Assessment of Executive Function in Neonatal Intensive Care Unit (Essay Sample)

 Assessment of Executive Function in Neonatal Intensive Care Unit Graduates at 2 years
Key Words: Executive Function, NICU, EF, assessment, follow-up
Abstract
Objective: This study examines the relationship between medical and sociodemographic risk factors, and cognitive and language skills of Neonatal Intensive Care Unit graduates, and their executive function (EF) at 24 months adjusted age. Method: The study employs a quantitative research design method to assess the cognitive and language skills in 234 NICU graduates who were at moderate to high risk at discharge and who participated in a 24-month adjusted NICU follow-up program clinic. The influence of medical and sociodemographic risk factors on cognitive, language, and EF skills, and completion of the EF assessment were examined. Results: Regression analyses revealed children’s gender as the single best predictor of their EF skills at 24 months adjusted age, such that girls demonstrated higher EF skills compared to boys. Logistic regression analyses showed language skills significantly influenced completion of the EF assessment with higher language skills associated with EF assessment completion. Conclusion: The findings support previous evidence that language and EF have a reciprocal relationship, with language skills thought to be a fundamental precursor to the development of EF skills. Implications for NICU follow up programs, and the consideration of early interventions aimed to positively affect EF skills are discussed.
Key Words: Executive Function, NICU, EF, assessment, follow-up
Assessment of Executive Function in Neonatal Intensive Care Unit Graduates At 2 Years
Introduction
Neonatal intensive care unit (NICU) admissions continue to rise,1 and an admission to the NICU is associated with higher risk for developmental impacts in children than their healthy peers. A NICU admission is not only associated with risk for neurodevelopmental delays in the early childhood years but is also linked with decreased school readiness upon entry into school.2 One critical component of school readiness is the development of executive function (EF) skills. These skills have been shown to be a stronger predictor of a child’s readiness for school when compared to intelligence quotients.3 EF processes are a set of cognitive processes that encompass attentional control, inhibitory control, self-regulation, working memory, and cognitive flexibility, as well as reasoning, problem solving, and planning.4
EF plays a key role in the regulation of behavior and learning, thus growing literature links these functions to academic success.6 Fuhs and colleagues7 identified a longitudinal relationship between EF, mathematics skills, language skills for pre-kindergarten and kindergarteners. Specifically, they found that at age four, children’s EF abilities were associated with math and oral language. Controlling for this effect, at age five they found EF was a strong predictor of math abilities and moderate predictor of language abilities. In addition to academic performance, EF skills have been associated with reading skills, social competence, and reduced aggression in pre-kindergarteners.8 There is a significant association between EF skills and adaptive, social emotional competence, and academic performance for adolescence as well, suggesting these effects persist throughout development.9
Given that EF is associated with language and cognitive development,10,11 identifying interventions targeting deficits are important. Specifically, the early childhood years are thought to be a prime opportunity to influence EF skills through targeted interventions,12 and early childhood EF skills are shown to be responsive to intervention.4 Targeted interventions can improve EF skills in children as evidenced by enrichment programs and activities that positively influence EF skills.13,14 While some research has demonstrated concern with the generalizability of EF interventions,15,16 most of this research is specific to working memory and with late elementary school children through adulthood.
Infants born prematurely, with low birthweight, multiple gestational pregnancy, and those with neonatal complications, such as bronchopulmonary dysplasia and intraventricular hemorrhage, have been found to have poor EF skills in their preschool and school age years.18 These deficits are linked to long-term impacts on social-emotional development, attentional skills, behaviors, and self-regulatory skills with subsequent influence on academic success. 19 In addition to medical risk factors, sociodemographic risk factors, such as social economic status and gender, are also associated with decreased EF.20,21
Given that many NICU graduates appear to be at high-risk for EF difficulties, establishing relevant factors influencing these skills is critical to identify children most at-risk for developmental delay as early as possible to ensure the implementation of focused interventions targeted at cultivating EF skills and subsequently improving academic outcomes. While associations between EF and language/academic abilities have been implicated, investigations have been predominantly completed with school-aged children and adolescents. To date, few studies focused on NICU graduates have examined these associations in early childhood and explorations of these relationships as early as the toddler years are minimal.