Neurologic soft signs and low birthweight: Their association and neuropsychiatric implications

Background: We examine the relationship between neurologic soft signs and c ognitive deficits, learning disorders, and psychiatric problems in low birt hweight (LBW) and normal birthweight (NBW) children, Methods: Representative samples of LEW and NEW children were selected from the 1983-1985 newborn discharges of two major hospitals in Michigan, Eight hundred-twenty three children (75% of the target sample) were evaluated at ages 6 and 11. A standardized neurologic evaluation was used by neurologist s to measure neurologic soft signs at age 6 (children with frank neurologic impairment were excluded), Ie was measured by WISC-R and behavior problem lists were rated by mothers and teachers, Standard tests of academic achiev ement were used to identify learning disorders, All assessments were blind to LEW status, Using multiple regression analysis, applying generalized est imating equations (GEE), we estimated the effects of soft signs on 3 behavi oral domains, based on information from multiple informants and times of as sessment. Results: LEW was associated with a two-fold increased risk for soft signs, Soft signs increased the risk for subnormal le and for learning disorders i n children with normal IQ Soft signs were associated with excess internaliz ing problems in LEW and NEW children, and with attention and externalizing problems in LEW children; the excess in externalizing problems in LEW child ren was observed only at age 6. Conclusions: Soft signs are a marker of high risk for cognitive and psychia tric problems, Of particular concern is their presence in LEW children, in whom they are associated with more severe cognitive deficits and more perva sive psychiatric problems.