11. tbl. 90. árg. 2004

Fræðigrein

Niðurstöður þroskamælinga við fimm ára aldur

Inngangur:

Tilgangur rannsóknarinnar ,,Fyrirburar – langtímaeftirlit með heilsu og þroska” var að varpa ljósi á lífslíkur, heilsufar, þroska og langtímahorfur lítilla íslenskra fyrirbura sem vógu minna en 1000g við fæðingu og bera saman við fullburða jafnaldra. Þessi hluti rannsóknarinnar fjallar um helstu niðurstöður þroskamælinga og niðurstöður á mati foreldra á hegðun barna sinna.

Aðferðir:

Allir 35 litlir fyrirburar áranna 1991-95 og 55 jafnaldra samanburðarbörn tóku þátt í framskyggnri rannsókn á heilsu og þroska. Börnin komu til læknisskoðunar við rúmlega fimm ára aldur á árunum 1996-2001 og gengust undir mælingar á vitsmunaþroska, málþroska, og skynhreyfiþroska. Auk þess svöruðu foreldrar barnanna spurningum um atferli þeirra. Við úrvinnslu var gerður samanburður á frammistöðu fyrirbura og samanburðarbarna.

Niðurstöður:

Mælingar á vitsmunaþroska samkvæmt Wechsler Preschool and Primary Scale of Intelligence–Revised (WPPSI-R) sýndu lægri heildarniðurstöðu hjá fyrirburum en samanburðarhópi (p<0,001). Þessi munur var meira afgerandi á verklegum hluta en málhluta. Mat á málþroska með Test of Language Development–2P (TOLD-2P) sýndi að málþroskatala var lægri hjá fyrirburum en samanburðarbörnum (p=0,025).

Ekki kom fram munur á hópunum þegar frammistaða þeirra á einstökum undirprófum eða málkerfum og málþáttum var borin saman. Mælingar á þroska með megináherslu á skynjun og hreyfingar samkvæmt Miller Assessment for Preschoolers (MAP) sýndu að heildarskor fyrirbura var lægra en samanburðarbarna (p<0,001) og reyndist mestur munur á skynhreyfiþáttum og skynúrvinnslu.

Marktækur munur kom í ljós á þremur af fimm kvörðum matstækisins þar sem frammistaða fyrirburanna var síðri. Niðurstöður mælinga á fínhreyfifærni með Finmotorisk Utvecklingsstatus 1-7år (FU) sýndu mun á öllum þáttum (p<0,001) og var um það bil árs munur á frammistöðu hópanna tveggja, samanburðar­börnunum í hag. Niðurstöður úr svörum foreldra við spurningalistanum Child Behavior Checklist (CBCL) sýndu mun á milli hópanna á þremur þáttum af átta, fyrirburum í óhag (p<0,001).

Ályktun:

Þroskamælingar við fimm ára aldur gefa til kynna að fjórðungur lítilla fyrirbura nær sama árangri og jafnaldra samanburðarbörn. Í heildina er frammistaða lítilla fyrirbura í þessari rannsókn þó marktækt slakari hvað varðar vitsmunaþroska og skynhreyfiþroska. Samkvæmt þeim þroskaprófum sem notuð voru birtist þroskavandi fyrirburanna einkum í flóknari skynúrvinnslu, samhæfingu og skipulagningu athafna. Hegðunarfrávik náðu ekki klínískum mörkum þótt munur væri á milli hópanna á einstaka þáttum.

Meirihluti lítilla fyrirbura glímir við umtalsverð þroskafrávik og því er mikilvægt að tryggja þeim snemmtæka íhlutun á leikskólaárum og sérstakan stuðning og kennslu í grunnskóla til þess að draga úr langtímaáhrifum þroskavanda þeirra.

Þakkir

Börnum og foreldrum er þakkað fyrir þátttöku í rannsókninni. Jónas G. Halldórsson sálfræðingur fær sérstakar þakkir fyrir vinnu við rannsóknina og Örn Ólafsson tölfræðingur fyrir aðstoð við tölfræðilega útreikninga.

Þakkir eru einnig færðar Guðmundi Arn­kelssyni dósent við Háskóla Íslands fyrir aðstoð og ábendingar, Guðrúnu Garðarsdóttur Fæðingarskráningu, Reyni Tómasi Geirssyni prófessor Kvennadeild Landspítala, Hildigunni Friðjónsdóttur, hjúkrunardeildarstjóra á Göngudeild Landspítala, Skúla Guðmundssyni, skrifstofustjóra Hagstofu Íslands fyrir aðstoð við að finna samanburðarbörn.

Einnig fá þakkir Ásgeir Haraldsson prófessor Barnaspítala Hringsins, Stefán J. Hreiðarsson forstöðumaður Greiningar- og ráðgjafarstöðvar ríkisins og Karl Steinar Guðnason forstjóri Tryggingastofnunar ríkisins. Rannsóknin var styrkt af Vísindasjóði Rannsóknaráðs Íslands og Verðlaunasjóði Óskars Þórðarsonar.

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