedID 17229952

  • Academic and educational outcomes of children with ADHD AMBULATORY PEDIATRICS Loe, I. M., Feldman, H. M. 2007; 7 (1): 82-90

    Abstract

    Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention. ADHD is also associated with increased use of school-based services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education. Children in community samples who show symptoms of inattention, hyperactivity, and impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes. Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment. Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.

    View details for Web of Science ID 000243950000004

    View details for PubMedID 17261487

  • Commentary on Hooper et al JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H. M., Paradise, J. L. 2006; 27 (4): 336-337

    View details for Web of Science ID 000239858400007

    View details for PubMedID 16906010

  • Reliability in assigning ICF codes to children with special health care needs using a developmentally structured interview DISABILITY AND REHABILITATION Kronk, R. A., Ogonowski, J. A., Rice, C. N., Feldman, H. M. 2005; 27 (17): 977-983

    Abstract

    The purpose of this study was to determine if two teams of raters could reliably assign codes and performance qualifiers from the Activities and Participation component of the International Classification of Functioning, Disability, and Health (ICF) to children with special health care needs based on the results of a developmentally structured interview.Children (N = 40), ages 11 months to 12 years 10 months, with a range of health conditions, were evaluated using a structured interview consisting of open-ended questions and scored using developmental guidelines. For each child, two raters made a binary decision indicating whether codes represented an area of need or no need for that child. Raters assigned a performance qualifier, based on the ICF guidelines, to each code designated as an area of need. Cohen's kappa statistic was used as the measure of inter-rater reliability.Team I reached good to excellent agreement on 39/39 codes and Team II on 38/39 codes. Team I reached good to excellent agreement on 5/5 qualifiers and Team II on 10/14 qualifiers.A developmentally structured interview was an effective clinical tool for assigning ICF codes to children with special health care needs. The interview resulted in higher rates of agreement than did results from standardized functional assessments. Guidelines for assigning performance qualifiers must be modified for use with children.

    View details for DOI 10.1080/09638280500052849

    View details for Web of Science ID 000231160800002

    View details for PubMedID 16096251

  • Developmental outcomes after early or delayed insertion of tympanostomy tubes NEW ENGLAND JOURNAL OF MEDICINE Paradise, J. L., Campbell, T. F., Dollaghan, C. A., Feldman, H. M., Bernard, B. S., Colborn, D. K., Rockette, H. E., Janosky, J. E., Pitcairn, D. L., Kurs-Lasky, M., Sabo, D. L., Smith, C. G. 2005; 353 (6): 576-586

    Abstract

    To prevent later developmental impairments, myringotomy with the insertion of tympanostomy tubes has often been undertaken in young children who have persistent otitis media with effusion. We previously reported that prompt as compared with delayed insertion of tympanostomy tubes in children with persistent effusion who were younger than three years of age did not result in improved developmental outcomes at three or four years of age. However, the effect on the outcomes of school-age children is unknown.We enrolled 6350 healthy infants younger than 62 days of age and evaluated them regularly for middle-ear effusion. Before three years of age, 429 children with persistent middle-ear effusion were randomly assigned to have tympanostomy tubes inserted either promptly or up to nine months later if effusion persisted. We assessed developmental outcomes in 395 of these children at six years of age.At six years of age, 85 percent of children in the early-treatment group and 41 percent in the delayed-treatment group had received tympanostomy tubes. There were no significant differences in mean (+/-SD) scores favoring early versus delayed treatment on any of 30 measures, including the Wechsler Full-Scale Intelligence Quotient (98+/-13 vs. 98+/-14); Number of Different Words test, a measure of word diversity (183+/-36 vs. 175+/-36); Percentage of Consonants Correct-Revised test, a measure of speech-sound production (96+/-2 vs. 96+/-3); the SCAN test, a measure of central auditory processing (95+/-15 vs. 96+/-14); and several measures of behavior and emotion.In otherwise healthy children younger than three years of age who have persistent middle-ear effusion within the duration of effusion that we studied, prompt insertion of tympanostomy tubes does not improve developmental outcomes at six years of age.

    View details for Web of Science ID 000231101500008

    View details for PubMedID 16093466

  • Concurrent and predictive validity of parent reports of child language at ages 2 and 3 years CHILD DEVELOPMENT Feldman, H. M., Dale, P. S., Campbell, T. F., Colborn, D. K., Kurs-Lasky, M., Rockette, H. E., Paradise, J. L. 2005; 76 (4): 856-868

    Abstract

    The MacArthur-Bates Communicative Development Inventories (CDI; Dale, 1996; Fenson et al., 1994), parent reports about language skills, are being used increasingly in studies of theoretical and public health importance. This study (N = 113) correlated scores on the CDI at ages 2 and 3 years with scores at age 3 years on tests of cognition and receptive language and measures from parent-child conversation. Associations indicated reasonable concurrent and predictive validity. The findings suggest that satisfactory vocabulary scores at age 2 are likely to predict normal language skills at age 3, although some children with limited skills at age 3 will have had satisfactory scores at age 2. Many children with poor vocabulary scores at 2 will have normal skills at 3.

    View details for Web of Science ID 000230493400007

    View details for PubMedID 16026501

  • Treatment of attention-deficit/hyperactivity disorder: Overview of the evidence PEDIATRICS BROWN, R. T., Amler, R. W., Freeman, W. S., Perrin, J. M., Stein, M. T., Feldman, H. M., Pierce, K., Wolraich, M. L. 2005; 115 (6): E749-E757

    Abstract

    The American Academy of Pediatrics' Committee on Quality Improvement, Subcommittee on Attention-Deficit/Hyperactivity Disorder, reviewed and analyzed the current literature for the purpose of developing an evidence-based clinical practice guideline for the treatment of the school-aged child with attention-deficit/hyperactivity disorder (ADHD). This review included several key reports, including an evidence review from the McMaster Evidence-Based Practice Center (supported by the Agency for Healthcare Research and Quality), a report from the Canadian Coordinating Office for Health Technology Assessment, the Multimodal Treatment for ADHD comparative clinical trial (supported by the National Institute of Mental Health), and supplemental reviews conducted by the subcommittee. These reviews provided substantial information about different treatments for ADHD and their efficacy in improving certain characteristics or outcomes for children with ADHD as well as adverse effects and benefits of multiple modes of treatment compared with single modes (eg, medication or behavior therapies alone). The reviews also compared the effects of different medications. Other evidence documents the long-term nature of ADHD in children and its classification as a chronic condition, meriting the application of general concepts of chronic-condition management, including an individual treatment plan with a focus on ongoing parent and child education, management, and monitoring. The evidence strongly supports the use of stimulant medications for treating the core symptoms of children with ADHD and, to a lesser degree, for improving functioning. Behavior therapy alone has only limited effect on symptoms or functioning of children with ADHD, although combining behavior therapy with medication seems to improve functioning and may decrease the amount of (stimulant) medication needed. Comparison among stimulants (mainly methylphenidate and amphetamines) did not indicate that 1 class outperformed the other.

    View details for DOI 10.1542/peds.2004-2560

    View details for Web of Science ID 000229504800076

    View details for PubMedID 15930203

  • Evaluation and management of language and speech disorders in preschool children PEDIATRICS IN REVIEW Feldman, H. M. 2005; 26 (4): 131-140

    View details for Web of Science ID 000232155300003

    View details for PubMedID 15805236

  • Language learning with an injured brain Language, Learning and Development Feldman, H. M. 2005; 1: 265-288
  • Inter-rater reliability in assigning ICF codes to children with disabilities DISABILITY AND REHABILITATION Ogonowski, J. A., Kronk, R. A., Rice, C. N., Feldman, H. M. 2004; 26 (6): 353-361

    Abstract

    The purpose of this study was to determine if independent raters would arrive at similar decisions about which codes from the Activities and Participation component of the International Classification of Functioning, Disability, and Health (ICF) to assign to children with disabilities based on the results of standard paediatric functional assessment measures.Children (N = 60), 9 months to 17.75 years old, with a range of disabilities were assessed using either the Vineland Adaptive Behavior Scales (n = 20), the Pediatric Evaluation of Disability Inventory (PEDI) (n = 20), or the School Function Assessment (SFA) (n = 20). Two raters independently determined which of 40 codes from the Activities and Participation component of the ICF applied to each child based on items and standard scores from the assessment measure. The Cohen's kappa statistic was used as the measure of inter-rater reliability.The kappa statistic was >/= 0.70, the criterion for good agreement in this study, for 23/40 codes using the Vineland, 17/40 codes using the PEDI, and 17/40 codes using the SFA. The mean kappa statistic reached >/= 0.70 for the Self care domain, using all three tools. The mean kappa statistic also reached >/= 0.70 for Learning and Applying Knowledge and Mobility using the Vineland.Independent raters reached high rates of agreement when assessment test items were structured developmentally and corresponded to a single ICF code. For domains other than Self care, alternative assessment strategies may be necessary to improve assigning ICF codes to children with disabilities.

    View details for DOI 10.1080/09638280410001658658

    View details for Web of Science ID 000220127100005

    View details for PubMedID 15204487

  • Phonological memory and vocabulary learning in children with focal lesions BRAIN AND LANGUAGE Gupta, P., MacWhinney, B., Feldman, H. A., Sacco, K. 2003; 87 (2): 241-252

    Abstract

    Eleven children with early focal lesions were compared with 70 age-matched controls to assess their performance in repeating non-words, in learning new words, and in immediate serial recall, a triad of abilities that are believed to share a dependence on serial ordering mechanisms (e.g.,; ). Results for the experimental group were also compared with other assessments previously reported for the same children by. The children with brain injury showed substantial impairment relative to controls in the experimental tasks, in contrast with relatively unimpaired performance on measures of vocabulary and non-verbal intelligence. The relationships between word learning, non-word repetition, and immediate serial recall were similar to those observed in several other populations. These results support previous reports that there are persistent processing impairments following early brain injury, despite developmental plasticity. They also suggest that word learning, non-word repetition, and immediate serial recall may be relatively demanding tasks, and that their relationship is a fundamental aspect of the cognitive system.

    View details for DOI 10.1016/S0093-934X(03)00094-4

    View details for Web of Science ID 000186485600003

    View details for PubMedID 14585293

  • Early versus delayed insertion of tympanostomy tubes for persistent otitis media: developmental outcomes at the age of three years in relation to prerandomization illness patterns and hearing levels PEDIATRIC INFECTIOUS DISEASE JOURNAL Paradise, J. L., Feldman, H. M., Campbell, T. F., Dollaghan, C. A., Colborn, D. K., Bernard, B. S., Rockette, H. E., Janosky, J. E., Pitcairn, D. L., Sabo, D. L., Kurs-Lasky, M., Smith, C. G. 2003; 22 (4): 309-314

    Abstract

    Whether prompt insertion of tympanostomy tubes in children with persistent early life otitis media prevents or minimizes subsequent developmental impairment has been the subject of conflicting opinions and differing approaches to management.We randomly assigned 429 children with persistent middle ear effusion (MEE) before the age of 3 years to have tympanostomy tubes inserted either as soon as possible or up to 9 months later if MEE persisted. In 402 of these children, we found no significant differences at age 3 years between the 2 treatment groups in mean scores on any measure of speech, language and cognition and in 401 of the children no significant differences in measures of psychosocial development. We then examined outcomes within subgroups of children who might have been the most severely affected, namely those who had been randomized on the basis of bilateral, continuous MEE rather than unilateral and/or discontinuous MEE and those who had the greatest degrees of hearing loss.In none of the subgroups we considered were scores on any outcome measure significantly more favorable in children in the early treatment group than in children in the late treatment group.In otherwise normal children who have MEE, during the first 3 years of life within the durations we studied, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at age 3 years, irrespective of whether MEE has been continuous or discontinuous and unilateral or bilateral and whether or not MEE has been accompanied by mild to moderate hearing loss.

    View details for Web of Science ID 000182327600002

    View details for PubMedID 12690269

  • Parent-reported language skills in relation to otitis media during the first 3 years of life JOURNAL OF SPEECH LANGUAGE AND HEARING RESEARCH Feldman, H. M., Dollaghan, C. A., Campbell, T. F., Colborn, D. K., Janosky, J., Kurs-Lasky, M., Rockette, H. E., Dale, P. S., Paradise, J. L. 2003; 46 (2): 273-287

    Abstract

    As part of a larger study of the potential impact of early-life otitis media (OM) on speech, language, cognition, and behavior, we studied the degree of association between parent-reported language scores at ages 1, 2, and 3 years and the cumulative duration of middle-ear effusion (MEE) during the first 3 years of life in a demographically diverse sample of 621 children. We estimated the cumulative percentage of days with MEE from prospective monthly observations of middle-ear status and interpolations for periods between visits. For each child, parents completed the appropriate inventory of the MacArthur Communicative Development Inventories (CDI; L. Fenson et al., 1993) at ages 1, 2, and 3 years. We also evaluated the contribution of maternal education, as a proxy for socioeconomic status, to scores on the parent reports. Scores on the new CDI-III (B. Oliver et al., in press) varied positively with sociodemographic variables and were significantly correlated with scores from the CDI used when the children were younger. Unadjusted correlations between scores at ages 1 and 2 years and the percentages of days with MEE in the respective antecedent periods were statistically nonsignificant or of questionable clinical importance. The correlations between parent-reported scores at age 3 years and children's cumulative percentage of days with MEE in Years 1, 2, and 3 combined ranged from -.187 to -.248 (all p values < .001). The percentage of days with MEE and maternal education each contributed independently to scores at age 3 years. In the light of other findings from the larger study, we think it likely that the negative associations between language measures and MEE reflect confounding factors that contribute, on the one hand, to the duration of OM in young children and, on the other hand, to slow development of their language skills.

    View details for DOI 10.1044/1092-4388(2003/022)

    View details for Web of Science ID 000184906200003

    View details for PubMedID 14700371

  • Risk factors for speech delay of unknown origin in 3-year-old children CHILD DEVELOPMENT Campbell, T. F., Dollaghan, C. A., Rockette, H. E., Paradise, J. L., Feldman, H. M., Shriberg, L. D., Sabo, D. L., Kurs-Lasky, M. 2003; 74 (2): 346-357

    Abstract

    One hundred 3-year-olds with speech delay of unknown origin and 539 same-age peers were compared with respect to 6 variables linked to speech disorders: male sex, family history of developmental communication disorder, low maternal education, low socioeconomic status (indexed by Medicaid health insurance), African American race, and prolonged otitis media. Abnormal hearing was also examined in a subset of 279 children who had at least 2 hearing evaluations between 6 and 18 months of age. Significant odds ratios were found only for low maternal education, male sex, and positive family history; a child with all 3 factors was 7.71 times as likely to have a speech delay as a child without any of these factors.

    View details for Web of Science ID 000182012100002

    View details for PubMedID 12705559

  • Sentence processing in children with early unilateral brain injury BRAIN AND LANGUAGE Feldman, H. M., MacWhinney, B., Sacco, K. 2002; 83 (2): 335-352

    Abstract

    This study examined how children use word order and animacy cues to determine the agent of the action in an on-line sentence-comprehension task. The subject group included 15 children, 5-12 years old, with brain injury incurred prior to the age of 2 months; 12 had left hemisphere (LH) damage and 3 had right hemisphere (RH) damage. The comparison group included 141 children, 5-10 years old, who were at the appropriate grade for age. The task required children to listen to sentences composed of two noun phrases (N) that varied in terms of animacy and a verb phrase (V) and then to indicate the agent of the action. Three word orders were presented: NVN, VNN, and NNV. Measures included the proportion of trials in which the first noun was selected (choice) and reaction time. Word order and animacy significantly influenced choice. The effect of subject group approached significance for choice. Word order and age influenced reaction time. The children with LH injury and two children with RH injury showed a developmental delay in choosing the appropriate N as agent; one child with RH injury had mature responses. The overlapping performance of children with LH and RH injury suggests that delays in the development of sentence comprehension strategies are more likely related to reliance on a smaller than usual neural network rather than to congenital specialization of the LH.

    View details for Web of Science ID 000178828600007

    View details for PubMedID 12387801

  • Effect of early or delayed insertion of tympanostomy tubes for persistent otitis media on developmental outcomes at the age of three years. NEW ENGLAND JOURNAL OF MEDICINE Paradise, J. L., Feldman, H. M., Campbell, T. F., Dollaghan, C. A., Colborn, D. K., Bernard, B. S., Rockette, H. E., Janosky, J. E., Pitcairn, D. L., Sabo, D. L., Kurs-Lasky, M., Smith, C. G. 2001; 344 (16): 1179-1187

    Abstract

    A main indication for the insertion of tympanostomy tubes in infants and young children is persistent otitis media with effusion, reflecting concern that this condition may cause lasting impairments of speech, language, cognitive, and psychosocial development. However, evidence of such relations is inconclusive, and evidence is lacking that the insertion of tympanostomy tubes prevents developmental impairment.We enrolled 6350 healthy infants from 2 to 61 days of age and evaluated them regularly for middle-ear effusion. Before the age of three years 429 children with persistent effusion were randomly assigned to have tympanostomy tubes inserted either as soon as possible or up to nine months later if effusion persisted. In 402 of these children we assessed speech, language, cognition, and psychosocial development at the age of three years.By the age of three years, 169 children in the early-treatment group (82 percent) and 66 children in the late-treatment group (34 percent) had received tympanostomy tubes. There were no significant differences between the early-treatment group and the late-treatment group at the age of three years in the mean (+/-SD) scores on the Number of Different Words test, a measure of word diversity (124+/-32 and 126+/-30, respectively); the Percentage of Consonants Correct-Revised test, a measure of speech-sound production (85+/-7 vs. 86+/-7); the General Cognitive Index of McCarthy Scales of Children's Abilities (99+/-14 vs. 101+/-13); or on measures of receptive language, sentence length, grammatical complexity, parent-child stress, and behavior.In children younger than three years of age who have persistent otitis media, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at the age of three years.

    View details for Web of Science ID 000168127600001

    View details for PubMedID 11309632

  • Expressive language delay in a toddler JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Stein, M. T., Parker, S., Coplan, J., Feldman, H. 2001; 22 (2): S99-S103

    View details for Web of Science ID 000168183100020

    View details for PubMedID 11332819

  • Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings PEDIATRICS BROWN, R. T., Freeman, W. S., Perrin, J. M., Stein, M. T., Amler, R. W., Feldman, H. M., Pierce, K., Wolraich, M. L. 2001; 107 (3)

    Abstract

    Research literature relating to the prevalence of attention-deficit/hyperactivity disorder (ADHD) and co-occurring conditions in children from primary care settings and the general population is reviewed as the basis of the American Academy of Pediatrics clinical practice guideline for the assessment and diagnosis of ADHD. Epidemiologic studies revealed prevalence rates generally ranging from 4% to 12% in the general population of 6 to 12 year olds. Similar or slightly lower rates of ADHD were revealed in pediatric primary care settings. Other behavioral, emotional, and learning problems significantly co-occurred with ADHD. Also reviewed were rating scales and medical tests that could be employed in evaluating ADHD. The utility of using both parent- and teacher-completed rating scales that specifically assess symptoms of ADHD in the diagnostic process was supported. Recommendations were made regarding the assessment of children with suspected ADHD in the pediatric primary care setting.

    View details for Web of Science ID 000167216200015

    View details for PubMedID 11230624

  • Language, speech sound production, and cognition in three-year-old children in relation to otitis media in their first three years of life PEDIATRICS Paradise, J. L., Dollaghan, C. A., Campbell, T. F., Feldman, H. M., Bernard, B. S., Colborn, D. K., Rockette, H. E., Janosky, J. E., Pitcairn, D. L., Sabo, D. L., Kurs-Lasky, M., Smith, C. G. 2000; 105 (5): 1119-1130

    Abstract

    As part of a prospective study of possible effects of early-life otitis media on speech, language, cognitive, and psychosocial development, we tested relationships between children's cumulative duration of middle ear effusion (MEE) in their first 3 years of life and their scores on measures of language, speech sound production, and cognition at 3 years of age.We enrolled 6350 healthy infants by 2 months of age who presented for primary care at 1 of 2 urban hospitals or 1 of 2 small town/rural and 4 suburban private pediatric practices. We intensively monitored the children's middle ear status by pneumatic otoscopy, supplemented by tympanometry, throughout their first 3 years of life; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated children for otitis media according to specified guidelines. Children who met specified minimum criteria regarding the persistence of MEE became eligible for a clinical trial in which they were assigned randomly to undergo tympanostomy tube placement either promptly or after a defined extended period if MEE remained present. From among those remaining, we selected randomly, within sociodemographic strata, a sample of 241 children who represented a spectrum of MEE experience from having no MEE to having MEE whose cumulative duration fell just short of meeting randomization criteria. In subjects so selected, the estimated duration of MEE ranged from none to 65.6% of the first year of life and 44.8% of the first 3 years of life. In these 241 children we assessed language development, speech sound production, and cognition at 3 years of age, using both formal tests and conversational samples.We found weak to moderate, statistically significant negative correlations between children's cumulative durations of MEE in their first year of life or in age periods that included their first year of life, and their scores on formal tests of receptive vocabulary and verbal aspects of cognition at 3 years of age. However, the percent of variance in these scores explained by time with MEE in the first year of life beyond that explained by sociodemographic variables ranged only from 1.2% to 2.9%, and the negative correlations were concentrated in the subgroup of children whose families had private health insurance (rather than Medicaid). We found no significant correlations in the study population as a whole or in any subgroup between time with MEE during antecedent periods and children's scores on measures of spontaneous expressive language, speech sound production, or other measured aspects of cognition. In contrast, by wide margins, scores on all measures were consistently highest among the most socioeconomically advantaged children and lowest among the most socioeconomically disadvantaged children.Our findings suggest either that persistent early-life MEE actually causes later small, circumscribed impairments of receptive language and verbal aspects of cognition in certain groups of children or that unidentified, confounding factors predispose children both to early-life otitis media and to certain types of developmental impairment. Findings in the randomized clinical trial component of the larger study should help distinguish between causality and confounding as explanations for our findings.language, speech, cognition, development, otitis media, middle ear effusion.

    View details for Web of Science ID 000086902600033

    View details for PubMedID 10790473

  • Measurement properties of the MacArthur Communicative Development Inventories at ages one and two years CHILD DEVELOPMENT Feldman, H. M., Dollaghan, C. A., Campbell, T. F., Kurs-Lasky, M., Janosky, J. E., Paradise, J. L. 2000; 71 (2): 310-322

    Abstract

    In a prospective study of child development in relation to early-life otitis media, we administered the MacArthur Communicative Development Inventories (CDI) to a large (N = 2,156), sociodemographically diverse sample of 1- and 2-year-old children. As a prerequisite for interpreting the CDI scores, we studied selected measurement properties of the inventories. Scores on the CDI/Words and Gestures (CDI-WG), designed for children 8 to 16 months old, and on the CDI/Words and Sentences (CDI-WS), designed for children 16 to 30 months old, increased significantly with months of age. On several scales of both CDI-WG and CDI-WS, standard deviations approximated or exceeded mean values, reflecting wide variability in results. Statistically significant differences in mean scores were found according to race, maternal education, and health insurance status as an indirect measure of income, but the directionality of differences was not consistent across inventories or across scales of the CDI-WS. Correlations between CDI-WG and CDI-WS ranged from .18 to .39. Our findings suggest that the CDI reflects the progress of language development within the age range 10 to 27 months. However, researchers and clinicians should exercise caution in using results of the CDI to identify individual children at risk for language deficits, to compare groups of children with different sociodemographic profiles, or to evaluate the effects of interventions.

    View details for Web of Science ID 000086683800004

    View details for PubMedID 10834466

  • Online measures of basic language skills in children with early focal brain lesions BRAIN AND LANGUAGE MacWhinney, B., Feldman, H., Sacco, K., Valdes-Perez, R. 2000; 71 (3): 400-431

    Abstract

    Twenty children with early focal lesions were compared with 150 age-matched control subjects on 11 online measures of the basic skills underlying language processing, a digit span task, and 6 standardized measures. Although most of the children with brain injury scored within the normal range on the majority of the tasks, they also had a disproportionately high number of outlier scores on the reaction time tests. This evidence for a moderate impairment of the basic skills underlying language processing contrasts with other evidence suggesting that these children acquire normal control of the functional use of language. Furthermore, these children scored within the normal range on a measure of general cognitive ability, suggesting that there is no particular sparing of linguistic functions at the expense of general cognitive functions. Using the MPD procedure (Valdés-Pérez & Pericliev, 1997), we found that the controls and the five clinical groups could be best distinguished with two measures of online processing (word repetition and visual number naming) and one standardized test subcomponent (the CELF Oral Directions subtest). The 12 children with left hemisphere lesions scored significantly lower than the 8 other children on the CELF-RS measure. Within the group of children with cerebral infarct, the nature of the processing disability could be linked fairly well to site of lesion. Otherwise, there was little relation between site or size of lesion and the pattern of deficit. These results support a model in which damage to the complex functional circuits subserving language leads to only minor deficits in process efficiency, because of the plasticity of developmental processes.

    View details for Web of Science ID 000085835100004

    View details for PubMedID 10716870

  • The pediatrician and childhood bereavement PEDIATRICS Wolraich, M. L., Aceves, J., Feldman, H. M., Hagan, J. F., Howard, B. J., Navarro, A., Richtsmeier, A. J., Tolmas, H. C. 2000; 105 (2): 445-447
  • Developmental and lesion effects in brain activation during sentence comprehension and mental rotation DEVELOPMENTAL NEUROPSYCHOLOGY Booth, J. R., MacWhinney, B., Thulborn, K. R., Sacco, K., Voyvodic, J. T., Feldman, H. M. 2000; 18 (2): 139-169

    Abstract

    The development of neurocognitive networks was examined in 2 cognitive paradigms: auditory sentence comprehension and mental rotation of alphanumeric stimuli. Patterns of brain activation were measured with whole brain echoplanar functional magnetic resonance imaging at 3 Tesla in 5 adults (20-28 years old), 7 children (9-12 years old), and 6 pediatric patients (9-12 years old) with perinatal strokes or periventricular hemorrhages. Healthy children and adults activated similar neurocognitive networks, but there were developmental differences in the distribution of activity across these networks. In the sentence task, children showed more activation in the inferior visual area suggesting an imagery strategy rather than a linguistic strategy for sentence processing. Furthermore, consistent use of a sentence comprehension strategy, whether correct or incorrect as compared to chance performance, was associated with greater activation in the inferior frontal area (Broca's) in both children and pediatric patients. In the mental rotation task, healthy adults showed more activation in the superior parietal and middle frontal areas and less activation in the supramarginal gyrus, suggesting adults were primarily engaged in visual-spatial manipulation and less engaged in the recognition of noncanonical views of stimuli. The pediatric patients showed patterns of activation consistent with organization of cognitive processing into homologous areas of the contralateral hemisphere.

    View details for Web of Science ID 000167447700001

    View details for PubMedID 11280962

  • Maternal education and measures of early speech and language JOURNAL OF SPEECH LANGUAGE AND HEARING RESEARCH Dollaghan, C. A., Campbell, T. F., Paradise, J. L., Feldman, H. M., Janosky, J. E., Pitcairn, D. N., Kurs-Lasky, M. 1999; 42 (6): 1432-1443

    Abstract

    The present study was designed to determine whether 4 measures of children's spontaneous speech and language differed according to the educational level of the children's mothers. Spontaneous language samples from 240 three-year-old children were analyzed to determine mean length of utterance in morphemes (MLUm), number of different words (NDW), total number of words (TNW), and percentage of consonants correct (PCC). A norm-referenced, knowledge-dependent measure of language comprehension, the Peabody Picture Vocabulary Test-Revised (PPVT-R), was also included for purposes of comparison with the spontaneous measures. Three levels of maternal education were compared: less than high school graduate, high school graduate, and college graduate. Trend analyses showed statistically significant linear trends across educational levels for MLUm, NDW, TNW, and PPVT-R; the trend for PCC was not significant. The relationship of maternal education and other sociodemographic variables to measures of children's language should be examined before using such measures to identify children with language disorders.

    View details for Web of Science ID 000084182700015

    View details for PubMedID 10599625

  • The child in court: A subject review PEDIATRICS Wolraich, M. L., Aceves, J., Feldman, H. M., Hagan, J. F., Howard, B. J., Navarro, A., Richtsmeier, A. J., Tolmas, H. C. 1999; 104 (5): 1145-1148

    Abstract

    When children come to court as witnesses, or when their needs are decided in a courtroom, they face unique stressors from the legal proceeding and from the social predicament that resulted in court action. Effective pediatric support and intervention requires an understanding of the situations that bring children to court and the issues that will confront children and child advocates in different court settings.

    View details for Web of Science ID 000083448000019

  • Parent-reported language and communication skills at one and two years of age in relation to otitis media in the first two years of life PEDIATRICS Feldman, H. M., Dollaghan, C. A., Campbell, T. F., Colborn, D. K., Kurs-Lasky, M., Janosky, J. E., Paradise, J. L. 1999; 104 (4)

    Abstract

    As part of a study of possible effects of early life otitis media on children's development, we attempted to determine whether levels of language and communication skills at 1 and 2 years of age are associated with the cumulative duration of middle ear effusion (MEE) in the first 2 years of life.Subjects (N = 2156) were followed at one of eight study sites in the Pittsburgh area. Middle ear status was monitored closely throughout the first 2 years of life. For each child, the cumulative percentage of days with MEE was estimated based on diagnoses at visits and interpolations for intervals between visits. For each child also, 1 or both parents completed the MacArthur Communicative Development Inventory-Words and Gestures (CDI-WG) when the child was 1 year of age and the MacArthur Communicative Development Inventory-Words and Sentences (CDI-WS) when the child was 2 years of age.Unadjusted correlations between scores on the CDI-WG and percentage of days with MEE in the first year of life were close to zero, and there were no statistically significant negative correlations. Unadjusted correlations between scores on the CDI-WS and the cumulative percentage of days with MEE in year 2 and in years 1 and 2 combined were generally negative and statistically significant, but the magnitudes of those correlations were no higher than 0.09. After adjustment for sociodemographic variables, only the Vocabulary Production Scale of the CDI-WS remained correlated significantly with the percentage of days with MEE, and the percentage of days with MEE accounted for only a negligible percentage of the variance in scores on this scale.In this diverse sample of children, parent-reported levels of language skills at 1 and 2 years of age were correlated negligibly with the cumulative percentage of days with MEE in the children's first and second years of life. otitis media, otitis media with effusion, language, communication.

    View details for Web of Science ID 000082907300028

    View details for PubMedID 10506277

  • Efficacy of methylphenidate among preschool children with developmental disabilities and ADHD JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Handen, B. L., Feldman, H. M., Lurier, A., Murray, P. J. 1999; 38 (7): 805-812

    Abstract

    This was a double-blind, placebo-controlled, crossover design study of the safety and efficacy of methylphenidate (MPH) in 11 preschool children (aged 4.0-5.11 years) with developmental disabilities and attention-deficit hyperactivity disorder (ADHD).MPH doses of 0.3 and 0.6 mg/kg per dose and a placebo were given. Drug response was evaluated via teacher-completed behavior checklists and clinic-based observations of activity level, attention, and compliance to adult requests. A side effects checklist was also completed by teachers and parents.Significant improvement on teacher ratings of hyperactivity and inattention as well as clinic-based observations of activity level and compliance were associated with MPH. Eight of 11 preschool children were medication responders (based on a minimum 40% decrease between placebo and one drug condition on either the teacher-rated Conners Hyperactivity Index or the Hyperactive-Distractible subscale of the Preschool Behavior Questionnaire). Five children exhibited significant adverse drug side effects such as severe social withdrawal, increased crying, and irritability, especially at the higher dose (0.6 mg/kg).Results suggest that preschool children with developmental disabilities and ADHD respond to MPH at rates similar to those of school-age children with mental retardation and ADHD. However, this population appears to be especially susceptible to adverse drug side effects.

    View details for Web of Science ID 000081223400009

    View details for PubMedID 10405497

  • A fork in the road: Decision time for behavioral pediatrics JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Kelleher, K. J., Scholle, S. H., Feldman, H. I., Nace, D. 1999; 20 (3): 181-186

    Abstract

    The rapid growth of managed care, and especially that of managed behavioral healthcare organizations (MBHOs), is likely to diminish the role of developmental-behavioral pediatrics and separate care for medical and behavioral problems. Thus, a rethinking of the practice of developmental-behavioral pediatrics is required. This study reviews the structure of MBHOs, identifies barriers to the provision of services by developmental-behavioral pediatricians, describes alternative practice models for consideration, and makes recommendations. The aims of the recommendations are to stimulate an active discussion about these issues, spark an advocacy effort, and ensure the continued participation of developmental-behavioral pediatricians in the care of children with special needs. The study concludes that managed care will push developmental-behavioral pediatricians into integration with primary care group practices or into specialty mental health networks. Immediate discussion, action, and advocacy will be required to ensure a presence in these decisions for developmental-behavioral pediatricians.

    View details for Web of Science ID 000080929700008

    View details for PubMedID 10393076

  • Naltrexone and communication skills in young children with autism JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Feldman, H. M., Kolmen, B. K., Gonzaga, A. M. 1999; 38 (5): 587-593

    Abstract

    To evaluate the effect of naltrexone on communication skills of young children with autism.Twenty-four children with autism, 3.0 to 8.3 years old (mean 5.1) who were living at home and attending appropriate school programs, participated in a randomized, double-blind, placebo-controlled, crossover trial. Naltrexone, 1.0 mg/kg, or placebo was administered daily for 2 weeks. Communication was evaluated from videotaped samples of seminaturalistic parent-child interaction. Child and parent language were assessed using similar measures.In this heterogeneous sample, the median number of words the child produced on placebo was 9.5 (range 0-124). The median proportion of utterances with echolalia was 0.16. No differences were found between the naltrexone and placebo conditions in any of the measures of children or parents' communication. Significant correlations were found between the child's number of words and developmental quotient (Spearman rho = 0.58, p = .003) and between the child's and parent's number of words (rho = 0.55, p = .005).Previous studies showed that naltrexone was associated with modest reduction in hyperactivity and restlessness in this group of children with autism. In this short-term study, the medication did not lead to improvement in communication, a core deficit of autism.

    View details for Web of Science ID 000079956100021

    View details for PubMedID 10230191

  • Functional organization of activation patterns in children: Whole brain fMRI imaging during three different cognitive tasks PROGRESS IN NEURO-PSYCHOPHARMACOLOGY & BIOLOGICAL PSYCHIATRY Booth, J. R., MacWhinney, B., Thulborn, K. R., Sacco, K., Voyvodic, J., Feldman, H. M. 1999; 23 (4): 669-682

    Abstract

    1. Patterns of brain activation were measured with whole brain echo-planar functional magnetic resonance imaging (fMRI) at 3.0 Tesla in healthy children (N = 6) and in one child with a left-hemisphere encephalomalacic lesion as sequellae from early stroke. 2. Three cognitive tasks were used: auditory sentence comprehension, verb generation to line drawings, and mental rotation of alphanumeric stimuli. 3. There was evidence for significant bilateral activation in all three cognitive tasks for the healthy children. Their patterns of activation were consistent with previous functional imaging studies with adults. 4. The child with a left-hemisphere stroke showed evidence of homologous organization in the non-damaged hemisphere.

    View details for Web of Science ID 000080564500011

    View details for PubMedID 10390725

  • Physician-family partnerships: The adaptive practice model JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H. M., Ploof, D., Cohen, W. I. 1999; 20 (2): 111-116

    Abstract

    In the traditional medical model, the physician, acting in the best interests of the patient, assumes full responsibility for delivering information, making decisions about treatment, and providing care. This model is not suitable for chronic care or preventive health maintenance. Recent alternatives to this model include participatory decision-making and family-centered care, clinical approaches in which the patient and family share the responsibility for decision-making with the physician. Research has demonstrated that patients and families vary in their willingness to make decisions about care. The Adaptive Practice model describes how compassionate and effective medical practice ranges from traditional hierarchical relationships to full patient or family control, depending on the situation. Four different clinical approaches--directing, teaching, collaborating, and supporting--result from variations in the direction of leadership and in the degree of interaction in the situation. Each approach is suitable for specific situations. For example, directing is appropriate in emergencies or crises. Supporting is appropriate when families are both knowledgeable and motivated to make decisions that affect their quality of life. Sensitive physicians assess the situation, negotiate an approach suitable to the family's and patient's needs at the time, and adjust their approach as the partnership evolves. The Adaptive Practice model provides a structure for analyzing clinical situations, choosing clinical approaches, and understanding problems in physician-family relationships when they arise.

    View details for Web of Science ID 000079667500007

    View details for PubMedID 10219690

  • How pediatricians can respond to the psychosocial implications of disasters. American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health, 1998-1999. Pediatrics Wolraich, M. L., Aceves, J., Feldman, H. M., Hagan, J. F., Howard, B. J., Navarro, A., Richtsmeier, A. J., Tolmas, H. C. 1999; 103 (2): 521-523

    Abstract

    Natural and human-caused disasters, violence with weapons, and terrorist acts have touched directly the lives of thousands of families with children in the United States.1 Media coverage of disasters has brought images of floods, hurricanes, and airplane crashes into the living rooms of most American families, with limited censorship for vulnerable young children. Therefore, children may be exposed to disastrous events in ways that previous generations never or rarely experienced. Pediatricians should serve as important resources to the community in preparing for disasters, as well as acting in its behalf during and after such events.

    View details for PubMedID 9925857

  • A playroom observation procedure to assess children with mental retardation and ADHD JOURNAL OF ABNORMAL CHILD PSYCHOLOGY Handen, B. L., McAuliffe, S., Janosky, J., Feldman, H., BREAUX, A. M. 1998; 26 (4): 269-277

    Abstract

    Forty-two children (ages 6 to 12 years old) with moderate mental retardation to borderline intellectual functioning were studied in a laboratory playroom setting to determine whether children identified as ADHD (attention deficit hyperactivity disorder) or controls differed on activity and attentional measures. Children with ADHD were further divided into ADHD + conduct problems (ADHD + CD) and ADHD-only subgroups (with an ADHD-combined group comprising children of both subgroups). An interval recording system was used to code observations of independent play and a restricted academic task. Results indicated that the ADHD-combined group was significantly more vocal and engaged in a significantly greater number of toy changes than controls during independent play. Significant group differences were also noted during the restricted academic task, with the ADHD-combined and ADHD + CD groups more off-task and engaging in a greater number of toy touches than controls. Discriminant analyses found independent play measures to predict group membership in 70 percent of cases (ADHD-combined vs. controls), but in only 64 percent of cases using measures from the restricted academic task. No significant findings resulted when the ADHD subjects were further divided into two subgroups. Despite some inconsistent findings, such laboratory-based observations may be of value in the diagnosis of ADHD in children with moderate mental retardation to borderline intellectual functioning.

    View details for Web of Science ID 000075117800004

    View details for PubMedID 9700519

  • Guidance for effective discipline PEDIATRICS Wolraich, M. L., Aceves, J., Feldman, H. M., Hagan, J. F., Howard, B. J., Richtsmeier, A. J., Tolchin, D., Tolmas, H. C. 1998; 101 (4): 723-728
  • Teaching pediatric residents about early intervention and special education JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Nalven, L. M., Hofkosh, D., Feldman, H., Kelleher, K. 1997; 18 (6): 371-376

    Abstract

    We compared two educational interventions (didactic lecture with handouts vs guidelines placed in patient charts) and assessed their impact on knowledge of early developmental services and identification of children eligible for these services. Forty-nine pediatric residents participated in preintervention and postintervention tests of knowledge of such services. Mean scores for all residents were 54% (pre-test) and 60% (post-test). First-year residents scored significantly lower than 2nd- and 3rd-year residents on pre- (p = .0001) and post-tests (p < .02). From our convenience sample of 1204 patients, ages newborn to 6 years, seen in the resident continuity clinic during the study period, residents identified children eligible for early developmental services. The mean percentage of identifying eligible children was 13% (range, 0-40%). We did not detect a statistically significant impact of either educational strategy. We conclude, therefore, that more comprehensive strategies are needed to change physician knowledge of and behavior toward early developmental services.

    View details for Web of Science ID 000071027400001

    View details for PubMedID 9431498

  • Naltrexone in young autistic children: Replication study and learning measures JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Kolmen, B. K., Feldman, H. M., Handen, B. L., Janosky, J. E. 1997; 36 (11): 1570-1578

    Abstract

    This study expanded upon previous work on naltrexone efficacy and safety in young autistic children and assessed performance on learning measures.Eleven children with autistic disorder, aged 3.0 to 8.3 years, were studied in home, school, and outpatient laboratory, bringing to 24 the combined study sample. Naltrexone, 1.0 mg/kg, was given daily in a randomized, double-blind, crossover design. Dependent measures were parent and teacher Clinical Global Impressions (CGI) and Naltrexone Side Effects Rating Scale (SE), Conners Parent Impulsivity/Hyperactivity Factor, Teacher Hyperactivity Factor, laboratory CGI, and analysis of videotaped behavior. Learning measures were the Early Intervention Developmental Profile-Language and paired-associate learning.Comparisons between naltrexone and baseline, but not naltrexone and placebo, on parent and teacher ratings showed statistical significance. Three of 11 subjects improved in two or more settings. Side effects were mild. Administering naltrexone was a challenge. The combined study sample showed improvement on all parent measures and on Teacher CGI and SE-Restlessness compared with baseline and placebo. Eleven of the 24 children improved in two or more settings. Scores on learning measures did not change across conditions.Naltrexone was associated with modest improvement of behavior in 11 of 24 children, but learning did not improve.

    View details for Web of Science ID A1997YC34000020

    View details for PubMedID 9394942

  • The prenatal visit PEDIATRICS Stein, M. T., Aceves, J., Feldman, H. M., Hagan, J. F., Perrin, E. C., Richtsmeier, A. J., Tolchin, D., Tolmas, H. C. 1996; 97 (1): 141-142
  • METHYLPHENIDATE IN CHILDREN WITH MENTAL-RETARDATION AND ADHD - EFFECTS ON INDEPENDENT PLAY AND ACADEMIC FUNCTIONING JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES Handen, B. L., McAuliffe, S., Janosky, J., Feldman, H., BREAUX, A. M. 1995; 7 (2): 91-103
  • NALTREXONE IN YOUNG AUTISTIC-CHILDREN - A DOUBLE-BLIND, PLACEBO-CONTROLLED CROSSOVER STUDY JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Kolmen, B. K., Feldman, H. M., Handen, B. L., Janosky, J. E. 1995; 34 (2): 223-231

    Abstract

    This study evaluated the efficacy and safety of naltrexone, an opiate blocker, in the treatment of autism.Thirteen children with autistic disorder, aged 3.4 to 8.3 years (mean 5.4), were studied in home, school, and outpatient laboratory. Naltrexone, 1.0 mg/kg, was given daily in a randomized, double-blind, placebo-controlled crossover design. Dependent measures included parent and teacher Clinical Global Impressions (CGI), Conners Rating Scales, and Naltrexone Side-Effects (SE) Rating Scale; laboratory CGI, movement actometer readings, and a 10-second interval recording system analysis of on-task, communication initiations, disruptive behavior, and self-stimulation.Eight of 13 subjects improved in two or more settings. Changes in parent measures (CGI, Conners Impulsivity-Hyperactivity Factor, and SE-Restlessness) and Teacher CGI achieved statistical significance. Teacher SE-Restlessness and initiation of communication in the clinic showed a trend toward improvement. Actometer readings improved in two children who were very active at baseline. Adverse side effects were behavioral, mild, and transient. Administering the bitter tablet was a challenge.Naltrexone offers promise as an agent for modest improvement of behavior and social communication in young children with autism. Parent and teacher measures can be useful in outpatient trials to evaluate change.

    View details for Web of Science ID A1995QD09100018

    View details for PubMedID 7896655

  • PARENT AND PROFESSIONAL PERCEPTIONS ABOUT STRESS AND COPING STRATEGIES DURING A CHILDS LENGTHY HOSPITALIZATION SOCIAL WORK IN HEALTH CARE Horn, J. D., Feldman, H. M., PLOOF, D. L. 1995; 21 (1): 107-127

    Abstract

    The two goals of this study were (1) to describe the stressors and coping strategies of families whose children with chronic illness require lengthy hospitalizations and (2) to compare family reports of stress and coping strategies to professionals perceptions of the same. A non-randomized sample of 13 families (13 mothers and 5 fathers) whose child with chronic illness was hospitalized for a minimum of 30 days and 11 professionals who worked with such children were interviewed in a semi-structured survey using open-ended questions. Key phrases from family interviews were organized into categories of family-reported stressors and coping strategies. Key phrases from professional interviews were categorized into family stressors and descriptions of challenging families. Families and professionals reported that personal emotions and communication problems were the most predominant stressors.

    View details for Web of Science ID A1995TA84400009

    View details for PubMedID 8553187

  • PREDICTION OF RESPONSE TO METHYLPHENIDATE AMONG CHILDREN WITH ADHD AND MENTAL-RETARDATION JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Handen, B. L., Janosky, J., McAuliffe, S., BREAUX, A. M., Feldman, H. 1994; 33 (8): 1185-1193

    Abstract

    The primary purpose of this study was to predict stimulant medication response among children with attention-deficit hyperactivity disorder (ADHD) and mental retardation (MR).Forty-seven children with ADHD and MR (IQs of 48 to 77) served as subjects; ages ranged from 6.1 to 12.5 years. Subjects participated in a double-blind, placebo-controlled study of two doses of methylphenidate (0.3 and 0.6 mg/kg per dose) and a placebo. Data were collected in each child's weekday classroom and a Saturday laboratory classroom. Stepwise multiple regression analyses were used to predict drug responses in both settings.Higher parent ratings of impulsivity and activity level at baseline were associated with greater gains in weekday classroom dependent measures. Similarly, higher weekday teacher measures of activity level, impulsivity, inattention, and conduct problems at baseline were related to improvement on Saturday laboratory classroom dependent measures. Finally, gender, race, and socioeconomic status (SES) were found to be important predictors, with males, Caucasian subjects, and subjects from families of higher SES more likely to evidence clinical gains on a number of variables than other subjects.These results were generally consistent with research conducted among children with ADHD but without MR. However, factors such as race and conduct problems appear to have predictive utility specific to children with MR.

    View details for Web of Science ID A1994PH20300016

    View details for PubMedID 7982869

  • LANGUAGE ABILITIES FOLLOWING PREMATURITY, PERIVENTRICULAR BRAIN INJURY, AND CEREBRAL-PALSY JOURNAL OF COMMUNICATION DISORDERS Feldman, H. M., Janosky, J. E., Scher, M. S., Wareham, N. L. 1994; 27 (2): 71-90

    Abstract

    This study compares language abilities in three groups of children who were born prematurely: children with bilateral spastic cerebral palsy associated with perinatal injury to the periventricular white matter of the brain; a group with similar brain injury but no motor impairment; and a group of controls with no brain injuries. Six boys in each group were 36 to 39 months of age at the time of the study. All achieved a standard score above 80 on the McCarthy Scales of Children's Abilities at the same age. Language samples, generated during parent-child interaction, were analyzed using the Child Language Data Exchange System. The size and diversity of the lexicon was assessed using types and tokens per minute. Morpho-syntactic skills were assessed using number of grammatical morphemes, mean length of utterance and the Index of Productive Syntax. Verbal productivity was assessed using number of utterances per minute. No significant differences were observed among any of the groups on any measure. Measures of the lexicon and morpho-syntactic skills were highly correlated with the scores on the McCarthy Scales of Children's Abilities. The data demonstrated that specific language impairments were not associated with cerebral palsy or brain injury after prematurity at this early stage of language development. However, individual children within each of the groups had delays in skill attainment that warranted language intervention.

    View details for Web of Science ID A1994QB62300003

    View details for PubMedID 7929881

  • CLASSROOM-BEHAVIOR AND CHILDREN WITH MENTAL-RETARDATION - COMPARISON OF CHILDREN WITH AND WITHOUT ADHD JOURNAL OF ABNORMAL CHILD PSYCHOLOGY Handen, B. L., McAuliffe, S., Janosky, J., Feldman, H., BREAUX, A. M. 1994; 22 (3): 267-280

    Abstract

    Thirty-four children (ages 6-12 years) with moderate to borderline mental retardation were studied in a laboratory classroom setting to determine whether children identified as having attention deficit hyperactivity disorder on the basis of Conners Questionnaires differed in classroom behavior. Half of the children scored 15 or greater on both the Parent and Teacher Conners; the remaining children scored 11 or less. All were participants in a Saturday Education Program serving children with mental retardation. Direct observation of the laboratory classroom documented significant differences between groups on measures of on-task behavior and fidgetiness, especially during situations where little direct teacher feedback or supervision was available. Saturday Education Program staff, while blind as to group designation, rated the two groups as differing significantly on all scales of two standardized behavior problem checklists. Checklists by parents and teachers appear to be valid measures of classroom behavior of children with moderate to borderline mental retardation.

    View details for Web of Science ID A1994NP01500001

    View details for PubMedID 8064033

  • DEVELOPMENTAL-CHANGES IN NARRATIVE AND NON-NARRATIVE DISCOURSE IN CHILDREN WITH AND WITHOUT BRAIN INJURY JOURNAL OF COMMUNICATION DISORDERS Hemphill, L., Feldman, H. M., Camp, L., Griffin, T. M., MIRANDA, A. E., Wolf, D. P. 1994; 27 (2): 107-133

    Abstract

    This study presents a set of narrative and non-narrative tasks and analytic procedures for examining the discourse development of children with perinatal brain injury and typically developing children. Three oral discourse genres were collected at ages 5, 6, and 7: script, picture description, and replica play narration. Genre performances were assessed for the presence of hypothesized genre features. Results suggest these tasks and procedures are able to characterize development in discourse abilities for both a normative group and for children with perinatal brain injury. The group of children with brain injury produced shorter discourse performance with more off-task talk. This group also showed difficulty in fully differentiating the various genre types and in creating integrated discourse performances. However, most of these children demonstrated considerable growth in control of genre features over this time period. The possible utility of these tasks and procedures for clinical assessment is discussed.

    View details for Web of Science ID A1994QB62300005

    View details for PubMedID 7929876

  • DEVELOPMENTAL NEEDS OF INFANTS AND TODDLERS WHO REQUIRE LENGTHY HOSPITALIZATION AMERICAN JOURNAL OF DISEASES OF CHILDREN Feldman, H. M., PLOOF, D. L., Hofkosh, D., GOEHRING, E. L. 1993; 147 (2): 211-215

    Abstract

    To describe demographic and medical characteristics of a sample of children younger than age 3 years who required lengthy hospitalization in a tertiary care hospital. To determine the proportion of children in the sample with biologic handicaps, developmental delays, or risk factors for developmental disorders who met eligibility criteria for early intervention services based on federal law PL 99-457 and state regulations.Survey of medical records.Large, urban, tertiary care children's hospital.All 135 children younger than age 3 years hospitalized for more than 30 days during 1990 and 1991.None.The most prevalent cause of lengthy hospitalization was congenital anomaly followed by chronic and perinatal conditions; 38 patients (28%) required technology assistance at the time of discharge. Seventy-three children (54%) were eligible for early intervention services based on the presence of a biologic handicap or developmental delay. An additional 48 patients (36%) were eligible for developmental screening and periodic developmental monitoring on the basis of medical and social risk factors.Because of the high prevalence of developmental disorders and risk factors in infants and toddlers requiring lengthy hospitalizations, hospital-wide systems for identification, developmental assessment, and early intervention services should be designed and implemented.

    View details for Web of Science ID A1993KL36300031

    View details for PubMedID 7678952

  • EARLY LANGUAGE AND COMMUNICATIVE ABILITIES OF CHILDREN WITH PERIVENTRICULAR LEUKOMALACIA AMERICAN JOURNAL ON MENTAL RETARDATION Feldman, H. M., Evans, J. L., BROWN, R. E., Wareham, N. L. 1992; 97 (2): 222-234

    Abstract

    Ten 2-year-old children with periventricular leukomalacia (PVL), a brain injury associated with prematurity, were evaluated using language samples. Five children scored less than 80 on cognitive testing (delayed). Five children with this disorder and normal cognitive scores were assessed at two ages, matched with the delayed group on CA and developmental level. The delayed group produced significantly fewer lexical tokens and spontaneous verbal utterances than did the CA-matched group. No significant differences were observed between the delayed group and either comparison group on other measures of lexicon, grammar, or communication. The data demonstrate a relation between cognitive abilities and measures of verbal productivity in children with PVL.

    View details for Web of Science ID A1992JM66100009

    View details for PubMedID 1384568

  • THERE CAR - UNGRAMMATICAL PARENTESE JOURNAL OF CHILD LANGUAGE Chafetz, J., Feldman, H. M., Wareham, N. L. 1992; 19 (2): 473-480

    Abstract

    This study of parents with their children demonstrates irregular and unpredictable grammatical features in their child-directed speech. The parents were observed quarterly in parent-child interaction with their oldest child beginning when she was two-years old, and with their younger twin daughters beginning when they reached two years. Language samples were transcribed and analyzed using CHILDES. The parents used grammatical speech with adults. A high proportion (8% to 32% per session) of their utterances to the children contained non-dialectal errors, primarily omissions of closed-class items. A typical example was 'she a puppet'. The evidence suggests these parents were trying to teach their children language. Their implicit theories of language and learning led to a highly unusual variant of parentese.

    View details for Web of Science ID A1992JB24900012

    View details for PubMedID 1527212

  • EFFECTS AND NONEFFECTS OF METHYLPHENIDATE IN CHILDREN WITH MENTAL-RETARDATION AND ADHD JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Handen, B. L., BREAUX, A. M., Janosky, J., McAuliffe, S., Feldman, H., Gosling, A. 1992; 31 (3): 455-461

    Abstract

    Stimulant medication efficacy was evaluated in 14 children with attention-deficit hyperactivity disorder and IQs of 48 to 74 in a double-blind crossover study of two methylphenidate doses and placebo. Dependent measures included behavioral ratings, work output, measures of learning, attention and impulsivity, and direct observation of peer social interactions. Nine children (64%) were methylphenidate-responders, based upon the Conners Hyperactivity Index. Significant gains in on-task behavior and attentional skills were noted with methylphenidate in comparison to placebo. No improvement on measures of learning or social interactions were observed. Results extend and replicate previous research conducted by the authors.

    View details for Web of Science ID A1992HT11000012

    View details for PubMedID 1592777

  • A FLUENT LANGUAGE DISORDER FOLLOWING ANTEPARTUM LEFT-HEMISPHERE BRAIN INJURY JOURNAL OF COMMUNICATION DISORDERS Feldman, H. M., Holland, A. L., BROWN, R. E. 1992; 25 (2-3): 125-142

    Abstract

    This article describes the development of language in a left-handed girl with a left middle cerebral artery infarction. Seven language samples of parent-child interaction, obtained when she was between 36 and 60 months of age, were transcribed and analyzed using the Child Language Data Exchange System. At 36 months of age, only 42 (20%) of the child's 214 utterances contained words; the other 80% were composed of jargon or interactional markers such as "uh-huh" and "uhn-uhn." Jargon incorporated familiar intonational contours and prosodic features to convey emotional states and communicative functions. Between 36 and 45 months of age, her jargon became differentiated into increasing approximations of English sentences. Simultaneously, her use of words and word combinations increased. By 54 months of age, no jargon was heard. The pattern of development observed in this child can be described as a transient jargon or fluent aphasia. It may have resulted from initial reliance on an uninjured right hemisphere. However, given the similarity between this pattern and the expressive or gestalt style of learning seen in some normal children, the pattern may also be related to other variables including characteristics of the parental input.

    View details for Web of Science ID A1992KE88400003

    View details for PubMedID 1487564

  • LANGUAGE-DEVELOPMENT AFTER UNILATERAL BRAIN INJURY BRAIN AND LANGUAGE Feldman, H. M., Holland, A. L., KEMP, S. S., Janosky, J. E. 1992; 42 (1): 89-102

    Abstract

    This longitudinal study describes the growth of syntactic abilities and vocabulary size in nine children with unilateral antepartum or perinatal brain injury. Five children with left hemisphere damage (LHD) and four with right hemisphere damage (RHD), ages 15 to 48 months, were evaluated on three or more occasions. Language samples generated from parent-child interaction were transcribed, coded, and analyzed using the Child Language Data Exchange System. Individual growth trajectories were constructed by graphing three dependent variables--MLU, scores on the Index of Productive Syntax (IPSYN), and number of different words--as a function of the child's age. One subject remained in a prelinguistic stage throughout the study. Simple linear functions best described the growth of MLU, IPSYN scores, and vocabulary in the other eight children. The slopes of the individual growth trajectories, the graphic representations of rates of progress, were comparable in the eight children. Seven children showed developmental delays in initial word use and five in the onset of multiword utterances. However, by age 24 months, four children with LHD and two children with RHD had syntactic capabilities comparable to those of children without brain injuries. The developmental patterns suggested that both cerebral hemispheres may play critical roles in the very earliest stages of language acquisition. Some unilateral lesions caused little discernible effect on language outcome in the toddler-preschool years after the initial developmental delays.

    View details for Web of Science ID A1992HB88400006

    View details for PubMedID 1547471

  • Organizing early intervention services in a hospital setting: The developmental support project as a parallel organization Infants and Young Children Ploof D, Feldman HM 1992; 5 (1): 28-39
  • 10 YEARS OF EXTRACORPOREAL MEMBRANE-OXYGENATION - NEURODEVELOPMENTAL OUTCOME PEDIATRICS Hofkosh, D., Thompson, A. E., Nozza, R. J., KEMP, S. S., Bowen, A., Feldman, H. M. 1991; 87 (4): 549-555

    Abstract

    Cf the 87 survivors of extracorporeal membrane oxygenation over a 10-year period, 67 participated in a follow-up study which included neurologic examination (n = 67), cognitive testing (n = 67), and audiologic assessment (n = 33). Matched control subjects for those older than 5 years were also evaluated. Outcome was defined as normal for cognitive scores greater than or equal to 85 and normal neurologic examination results, suspect for cognitive scores 70 through 84 or nonfocal neurologic findings such as hypertonia/hypotonia, and abnormal for cognitive scores less than 70 or abnormal neurologic examination results. Of the 10 school-aged children studied, 9 were normal and there were no differences in mean cognitive scores between subjects and controls (IQ subjects = 109 +/- 12 [SD], IQ controls = 107 +/- 13). For preschoolers aged 2.7 through 4.11 years, the mean cognitive score was 91 +/- 11 and 7 (70%) were normal. For infants 6 through 30 months, the mean cognitive score was 101 +/- 22 and 27 (57%) were normal. A total of 7 children (21% of those studied) had abnormal audiologic assessments. Three children demonstrated mild high-frequency and 4 moderately severe high-frequency sensorineural hearing loss which was bilateral in 3 and of undetermined laterality in 1. Abnormal neurodevelopmental outcome was significantly associated with cerebral infarction and chronic lung disease. Outcome was not related to demographic or perinatal variables, illness severity prior to extracorporeal membrane oxygenation, or underlying diagnosis. Neurodevelopmental outcome among survivors of extracorporeal membrane oxygenation in this series is consistent with previous reports of morbidity among neonates with severe respiratory failure treated conventionally.

    View details for Web of Science ID A1991FF72700019

    View details for PubMedID 1707157

  • ADVERSE SIDE-EFFECTS OF METHYLPHENIDATE AMONG MENTALLY-RETARDED CHILDREN WITH ADHD JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY Handen, B. L., Feldman, H., Gosling, A., BREAUX, A. M., McAuliffe, S. 1991; 30 (2): 241-245

    Abstract

    The adverse side effects of methylphenidate were evaluated in 27 children with attention deficit hyperactivity disorder and IQs of 48 to 74 who participated in a double-blind study of two doses of methylphenidate and placebo. A checklist of 13 side effects, generated from the Physician's Desk Reference, was completed by teachers. Rates of irritability, anxiety, moodiness, and activity level decreased significantly when comparing the placebo with drug conditions. However, medication for six (22%) of the children was discontinued because of the appearance of motor tics (three children) and severe social withdrawal (two children), suggesting that mentally retarded children with attention deficit hyperactivity disorder may be at a greater risk for developing these side effects than the nonretarded population.

    View details for Web of Science ID A1991FB92100012

    View details for PubMedID 2016228

  • NEURODEVELOPMENTAL OUTCOME OF CHILDREN WITH EVIDENCE OF PERIVENTRICULAR LEUKOMALACIA ON LATE MRI PEDIATRIC NEUROLOGY Feldman, H. M., Scher, M. S., KEMP, S. S. 1990; 6 (5): 296-302

    Abstract

    Fifteen children, 8 months of age or older, from a neonatal follow-up program underwent magnetic resonance imaging and neurologic, cognitive, and language evaluations. Magnetic resonance imaging findings in all children included increased white matter signal on T2-weighted images and ventricular enlargement adjacent to regions of abnormal white matter. The extent of degree of abnormal white matter signal and the degree of sulcal prominence were variable. Twelve children had cerebral palsy; 5 children, 4 of whom had cerebral palsy, manifested significant sensory impairments. The median score on cognitive testing was 89; only 2 children exhibited severe-to-profound cognitive disability. Cognitive scores were stable on retesting. The degree of motor disability was correlated with the extent of white matter signal abnormality; however, cognitive outcome was not related to the extent and degree of white matter signal abnormality or to the degree of sulcal prominence. Despite the association of a major handicapping condition and periventricular leukomalacia, cognitive and language functioning may be relatively spared.

    View details for Web of Science ID A1990EC12400002

    View details for PubMedID 2242170

  • METHYLPHENIDATE IN CHILDREN WITH SEIZURES AND ATTENTION-DEFICIT DISORDER AMERICAN JOURNAL OF DISEASES OF CHILDREN Feldman, H., Crumrine, P., Handen, B. L., Alvin, R., TEODORI, J. 1989; 143 (9): 1081-1086

    Abstract

    This study assessed the safety and efficacy of methylphenidate in children with seizures and attention-deficit disorder. Ten children, aged 6 years 10 months to 10 years 10 months, without seizures while receiving a single antiepileptic drug, were evaluated in a double-blind medication-placebo crossover study with methylphenidate hydrochloride was administered at 0.3 mg/kg per dose and given at 8 AM and 12 PM on school days only. The use of methylphenidate was associated with statistically significant improvements on the Conners' Teacher Rating Scale and on the Finger Tapping Task and with trends toward improvement on the Matching Familiar Figures Test and Discriminant Reaction Time tests. No child had seizures during the study period nor subsequently for those who continued receiving psychostimulants. There were no significant changes of epileptiform features or back-ground activity on electroencephalograms and no alterations in antiepileptic drug levels. Methylphenidate may be a safe and effective treatment for certain children with seizures and concurrent attention-deficit disorder.

    View details for Web of Science ID A1989AN66100028

    View details for PubMedID 2672786

  • LEXICAL LEARNING AND LANGUAGE ABILITIES IN PRESCHOOLERS WITH PERINATAL BRAIN-DAMAGE JOURNAL OF SPEECH AND HEARING DISORDERS Keefe, K. A., Feldman, H. M., Holland, A. L. 1989; 54 (3): 395-402

    Abstract

    Studies of children with early-acquired brain damage have noted limitations on language development following such damage and have raised questions regarding the process by which these children acquire language skills. The purpose of this study was to examine the effects of perinatally acquired brain damage on early language abilities and on lexical development through the use of standard assessments, language samples, and a miniature linguistic system approach to teach a novel lexicon. Four children, ages 26-41 months, with localized, perinatal brain lesions documented on ultrasound or CT scan were selected for this study and were compared to 4 matched controls. The results show no differences in the pattern of scores and learning in children with right and left brain damage. With the exception of phonological development, subjects scored below controls on all formal language measures; however, the subjects often scored at or above test norms. Brain-injured subjects were similar to controls with respect to the number of novel words that they initially learned on comprehension and production tasks and the number that they consistently comprehended. Brain-injured subjects generally acquired fewer words when the criterion was consistent accurate production. Interestingly, subjects required more exposures to novel lexical items than did controls before reaching a given level of proficiency. Production seemed to be more difficult for all children, but more so for the brain-injured subjects. It appears that the effects of early damage have an impact on many aspects of language development and that these apparent deficits may reflect the child's need for greater exposure to language skills and structures before acquiring them.

    View details for Web of Science ID A1989AK22300010

    View details for PubMedID 2755102

  • Language abilities after left hemisphere brain injury: A case study of twins Topics in Special Education Feldman HM, Keefe, KA, Holland AL 1989; 9 (1): 32-47
  • ACADEMIC-ACHIEVEMENT IN CHILDREN 10 TO 12 YEARS AFTER HEMOPHILUS-INFLUENZAE MENINGITIS PEDIATRICS Feldman, H. M., Michaels, R. H. 1988; 81 (3): 339-344

    Abstract

    Academic achievement by 23 children 10 to 12 years after treatment of Haemophilus influenzae meningitis was assessed using individually administered standardized tests, review of school transcripts, and parent and teacher questionnaires. The children's performance was compared with (1) their own performance in a previous study 6 to 8 years after the illness; (2) the performance of 23 similarly aged siblings in the previous study, a comparison which served to age match subjects and sibling controls; and (3) the performance of 11 of those similarly aged siblings retested in the current study. Subjects scored in the average range on all measures. Scores were comparable to results 4 years previous in four of six academic measures, with minor deterioration in reading single words and decoding nonsense words. There were no differences between subjects in the current study and control subjects from the previous study, except in decoding nonsense words, and no differences between subjects and control subjects in the current study, except in paragraph reading accuracy. Scholastic grade point averages and scores on parent and teacher behavior problem-rating scales showed no group differences. Subjects used more school-based remedial services, although the trend did not achieve statistical significance. Parents reported spending more time with subjects than with control subjects helping with homework. These findings suggest that children who have recovered from meningitis due to H influenzae can maintain scores and grades comparable to their siblings as they progress to middle school. Their academic success may involve more school and family support to compensate for the mild differences in intelligence quotient and neuropsychologic testing found in the previous study.

    View details for Web of Science ID A1988M438800002

    View details for PubMedID 3344177

  • ESTIMATING PERSONAL PERFORMANCE - A PROBLEM FOR CHILDREN WITH SCHOOL DYSFUNCTION JOURNAL OF DEVELOPMENTAL AND BEHAVIORAL PEDIATRICS Feldman, H., Levine, M. D., Fenton, T. 1986; 7 (5): 281-287

    Abstract

    Children with school dysfunction typically do limited planning and fail to use potentially beneficial mediational strategies on cognitive tasks. This study tested the hypothesis that these children are poor at assessing their own performance capabilities, a deficit which might contribute to this passive learning style. Thirty children, 9-12 years old, attending a multidisciplinary clinic in a pediatric setting for school underachievement, and 30 age, grade, and socioeconomic status (SES)-matched controls were asked to predict their performance in four domains of function before they were given the opportunity to perform the tasks. Clinic subjects overestimated their performance to a greater degree than controls in two domains. This performance resembles the performance of younger children on related tasks and may be amenable to therapeutic or educational intervention.

    View details for Web of Science ID A1986E376200001

    View details for PubMedID 3771802

  • Scrutinizing mental health and me. Journal of psychiatric nursing and mental health services Ryan, J. B. 1978; 16 (11): 32-35

    View details for PubMedID 213568

  • HUMAN ERYTHROCYTE TRANSGLUTAMINASE PURIFICATION AND PROPERTIES BIOCHIMICA ET BIOPHYSICA ACTA Brenner, S. C., WOLD, F. 1978; 522 (1): 74-83

    View details for Web of Science ID A1978EJ17200008

    View details for PubMedID 23166

  • The development of language like communication without a language models Science Goldin Meadow S, Feldman HM 1977; 197 (4301): 401-403
  • The creation of a communication system: A study of deaf children of hearing parents Sign Language Studies Goldin Meadow S, Feldman HM 1975; 8: 225-234

Books and Book Chapters


  • Developmental-Behavioral Pediatrics Feldman, H. M. edited by Carey, W. B., Coleman, W., Crocker, A. C., Elias, E. Elsevier,. 2009
  • The Parent’s Guide to Speech and Language Problems Feit, D. McGraw-Hill. 2007

Conference Proceedings


  • Parental stress and parent-rated child behavior in relation to otitis media in the first three years of life Paradise, J. L., Feldman, H. M., Colborn, D. K., Campbell, T. F., Dollaghan, C. A., Rockette, H. E., Janosky, J. E., Kurs-Lasky, M., Bernard, B. S., Smith, C. G. AMER ACAD PEDIATRICS. 1999: 1264-1273

    Abstract

    As part of a long-term study of possible effects of early-life otitis media on speech, language, cognitive, and psychosocial development, we tested relationships between parents' ratings of parent-child stress at ages 1, 2, and 3 years, and of their children's behavior problems at ages 2 and 3 years, and the children's cumulative duration of middle-ear effusion (MEE) in their first 3 years of life.We enrolled healthy infants by age 2 months who presented for primary care at 1 of 2 urban hospitals or 1 of 2 small-town/rural and 4 suburban private pediatric practices. We obtained standardized baseline measures of parental stress; we intensively monitored the children's middle-ear status by pneumatic otoscopy, supplemented by tympanometry, throughout their first 3 years of life; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated children for otitis media according to specified guidelines. We obtained parent ratings of parental stress using the Parenting Stress Index/Short Form when the children reached ages 1, 2, and 3 years, and parent ratings of children's behavior using the Child Behavior Checklist when the children reached ages 2 and 3 years.In 2278 children we found no substantial relationships between parents' ratings of parent-child stress when the children reached ages 1, 2, and 3 years, or of their children's behavior problems at ages 2 and 3 years, and the cumulative duration of the children's MEE during antecedent periods. On the other hand, ratings both of parent-child stress and of behavior problems were consistently highest among the most socioeconomically disadvantaged children and lowest among the most socioeconomically advantaged children. Ratings also tended to be highest among children whose parents' baseline stress scores were highest.Parent-child stress and children's behavior problems in the first 3 years of life, as rated by parents, bear little or no relationship to the children's previous cumulative duration of MEE.

    View details for Web of Science ID 000084069000005

    View details for PubMedID 10585976

Presentations


  • Language and Reading Outcomes of Prematurity: Behavioral Descriptions, Neuroimaging Findings, Clinical and Educational Implications.

    Time Period

    3/15/2014 - 3/19/2014

    Presented To

    Fourth Annual Latin American School of Education, Cognition, and Neural Sciences

    Location

    Punta del Este, Uruguay

  • Developmental Delay: Screening and Evaluation; Autism as a Community Problem; Developmental Outcomes of Premature Babies

    Lectures and Workshops

    Time Period

    10/16/2012 - 10/18/2012

    Presented To

    First Regional Symposium on Developmental and Behavioral Pediatrics

    Location

    King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia

  • Using Neuroimaging to Understand Language and Reading Outcomes of Preterm Children.

    Time Period

    10/21/2011

    Presented To

    Grand Rounds, Department of Paediatrics

    Location

    University of British Columbia, Vancouver CA

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