This project continues to study premature and brain injured neonates, hypothesizing (a) that these risk conditions differentially reduce the ability to modulate arousal and attention processes, and (b) that the pattern of disruption in arousal/attention modulation predicts both degree of early brain injury and later percentual cognitive and motivational development. We have developed and refined a measure of neonatal behavior using the visual preference technique that shows systematic differences in preference functions with controlled manipulations of arousal due to changes in internal as well as external sources of stimulation. We have demonstrated that: (a) high-risk and preterm infants, as to normal term infants, show a general shift in looking preference with arousal manipulations; but that (b) the more severe the brain injury, the less the shift in looking preferences toward higher frequencies when less aroused. The present proposal will enable us to establish how CNS pathology, acting through poor arousal/attention modulation in the neonate, can form the substrate on which later behavior develops and can be expressed in diverse circumstances related to higher- level cognitive attainment. Infants (n=288) stratified into 8 groups related to brain injury will be studied from birth to 19 months at 3 month intervals. We have designed studies that will provide converging information from measures of arousal modulated visual recognition memory, cortisol reactivity to different stressors, and vagally mediated control over heart rate. We predict that arousal manipulations will modulate responding across measures, but that degree of response modulation will be differentially affected by degree and type of CNS compromise. Prior to hospital discharge, and at 1 and 4 months, visual recognition memory will interact with arousal level in a manner analogous to the visual preference task such that the magnitude of difference between preferences for novelty in different arousal conditions will be proportional to CNS insult, with arousal less influential the older and healthier the infant. As the infant matures, more challenging tasks will be needed to differentiate brain injury; for example, those involving intersensory (auditory-visual) integration may become better discriminators. We hypothesize that measures of focused attention, distractibility, irritability, goal-directed behavior, and exploratory behavior at later ages will correlate to lack of modulation of early attention.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Special Emphasis Panel (ZRG1-HUD-1 (01))
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Institute for Basic Research in Dev Disabil
Staten Island
United States
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Kittler, Phyllis M; Brooks, Patricia J; Rossi, Vanessa et al. (2013) Neonatal Intensive-Care Unit Graduates Show Persistent Difficulties in an Intra-Dimensional Shift Card Sort. J Cogn Dev 14:633-650
Kittler, Phyllis M; Gardner, Judith M; Lennon, Elizabeth M et al. (2011) The development of selective attention and inhibition in NICU graduates during the preschool years. Dev Neuropsychol 36:1003-17
Karmel, Bernard Z; Gardner, Judith M; Meade, Lauren Swensen et al. (2010) Early medical and behavioral characteristics of NICU infants later classified with ASD. Pediatrics 126:457-67
Kittler, Phyllis M; Phan, Ha T T; Gardner, Judith M et al. (2009) Auditory brainstem evoked responses in newborns with Down syndrome. Am J Intellect Dev Disabil 114:393-400
Karmel, Bernard Z; Gardner, Judith M (2005) Neurobehavioral assessment in the neonatal period--the impact of Ferenc Katona. Ideggyogy Sz 58:315-23
Geva, R; Gardner, J M; Karmel, B Z (1999) Feeding-based arousal effects on visual recognition memory in early infancy. Dev Psychol 35:640-50
Freedland, R L; Karmel, B Z; Gardner, J M et al. (1998) Prenatal cocaine exposure and stimulus-seeking behaviors during the first year of life. Ann N Y Acad Sci 846:386-90
Karmel, B Z; Gardner, J M; Freedland, R L (1998) Neonatal neurobehavioral assessment Bayley I and II scores of CNS-injured and cocaine-exposed infants. Ann N Y Acad Sci 846:391-5
Karmel, B Z; Gardner, J M (1996) Prenatal cocaine exposure effects on arousal-modulated attention during the neonatal period. Dev Psychobiol 29:463-80
Karmel, B Z; Gardner, J M; Freedland, R L (1996) Arousal-modulated attention at four months as a function of intrauterine cocaine exposure and central nervous system injury. J Pediatr Psychol 21:821-32

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