Cognitive and Speech Development of Preschool Children, Conceived through Assisted Reproductive Technologies

11

Abstract

Objectives. The mental health of children conceived using assisted reproductive technologies (ART) is a growing concern for parents and professionals. With a maximum compliance with the conditions for using reproductive technologies, the birth of a healthy child is expected. But some children conceived through artificial insemination have developmental problems, speech and/or cognitive problems. A pilot study was conducted on the cognitive and speech development of children from 3 to 8 years old with the aim of a comparative analysis of children from induced pregnancy with children conceived naturally, to determine the possible impact of ART methods on children's health.

Methods. The cognitive and speech functions of 115 children aged 3 to 8 years were studied: 54 children from induced pregnancy were included in the experimental groups (EG 1 and EG 2) and 61 children from natural conception were included in the control groups (CG 1 and CG 2). The method of neuropsychological diagnostics of children of L.S. Tsvetkova and methods of speech therapy examination (assessment of the state of facial and articulatory muscles, breathing, prosodic speech, general speech development) were used. The results were processed through the qualitative and quantitative assessment of the correspondence of the child’s cognitive and speech development to normative ontogenesis.

Results. It has been determined that children conceived through ART have a high percentage of perinatal risk: 35% of children (n=54) conceived through ART have: mental disorders (autism, intellectual disability) and various speech disorders in 77% of cases, — which has a negative impact on the development of cognitive activity. In children conceived naturally (n=61), the percentage of disorders was lower: in 47% of cases, cognitive disorders were noted, and in 60% of children, speech disorders of mild to moderate severity were identified.

Conclusions. The hypothesis about the possible influence of the fertilization methods used, the characteristics of the procedure, the health status of the parents before conception, the course of the mother’s pregnancy and other prenatal factors on the occurrence of developmental disorders in children conceived through ART is supported. An interdisciplinary approach to organizing research will allow a comprehensive study of the developmental features of children from induced pregnancy and the timely identification of possible dysontogenetic risk factors.

General Information

Keywords: in vitro fertilization (IVF); assisted reproductive technologies (ART); artificial insemination; cognitive and speech development of children; induced pregnancy

Journal rubric: Research of ASD

Article type: scientific article

DOI: https://doi.org/10.17759/autdd.2024220105

Funding. The study was financially supported by the Mental Health Research Center within the framework of scientific project No. 0393-2019-0009

Acknowledgements. The author thanks the scientific director of the project, leading researcher, PhD in Psychology N.V. Zverev and leading researcher, PhD in Psychology A.A. Sergienko

Received: 31.01.2024

Accepted:

For citation: Surkova K.L. Cognitive and Speech Development of Preschool Children, Conceived through Assisted Reproductive Technologies. Autizm i narusheniya razvitiya = Autism and Developmental Disorders, 2024. Vol. 22, no. 1, pp. 38–44. DOI: 10.17759/autdd.2024220105.

Full text

Introduction

The infertility of men and women is an important modern medical and demographic problem. One of the ways to solve the problem is the use of assisted reproductive technologies (ART), among which in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are the most sought after. ART methods also include surrogacy, oocyte/sperm/embryo donation, preimplantation genetic testing, etc., all of which allow the family to utilize higher quality genetic material for a successful conception [3; 4; 5; 6; 7].

It may seem that favorable conditions have been created in which the percentage of healthy births in induced pregnancies will be significantly higher than in natural conception. But the presented studies in the field of studying the psychomotor development of a child from an induced pregnancy are very few and contradictory. Some authors claim that there are no significant differences in the development of children conceived with the help of ART and naturally conceived (NC) children [9; 10; 12; 15]. Other studies provide data on a higher incidence of developmental disorders among artificially inseminated children [1; 2; 11; 13; 14], which raises many questions about the possible impact of new technologies in human reproduction on further child development.

The presented study analyzes the obtained developmental history and data on the results of a neuropsychological and speech therapy examination of children conceived by ART, compared to children conceived in natural conditions. An integrated approach to the study of a child’s cognitive and speech development will make it more likely to identify variants of dysontogenesis at an early stage and to begin timely correctional work. The analysis of the applied methods of ART, the number of performed embryo transfers before pregnancy, the anamnestic data on child development allows us to consider the influence of these factors on the further psychospeech development of children. The cognitive and speech development of children aged 3 to 8 years old conceived by means of ART was analyzed.

Materials and Methods

Participants. The study included 115 children aged 3 to 8 years old, 54 of whom were conceived by ART and were the experimental group, and 61 children were the control group of children conceived naturally.

Research Methods. In the diagnostic examination of children’s cognitive and speech development, we used the methods of neuropsychological examination proposed by L.S. Tsvetkova [8] and standardized speech therapy diagnostics, including the assessment of the state of the mimic and articulatory muscles, breathing, vocalization, the features of sound pronunciation, syllabic structure, and the state of the general lexicogrammar structure of speech.

In accordance with the diagnostic methods used and for a more effective differentiated assessment of cognitive development, it was decided to divide the children involved in the study into two age groups: children aged 3 years to 4 years 11 months old and children aged 5 years to 7 years 11 months old. The two experimental groups (EG 1 and EG 2) included 54 children conceived through ART. The two control groups (CG 1 and CG 2) included 61 children conceived in naturally and with no history of clinical disease. The two groups were composed of children aged 3 to 5 years old: 25 children (15 boys, 10 girls) were included in EG 1; 25 children (16 boys, and 9 girls) were included in CG 1. Children aged 5 to 8 years old were also divided into two groups: EG 2 had 29 children (16 boys, 13 girls) and CG 2 included 36 children (18 boys, 18 girls). This division into age groups was dictated by the features of the neuropsychological examination for each age period. In the group of the younger and middle preschool age of children, adapted neuropsychological tests were used to assess intellectual activity, selected with regard to the age and individual abilities of the child.

Results and Discussion

In accordance with the purpose of the work, the data of the child’s medical history, protocols for the management of the ART procedure and the comprehensive diagnostics of psychospeech development were studied.

Detailed information about the applied methods of ART is given in Table 1. In the studied sample of 54 children conceived by ART: 28 children (53%) were conceived by the IVF procedure; 26 children (47%) were conceived by the ICSI procedure.

According to the medical records of the examined children conceived by ART, conditionally normal ontogenetic development was determined in 41% of cases in children from 3 to 8 years old. In 37% of the total number of children in the group, there were confirmed mental disorders, in 22% of cases there were neurological and genetic disorders.

According to the medical history, the examined children from the experimental groups had both normotypic development and different variants of deviant development. The data is presented in Table 2.

Intellectual disability was observed out of the whole sample of children aged 3—8 years old in 15% of cases. Autism spectrum disorders (ASD), as well as ADHD, were identified in 10% of children conceived by ART. Epilepsy was diagnosed in one child (2%).

In the comparison group: CG 1 and CG 2, no clinical illnesses were identified when analyzing medical history data, and dysontogenetic developmental variants had not been diagnosed previously. All children in the control groups had mental and speech development within the age norm.

Table 1

Distribution of Performed ART Procedures Among the Children of the Experimental Groups

 

 

Fertilization Method

Number of Embryo Transfers

 

IVF

ICSI

from 1 to 3

from 4 to 5

over 6

EG 1

28%

16%

36%

8%

0%

EG 2

32%

24%

38%

16%

2%

Note: n=54 respondents, corresponding to 100% of the sample.

Mental Disorders in Children Conceived by Means of ART (n=54)

Note: ID intellectual disability; autism autism spectrum disorder; ADHD attention deficit hyperactivity disorder.
Table 2
 
When analyzing the data obtained during the neuropsychological examination, it was decided to distinguish the following parameters for assessing the state of cognitive functions: 1. Cognitive development corresponds to the age: no cognitive disorders were detected in the child; 2. Functional insufficiency of the development of separate mental functions: partial disorders in the cognitive sphere, which are functional in nature and are likely to be compensated independently as the brain matures, are diagnosed in the child; 3. Borderline cognitive development: a high probability of the insufficiency of the development of separate cognitive functions of a predominantly organic etiology is diagnosed, with good compensatory capabilities. 4. Risk of dysontogenetic development: the child is diagnosed with severe cognitive function development disorders of various etiologies, which require targeted correctional psychological and pedagogical work.
Let us consider the results obtained within the framework of neuropsychological research.
 
The data obtained from the neuropsychological examination shows that conditionally normal cognitive development was more common in the control groups of children born from natural conception than in the experimental groups. The high rates of risk of dysontogenetic development in the groups of children conceived with the help of ART are much higher than in the control groups, which can be explained by the inclusion and exclusion of the study participants. There were no significant differences between the experimental and control groups of children in terms of the degree of the insufficient development of individual cognitive functions. The revealed features of development were predominantly functional in nature.
 
During the course of neuropsychological examination, the immaturity of the arbitrary regulation of activity, expressed in negativism, stubbornness, and outbursts of aggression, was most clearly noted in the EG 1 group. The immaturity of inhibitory control was manifested by motor disinhibition and rapid exhaustion in some children or increased distractibility against the background of exhaustion in others. The development of other higher mental functions was secondarily affected by difficulties in arbitrary control. In the comparative group of CG 1 children had a less frequent insufficiency of arbitrary regulation, and it did not have a severe character of disorders of the emotional and/or behavioral sphere. In children from EG 1 and CG 1, an insufficiency of motor sphere development was noted with the same frequency. An errorfree performance of tests on the kinesthetic and dynamic praxis was not available to children up to 3.5— 4 years old. The analysis of the formation of thinking operations showed that children from the groups EG 1 and CG 1 equally experienced difficulties in the tests for visual and figurative and verbal logical reasoning, which is quite expected for children of this age period.
 

Assessment of the Cognitive Development of Children Participating in the Study Using Neuropsychological Research Methods


Table 3

Indicators

EG 1

CG 1

EG 2

CG 2

n (% of each group)

25

25

29

36

Cognitive Development Corresponds to the Age

5

20%

14

56%

1

3,4%

8

22%

Functional Insufficiency of the Development of Separate Mental Functions

9

36%

8

32%

7

24,1%

11

30%

Borderline Cognitive Development

4

16%

3

12%

7

24,1%

7

19%

Risk of Dysontogenetic Development

7

28%

0

0%

14

48,2%

0

0%

 

Neuropsychological examination in the EG 2 group and in the CG 2 comparative group gave the following results: in the EG 2 group, the majority of children had a severe dissociation of the formation of a number of mental processes (voluntary attention, thinking, memory, perception, motor sphere), as compared to children from CG 2, who did not have any dissociation in cognitive development, and the insufficient formation of some mental functions was mainly functional in nature. The symptoms of underdevelopment of subcortical structures (diencephalic and stem structures), as well as of certain cortical structures, were observed in 35% of children from EG 2 and 23% of children from CG 2. Decreases in general neurodynamics were observed with approximately equal frequency in the two groups. In 15 % of children from EG 2 there were symptoms of the functional deficiency of the regulatory factor, which manifested themselves in the lack of assiduity, difficulties in retaining a given program, in a decrease in the motivational component of activity (rapid saturation of activity), in difficulties in concentrating on the task. In CG 2, 9% of children showed symptoms of the insufficient development of the regulatory factor, and the manifestations were functional and less pronounced than in the EG 2 group.

The development of thinking operations in EG 2 children, as compared to CG 2, was characterized by unevenness. In children with mental and speech developmental delays, the tasks of classification by a common characteristic, the method of Excluding objects (“4th is the odd one out”, “nonsense” exercises were available only when performed jointly with an adult, whereas in children with normal mental development, the success of the task completion depended on the conditions of domestic pedagogical training and the zone of actual development.

The speech therapy examination revealed different types of speech disorders (see Table 4).

Table 4 shows the percentage of speech disorders for each group of children in the study. Conditionally normal speech development was found in 39% of children (n=61) from the control group and in 22% of children (n=54) from the experimental group. Speech disorders of the dysarthria and alalia type were more common among children conceived by ART (78% of cases) and varied in severity: from a complete absence of speech to unexpressed, erased manifestations, as well as combined with general underdevelopment of speech from level 1 to 3. In the control groups, speech disorders were observed in 61% of children and manifested themselves in the form of minimal disorders of muscle tone in the organs of mimic muscles and articulation, the insufficiency of speech breathing and the prosodic design of speech, and the insufficiency of the phonetic and phonemic perception. General underdevelopment of speech in groups CG 1 and CG 2 was diagnosed less frequently and was within the 3rd level of development. Dyslalia was diagnosed in almost all groups of children with approximately the same percentage of occurrence.

According to the results of the study, it can be concluded that children conceived through assisted reproductive technologies represent a heterogeneous group in terms of cognitive and speech development parameters. According to the data of the study, the children from the experimental groups have a tendency towards a decrease in general neurodynamics, an insufficient regulation of emotions and behavior, and speech disorders of varying degrees of severity, which shows the need for early psychological and pedagogical support. Timely correctional work will allow to compensate the existing disorders most successfully by the beginning of educational activity.

The data obtained in the study of the medical, psychological and pedagogical examination of children of 3—8 years old conceived with the help of reproductive technologies shows different variants of neurocognitive development, characterized by the peculiarity of formation of higher mental functions. Therefore, the study of the issue of the possible interrelation of the influence of the fertilization method on the ontogenetic development of the child is extremely relevant. In our study, different variants from severe underdevelopment to a high normality were revealed in the designated spheres of development.

Table 4

 

Speech Disorders in Children of the Experimental and Control Groups Identified During the Speech Therapy Examination

 

Groups

 

Speech Disorders

 

EG 1

 

CG 1

 

EG 2

 

CG 2

N

25

25

29

36

No Speech Disorders

6

24%

8

32%

6

20%

16

44%

Dysarthria

4

16%

5

20%

15

51%

11

30%

Alalia

7

28%

1

4%

4

13%

2

5%

Dyslalia

7

28%

8

32%

4

13%

5

13%

Stuttering

1

4%

0

0%

0

0%

0

0%

 

 

 

Conclusion

The frequently occurring psychiatric and neurological pathology in children conceived by ART requires


a closer study of different spheres of possible influence (health status of parents, pregnancy and labor period, etc.) on the further development of the child.

A qualitative and comprehensive study of the impact of ART on children’s cognitive and speech development is possible only through an interdisciplinary approach towards the organization of the study. This will allow for a comprehensive and more detailed assessment of the impact of the chosen reproductive method on the child’s further development. Combining specialists from different fields: fertility specialists, gynecologists, neonatologists, pediatricians, psychologists, and teachers will help to create a more comprehensive picture of the development of children conceived artificially.

 

 

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Information About the Authors

Karolina L. Surkova, research assistant, Mental Health Research Center, Moscow, Russia, ORCID: https://orcid.org/0000-0001-7501-0535, e-mail: www1-11@yandex.ru

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