October 6, 1994: Vol26n5: Study gives weight to early exam

By LOIS BAKER
News Bureau Staff
A UB researcher has shown that physicians can identify most of the
prematurely born children among their patients who will experience
sensory and/or motor deficits at 4 to 5 years of age by referring to
the results of a standard neurologic examination administered
routinely to premature babies at age 18 months.
	The research showed that 89 percent of the children who tested
in the low range at 18 months also tested low in a follow-up exam
administered between the ages of 3 and 5.
	Shelly J. Lane, UB assistant professor of occupational therapy
and lead author on the study, said the findings indicate that the
neurologic exam at 18 months can be used as a rationale for referring
children to early intervention programs. RThese results indicate that
among children born prematurely, 18-month neurologic statusIis
significantly predictive of sensorimotor deficits at four years,S Lane
states.
	The study was published in the  American Journal of
Occupational Therapy. 
	Many studies have shown that babies born prematurely are at
risk for neurologic and developmental problems merely by virtue of
their early birth. The 5-15 percent of these children with specific,
identified deficits, such as cerebral palsy, hydrocephalus, or visual
and hearing deficits, will likely receive early intervention and
follow-up services.
	ItUs the children whose deficits are more subtle and less
well-defined, but capable of causing learning and behavior problems by
the time they reach school age, who often get no early intervention
and follow-up services, Lane says. This is because no relationship has
been firmly established between early test results and problems at
school age, she adds.

In an effort to establish such a relationship, LaneUs team followed 30
children born prematurely who had been tested at 18 months: 20 who
were designated neurologically normal and 10 who were assessed as
neurologically suspicious, and tested them again between the ages of 3
and 5 with a standard preschool assessment device.
	Results showed that 8 of 9 children who tested neurologically
suspicious at 18 months continued to show neurologic deficits as they
reached preschool age. One child was unable to complete the test.
	Lane points out that children born prematurely who have
serious neurologic problems are identified early and receive a variety
of special services, and that children who test firmly in the normal
range at 18 months end up holding their own as a group.
	RItUs the kids in the gray area that weUre concerned with in
this study - kids whose parents notice several areas in which the
child is progressing differently than other kids,S she says.
RPhysicians tend to take the global view in these cases, because the
deficits often are subtle. They may advise parents that these children
will grow out of their problems.S
	It would be in the best interest of the child if physicians
would be sensitive to the concerns of parents, she says, and more
willing to refer children who fall into a suspicious category for
further evaluation. She recommends evaluating these children every
12-18 months so they can get help as soon as possible.
	Addressing deficits early has several advantages, she says:
The services have more impact, health professionals have more
flexibility, and correcting problems before children enter school
saves them from being stigmatized as developmentally needy.
	RAfter five, you have to label children with a specific
deficit for them to receive special help,S Lane says. RIf you get
services early, you can perhaps circumvent the onset of problems when
these children face the stress of school, and you donUt label the
child at kindergarten.S
	Members of the research team, in addition to Lane, were Carla
Soares Attanasio of Glenrose Hospital in Edmonton, Alberta, and
Rebecca Farmer Huselid of Hunter College, a doctoral fellow in the UB
Center for the Study of Biobehavioral and Social Aspects of Health
when the study was conducted.