Introduction: High-risk children may show normal cognitive abilities, but require extensive therapy or educational support due to uneven learning patterns that are not apparent with summary measures of outcomes. The purpose of this study was to evaluate patterns of uneven learning in high-risk children.
Patients and Methods: Children (n=95) were enrolled in this prospective longitudinal study for extreme prematurity, significant neurologic problems, neonatal cardiac surgery, or prolonged hospitalization. Children were assessed at 18 to 24 months and 3.5 to 5 years corrected age using the Bayley Scales of Infant Development, Third Edition (Bayley-III) and the Differential Abilities Scale, Second Edition (DAS-II). Uneven abilities were defined as composite/cluster score differences of >15 points (one standard deviation)
Results: There was a significant correlation between the Bayley-III cognitive scores and the DAS-II General Conceptual Ability (GCA; r=0.568 p<0.001), but more children had low cognitive scores at preschool (14/91) than at 18 to 24 months (4/95, p<0.001). Uneven patterns of learning (>1 standard deviation difference between composite or cluster scores) occurred in 52/95 (54.7%) of children tested with the Bayley-III and 42/95 (44.2%) of children tested with the DAS-II. Children with uneven learning at 18 to 24 months had a trend toward lower preschool GCA scores than children with evenly-developed 18 to 24 month skills (94.8±4.5, 101.5±5.5, p=0.057).
Conclusion: In this group of medically complex children, uneven patterns of learning were common and cognitive delays emerged over time, emphasizing that it is important to follow children longitudinally and present each child's pattern of strengths and weaknesses to help identify children's needs and target appropriate therapeutic intervention prior to school entry.