Spina bifida myelomeningocele (SB), a neural tube defect associated with deformities of the spine and brain, is associated with motor, non-verbal cognitive, attention, language, and adaptive behavior problems. While these deficiencies are well documented in school-age children, their developmental origins are not well understood since few studies have examined cognitive development for children with SB in early childhood. Research with school- age children has demonstrated that older children with SB have core deficits involving timing, attention orientation, and motor control/learning, and functional deficits in visual perception, attention regulation, and skills involving the integration of information/contingency learning (II/CL): rule-based problem solving, contextual language, and behavioral regulation. These deficits cut across outcome domains. In the current longitudinal study of infants with SB, the development over 6 to 36 months of core deficits and functional deficits from 6-36 months of age, including II/CL skills, have been examined in order to determine their origins and possible links to the later problems identified for SB. Findings from the current longitudinal study show that infants with SB do exhibit core deficits in timing, motor quality and organization, and attention orientation. These core deficits are apparent as early as 7 months of age, persist across early childhood, and appear to be related to growth in emerging functional deficits at 3 years, which demonstrates their importance as a foundation for later SB problems. To link core and functional deficits with school age assessments of similar skills, and to traditional assessments of outcomes, the proposed research will examine longitudinally core and functional deficits for the same 85 children with SB and 73 children normally developing controls that have participated in our current study. In the proposed extension, we will see these children at 7.5, 8.5, and 9.5 years of age to examine growth of core and functional deficits, assess traditional outcomes involving intelligence, language, academics, adaptive behavior, and social functions. We expect that the children's early performance on core and functional tasks will predict their development of similar skills during the early school-age period, and explain variations in traditional outcomes. However, we predict that relations among skills over time will be moderated by the nature and severity of CNS (spine and brain) anomalies and by important environmental variables, including concurrent and previous maternal interactive style. In particular, the caregivers' abilities to maintain the children's attention focus, respond contingently and warmly to children's signals, and provide cognitively enriching verbal input are likely to moderate the degree to which early core deficits lead to functional deficits and predict later ability in these skills. Relations between specific CNS abnormalities documented at 9.5 years for children with SB and the developmental trajectories and concurrent relations with this group of skills, should reveal important information about brain- behavior relations for younger SB children. This study is 1 of few studies of children with SB in the preschool years, and would be the only systematic, comprehensive follow- up into the school- age years. Completion of the study would allow a link with a significant body of research on school- age children with SB.
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