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BACKGROUND: Evidence shows that greenspace exposure benefits children's health and cognitive development. However, evidence assessing this association in young children in low- and middle-income economies is scarce. OBJECTIVE: To assess the association between exposure to greenness and cognitive performance in pre-pubertal boys living in Mexico City. METHODS: Cross-sectional study using data from 144 boys aged 6-11 years living in Mexico City in 2017 and enrolled in the "MetCog" study. Cognitive performance was evaluated through selected Wechsler Scale for Intelligence in Children Fourth Edition (WISC-IV) and Neuropsychological Assessment of Children (Evaluación Neuropsicológica Infantil, ENI) tests. Exposure to greenness was assessed through Normalised Difference Vegetation Index (NDVI) at 300, 500, 1500, 2000, and 3000 m buffer zones from children's residences. Multiple linear regression analysis was undertaken to assess associations between cognitive performance and greenness (aß) with 95% confidence intervals (CI) and adjusted for potential confounding variables. Significance was set at q < 0.05 after False Discovery Rate (FDR) correction. RESULTS: A positive association was found between the NDVI Interquartile Range (IQR) at 2000 m and the WISC-IV block design test score (aß 2000 = 1.18, 95% CI = 0.31, 2.06; q < 0.05), which assesses perceptual reasoning. Positive associations were found with NDVI IQR at 1500 m and WISC-IV block design (aß1500 = 1.00, 95% CI = 0.14, 1.86) and matrix reasoning (aß1500 = 0.83, 95% CI = 0.06, 1.61) scores, but neither survived FDR correction. No significant associations were found between NDVI IQR at any buffer size with other WISC-IV and ENI task scores. CONCLUSIONS: Greater exposure to greenness was associated with higher perceptual reasoning skills in 144 pre-pubertal boys living in Mexico City. Thus, urban planning should consider increasing vegetation in megacities, especially in neighbourhoods with high percentages of young children.

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OBJECTIVES: To describe the neurocognitive profile of 458 children with congenital hypothyroidism detected by neonatal screening, followed under the same treatment protocol over 25 years. To correlate estimated full-scale IQ (FSIQ) scores with age at the start of treatment, disease severity, and maternal education. METHODS: Observational, analytical, retrospective, and longitudinal cohort study, that evaluated children detected between 1991 and 2014, who underwent at least one psychometric assessment (WPPSI- R and/or WISC-III). Estimated FSIQ scores are described and correlated with prognosis determinants. RESULTS: Median T4 at diagnosis was 2.8 µg/dL (0.0-16.5), the median age at the start of treatment was 18.5 days (3-309). Maternal education (n = 445): 2.7% of illiteracy, 59.8% with basic education. Estimated FSIQ scores were 88.0 (±11.8) in WPPSI-R (age 5.6 ± 0.5 years) and 84.1 (±13.0) in WISC-III (age 9.1 ± 1.4 years). The intellectual deficit was identified in 11.6%. Correlation between age at the start of treatment and estimated FSIQ was found only in the WPPSI-R test (p = 0.02). Initial T4 and maternal education significantly correlated with estimated FSIQ scores in both tests, with the latter being the most important determining factor. CONCLUSIONS: In this large cohort of mainly low socioeconomic status children, most children achieved normal cognitive levels; however, a significant percentage presented with below-average estimated FSIQ scores and intellectual deficits. Maternal education was the main determining factor in cognitive level followed by hypothyroidism severity.

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Abstract Objectives: To describe the neurocognitive profile of 458 children with congenital hypothyroidism detected by neonatal screening, followed under the same treatment protocol over 25 years. To correlate estimated full-scale IQ (FSIQ) scores with age at the start of treatment, disease severity, and maternal education. Methods: Observational, analytical, retrospective, and longitudinal cohort study, that evaluated children detected between 1991 and 2014, who underwent at least one psychometric assessment (WPPSI- R and/or WISC-III). Estimated FSIQ scores are described and correlated with prognosis determinants. Results: Median T4 at diagnosis was 2.8 µg/dL (0.0-16.5), the median age at the start of treatment was 18.5 days (3-309). Maternal education (n = 445): 2.7% of illiteracy, 59.8% with basic education. Estimated FSIQ scores were 88.0 (±11.8) in WPPSI-R (age 5.6 ± 0.5 years) and 84.1 (±13.0) in WISC-III (age 9.1 ± 1.4 years). The intellectual deficit was identified in 11.6%. Correlation between age at the start of treatment and estimated FSIQ was found only in the WPPSI-R test (p = 0.02). Initial T4 and maternal education significantly correlated with estimated FSIQ scores in both tests, with the latter being the most important determining factor. Conclusions: In this large cohort of mainly low socioeconomic status children, most children achieved normal cognitive levels; however, a significant percentage presented with below-average estimated FSIQ scores and intellectual deficits. Maternal education was the main determining factor in cognitive level followed by hypothyroidism severity.

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O objetivo do estudo foi avaliar a associação entre a cesariana e o quociente de inteligência (QI) em adolescentes do Município de São Luís, Maranhão, Brasil. Trata-se de um estudo longitudinal utilizando dados da coorte de nascimento em São Luís, iniciado no ano de 1997. A abordagem ocorreu na terceira fase da coorte, em 2016, com adolescente aos 18 e 19 anos de idade. A variável de exposição foi a via de nascimento e a variável de desfecho foi o QI, mensurada a partir da aplicação da terceira versão da Escala de Inteligência Wechsler para Adultos (WAIS-III). Na análise dos dados verificou-se a média do QI segundo as covariáveis e utilizou-se a regressão linear multivariada. Para controlar os fatores de confundimento foi elaborado um modelo teórico utilizando o gráfico acíclico dirigido. As variáveis confundidoras foram as socioeconômicas no momento do nascimento e as variáveis perinatais. A média do QI dos adolescentes foi 101,4. Na análise bruta, o QI dos adolescentes nascidos de cesariana foi 5,8 pontos maior em relação aos nascidos de parto vaginal (IC95%: 3,8; 7,7, p ≤ 0,001), com significância estatística. Na análise multivariada, o valor reduziu para 1,9 (IC95%: -0,5; 3,6, p = 0,141), sem significância estatística. O resultado do estudo mostrou que a cesariana não está associada ao QI dos adolescentes nessa amostra e reflete que as diferenças encontradas podem ser explicadas por outros fatores, como aspectos socioeconômicos e perinatais.

This study aimed to evaluate the association between cesarean section and intelligence quotient (IQ) in adolescents from the Municipality of São Luís, Maranhão State, Brazil. This is a longitudinal study using data from the São Luís birth cohort, started in 1997. The approach occurred in the third phase of the cohort, in 2016, with adolescents aged 18 and 19 years. The exposure variable was mode of delivery and the outcome variable was IQ, measured by applying the third version of the Wechsler Adult Intelligence Scale (WAIS-III). In the data analysis, the average IQ was verified according to the covariates and multivariate linear regression was used. To control confounding factors, a theoretical model was elaborated using the directed acyclic graph. The confounding variables were socioeconomic variables at birth and perinatal variables. Their average IQ was 101.4. In the crude analysis, the IQ of adolescents born by cesarean section was 5.8 points higher than those born by vaginal delivery (95%CI: 3.8; 7.7, p ≤ 0.001), with statistical significance. In the multivariate analysis, the value decreased to 1.9 (95%CI: -0.5; 3.6, p = 0.141), without statistical significance. The result of the study showed that cesarean section is not associated with the IQ of adolescents in this sample and reflects that the differences can be explained by other factors, such as socioeconomic and perinatal aspects.

El objetivo del estudio fue evaluar la asociación entre la cesárea y el cociente de inteligencia (CI) en adolescentes del Municipio de São Luís, Maranhão, Brasil. Este es un estudio longitudinal que utiliza datos de la cohorte de nacimiento en São Luís, que comenzó en 1997. El abordaje ocurrió en la tercera fase de la cohorte, en 2016, con adolescente a los 18 y 19 años de edad. La variable de exposición fue la vía de nacimiento y la variable de resultado fue el CI, medido a partir de la aplicación de la tercera versión de la Escala de Inteligencia para Adultos (WAIS-III). En el análisis de datos se verificó el CI medio según las covariables y se utilizó la regresión lineal multivariada. Para controlar los factores de confusión se elaboró un modelo teórico utilizando el gráfico acíclico dirigido. Las variables de confusión fueron las socioeconómicas en el momento del nacimiento y las variables perinatales. El coeficiente intelectual promedio de los adolescentes fue de 101,4. En el análisis bruto, el CI de los adolescentes nacidos de cesárea fue 5,8 puntos mayor en relación a los nacidos de parto vaginal (IC95%: 3,8; 7,7, p ≤ 0,001), con significancia estadística. En el análisis multivariado, el valor se redujo a 1,9 (IC95%: -0,5; 3,6, p = 0,141), sin significación estadística. El resultado del estudio mostró que la cesárea no está asociada con el coeficiente intelectual de los adolescentes en esta muestra y refleja que las diferencias encontradas pueden explicarse por otros factores, como los aspectos socioeconómicos y perinatales.

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BACKGROUND: Cognitive dysfunctions are frequently found in the 22q11.2 Deletion Syndrome, being an aggravating factor in the impairment of social relationships and communication, strongly impacting the functionality of the individual. Increasing the knowledge regarding cognitive skills may provide contributions to the diagnostic process and the intervention planning. OBJECTIVES: To estimate the general, verbal, and non-verbal cognitive functioning of children and adolescents with 22q11.2 Deletion Syndrome. METHODS: This is a cross-sectional, descriptive, and case series study regarding 15 individuals between 7-18 years-old diagnosed with 22q11.2 Deletion Syndrome. An assessment of the cognitive functions was performed using the Wechsler Abbreviated Scale of Intelligence (WASI). For data analysis we used a descriptive statistics analysis, having absolute frequencies for variables, and mean, median, standard deviation, minimum and maximum values for numerical variables. RESULTS: In the group analysis, we observed an important cognitive impairment degree. Most of the sampling (n=8; 53.33%) presented a considerably low total intelligence quotient score. Cases showing lower performances also presented greater difficulties regarding Visual Motor and Visuospatial coordination. Regarding the intelligence quotient representative punctuation in the WASI scale, the sample showed a large variability in the results (between 40 and 92 points), with the median total of 83. CONCLUSIONS: We observed important dysfunctions, cognitive difficulties, and intellectual, verbal, and non-verbal disabilities in the population studied. These findings indicate the need for an early intervention to assist not only the cognitive aspect, but also the socio-emotional development of children with the 22q11.2 Deletion Syndrome, aiming at their participation in society.

FUNDAMENTO: Disfunções cognitivas são frequentemente encontradas na Síndrome de Deleção 22q11.2, sendo um agravante no comprometimento das relações sociais e da comunicação, impactando fortemente na funcionalidade do indivíduo. O aumento do conhecimento sobre as habilidades cognitivas pode trazer contribuições no processo diagnóstico e no planejamento da intervenção. OBJETIVO: Estimar o funcionamento cognitivo geral, verbal e não verbal de crianças e adolescentes com Síndrome de Deleção 22q11.2. MÉTODOS: Estudo transversal, descritivo, tipo série de casos, com 15 indivíduos entre 7-18 anos com diagnóstico da Síndrome de Deleção 22q11.2. A avaliação das habilidades cognitivas foi realizada com a Escala Wechsler Abreviada de Inteligência (WASI). Para análise dos dados, foi utilizada análise estatística descritiva, com frequências absolutas para variáveis, e média, mediana, desvio padrão, mínima e máximo para variáveis numéricas. RESULTADOS: Na análise do grupo, observou-se um importante grau de comprometimento cognitivo. A maior parte da amostra (n=8; 53,33%) mostrou quociente de inteligência total extremamente baixo. Os casos com desempenhos mais baixos apresentaram maiores dificuldades em relação às habilidades de coordenação visuomotora e visuoespacial. Em relação à pontuação representativa do quociente de inteligência na escala WASI, a amostra apresentou uma grande variabilidade de resultados (entre 40 a 92 pontos), com mediana total de 83 pontos. CONCLUSÕES: As dificuldades cognitivas encontradas indicam a necessidade de uma intervenção precoce para auxiliar não só no desenvolvimento cognitivo, mas socioemocional de crianças com a Síndrome de Deleção 22q11.2 visando sua participação na sociedade.

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OBJECTIVE: There is limited understanding of the cognitive profiles of Spanish-speaking children with Attention-Deficit/Hyperactivity Disorder (ADHD). The current study investigated the cognitive cluster profiles of Puerto Rican Spanish-speaking children with ADHD using the Wechsler Intelligence Scales for Children-Fourth Edition Spanish (WISC-IV Spanish) Index scores and examined the association between cognitive cluster profiles with other potentially relevant factors. METHOD: Hierarchical cluster analysis was used to identify WISC-IV clusters in a sample of 165 Puerto Rican children who had a primary diagnosis of ADHD. To examine the validity of the ADHD clusters, analysis of variances and chi-square analyses were conducted to compare the clusters across sociodemographics (e.g., age and education), type of ADHD diagnosis (ADHD subtype, Learning Disorder comorbidity), and academic achievement. RESULTS: Clusters were differentiated by level and pattern of performance. A five-cluster solution was identified as optimal that included (C1) multiple cognitive deficits, (C2) processing speed deficits, (C3) generally average performance, (C4) perceptual reasoning strengths, and (C5) working memory deficits. Among the five clusters, the profile with multiple cognitive deficits was characterized by poorer performance on the four WISC-IV Spanish Indexes and was associated with adverse sociodemographic characteristics. CONCLUSIONS: Results illustrate that there is substantial heterogeneity in cognitive abilities of Puerto Rican Spanish-speaking children with ADHD, and this heterogeneity is associated with a number of relevant outcomes.

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BACKGROUND: Maternal obesity and high gestational weight gain (GWG) disproportionally affect low-income populations and may be associated with child neurodevelopment in a sex-specific manner. We examined sex-specific associations between prepregnancy BMI, GWG, and child neurodevelopment at age 7. METHODS: Data are from a prospective low-income cohort of African American and Dominican women (n = 368; 44.8% male offspring) enrolled during the second half of pregnancy from 1998 to 2006. Neurodevelopment was measured using the Wechsler Intelligence Scale for Children (WISC-IV) at approximately child age 7. Linear regression estimated associations between prepregnancy BMI, GWG, and child outcomes, adjusting for race/ethnicity, marital status, gestational age at delivery, maternal education, maternal IQ and child age. RESULTS: Overweight affected 23.9% of mothers and obesity affected 22.6%. At age 7, full-scale IQ was higher among girls (99.7 ± 11.6) compared to boys (96.9 ± 13.3). Among boys, but not girls, prepregnancy overweight and obesity were associated with lower full-scale IQ scores [overweight ß: - 7.1, 95% CI: (- 12.1, - 2.0); obesity ß: - 5.7, 95% CI: (- 10.7, - 0.7)]. GWG was not associated with full-scale IQ in either sex. CONCLUSIONS: Prepregnancy overweight and obesity were associated with lower IQ among boys, but not girls, at 7 years. These findings are important considering overweight and obesity prevalence and the long-term implications of early cognitive development.

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The 22q11.2 Deletion Syndrome (22q11.2DS), the most common human chromosome microdeletion syndrome, is associated with a very heterogeneous neurocognitive phenotype. One of the main characteristics of the syndrome spectrum is the intellectual variability, which encompasses average performance and intellectual disability and discrepancies between Verbal Intelligence Quotient and Performance Verbal Intelligence Quotient, with greater impairment in nonverbal tasks. The present study aimed at investigating the intellectual performance aspects of a 21children and adolescents sample from Brazil who had been diagnosed with 22q11.2DS, based on the Wechsler Intelligence Scale for Children - 4th edition. The samples were reviewed considering the differences between indices. The results revealed an Full Scale Intelligence Quotient predominant in the borderline range (42 to 104) and a significant discrepancy between the indices of Verbal Comprehension and Perceptual Reasoning in 42% of the sample. With regard to the performance in the subtests alone, a better performance was found in Similarities, whereas block design, matrix reasoning, digit span and letter-number sequencing subtests were the most challenging. These findings indicate that a comprehensive assessment of intellectual performance aspects covering the different measures of the Wechsler Intelligence Scale may contribute to a broader understanding of the neurocognitive phenotype associated with 22q11.2DS.

A Síndrome da Deleção 22q11.2 (SD22q11.2), microdeleção cromossômica mais frequente em humanos, é associada a um fenótipo neurocognitivo muito heterogêneo. Uma das principais características do espectro da síndrome é a variabilidade intelectual, que abrange de desempenho médio a deficiência intelectual, bem como discrepâncias entre Quociente de Inteligência Verbal e de Quociente de Inteligência de Execução, com maior prejuízo nas tarefas não verbais. O presente estudo teve por objetivo investigar aspectos do desempenho intelectual de uma amostra brasileira de 21 crianças e adolescentes diagnosticados com SD22q11.2, com base nos indicadores da Wechsler Intelligence Scale for Children - 4th edition. As amostras foram analisadas considerando diferenças entre os índices. Os resultados revelaram predomínio de Quociente de Inteligência Total na faixa limítrofe, entre 42 e 104, assim como discrepância significativa entre os índices de compreensão verbal e organização perceptual em 42% da amostra. No que concerne ao desempenho nos subtestes de forma isolada, um melhor resultado foi verificado em semelhanças, ao passo que cubos, raciocínio matricial, dígitos e sequência de números e letras foram os mais desafiadores. Esses achados indicam que uma avaliação abrangente de aspectos do desempenho intelectual contemplando as diversas medidas da Escala Wechsler de Inteligência pode contribuir para uma compreensão mais ampla do fenótipo neurocognitivo associado à SD22q11.2.

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El objetivo fue analizar la estructura interna de la versión brasileña del WISC-IV, comparando el modelo de puntuaciones compuestas con otros dos modelos, el de un factor general de la inteligencia y un modelo con base en la teoría CHC de Cattell-Horn-Carroll. Participaron 795 niños y adolescentes de diferentes regiones de Brasil, con edades entre 6 y 16 años. Los resultados mostraron que el modelo que mejor se ajustó fue el propuesto por el manual del WISC-IV. El modelo con base en la teoría CHC también presentó buen ajuste, pero con valores un poco inferiores a la propuesta original. El modelo de un factor general fue rechazado, pues los índices de bondad de ajuste no fueron satisfactorios. Se sugieren futuras investigaciones que estudien la estructura del WISC-IV en otros países.

This study analyzed the internal structure of the Brazilian version of the WISC-IV by comparing the composed scoring model with two other models: one based on a general factor of intelligence and another based on the CHC theory. The participants included 795 children and adolescents between the ages of 6 and 16 hailing from different regions of Brazil. The results indicated that the most suitable model was the one proposed in the manual. The model of the CHC theory also presented a good fit, but with values that was inferior to those of the original proposal. Moreover, the model of the general factor was rejected because the goodness-of-fit indices were not satisfactory.

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O presente trabalho busca verificar qual o modelo fatorial mais adequado para o WISC-III no grupo clínico das crianças com dificuldades de aprendizagem. Foram analisados 263 protocolos de testes aplicados em alunos de escolas públicas, encaminhados por seus professores para avaliação psicológica. Foram utilizadas as técnicas estatísticas da análise fatorial exploratória e confirmatória. O presente estudo, além de corroborar a estrutura fatorial definida na padronização brasileira, vai ao encontro dos resultados da pesquisa internacional quanto à definição do modelo de quatro fatores como o de melhor ajuste para esse grupo clínico. Apesar de também ter identificado dois modelos trifatoriais como vantajosos quanto ao ajuste, parcimônia e interpretabilidade teórica, a estrutura quadrifatorial é a mais indicada para interpretar clinicamente as pontuações que expressam as habilidades cognitivas do grupo estudado, uma vez que permite aproveitar as normas existentes do WISC-III para a população geral.(AU)

This work contributes to the investigation of a factorial model that is more appropriate for Brazilian children with learning disabilities (LD). 263 WISC-III test protocols of public school students with academic difficulties referred by their teachers for psychological evaluation were analyzed. Statistical techniques of exploratory factor analysis and confirmatory factor analysis were performed. This study, besides corroborating the factor structure defined in the Brazilian standardization, meets the results of the international research for the definition of four-factor model as the best adjusting for the LD population. Although we have also identified two three-factor models as advantageous as to the fit, parsimony and theoretical interpretability, the four-factor structure is the most suitable for clinical interpretation of the scores that express the LD group cognitive abilities, since it allows us to leverage existing standards of WISC-III for the general population.(AU)

El presente trabajo busca verificar cual el modelo factorial más adecuado para el WISC-III en el grupo clínico de niños con dificultades de aprendizaje. Se analizaron 263 testes aplicados en alumnos de escuelas públicas, encaminados por sus maestros para evaluación psicológica. Se utilizaron las técnicas estadísticas del análisis factorial exploratorio y confirmatorio. Este estudio, además de corroborar la estructura factorial definida en la estandarización brasileña, coincide con los resultados de la investigación internacional en cuanto a la definición del modelo de cuatro factores como de mejor ajuste para ese grupo clínico. Además de haber también identificado dos modelos trifactoriales como ventajosos en cuanto al ajuste, a la economía factorial y a la interpretabilidad teórica, la estructura de cuatro factores es la más indicada para interpretar clinicamente los puntajes que expresan las habilidades cognitivas del grupo estudiado, pues permite aprovechar las normas ya existentes del WISC-III para la población general.(AU)

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O presente trabalho busca verificar qual o modelo fatorial mais adequado para o WISC-III no grupo clínico das crianças com dificuldades de aprendizagem. Foram analisados 263 protocolos de testes aplicados em alunos de escolas públicas, encaminhados por seus professores para avaliação psicológica. Foram utilizadas as técnicas estatísticas da análise fatorial exploratória e confirmatória. O presente estudo, além de corroborar a estrutura fatorial definida na padronização brasileira, vai ao encontro dos resultados da pesquisa internacional quanto à definição do modelo de quatro fatores como o de melhor ajuste para esse grupo clínico. Apesar de também ter identificado dois modelos trifatoriais como vantajosos quanto ao ajuste, parcimônia e interpretabilidade teórica, a estrutura quadrifatorial é a mais indicada para interpretar clinicamente as pontuações que expressam as habilidades cognitivas do grupo estudado, uma vez que permite aproveitar as normas existentes do WISC-III para a população geral.

This work contributes to the investigation of a factorial model that is more appropriate for Brazilian children with learning disabilities (LD). 263 WISC-III test protocols of public school students with academic difficulties referred by their teachers for psychological evaluation were analyzed. Statistical techniques of exploratory factor analysis and confirmatory factor analysis were performed. This study, besides corroborating the factor structure defined in the Brazilian standardization, meets the results of the international research for the definition of four-factor model as the best adjusting for the LD population. Although we have also identified two three-factor models as advantageous as to the fit, parsimony and theoretical interpretability, the four-factor structure is the most suitable for clinical interpretation of the scores that express the LD group cognitive abilities, since it allows us to leverage existing standards of WISC-III for the general population.

El presente trabajo busca verificar cual el modelo factorial más adecuado para el WISC-III en el grupo clínico de niños con dificultades de aprendizaje. Se analizaron 263 testes aplicados en alumnos de escuelas públicas, encaminados por sus maestros para evaluación psicológica. Se utilizaron las técnicas estadísticas del análisis factorial exploratorio y confirmatorio. Este estudio, además de corroborar la estructura factorial definida en la estandarización brasileña, coincide con los resultados de la investigación internacional en cuanto a la definición del modelo de cuatro factores como de mejor ajuste para ese grupo clínico. Además de haber también identificado dos modelos trifactoriales como ventajosos en cuanto al ajuste, a la economía factorial y a la interpretabilidad teórica, la estructura de cuatro factores es la más indicada para interpretar clinicamente los puntajes que expresan las habilidades cognitivas del grupo estudiado, pues permite aprovechar las normas ya existentes del WISC-III para la población general.

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