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Heidi Feldman

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Papers by Heidi Feldman

Title: Longitudinal associations of behavioral problems and text reading skills in school-aged children born term and preterm. Authors

We assessed the contribution of total behavioral problems at 6 years to text reading skills at 8 ... more We assessed the contribution of total behavioral problems at 6 years to text reading skills at 8 years in children born term and preterm. Birth group moderated associations among total behavioral problems and reading skills; total behavioral problems predicted reading skills in the term but not preterm group.

The Effect of Bilingual Exposure on Executive Function Skills in Preterm and Full-Term Preschoolers

Journal of Developmental & Behavioral Pediatrics, 2016

Objective-To evaluate the effects of bilingual exposure on executive function (EF) skills, measur... more Objective-To evaluate the effects of bilingual exposure on executive function (EF) skills, measured by parent-rating and performance-based instruments, in preterm and full term preschoolers. Patients and methods-Children age 3 to 5 years (mean 4.4) born preterm (PT; n=82) and full term (FT; n=79) had monolingual (PT-M, n=51; FT-M, n=53) or bilingual (PT-B, n=31; FT-B, n=26) language exposure. Groups were similar in age, gender and race but PT children had lower socioeconomic status (SES) than FT children. Parents completed a language questionnaire and diary and a standardized parent rating of EF skills. Children completed EF tasks that tap response inhibition, working memory, and cognitive flexibility. ANCOVA and logistic regression examined effects on EF of birth group (PT/FT), language status (M/B), and birth group by language status interaction, controlling for age and SES. Results-Compared to children born FT, children born PT had significantly higher parent-rated EF scores and poorer performance on all but one EF task, both indicating more EF problems. No main effects of language status and no birth group by language status interactions were significant. Conclusions-PT status was clearly associated with poorer EF skills, similar to many other studies. In this sample, bilingual exposure conferred neither an advantage nor disadvantage in the FT and PT group. This information may prove useful in counseling families of both PT and FT children about the impact of bilingual exposure on their children's cognitive skills.

Tract Profiles of White Matter Properties: Automating Fiber-Tract Quantification

PLoS ONE, 2012

Tractography based on diffusion weighted imaging (DWI) data is a method for identifying the major... more Tractography based on diffusion weighted imaging (DWI) data is a method for identifying the major white matter fascicles (tracts) in the living human brain. The health of these tracts is an important factor underlying many cognitive and neurological disorders. In vivo, tissue properties may vary systematically along each tract for several reasons: different populations of axons enter and exit the tract, and disease can strike at local positions within the tract. Hence quantifying and understanding diffusion measures along each fiber tract (Tract Profile) may reveal new insights into white matter development, function, and disease that are not obvious from mean measures of that tract. We demonstrate several novel findings related to Tract Profiles in the brains of typically developing children and children at risk for white matter injury secondary to preterm birth. First, fractional anisotropy (FA) values vary substantially within a tract but the Tract FA Profile is consistent across subjects. Thus, Tract Profiles contain far more information than mean diffusion measures. Second, developmental changes in FA occur at specific positions within the Tract Profile, rather than along the entire tract. Third, Tract Profiles can be used to compare white matter properties of individual patients to standardized Tract Profiles of a healthy population to elucidate unique features of that patient's clinical condition. Fourth, Tract Profiles can be used to evaluate the association between white matter properties and behavioral outcomes. Specifically, in the preterm group reading ability is positively correlated with FA measured at specific locations on the left arcuate and left superior longitudinal fasciculus and the magnitude of the correlation varies significantly along the Tract Profiles. We introduce open source software for automated fiber-tract quantification (AFQ) that measures Tract Profiles of MRI parameters for 18 white matter tracts. With further validation, AFQ Tract Profiles have potential for informing clinical management and decisionmaking.

Oculomotor Assessments of Executive Function in Preterm Children

The Journal of Pediatrics, 2012

Objective-To use objective, nonverbal oculomotor tasks to assess executive function and infer the... more Objective-To use objective, nonverbal oculomotor tasks to assess executive function and infer the neural basis of impairments in preterm children. Study design-Cross-sectional study of preterm children age 9 to 16 years (n = 69; mean gestational age 29 weeks) and full term controls (n = 43). Tasks assessed sensorimotor function (reflexive prosaccades); resistance to peripheral distracters (fixation); response inhibition, response preparation, and execution of a voluntary saccade (antisaccades); and spatial working memory (memory-guided saccades). Group differences were analyzed using ANOVA. We used linear regression to analyze the contributions of age, sex, gestational age, and white matter category to task performance. Results-Preterm children did not differ from controls on basic sensorimotor function, response inhibition, and working memory. Compared with controls, preterm children showed greater susceptibility to peripheral distracters (p = .008) and were slower to initiate an inhibitory response (p = .003). Regression models showed contributions of age and white matter category to task performance. Conclusions-Preterm children show intact basic sensorimotor function and demonstrate difficulties in processes underlying executive control, including increased distractibility and prolonged response preparation. These limitations may reflect specific neural abnormalities in fronto-subcortical executive control of behavior.

Journal of Child Neurology, 2012

This case series assesses white matter microstructure in 3 adolescents born preterm with nonshunt... more This case series assesses white matter microstructure in 3 adolescents born preterm with nonshunted ventricular dilation secondary to intraventricular hemorrhage. Subjects (ages 12-17 years, gestational age 26-29 weeks, birth weight 825-1624 g) were compared to 3 full-term controls (13-17 years, 39-40 weeks, 3147-3345 g) and 3 adolescents born preterm without ventricular dilation (10-13 years, 26-29 weeks, 630-1673 g). Tractography using a 2 region of interest method reconstructed the following white matter tracts: superior longitudinal/arcuate fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, and corticospinal tract. Subjects showed increased fractional anisotropy and changes in the pattern of fractional anisotropy along the trajectory of tracts adjacent to the lateral ventricles. Tensor shape at areas of increased fractional anisotropy demonstrated increased linear anisotropy at the expense of planar and spherical anisotropy. ...

Effects of early language, speech, and cognition on later reading: a mediation analysis

Frontiers in Psychology, 2013

This longitudinal secondary analysis examined which early language and speech abilities are assoc... more This longitudinal secondary analysis examined which early language and speech abilities are associated with school-aged reading skills, and whether these associations are mediated by cognitive ability. We analyzed vocabulary, syntax, speech sound maturity, and cognition in a sample of healthy children at age 3 years (N = 241) in relation to single word reading (decoding), comprehension, and oral reading fluency in the same children at age 9-11 years. All predictor variables and the mediator variable were associated with the three reading outcomes. The predictor variables were all associated with cognitive abilities, the mediator. Cognitive abilities partially mediated the effects of language on reading. After mediation, decoding was associated with speech sound maturity; comprehension was associated with receptive vocabulary; and oral fluency was associated with speech sound maturity, receptive vocabulary, and syntax. In summary, all of the effects of language on reading could not be explained by cognition as a mediator. Specific components of language and speech skills in preschool made independent contributions to reading skills 6-8 years later. These early precursors to later reading skill represent potential targets for early intervention to improve reading.

Academic and Educational Outcomes of Children With ADHD

Ambulatory Pediatrics, 2007

Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and ... more Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention. ADHD is also associated with increased use of schoolbased services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education. Children in community samples who show symptoms of inattention, hyperactivity, and impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes. Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment. Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.

Cerebellar white matter pathways are associated with reading skills in children and adolescents

Human Brain Mapping, 2014

Community ECHO (Extension for Community Healthcare Outcomes) Project Promotes Cross-Sector Collaboration and Evidence-Based Trauma-Informed Care

Background Adverse Childhood Experiences (ACEs) are traumatic events that occur before age 18 yea... more Background Adverse Childhood Experiences (ACEs) are traumatic events that occur before age 18 years. ACEs, associated with negative health behaviors and chronic health disorders, disproportionately impact people from poor and marginalized communities. Toxic stress from ACEs can be prevented and treated with trauma-informed care. Inadequate training prevents the maternal and child workforce from providing evidence-based trauma-informed care. Cross-sector collaboration between pediatric care sectors is crucial to providing systems-wide trauma-informed care, but significant barriers impede cross sector communication. Training and formal cross-sector communication networks are needed to create strong systems of trauma-informed care in communities. The Stanford ACEs Aware ECHO (Extension for Community Healthcare Outcomes) program was created with 3 workforce development goals: 1) introduce the California Office of Surgeon General-led ACEs Aware Initiative to the maternal and child health...

Quality of caregiver-child play interactions with toddlers born preterm and full term: Antecedents and language outcome

Early human development, Dec 1, 2017

Preterm birth may leave long-term effects on the interactions between caregivers and children. La... more Preterm birth may leave long-term effects on the interactions between caregivers and children. Language skills are sensitive to the quality of caregiver-child interactions. Compare the quality of caregiver-child play interactions in toddlers born preterm (PT) and full term (FT) at age 22months (corrected for degree of prematurity) and evaluate the degree of association between caregiver-child interactions, antecedent demographic and language factors, and subsequent language skill. A longitudinal descriptive cohort study. 39 PT and 39 FT toddlers individually matched on sex and socioeconomic status (SES). The outcome measures were dimensions of caregiver-child interactions, rated from a videotaped play session at age 22months in relation to receptive language assessments at ages 18 and 36months. Caregiver intrusiveness was greater in the PT than FT group. A composite score of child interactional behaviors was associated with a composite score of caregiver interactional behaviors. The...

White Matter Plasticity in Reading-Related Pathways Differs in Children Born Preterm and at Term: A Longitudinal Analysis

Frontiers in Human Neuroscience

Children born preterm (PT) are at risk for white matter injuries based on complications of premat... more Children born preterm (PT) are at risk for white matter injuries based on complications of prematurity. They learn to read but on average perform below peers born full term (FT). Studies have yet to establish whether properties of white matter pathways at the onset of learning to read are associated with individual variation later in reading development in PT children. Here, we asked whether fractional anisotropy (FA) at age 6 years is associated with reading outcome at age 8 years in PT children in the same pathways as previously demonstrated in a sample of FT children. PT (n = 34, mean gestational age = 29.5 weeks) and FT children (n = 37) completed diffusion MRI and standardized measures of non-verbal IQ, language, and phonological awareness at age 6 years. Reading skills were assessed at age 8 years. Mean tract-FA was extracted from pathways that predicted reading outcome in children born FT: left arcuate fasciculus (Arc), bilateral superior longitudinal fasciculus (SLF), and left inferior cerebellar peduncle (ICP). We explored associations in additional pathways in the PT children: bilateral inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus. Linear regression models examined whether the prediction of reading outcome at age 8 years based on mean tract-FA at age 6 years was moderated by birth group. Children born PT and FT did not differ significantly in tract-FA at age 6 years or in reading at age 8 years. Sex, socioeconomic status, and nonverbal IQ at age 6 years were associated with reading outcome and were included as covariates in all models. Birth group status significantly moderated associations between reading outcome and mean tract-FA only in the left Arc, right SLF, and left ICP, before and after consideration of pre-literacy skills. Microstructural properties of these cerebral and cerebellar pathways predicted later reading outcome in FT but not in PT children. Children born PT may rely on alternative pathways to achieve fluent reading. These findings have implications for plasticity of neural organization after early white matter injury.

Teaching Yoga to School-Aged Children: Principles and Personal Experiences

International Journal of Yoga Therapy

School-aged children are expected to learn new skills and work productively in many domains of li... more School-aged children are expected to learn new skills and work productively in many domains of life. Those who fail to keep up, particularly those who have developmental disorders, often experience feelings of inferiority and social isolation. I created a Yoga class for school-aged children of all abilities that is designed to serve as a haven from the performance demands of their lives. The class capitalizes on children's pleasure in learning and actively promotes selfawareness without self-judgment. The class draws inspiration from tantric philosophy, which allows for life to be experienced playfully while recognizing the sacred interconnectedness of all things. Three features differentiate this class from a typical adult Yoga class:(1) use of an integrating theme, (2) designated times for discussion and movement, and (3) inclusion of a creative portion. These features are designed to engage and motivate school-aged children. Some traditional elements of a Yoga practice, inclu...

More than myelin: Probing white matter differences in prematurity with quantitative T1 and diffusion MRI

NeuroImage: Clinical

Age-Dependent White Matter Characteristics of the Cerebellar Peduncles from Infancy Through Adolescence

The Cerebellum

Microstructural properties of white matter pathways in relation to subsequent reading abilities in children: a longitudinal analysis

Brain Structure and Function

Parent Communication Prompt to Increase Shared Decision-Making: A New Intervention Approach

Frontiers in pediatrics, 2018

Shared decision-making (SDM) is the process by which patients, clinicians, and in pediatrics, par... more Shared decision-making (SDM) is the process by which patients, clinicians, and in pediatrics, parents/caregivers, discuss treatment options, communicate available evidence for or against the different options, share preferences and values, and eventually arrive at a joint decision. This study evaluates the use of a novel, universally applicable, SDM intervention, provided to parents, intended to promote engagement and participation with their child's clinician. Two-arm randomized controlled trial comparing the impact of a SDM-focused intervention prompt to a neutral comparison prompt on perception of SDM participation. Participants included English-speaking parents of children (0-17 years) attending one Developmental-Behavioral Pediatric (DBP) clinic and their child's clinician. Prior to visit start, parents received either the intervention prompt encouraging engagement with the clinician in decision-making, or the comparison prompt reminding them to request a school/work ex...

Nonword Repetition and Language Outcomes in Young Children Born Preterm

Journal of speech, language, and hearing research : JSLHR, Jan 17, 2018

The aims of this study were to examine phonological short-term memory in children born preterm (P... more The aims of this study were to examine phonological short-term memory in children born preterm (PT) and to explore relations between this neuropsychological process and later language skills. Children born PT (n = 74) and full term (FT; n = 60) participated in a nonword repetition (NWR) task at 36 months old. Standardized measures of language skills were administered at 36 and 54 months old. Group differences in NWR task completion and NWR scores were analyzed. Hierarchical multiple regression analyses examined the extent to which NWR ability predicted later performance on language measures. More children born PT than FT did not complete the NWR task. Among children who completed the task, the performance of children born PT and FT was not statistically different. NWR scores at 36 months old accounted for significant unique variance in language scores at 54 months old in both groups. Birth group did not moderate the relation between NWR and later language performance. These findings...

White matter properties associated with pre-reading skills in 6-year-old children born preterm and at term

Developmental medicine and child neurology, Jul 3, 2018

To assess associations between white matter properties and pre-reading skills (phonological aware... more To assess associations between white matter properties and pre-reading skills (phonological awareness and receptive and expressive language) in children born preterm and at term at the onset of reading acquisition. Six-year-old children born preterm (n=36; gestational age 22-32wks) and at term (n=43) underwent diffusion magnetic resonance imaging and behavioural assessments. Tracts were selected a priori based on findings from a study of 6-year-old children born at term: the left-hemisphere arcuate fasciculus and superior longitudinal fasciculus, and right-hemisphere uncinate fasciculus. Using linear regression, we assessed associations between fractional anisotropy of tracts and phonological awareness and receptive and expressive language scores. We investigated whether associations were moderated by prematurity. Fractional anisotropy of the left-hemisphere arcuate fasciculus contributed unique variance to phonological awareness across birth groups. The association between fraction...

Speed of Language Comprehension at 18 Months Old Predicts School-Relevant Outcomes at 54 Months Old in Children Born Preterm

Journal of developmental and behavioral pediatrics : JDBP, Jan 3, 2018

Identifying which preterm (PT) children are at increased risk of language and learning difference... more Identifying which preterm (PT) children are at increased risk of language and learning differences increases opportunities for participation in interventions that improve outcomes. Speed in spoken language comprehension at early stages of language development requires information processing skills that may form the foundation for later language and school-relevant skills. In children born full-term, speed of comprehending words in an eye-tracking task at 2 years old predicted language and nonverbal cognition at 8 years old. Here, we explore the extent to which speed of language comprehension at 1.5 years old predicts both verbal and nonverbal outcomes at 4.5 years old in children born PT. Participants were children born PT (n = 47; ≤32 weeks gestation). Children were tested in the "looking-while-listening" task at 18 months old, adjusted for prematurity, to generate a measure of speed of language comprehension. Parent report and direct assessments of language were also adm...

Creating the Subspecialty Pediatrics Investigator Network

The Journal of pediatrics, 2018

Title: Longitudinal associations of behavioral problems and text reading skills in school-aged children born term and preterm. Authors

We assessed the contribution of total behavioral problems at 6 years to text reading skills at 8 ... more We assessed the contribution of total behavioral problems at 6 years to text reading skills at 8 years in children born term and preterm. Birth group moderated associations among total behavioral problems and reading skills; total behavioral problems predicted reading skills in the term but not preterm group.

The Effect of Bilingual Exposure on Executive Function Skills in Preterm and Full-Term Preschoolers

Journal of Developmental & Behavioral Pediatrics, 2016

Objective-To evaluate the effects of bilingual exposure on executive function (EF) skills, measur... more Objective-To evaluate the effects of bilingual exposure on executive function (EF) skills, measured by parent-rating and performance-based instruments, in preterm and full term preschoolers. Patients and methods-Children age 3 to 5 years (mean 4.4) born preterm (PT; n=82) and full term (FT; n=79) had monolingual (PT-M, n=51; FT-M, n=53) or bilingual (PT-B, n=31; FT-B, n=26) language exposure. Groups were similar in age, gender and race but PT children had lower socioeconomic status (SES) than FT children. Parents completed a language questionnaire and diary and a standardized parent rating of EF skills. Children completed EF tasks that tap response inhibition, working memory, and cognitive flexibility. ANCOVA and logistic regression examined effects on EF of birth group (PT/FT), language status (M/B), and birth group by language status interaction, controlling for age and SES. Results-Compared to children born FT, children born PT had significantly higher parent-rated EF scores and poorer performance on all but one EF task, both indicating more EF problems. No main effects of language status and no birth group by language status interactions were significant. Conclusions-PT status was clearly associated with poorer EF skills, similar to many other studies. In this sample, bilingual exposure conferred neither an advantage nor disadvantage in the FT and PT group. This information may prove useful in counseling families of both PT and FT children about the impact of bilingual exposure on their children's cognitive skills.

Tract Profiles of White Matter Properties: Automating Fiber-Tract Quantification

PLoS ONE, 2012

Tractography based on diffusion weighted imaging (DWI) data is a method for identifying the major... more Tractography based on diffusion weighted imaging (DWI) data is a method for identifying the major white matter fascicles (tracts) in the living human brain. The health of these tracts is an important factor underlying many cognitive and neurological disorders. In vivo, tissue properties may vary systematically along each tract for several reasons: different populations of axons enter and exit the tract, and disease can strike at local positions within the tract. Hence quantifying and understanding diffusion measures along each fiber tract (Tract Profile) may reveal new insights into white matter development, function, and disease that are not obvious from mean measures of that tract. We demonstrate several novel findings related to Tract Profiles in the brains of typically developing children and children at risk for white matter injury secondary to preterm birth. First, fractional anisotropy (FA) values vary substantially within a tract but the Tract FA Profile is consistent across subjects. Thus, Tract Profiles contain far more information than mean diffusion measures. Second, developmental changes in FA occur at specific positions within the Tract Profile, rather than along the entire tract. Third, Tract Profiles can be used to compare white matter properties of individual patients to standardized Tract Profiles of a healthy population to elucidate unique features of that patient's clinical condition. Fourth, Tract Profiles can be used to evaluate the association between white matter properties and behavioral outcomes. Specifically, in the preterm group reading ability is positively correlated with FA measured at specific locations on the left arcuate and left superior longitudinal fasciculus and the magnitude of the correlation varies significantly along the Tract Profiles. We introduce open source software for automated fiber-tract quantification (AFQ) that measures Tract Profiles of MRI parameters for 18 white matter tracts. With further validation, AFQ Tract Profiles have potential for informing clinical management and decisionmaking.

Oculomotor Assessments of Executive Function in Preterm Children

The Journal of Pediatrics, 2012

Objective-To use objective, nonverbal oculomotor tasks to assess executive function and infer the... more Objective-To use objective, nonverbal oculomotor tasks to assess executive function and infer the neural basis of impairments in preterm children. Study design-Cross-sectional study of preterm children age 9 to 16 years (n = 69; mean gestational age 29 weeks) and full term controls (n = 43). Tasks assessed sensorimotor function (reflexive prosaccades); resistance to peripheral distracters (fixation); response inhibition, response preparation, and execution of a voluntary saccade (antisaccades); and spatial working memory (memory-guided saccades). Group differences were analyzed using ANOVA. We used linear regression to analyze the contributions of age, sex, gestational age, and white matter category to task performance. Results-Preterm children did not differ from controls on basic sensorimotor function, response inhibition, and working memory. Compared with controls, preterm children showed greater susceptibility to peripheral distracters (p = .008) and were slower to initiate an inhibitory response (p = .003). Regression models showed contributions of age and white matter category to task performance. Conclusions-Preterm children show intact basic sensorimotor function and demonstrate difficulties in processes underlying executive control, including increased distractibility and prolonged response preparation. These limitations may reflect specific neural abnormalities in fronto-subcortical executive control of behavior.

Journal of Child Neurology, 2012

This case series assesses white matter microstructure in 3 adolescents born preterm with nonshunt... more This case series assesses white matter microstructure in 3 adolescents born preterm with nonshunted ventricular dilation secondary to intraventricular hemorrhage. Subjects (ages 12-17 years, gestational age 26-29 weeks, birth weight 825-1624 g) were compared to 3 full-term controls (13-17 years, 39-40 weeks, 3147-3345 g) and 3 adolescents born preterm without ventricular dilation (10-13 years, 26-29 weeks, 630-1673 g). Tractography using a 2 region of interest method reconstructed the following white matter tracts: superior longitudinal/arcuate fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, and corticospinal tract. Subjects showed increased fractional anisotropy and changes in the pattern of fractional anisotropy along the trajectory of tracts adjacent to the lateral ventricles. Tensor shape at areas of increased fractional anisotropy demonstrated increased linear anisotropy at the expense of planar and spherical anisotropy. ...

Effects of early language, speech, and cognition on later reading: a mediation analysis

Frontiers in Psychology, 2013

This longitudinal secondary analysis examined which early language and speech abilities are assoc... more This longitudinal secondary analysis examined which early language and speech abilities are associated with school-aged reading skills, and whether these associations are mediated by cognitive ability. We analyzed vocabulary, syntax, speech sound maturity, and cognition in a sample of healthy children at age 3 years (N = 241) in relation to single word reading (decoding), comprehension, and oral reading fluency in the same children at age 9-11 years. All predictor variables and the mediator variable were associated with the three reading outcomes. The predictor variables were all associated with cognitive abilities, the mediator. Cognitive abilities partially mediated the effects of language on reading. After mediation, decoding was associated with speech sound maturity; comprehension was associated with receptive vocabulary; and oral fluency was associated with speech sound maturity, receptive vocabulary, and syntax. In summary, all of the effects of language on reading could not be explained by cognition as a mediator. Specific components of language and speech skills in preschool made independent contributions to reading skills 6-8 years later. These early precursors to later reading skill represent potential targets for early intervention to improve reading.

Academic and Educational Outcomes of Children With ADHD

Ambulatory Pediatrics, 2007

Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and ... more Attention-deficit/hyperactivity disorder (ADHD) is associated with poor grades, poor reading and math standardized test scores, and increased grade retention. ADHD is also associated with increased use of schoolbased services, increased rates of detention and expulsion, and ultimately with relatively low rates of high school graduation and postsecondary education. Children in community samples who show symptoms of inattention, hyperactivity, and impulsivity with or without formal diagnoses of ADHD also show poor academic and educational outcomes. Pharmacologic treatment and behavior management are associated with reduction of the core symptoms of ADHD and increased academic productivity, but not with improved standardized test scores or ultimate educational attainment. Future research must use conceptually based outcome measures in prospective, longitudinal, and community-based studies to determine which pharmacologic, behavioral, and educational interventions can improve academic and educational outcomes of children with ADHD.

Cerebellar white matter pathways are associated with reading skills in children and adolescents

Human Brain Mapping, 2014

Community ECHO (Extension for Community Healthcare Outcomes) Project Promotes Cross-Sector Collaboration and Evidence-Based Trauma-Informed Care

Background Adverse Childhood Experiences (ACEs) are traumatic events that occur before age 18 yea... more Background Adverse Childhood Experiences (ACEs) are traumatic events that occur before age 18 years. ACEs, associated with negative health behaviors and chronic health disorders, disproportionately impact people from poor and marginalized communities. Toxic stress from ACEs can be prevented and treated with trauma-informed care. Inadequate training prevents the maternal and child workforce from providing evidence-based trauma-informed care. Cross-sector collaboration between pediatric care sectors is crucial to providing systems-wide trauma-informed care, but significant barriers impede cross sector communication. Training and formal cross-sector communication networks are needed to create strong systems of trauma-informed care in communities. The Stanford ACEs Aware ECHO (Extension for Community Healthcare Outcomes) program was created with 3 workforce development goals: 1) introduce the California Office of Surgeon General-led ACEs Aware Initiative to the maternal and child health...

Quality of caregiver-child play interactions with toddlers born preterm and full term: Antecedents and language outcome

Early human development, Dec 1, 2017

Preterm birth may leave long-term effects on the interactions between caregivers and children. La... more Preterm birth may leave long-term effects on the interactions between caregivers and children. Language skills are sensitive to the quality of caregiver-child interactions. Compare the quality of caregiver-child play interactions in toddlers born preterm (PT) and full term (FT) at age 22months (corrected for degree of prematurity) and evaluate the degree of association between caregiver-child interactions, antecedent demographic and language factors, and subsequent language skill. A longitudinal descriptive cohort study. 39 PT and 39 FT toddlers individually matched on sex and socioeconomic status (SES). The outcome measures were dimensions of caregiver-child interactions, rated from a videotaped play session at age 22months in relation to receptive language assessments at ages 18 and 36months. Caregiver intrusiveness was greater in the PT than FT group. A composite score of child interactional behaviors was associated with a composite score of caregiver interactional behaviors. The...

White Matter Plasticity in Reading-Related Pathways Differs in Children Born Preterm and at Term: A Longitudinal Analysis

Frontiers in Human Neuroscience

Children born preterm (PT) are at risk for white matter injuries based on complications of premat... more Children born preterm (PT) are at risk for white matter injuries based on complications of prematurity. They learn to read but on average perform below peers born full term (FT). Studies have yet to establish whether properties of white matter pathways at the onset of learning to read are associated with individual variation later in reading development in PT children. Here, we asked whether fractional anisotropy (FA) at age 6 years is associated with reading outcome at age 8 years in PT children in the same pathways as previously demonstrated in a sample of FT children. PT (n = 34, mean gestational age = 29.5 weeks) and FT children (n = 37) completed diffusion MRI and standardized measures of non-verbal IQ, language, and phonological awareness at age 6 years. Reading skills were assessed at age 8 years. Mean tract-FA was extracted from pathways that predicted reading outcome in children born FT: left arcuate fasciculus (Arc), bilateral superior longitudinal fasciculus (SLF), and left inferior cerebellar peduncle (ICP). We explored associations in additional pathways in the PT children: bilateral inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and uncinate fasciculus. Linear regression models examined whether the prediction of reading outcome at age 8 years based on mean tract-FA at age 6 years was moderated by birth group. Children born PT and FT did not differ significantly in tract-FA at age 6 years or in reading at age 8 years. Sex, socioeconomic status, and nonverbal IQ at age 6 years were associated with reading outcome and were included as covariates in all models. Birth group status significantly moderated associations between reading outcome and mean tract-FA only in the left Arc, right SLF, and left ICP, before and after consideration of pre-literacy skills. Microstructural properties of these cerebral and cerebellar pathways predicted later reading outcome in FT but not in PT children. Children born PT may rely on alternative pathways to achieve fluent reading. These findings have implications for plasticity of neural organization after early white matter injury.

Teaching Yoga to School-Aged Children: Principles and Personal Experiences

International Journal of Yoga Therapy

School-aged children are expected to learn new skills and work productively in many domains of li... more School-aged children are expected to learn new skills and work productively in many domains of life. Those who fail to keep up, particularly those who have developmental disorders, often experience feelings of inferiority and social isolation. I created a Yoga class for school-aged children of all abilities that is designed to serve as a haven from the performance demands of their lives. The class capitalizes on children's pleasure in learning and actively promotes selfawareness without self-judgment. The class draws inspiration from tantric philosophy, which allows for life to be experienced playfully while recognizing the sacred interconnectedness of all things. Three features differentiate this class from a typical adult Yoga class:(1) use of an integrating theme, (2) designated times for discussion and movement, and (3) inclusion of a creative portion. These features are designed to engage and motivate school-aged children. Some traditional elements of a Yoga practice, inclu...

More than myelin: Probing white matter differences in prematurity with quantitative T1 and diffusion MRI

NeuroImage: Clinical

Age-Dependent White Matter Characteristics of the Cerebellar Peduncles from Infancy Through Adolescence

The Cerebellum

Microstructural properties of white matter pathways in relation to subsequent reading abilities in children: a longitudinal analysis

Brain Structure and Function

Parent Communication Prompt to Increase Shared Decision-Making: A New Intervention Approach

Frontiers in pediatrics, 2018

Shared decision-making (SDM) is the process by which patients, clinicians, and in pediatrics, par... more Shared decision-making (SDM) is the process by which patients, clinicians, and in pediatrics, parents/caregivers, discuss treatment options, communicate available evidence for or against the different options, share preferences and values, and eventually arrive at a joint decision. This study evaluates the use of a novel, universally applicable, SDM intervention, provided to parents, intended to promote engagement and participation with their child's clinician. Two-arm randomized controlled trial comparing the impact of a SDM-focused intervention prompt to a neutral comparison prompt on perception of SDM participation. Participants included English-speaking parents of children (0-17 years) attending one Developmental-Behavioral Pediatric (DBP) clinic and their child's clinician. Prior to visit start, parents received either the intervention prompt encouraging engagement with the clinician in decision-making, or the comparison prompt reminding them to request a school/work ex...

Nonword Repetition and Language Outcomes in Young Children Born Preterm

Journal of speech, language, and hearing research : JSLHR, Jan 17, 2018

The aims of this study were to examine phonological short-term memory in children born preterm (P... more The aims of this study were to examine phonological short-term memory in children born preterm (PT) and to explore relations between this neuropsychological process and later language skills. Children born PT (n = 74) and full term (FT; n = 60) participated in a nonword repetition (NWR) task at 36 months old. Standardized measures of language skills were administered at 36 and 54 months old. Group differences in NWR task completion and NWR scores were analyzed. Hierarchical multiple regression analyses examined the extent to which NWR ability predicted later performance on language measures. More children born PT than FT did not complete the NWR task. Among children who completed the task, the performance of children born PT and FT was not statistically different. NWR scores at 36 months old accounted for significant unique variance in language scores at 54 months old in both groups. Birth group did not moderate the relation between NWR and later language performance. These findings...

White matter properties associated with pre-reading skills in 6-year-old children born preterm and at term

Developmental medicine and child neurology, Jul 3, 2018

To assess associations between white matter properties and pre-reading skills (phonological aware... more To assess associations between white matter properties and pre-reading skills (phonological awareness and receptive and expressive language) in children born preterm and at term at the onset of reading acquisition. Six-year-old children born preterm (n=36; gestational age 22-32wks) and at term (n=43) underwent diffusion magnetic resonance imaging and behavioural assessments. Tracts were selected a priori based on findings from a study of 6-year-old children born at term: the left-hemisphere arcuate fasciculus and superior longitudinal fasciculus, and right-hemisphere uncinate fasciculus. Using linear regression, we assessed associations between fractional anisotropy of tracts and phonological awareness and receptive and expressive language scores. We investigated whether associations were moderated by prematurity. Fractional anisotropy of the left-hemisphere arcuate fasciculus contributed unique variance to phonological awareness across birth groups. The association between fraction...

Speed of Language Comprehension at 18 Months Old Predicts School-Relevant Outcomes at 54 Months Old in Children Born Preterm

Journal of developmental and behavioral pediatrics : JDBP, Jan 3, 2018

Identifying which preterm (PT) children are at increased risk of language and learning difference... more Identifying which preterm (PT) children are at increased risk of language and learning differences increases opportunities for participation in interventions that improve outcomes. Speed in spoken language comprehension at early stages of language development requires information processing skills that may form the foundation for later language and school-relevant skills. In children born full-term, speed of comprehending words in an eye-tracking task at 2 years old predicted language and nonverbal cognition at 8 years old. Here, we explore the extent to which speed of language comprehension at 1.5 years old predicts both verbal and nonverbal outcomes at 4.5 years old in children born PT. Participants were children born PT (n = 47; ≤32 weeks gestation). Children were tested in the "looking-while-listening" task at 18 months old, adjusted for prematurity, to generate a measure of speed of language comprehension. Parent report and direct assessments of language were also adm...

Creating the Subspecialty Pediatrics Investigator Network

The Journal of pediatrics, 2018