Bożena Banasiak, PhD
TheDepartmentofDidacticsandTeacherEducation FacultyofEducationalSciences
UniversityofLodz
CoGnItIve DeveloPment of ChIlDren wIth Growth retarDatIon
In the Prenatal PerIoD – a PIlot stuDy
Introduction
Recentepidemiologicalstudiesrevealanincreaseinthenumberofchildren
bornwithgrowthretardationintheprenatalperiod�Hithertoprevailingresults
statethatintrauterinegrowthretardationmayleadtotheformationofdevelop- mentaldefects,weakercognitivefunctioningofthechildanddifficultiesinthe
courseofeducation�
Duringdiagnosticproceduresinclinicalpracticeonemustaknowledgedata
concerningboththepatientandtheirsocialenvironment�Informationconcerning
mother’sandfetus’stateofhealthduringpregnancyanddeliveryisvitalinpsy- chologicaltestsevaluatingachild’spsychicdevelopment�
Developmental psychology determines multifactor developmental con- ceptswhichemphasisethemutualandcomplexinfluenceofbiologicaland
environmentalfactorsonthechild’sdevelopment,highlightingself-activity
oftheindividual�Oneofthemostimportanttasksofdevelopmentalpsycholo- gistsisnotonlytoexplainthecausesofchangesinthegrowthprocess,but
alsotoestablishtherulesgoverningtheaforementionedchanges�Familyand
culturalfactorsaswellasdevelopmentindicators:subject’sactivity,upbring- ingandeducation,areofvitalimportanceforthechild’sgrowth(Przetacznik- Gierowska,2000)�
Whileanalysinggrowthdisordersintheprenatalperiod,whichmayaffect
child’ssubsequentpsychicfunctioning,onemusttakeintoaccountthreegroups
offactors:genetic,genetic-likeandextra-geneticaswellasthecourseofdelivery
anditspotentialcomplications�However,onemustrememberthatharmfulnessof
theaforementionedfactorsdependsontheirduration,themomenttheyappeared,
constitutionalpropertiesofthemotherandthechildandotherunfavourablecon- ditionsinthatperiodoftime(Kornas-Biela,2000)�
Modernmedicinehasconsiderablywideneddiagnostic-therapeuticposibili- tiesofprenatalperiod�Thankstoultrasoundtechnologyonemayinvestigatefe- tus’growthanditspotentialdisorders�Itallowsforearlier,andatthesametime
moreeffectivepreventiveandcurativeactionsbothintherangeofmedicaland
psychologicalactivitiesstimulatingchild’sgrowth�Oneofthemostfrequently
describedirregularitiesoftheprenatalperiodistheintrauterinegrowthretarda- tion (IUGR)� Fetus’ growth retardation may be symmetrical or asymmetrical�
Thefetusdevelopsmoreslowlyorunharmoniously,itissmalleranddystrophic�
Epidemiologicalstudiesindicatethatthefrequencyofchildrenbornwithreduced
bodymassisincreasedinsocietiesoflowsocio-economicstanding�Threegroups
ofriskfactorshavebeendistinguished:maternal,fetalandplacental�Maternal
factors are among others too young or too old age, increased parity, mothers’
lifestyle,e�g�improperdiet,smoking,alcoholanddruguse,severestress�Fetal
factorsincludemultiplepregnancies,developmentaldefects,chronicinfections�
Placentalfactorsareforinstanceplacentalinsufficiencyorarterio-venousanasto- moses(Bada-Ellzey,2001)�Inconsequence,symmetricalgrowthdisordersmay
leadtodevelopmentaldefects(Bada-Ellzey,2001)�Hence,itisofgreatimpor- tancetodiagnosethedisordersearlyandtotakepreventiveactions,bothofmedi- calandpsychologicalnature�
IUGRmayresultinthebirthofachild“smallforgestationalage”(SGA)�
SGAhasnumerousnegativehealthconsequencessuchaslowheight,riskof
cardiovasculardiseasesanddiabetesinadulthood�Lowbirthweightincreases
theriskofmortalityininfants�Itcanalsoconstituteoneoftheriskfactorsof
weakerintellectualdevelopmentand,consequently,learningdifficulties�Some
studies point to statistically lower IQ results of SGA children, however, this
differenceconstitutesonlyonestandarddeviation�Theresultsofthesestudies
shouldbetreatedwithcaution(Geva,Eshel,Leitner,Valevski,Harel,2006)�
Some authors, however, emphasise the relation between genetic and psycho- social factors in the course of intellectual development of SGA children and
withintrauterineretardation�
The most important psycho-social factors include: the family’s socio-eco- nomicstatus,schoolandfamilyenvironment,parents’intelligenceandeducation
(Theodore,Thompson,Waldie,Becroft,Robinson,Wild,Clark,Mitchell,2009)�
InthetheoreticalmodelofcognitivedevelopmentofIUGRandSGAchildren,
thefollowingfactorgroupscanbedistinguished:characteristicsoffetalandtera- togensdevelopment,postnatalchildgrowth,geneticconditions(e�g�parents’in- telligence)andpsycho-socialfactors(DeBie,Oostrom,Delemarre-vandeWaal,
2010)�TheauthorsemphasisethatIUGRandSGAmayleadtothechild’sabnor- malcognitivefunctioning,buttherelationsbetweenthesefactorsareverysubtle
andcomplex�
Childrenbornwithlowbirthweightandwhosephysicaldevelopmentinthe
prenatalperiodisimproperoftenmanifestabroadspectrumofdevelopmental
problems�Thosechildrenmoreoftenthanothershavebehavioralandemotional
problems,cognitivedeficitandlearningdifficultiesduringschoolyears�Weaker
fetus’developmentandlowbirthweightareconnectedwithworseschoolachieve- mentsandworseeducationinadulthood�Researchresultsemphasisethatsuch
problemsconcernchildrenbroughtupinfamiliesinadifficultsocio-economic
situation,thereforethemutualinfluenceofenvironmentalandbiologicalfactors
mustbeaknowledged(Nomura,Halperin,Newcorn,Davey,Fifer,Savitz,Brooks- Gunn,2009)�
Theundertakenstudiesareofapilotnatureandconcernchildrenaged5–9,
whowerebornwithsymmetricintrauterinegrowthretardationandalowbirth
weight�
the aim of the research
Theaimoftheresearchwastoestablishthelevelofcognitivedevelopmentof
childrenwhowererecognisedwithintrauterinegrowthretardation(IUGR)inthe
prenatalperiodandwithlowbirthweight(SGA–smallforgestationage)�
Detailedresearchquestions:
• Whatistheoverallabilityofproperthinking?
• Whatisthecourseofdevelopmentofperceptionandeye-handcoordi- nation?
• Dothechildrenhavedifficultiesanddevelopmentaldisorders?
study Group
31children,whounderwentspecialisedtreatmentduetoIUGRandwhopres- entlyhadacontrolexamination,tookpartintheresearch�Thestudygroupin- cludedchildrenaged5-9,18girlsand13boys(Table1)�
Table1�Groupcharacteristic
Sex Numberofpeople %
Girls 18 58
Boys 13 42
Total 31 100
Source: Own work
Theexaminedchildrenwerediagnosedwithfetus’developmentaldisorders
intheformofsymmetricintrauterinegrowthretardationintheprenatalperiod�
Thechildrenwereborninpropertime,thatisbetween36thand40thweekof
pregnancy, however, their birth weight was substantially lower, what confirms
aweakerdevelopmentofthefetusintheprenatalperiod�15childrenwereborn
vaginally,16,however,werebornthroughacesareansection,whichwasneces- saryduetothreattothelifeofthemotherorchild�
Parents’educationispresentedinTable2andindicatesthatthemajorityhas
secondaryandhighereducation�
Table2:Parents’education
Education Moher Father total %
Elementary 6 12 18 29
Secondary 11 10 21 33,9
Higher 14 9 23 37,1
Total 31 31 62 100
Source: Own work
Theanalysisoffamilysituationindicatesthat27examinedchildrenlivein
afullfamilyandonly4childrenarebroughtupbyasingleparent(3singlemoth- ersandonesinglefather)�Takingintoaccountnumberofchildreninafamily,the
mostnumerousarefamilieswithtwochildren(16),12childrenhadnosiblings
and3liveinafamilywiththreechildren�
applied research tools
Thefollowingresearchmethodswereused:
• Raven’sColouredProgressiveMatricesTestusedtomeasurethelevelof
generalintelligenceofchildrenaged3yearsand11monthsthrough9yearsand
11months�Thistestmeasurestheabilityofproperthinkingrelativelyindependent
oftheindividual’sexperience�Psychometricpropertiesofthistestallowforstud- iesofscreeningnature,
• Marianne Frostig’s Developmental Test of Visual Perception is used to
evaluatevisualperceptionofchildrenaged3yearsand11monthsthrough7years
and11months�Intheareaofvisualperceptionthereare5operationallydefined
capabilities:eye-handcoordination,perceptionoffigureandbackground,percep- tionofshapeconstancy,perceptionoffigurepositionandspacialrelationships,
• LateralisationtestsaccordingtoH�Spionekallowingtodeterminethelat- eralisationofhands,eyes,legsandearsandtoestablishthefunctioningsuperior- ityofonehalfofthebody,
• Bender–KoppitzTestexaminingthelevelofeye-handintegrationdevel- opmentofchildrenaged5–8anddetectingretardationofthisfunctioninchildren
over8yearsold,
• Interviewwithparentsconcerningpregnancyandbirth,currentfamilysit- uation,numberofchildreninthefamily,parents’education,thecourseofchild’s
developmentandpossibledifficultiesanddisordersofphysical,somaticandpsy- chicgrowth�
Thesepsychologicaltestsareusedindiagnosisofchild’spsychicdevelop- ment(Frydrychowicz,Koźniewska,Sobolewska,Zwierzyńska,1998)�
The psychological examinations were conducted in Pediatric Cardiology
ClinicoftheMedicalUniversityofLodzin2011�Eachtestwasperformedindi- viduallywiththechildandtheirparents�
research results
Onthebasisoftheobtainedresultsonemaystatethattheabilityofproper
thinkingrelativelyindependentoftheindividual’sexperience,measuredwiththe
useofRaven’stest, fallswithinthelimitsofmediumandhighperformance(Table
3)�48,4%ofthesubjectsachievedtheseconddegree,whatshowschildren’sgreat
mentalabilitiesinthelogicalanalysisofnon-verbalmaterial�Onlyonechild’s
resultswereworsethanaverage�
Table3�Raventestresults
Globalresult Girls Boys Total %
Idegree
>95centil 1 1 2 6,5
IIdegree
75-95centile 9 6 15 48,4
III+degree
50-75centile 5 4 9 29
IIIdegree
25-50centile 2 2 4 12,9
IVdegree
10-25centile 1 0 1 3,2
IV-degree
>10centile 0 0 0 0
Vdegree
>5centile 0 0 0 0
Total 18 13 31 100
Source: Own work
Theresultsofthedevelopmentaltestofvisualperceptionindicatethatmost
ofthechildrenaged5through7years11monthsarecharacterisedwithcorrect
developmentofvisualperception(Table4)�Perceptionquotientin10subjects
wasaverageandamountedto100-115points,9childrenachievedaresultabove
averageinthefieldofvisualperception�However,theabilityofcorrectvisual
perceptionof5childrenreachedthelowerlimitfortheirage�
Table4�ResultsoftheDevelopmentalTestofVisualPerception–perceptionquotient
Perceptionquotient Girls Boys Total
115-130 7 2 9
100-115 6 4 10
85-100 2 3 5
Total 15 9 24
Source: Own work
The results of individual subtests of the Developmental Test of Visual
Perceptionarepresentedbelow:
• Eye-handcoordination:obtainedresultswerecalculatedwithinthelimits
of8-17points,averagescore:13,9
• Perception of figure and background: obtained results were calculated
withinthelimitsof5-15points,averagescore:9,6
• Perceptionofshapeconstancy:obtainedresultswerecalculatedwithinthe
limitsof6-15points,averagescore:10,4
• Perceptionoffigureposition:obtainedresultswerecalculatedwithinthe
limitsof8-15points,averagescore:12
• Perceptionofspacialrelationships:obtainedresultswerecalculatedwithin
thelimitsof9-15points,averagescore:12,7
Theabovedataindicatethattheexaminedchildrenachievedbestresultsin
thefieldofeye-handcoordination,whereasthelowestresultsinthefieldofper- ceptionoffigureandbackground�Allresultsfallwithinthestandardlimitsfor
acertain age,however,insinglecasessubjectsreachedlowerlimitsforsome
subtests�
Thelevelofperceptionandeye-handcoordinationwasevaluatedwiththeuse
ofBender–Koppitztestinthegroupofchildrenaged8-9(Table5)�5children
inthisagegroupachievedresultsindicatingeye-handintegrationdevelopment
retardation�
Table5�Bender–Koppitztestresults Visualperception,
visual-motorcoordination Girls Boys Total
Correct 1 1 2
Delayed 2 3 5
Total 3 4 7
Source: Own work
Allchildreninthestudygroup,havingright-handheterogenouslateralisa- tion,usetheirrighthands�14childrenhadhomogenousright-handlateralisation,
15–heterogenousandintwocasesthelateralisationcouldnotbeestablished�
Variousdevelopmentaldisfunctionsintheformofpsycho-motor,emotional
andspeechdisorderswerefoundinasmuchas50%ofthestudygroup�Sixchil- drenhadspeechdisorders,mostlyintheformofimproperarticulationrequiring
logopediccare�Datagatheredinthecourseofinterviewsindicatethatfivechil- drenwereretardedasfaraslocomotiondevelopmentandposturecontroliscon- cerned�4subjectsrevealedemotionaldisordersintheformofselectivemutism,
nocturnal enuresis, emotional hypersensitivity and psycho-motor hyperactivity�
OnechildrevealedsymptomsprobablyconnectedwithAsperger’ssyndrome�The
boywasreferedtospecialisedexaminationsinordertobeproperlydiagnosed
andtoundergofurthertreatment�Theabovedescribeddevelopmentaldifficulties,
occuringinasmuchas16cases,areworryingbecausetheyconcernhalfofthe
studygroup�Atthesametimetheyindicatethenecessesitytobroadenresearch
diagnostics�
Discussion and Conclusions
Studies concerning psychic functioning of children, whose growth was
retarded in the prenatal period, are presented in the literature on the subject�
Researchconductedinthegroupof9-year-oldsindicateanegativeinfluenceof
IUGRontheirsubsequentneuro-cognitivedevelopment�(Puga,Puga,deArriba,
Armendariz,Labarta,Longas,2009)�
Inthepresentedresearch,explicitretardationinthefieldofperceptionand
eye-handcoordinationwasnotobservedinthegroupofchildrenaged5through7
yearsand11months�Onlyinthegroupofolderchildren(aged8-9)retardationof
eye-handintergationdevelopmentcouldbenoted�Theseresultsrequire,however,
toberepeatedinamorenumerousstudygroup�
AconnectionbetweenIUGRandshort-termverbalmemorydisordersisalso
observedinthisagegroup(Geva,Eshel,Leitner,Valevski,Harel,2008)�Aspe- cific neuro-cognitive development profile can be observed, which may cause
learning difficulties and worse school achievements (Leitne, Fattal-Valevski,
Geva,Eshel,Toledano-Alhadef,Rotstein,Bassan,Radianu,Bitchonsky,Jaffa,
Harel,2007)�Inthepresentlyconductedstudiesresearchersnotethatspeechde- velopmentdisordersandretardation,requiringlogopediccare,wererelatively
frequent�Logopedicdisordersmaybethecauseofproblemsatschool�
Some authors pay attention to the possibility of a connection between
IUGRandanincreasedfrequencyofautisticdisordersandintellectualdisabil- ity(Leonard,NassarN,Bourke,Blair,Mulroy,deKlerk,Bower,2008)�The
resultsofthecurrentresearchindicatedthatonechildsufferedfromdisorders
ofautisticnature�
Studies concerning the course of mental development of children with
IUGRareinconclusive�SomeauthorsemphasisetheconnectionbetweenIUGR
andlowerintellectualefficiency,inthiscasechildrenwithmorecomplexdisor- dersoccurringinprenatalperiodwereexamined(Tideman,Marsal,Ley,2007)�
Inthecurrentstudygroupreducedintellectualdevelopmentwasnotobserved�
Raven’sProgressiveMatricesTestresults,evaluatingabilitiesofproperthink- ingrelativelyindependentofindividualexperience,fellwithintherangeofme- diumandhighperformance�Itisworthnoticing,however,thatthemajorityof
childrencomefromeducatedfamilies(secondaryandhighereducation),what
mayalsobeconnectedwiththeachievedtestresults�Parentswithsecondary
andhighereducationconstituted71%ofthestudygroup�
Someauthorspresentresearchaccordingtowhichtheconnectionbetween
IUGRandlowintellectualefficiencyinlaterdevelopmentalperiodsisinsig- nificant,whereasfamilyfactorsareofmuchgreaterimportance(Sommerfelt,
Andersson, Sonnander, Ahlsten, Ellertsen, Markestad, Jacobsen, Hoffman,
Bakketeig,2000)�Longitudinalstudieslastingforover30yearsindicatedthat
prematurelybornchildrenraisedinpovertyhavemuchmorelearningdifficulties
andworseeducationalachievementsinadulthood�Nosuchconnectionwasde- tectedinthegroupofchildrenbornwithsmallbirthweight(Nomura,Halperin,
Newcorn,Davey,Fifer,Savitz,Brooks-Gunn,2009)�Inthecurrentresearchthe
studygroupwasratherhomogenousintermsofsocio-economicstanding,the
majorityofparentsdeclaredtheirincomeatthelevelofthenationalaverage�
Obtainedresultsconfirmpreviousobservations,namelythatchildrenborn
withintrauterinegrowthretardationandwithlowbirthweightareatgreaterrisk
ofdevelopmentaldisorders,however,theoccuranceofsuchdisfunctionsde- pendsonnumerousmutuallyaffectingfactors�Developmentaldisorders,which
may occur in this group of children, constitute a broad and diversified spec- trumandrequiretakingintoaccountnotonlythecognitiveareaandevaluation
of intellectual and perceptive abilities� The analysis of social and emotional
developmentofthechildaswellassocio-economicconditionsofthefamilyare
alsoofgreatimportance�
Thepresentedpilotstudyconstituteonlyapartoftheplannedresearchand
arebasedonasmallstudygroup�Furtherresearchaswellasamoredetailedsta- tisticanalysisoftheresultswillbecontinuedinordertodetectpossibleconnec- tionsbetweenvariousfactorsaffectingchild’sdevelopment�
Theobtainedresultswillallowforcompilingasetofpreventiveactionsand
activitiessupportingthedevelopmentofthisgroupofchildren�
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