Mental health and developmental outcomes for children born after ART: a comparative prospective study on child gender and treatment type. Developmental course of attention deficit hyperactivity disorder and its predictors. Psychoeducational treatment for school-aged children with bipolar disorder. The Groningen assisted reproductive technologies cohort study: developmental status and behavior at 2 years. Preliminary data suggesting the efficacy of attention training for school-aged children with ADHD Acute hyperglycemia alters mood state and impairs cognitive performance in people with type 2 diabetes. Does Cognitive Training Prevent Cognitive Decline? Transitions on and off AFDC: implications for parenting and children's cognitive development. Increased time to pregnancy is associated with less optimal neurological condition in 4-year-old singletons, in vitro fertilization itself is not. The Power of Personality: The Comparative Validity of Personality Traits, Socioeconomic Status, and Cognitive Ability for Predicting Important Life Outcomes Development of children born after ovarian superovulation induced by long-acting gonadotropin-releasing hormone agonist and menotropins, and by in vitro fertilization. “Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review” Short-Term Intervention Effects of the PATHS Curriculum in Young Low-Income Children: Capitalizing on Plasticity Does money matter? The effects of cash transfers on child development in rural Ecuador. Medical and developmental outcome at 1 year for children conceived by intracytoplasmic sperm injection From the Editors’ Desk: Bias in Systematic Reviews—Let the Reader Beware Psychosocial interventions for people with dementia: An overview and commentary on recent developments Botulinum toxin assessment, intervention and after-care for lower limb spasticity in children with cerebral palsy: international consensus statement. Cognitive and psychomotor development of 5- to 6-year-old singletons born after PGD: a prospective case-controlled matched study. Examining Infertility Treatment and Early Childhood Development in the Upstate KIDS Study. Hypnosis Reduces Distress and Duration of an Invasive Medical Procedure for Children The Development of LISTEN: A Novel Intervention for Loneliness. Advanced reproductive age and fertility.
STUDY QUESTION Do children born after assisted reproductive techniques ( ART ; IVF/ICSI )  display more mental health issues or social and cognitive developmental problems at 7 - 8 years than naturally conceived ( NC ) controls , and does child gender play a role ? SUMMARY ANSWER ART children do not differ with regard to mental health or social and cognitive developmental problems when compared with controls , but some gender-specific differences do exist . WHAT IS KNOWN ALREADY Systematic review s have not found any evidence of delays in neurocognitive or sensorimotor development in ART children . However findings on the effect of the type of ART treatment ( IVF versus ICSI ) on the offspring 's physical and mental development have not been uniform . Knowledge of the role of child gender in ART research is scarce . STUDY DESIGN , SIZE , DURATION This prospect i ve follow-up study compares mental health and social and cognitive developmental problems between 7 - 8-year-old ART and NC children , controlling for the father 's age , length of the parents ' partnership , mother 's parity , child 's gestational age , and the need of neonatal intensive care unit ( NICU ) . Further , within the ART group , we analysed whether the treatment type ( IVF versus ICSI ) and the child 's gender are associated with the mental health and developmental outcomes . PARTICIPANTS / MATERIAL S , SETTING , METHODS In this study , 255 singleton ART children ( IVF and ICSI ) were compared with 278 NC children on parent-reported internalizing and externalizing symptoms , and social ( social skills and peer relations ) and cognitive development ( executive functioning , perception , memory , and language ) . Within the ART group , 164 IVF and 76 ICSI children were compared on the same outcomes . Statistics included analyses of covariates ( ANCOVA ) with group main effects , group and gender interaction effects , and Bonferroni post hoc tests . MAIN RESULTS AND THE ROLE OF CHANCE ART and NC children did not differ generally in terms of their internalizing and externalizing symptoms or in the number of social and cognitive developmental problems ( Group main effects , P > 0.05 ) , but gender-specific group differences existed . The ART boys showed lower levels of cognitive problems than the NC boys , whereas ART girls showed higher levels of cognitive problems than the NC girls ( Group × Gender-interaction effects with Bonferroni post hoc tests on mother-reports , P < 0.01 ) . Further , unlike in the NC group , where boys showed more externalizing symptoms and social and cognitive developmental problems than girls ( Group × Gender-interaction effects with Bonferroni post hoc tests for both parents ' reports , P < 0.05 ) , gender differences were not found in the ART group . Within the ART group , IVF and ICSI children did not differ in terms of mental health or developmental outcomes , and no significant gender differences emerged . LIMITATIONS , REASONS FOR CAUTION The information on children 's mental health and development was based on parental reports only . The dropout rate between the child 's first year and the school age assessment s was very high for fathers ( 57.4 % ) and substantial for mothers ( 30.1 % ) , and the participating group was biased for older age of both parents and for better education of the fathers . WIDER IMPLICATION S OF THE FINDINGS The findings indicate the importance of considering child gender in learning about multiple developmental outcomes among children born after ART . STUDY FUNDING /COMPETING INTERESTS This study was supported by the Academy of Finl and ( # 11232276 ) , the Emil Aaltonen Foundation , The Family Federation of Finl and , Helsinki University Central Hospital Research Funds , and the National Graduate School of Psychology . None of authors has any competing interests to declare OBJECTIVE To outline the key features of the developmental progression of ADHD and to consider the most prominent influences on its developmental course and outcomes . METHODS This is a selective review focusing primarily on prospect i ve follow-up studies . Relevant publications were selected by search ing the MEDLINE and PubMed data bases using keywords : ADHD , development , preschool , adolescent , adult , follow up , outcome , long-term , predictors , and treatment . Reference lists of the result ing articles were then review ed for additional publications . RESULTS Presentation of ADHD and associated impairments evolve across development , as do outcome predictors . In early development , in addition to genetics , some forms of prenatal adversity increase the risk for ADHD . In preschool years , symptom severity , cognitive function , and family factors become significant predictors of school age outcomes . These continue to predict long-term outcomes in school aged children , and comorbidity emerges as another significant long-term outcome predictor at this stage . CONCLUSIONS Presentation of ADHD and risk factors for later adversity evolve across development , which calls for developmentally-informed clinical practice Bipolar disorder ( BPD ) has received increasing attention from public and professional sources . Although pharmacologic treatments are considered the sine qua non in the treatment of youth with BPD , psychosocial interventions are critical to assist the child and family cope with symptoms that carry with them significant morbidity and mortality . Treatments developed to date are few in number ; all are psychoeducationally based , using cognitive-behavioral and family systems interventions within a biopsychosocial framework . This paper review s possible mediators of outcome , including caregiver concordance , children 's social skills , hopelessness , and family stress . The author has developed two family-based psychoeducational interventions for the treatment of youth with BPD : multifamily psychoeducation groups ( MFPG ) and individual family psychoeducation ( IFP ) . These treatments are both described and the results from a previously published r and omized clinical trial ( RCT ) of MFPG are summarized . Then , new findings from an RCT of IFP are presented , along with preliminary pilot data from an exp and ed version of IFP . The paper concludes with recommendations for future research OBJECTIVE To evaluate whether children 's  cognitive and psychomotor development and behavior at 2 years are affected by ovarian hyperstimulation and the IVF laboratory procedures or subfertility . DESIGN Prospect i ve longitudinal cohort study . SETTING University Medical Center Groningen , the Netherl and s. PATIENT(S ) Singletons born after controlled ovarian hyperstimulation (COH)-IVF ( n=66 ) and modified natural cycle-IVF ( n=56 ) , singletons born to subfertile couples who conceived naturally ( subfertile-naturally conceived , n=87 ) , and a reference group of 101 2-year-old singletons born to fertile couples . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Bayley Scales of Infant Development and Achenbach Child Behavior Checklist . RESULT ( S ) Mental and psychomotor development and behavioral outcome in COH-IVF , modified natural cycle-IVF , and subfertile-natural cycle groups was not different . Developmental outcome and behavior of the subfertile groups were largely similar to those of the fertile reference group . Nevertheless , the subfertile groups scored higher on the scale of anxious-depressed behavior than the reference group . CONCLUSION ( S ) This present relatively small study found no differences in cognitive and psychomotor development and behavior at 2 years in children born after COH-IVF or modified natural cycle-IVF or naturally conceived children of subfertile parents . Replication of the study is needed before firm conclusions can be drawn . Furthermore , long-term follow-up is needed to confirm these findings in older children A pilot r and omized clinical trial was conducted to examine the initial efficacy of Pay Attention ! , an intervention training sustained , selective , alternating , and divided attention , in children diagnosed with Attention-Deficit/Hyperactivity Disorder ( ADHD ) . After a diagnostic and baseline evaluation , school-aged children with ADHD were r and omized to receive 16 bi-weekly sessions of Pay Attention ! ( n=54 ) or to a waitlist control group ( n=51 ) . Participants completed an outcome evaluation approximately 12 weeks after their baseline evaluation . Results showed significant treatment effects for parent and clinician ratings of ADHD symptoms , child self-report of ability to focus , and parent ratings of executive functioning . Child performance on neuropsychological tests showed significant treatment-related improvement on strategic planning efficiency , but no treatment effects were observed on other neuropsychological outcomes . Treatment effects were also not observed for teacher ratings of ADHD . These data add to a growing body of literature supporting effects of cognitive training on attention and behavior , however , additional research is warranted OBJECTIVE To examine the effects of acute hyperglycemia on cognitive function and mood in people with type 2 diabetes . RESEARCH DESIGN AND METHODS Twenty subjects with type 2 diabetes , median age 61.5 years ( range 53.1 - 72.0 ) , known duration of diabetes 5.9 years ( range 2.8 - 11.2 ) , BMI 29.8 kg/m2 ( range 22.0 - 34.6 ) , and HbA1c 7.5 % ( range 6.7 - 8.4 ) were studied . Treatment modalities varied from antidiabetic medications to insulin . A hyperinsulinemic glucose clamp was used to maintain arterialized blood glucose at either 4.5 ( euglycemia ) or 16.5 mmol/l ( hyperglycemia ) on two occasions in a r and omized and counterbalanced fashion . Tests of information processing , immediate and delayed memory , working memory , and attention were administered , along with a mood question naire , during each experimental condition . RESULTS Speed of information processing , working memory , and some aspects of attention were impaired during acute hyperglycemia . Subjects were significantly more dysphoric during hyperglycemia , with reduced energetic arousal and increased sadness and anxiety . CONCLUSIONS During acute hyperglycemia , cognitive function was impaired and mood state deteriorated in a group of people with type 2 diabetes . These findings are of practical importance because intermittent or chronic hyperglycemia is common in people with type 2 diabetes and may interfere with many daily activities through adverse effects on cognitive function and mood Fear of losing one 's cognitive ability to Alzheimer disease and related dementias ( ADRD ) and ultimately declining to a state considered by many to be worse than death ( 1 ) is driving a growing brain-training industry . Cognitive training programs , marketed to otherwise healthy adults and persons with a recent diagnosis of mild cognitive impairment ( MCI ) , make bold cl aims for reversing brain aging . Such cl aims include the ability to boost cognitive reserve in midlife ( with cognitive reserve referring to both the mismatch between clinical symptoms of dementia and pathologic brain lesion load at death and the repeatedly demonstrated association between educational achievement and dementia risk ) . However , few studies have evaluated the effect of cognitive training programs on cognitive decline or the onset of dementia , which is the outcome of interest for most people who buy these programs . This review systematic ally evaluates the existing literature on the effectiveness of cognitive training in preventing cognitive decline and ADRD . It is part of a larger systematic review commissioned by the National Institute on Aging to address a range of potential interventions to slow cognitive decline and prevent or delay dementia . Methods We developed and followed a st and ard protocol that was posted on the Agency for Healthcare Research and Quality ( AHRQ ) Web site ( www.effectivehealthcare.ahrq.gov ) . Full details of the methods , including literature search es , findings , and evidence tables , are available in the final report ( 2 ) . Data Sources and Search es We search ed Ovid MEDLINE , PsycINFO , EMBASE , and the Cochrane Central Register of Controlled Trials for relevant literature published between January 2009 and July 2017 ( see Part A of the Supplement , for search es ) and h and - search ed reference lists of selected articles . We identified studies published before 2009 by review ing studies included and excluded from the 2010 AHRQ review on preventing Alzheimer disease and cognitive decline ( 3 ) . Supplement . Cognitive Training Supplement Study Selection Two investigators independently review ed titles and abstract s of search results and screened the full text of potentially eligible references . We included r and omized trials of cognitive training interventions enrolling adults with either normal cognition or MCI if the studies followed participants for at least 6 months , provided cognitive performance or incident dementia outcomes , and were published in English . We excluded studies that enrolled only persons diagnosed with dementia . The final health outcome of interest was incident ADRD . Intermediate health outcomes of interest included performance on cognitive testing , biomarker protein levels , brain matter volume , and brain cell activity level . No restrictions were placed on sample size or comparator type . Data Extraction and Quality Assessment One review er extracted study , population , intervention , comparator , and setting characteristics as well as the funding source from all eligible studies . Risk of bias was assessed independently from full texts by 2 investigators using an instrument based on AHRQ guidance ( 4 ) . Risk of bias was individually review ed overall and for each outcome and time point , and was summarized as low , medium , or high on the basis of a summary of bias risk across risk-of-bias domains and confidence that results were credible given the study 's limitations . Outcomes and adverse events were extracted from studies with low to medium risk of bias . A second review er checked the quality of all data . Data Synthesis and Analysis Only studies with low or medium risk of bias were summarized , because we judged findings from studies with high risk of bias to lack validity , have little meaning , or be easily misinterpreted . Because studies used a highly varied set of outcome measures , neuropsychological tests were categorized by the following specific cognitive domains to facilitate analysis : executive function , attention , and processing speed ; memory ; language ; and visuospatial abilities ( Supplement Table A1 ) . The domains of executive function , attention , and processing speed were grouped together because cognitive tests frequently measure all 3 of these related domains . Because studies analyzed and reported cognitive test results in many different ways , making it difficult or impossible to determine effect size or to assess whether between-group differences in scores or subscores were clinical ly meaningful ( Supplement Table A2 ) , we analyzed and reported cognitive test results by direction of effect and statistical significance . When we identified at least 2 studies or 1 large study ( > 500 participants ) for a treatment comparison , 2 review ers grade d strength of evidence for each outcome on the basis of study limitations , directness , consistency , and precision ; otherwise , strength of evidence was grade d as insufficient . Assessment s were confirmed by consensus . Role of the Funding Source The National Institute on Aging of the National Institutes of Health requested this report from the AHRQ Evidence -based Practice Center Program . The funding agencies provided comments on draft reports but had no role in data collection , analysis , interpretation , or manuscript development . Results We identified 35 publications of 34 unique r and omized controlled trials of cognitive training interventions , 11 of which had medium or low risk of bias ( 516 ) . Only 1 trial was industry funded ( 8) , whereas in 3 cases , trial funding was not reported ( 9 , 15 , 16 ) . ( See the Supplement Figure and Supplement Tables C1 to C4 for the literature flow diagram , evidence tables , and risk-of-bias assessment s. ) The Table summarizes the overall strength-of- evidence findings . For cognitively normal adults , moderate-strength evidence suggests that cognitive training in a particular domain improves performance in that domain compared with inactive or attention control population s. These results are driven largely by the results from the ACTIVE ( Advanced Cognitive Training for Independent and Vital Elderly ) trial . Low-strength evidence suggests that for persons with MCI , cognitive training in a particular domain does not improve performance in that domain compared with controls . The MCI trials have more limitations and are less precise than the studies conducted with cognitively normal participants . Evidence is insufficient for incident MCI or ADRD outcomes . Table . Summary of Conclusions and Strength of Evidence for Cognitive Training in Adults With Normal Cognition or MCI * Studies in Cognitively Normal Population s Six trials with low to medium risk of bias tested training interventions in cognitively normal older adults ( 510 ) . Sample sizes for the selected studies ranged from 40 to 2832 participants . Interventions lasted from 2 weeks to 6 months ; follow-up ranged from 6 months to 2 years . Three of the 6 trials used only computer-based interventions ( 68 ) , 2 used a combination of computer and noncomputer ( paper- and -pencil ) interventions ( 5 , 9 ) , and 1 used group-based competition to increase divergent thinking ( 10 ) . Three of the computer-based interventions were design ed to increase performance on a specific cognitive domain ( such as processing speed ) ( 5 , 6 , 9 ) , 1 used computers for cognitive stimulation more generally ( 7 ) , and 1 used a computer program design ed to train several cognitive domains ( 8) . Comparators included both inactive ( 5 , 7 , 8 , 10 ) and attention controls ( 6 , 9 ) . No studies reported adverse effects . The largest trial of cognitive training , ACTIVE , r and omly assigned 2832 older adults ( mean age , 74 years ) without clinical ly significant cognitive impairment to 1 of 3 training groups or a no-contact control group ( 5 ) . In each training group , a different cognitive domain was targeted : memory , reasoning , or processing speed . Participants in the intervention groups received 10 trainings of 60 to 70 minutes over 6 weeks . Cognitive testing outcomes included measuring changes in domain-specific test performance . Patient-centered cognitive outcomes included measuring changes in everyday problem solving ( such as the ability to identify information on medication bottles ) , everyday speed ( such as the time required to find food items on a grocery shelf ) , driving , and degree of dependency in completing activities of daily living and instrumental activities of daily living . Incident MCI or ADRD was not a prespecified outcome . Although 5- and 10-year outcomes from the ACTIVE trial have been published ( 17 , 18 ) , only the results from the 2-year study had a medium risk of bias ( 5 ) . At 2 years , ACTIVE participants showed improvement in the cognitive domains in which they were trained ( for example , those who received memory training improved on memory-related tasks compared with control participants ) , but no statistically significant differences were found among groups with regard to other cognitive outcomes ( for example , persons who received training in memory did not do better than control participants on reasoning tasks ) . Intervention and control groups did not differ in other patient-centered cognitive outcomes at 2-year follow-up . Modeled on the visual process and speed training group of the ACTIVE trial , IHAMS ( the Iowa Healthy and Active Minds Study ) ( n= 681 ) ( 6 ) r and omly assigned adults by age group ( 50 to 64 years vs. 65 years ) to visual processing speed training at the study center , visual processing speed training on the participant 's home computer , or computerized crossword puzzles ( attention control group ) . Two-hour training sessions were held once a week for 5 weeks . Participants assigned to the intervention at the training center also received a booster training at 11 months . One year after training , both intervention groups showed statistically significant improvement in the primary outcome of the Useful Field of View test compared with the attention control group . The IHAMS participants also were administered 8 secondary cognitive tests on which they had not been The goal of current national and state legislation on welfare reform is to decrease the number of people who are dependent on public assistance  , most of whom are mothers and their young children . Mothers ' patterns of welfare receipt in the 3 years following the birth of a child were examined vis-à-vis their associations with maternal emotional distress ( General Health Question naire ) , provision of learning experiences ( Home Observation of the Measurement of the Environment ) , parenting behavior , and the child 's cognitive test score ( Stanford-Binet ) in the third year of life . The data set was the Infant Health and Development Program , an eight-site r and omized clinical trial design ed to test the efficacy of educational and family support services in reducing developmental delays in low-birthweight , preterm infants ( N = 833 ) . Strong negative associations were found between receiving welfare and parenting behavior and child outcomes at age 3 years . Outcomes varied depending on when the mother received public assistance  ( earlier or later in her child 's first 3 years ) and family poverty status on leaving welfare . The parenting behavior of mothers who had left welfare by their child 's third birthday was more likely to be authoritarian if she had left public assistance without also leaving poverty . Implication s of these findings for the well-being of children in low-income families are discussed STUDY QUESTION Does ovarian hyperstimulation , the in vitro procedures required for in vitro fertilization (IVF)/ intracytoplasmic sperm injection or the combination of both , affect the  neurological outcome  of 4-year-old singletons ? SUMMARY ANSWER Ovarian hyperstimulation , the in vitro procedure and the combination of both , were not associated with the worse neurological outcome in 4-year-old singletons . WHAT IS KNOWN ALREADY Assisted reproduction techniques ( ARTs ) are not associated with neurological dysfunction during the first post-natal years ; however , effects on the long-term neurological outcome are still inconclusive . An increased time to pregnancy ( TTP , a proxy for the severity of subfertility ) has been associated with a less optimal neurological condition at age 2 . The present study focuses on the neurodevelopmental outcome of 4-year-old ART-offspring . STUDY DESIGN , SIZE , DURATION Longitudinal , prospect i ve follow-up study . PARTICIPANTS , SETTING , METHODS Four-year-old singletons born to subfertile parents ( subfertile group , n = 195 ) , including singletons born after controlled ovarian hyperstimulation IVF ( COH-IVF , n = 63 ) , modified natural cycle IVF ( MNC-IVF , n = 53 ) and natural conception ( Sub-NC , n = 79 ) . Data on underlying cause of subfertility and TTP were present . In addition , we assessed newly recruited 4-year-old singletons born to fertile parents after natural conception ( reference group , n = 98 ) . Neurological development was evaluated with the neurological examination according to Hempel , result ing in a neurological optimality score ( NOS ) , a fluency score and the occurrence of the clinical ly relevant form of minor neurological dysfunction ( complex MND ) . The primary outcome was the fluency score , as fluency of movements is easily reduced by subtle brain dysfunction . Data were analysed with univariable and multivariable regression analyses , in which special attention was paid to sex differences in the neurological outcome . MAIN RESULTS AND THE ROLE OF CHANCE The fluency score , NOS and the prevalence of complex MND were similar in COH-IVF , MNC-IVF and Sub-NC children . The neurological condition of children born to subfertile parents was similar to that of children of fertile parents and was independent of the underlying cause of subfertility . No statistically significant associations were found between TTP and the fluency score and NOS . However , a positive correlation was found between TTP and the prevalence of complex MND ( TTP in years , adjusted odds ratio [ OR ] [ 95 % confidence interval , CI ] : 1.207 [ 1.038 to 1.404 ] , P = 0.014 ) ; a correlation which could be attributed to girls , in whom an evident positive correlation was present ( adjusted OR [ 95 % CI ] : 1.542 [ 1.161 to 2.047 ] , P = 0.003 ) . A similar association was absent in boys . LIMITATIONS , REASONS FOR CAUTION The prospect i ve design of our study and small post-natal attrition rate ( 9.3 % ) reduced potential selection bias based on the child 's development or health . The assessors were blind to the mode of conception , except for the group of children born to fertile parents , which was newly recruited . The study lacks sufficient power to conclude firmly that increased TTP is associated with a higher prevalence of complex MND . WIDER IMPLICATION S OF THE FINDINGS Our study suggests that the severity of subfertility , rather than its simple presence or components of IVF treatment , affects the neurological outcome . Moreover , girls may be neurologically more vulnerable for the effect of severity of subfertility . The finding that the severity of subfertility may be the decisive factor rather than the presence of a history of subfertility per se corroborates previous reports . Our results can not be generalized to multiples , as we studied singletons only . STUDY FUNDING /COMPETING INTERESTS The study was financially supported by the University Medical Center Groningen , grant number : 754510 , the Junior Scientific Masterclass , the Postgraduate School Behavioural and Cognitive Neurosciences and the Cornelia Foundation , Groningen , The Netherl and s. The authors have no conflicts of interest to declare The ability of personality traits to predict important life outcomes has traditionally been question ed because of the putative small effects of personality . In this article , we compare the predictive validity of personality traits with that of socioeconomic status ( SES ) and cognitive ability to test the relative contribution of personality traits to predictions of three critical outcomes : mortality , divorce , and occupational attainment . Only evidence from prospect i ve longitudinal studies was considered . In addition , an attempt was made to limit the review to studies that controlled for important background factors . Results showed that the magnitude of the effects of personality traits on mortality , divorce , and occupational attainment was indistinguishable from the effects of SES and cognitive ability on these outcomes . These results demonstrate the influence of personality traits on important life outcomes , highlight the need to more routinely incorporate measures of personality into quality of life surveys , and encourage further research about the developmental origins of personality traits and the processes by which these traits influence diverse life outcomes The use of a gonodotropin-releasing hormone ( Gn-RH ) agonist in an in vitro fertilization ( IVF ) program raises the question of any influence on the physical , neurologic , and mental development of the children . We compared the development of children born after long-acting Gn-RH agonist treatment with that of children born after spontaneous pregnancies . Children from singleton pregnancies and > or = 28 months of age were examined by a pediatric neurologist and a psychologist who did not know to which group the children belonged . The General Cognitive Index test was used . Each group included 30 children . Five children cooperated only partly . Physical and neurologic findings were normal in all children , except that one in the group born after in vitro fertilization had diffuse hypotonia , attention-deficit hyperactivity disorder , and hyperactivity . The General Cognitive Index for the 26 children in the study group and the 29 children in the control group who fully cooperated were 102 + /- 13.3 and 106 + /- 13.5 , respectively ( p = 0.37 ) . The verbal perception , motor , and memory indexes were not significantly different . We conclude that the long-acting Gn-RH agonist had no clinical ly identifiable influence on the development of these children Background Calcaneal apophysitis , also commonly known as sever ’s disease , is a condition seen in children usually aged between 8–15 years . Conservative therapies , such as taping , heel lifts and orthotic intervention are accepted management practice s for calcaneal apophysitis , though there is very little high quality research examining the efficacy of such treatment modalities . Previous narrative literature review s and opinion pieces provide some evidence for the use of heel raises or orthoses . The aim of this manuscript was to complete a systemic review on the treatment options for calcaneal apophysitis as measured by pain reduction and maintenance of physical activity . Methods A search strategy completed by two review ers examined nine data bases from inception to May 2012 . Search terms included heel pain , children , adolescent , calcaneal apophysitis , sever ’s disease , treatment , and management ( full text publications , human studies ) . Systematic review s , r and omised control trials , case series , and case studies were included . The reference lists of the selected articles were also examined . The methodology , quality and risk of bias was examined and assessed using the PEDro scale . Results Nine articles were retrieved including three clinical trials involving r and omisation , two case series , two retrospective case review s , and two case reports . Effect size calculations and a meta analysis were unable to be completed due to the limited data reported within the literature . Numerous treatment options were reported throughout the literature , though few were examined against a control or alternate treatment option in well- design ed trials . The limited evidence indicated that orthoses provided greater short-term pain relief than heel raises . Health practitioners should view these results with caution , as there were apparent method ological problems with the employed study design and limited follow-up of participants . Conclusion There is limited evidence to support the use of heel raises and orthoses for children who have heel pain related to calcaneal apophysitis . Further research is needed to generate higher quality evidence with larger sample sizes , and vali date d measures of pain and function to establish effective treatment approaches for children with calcaneal apophysitis Deficits in behavioral and cognitive regulation are prevalent in children reared in poverty relative to more affluent children due to the effects of adverse conditions on the developmental underpinnings of these skills . Despite evidence to suggest that these emergent processes are susceptible to environmental inputs , research documenting short-term intervention program influences on these regulatory domains in young impoverished children is limited . We sought to determine the proximal effects of a universal school-based intervention ( the PATHS Curriculum ) on social , emotional , relational , and cognitive outcomes in urban poor kindergarten children . Four schools in high-poverty neighborhoods with similar demographic characteristics were r and omly assigned to either PATHS or an attentional control . Teacher-reported measures of behavior ( e.g. , attention , concentration , aggression ) , peer nominations ( e.g. , likability , aggression , acceptance ) , and tasks gauging inhibitory control  were administered in the fall of kindergarten and again in the spring after one academic year ( about 6 months ) of PATHS . Children who received PATHS exhibited significantly greater improvements than control students across all teacher-rated behavioral measures of social competence ( i.e. , emotion regulation , prosocial behavior , peer relations ) and behavioral problems ( i.e. , aggression , internalizing behaviors , impulsivity and hyperactivity ) at post-test as well as improvements in motor inhibition . This line of research constitutes an important frontier for prevention research given the implication s for improving ultimate outcomes for otherwise disadvantaged children A large body of research indicates that child development is sensitive to early-life environments , so that poor children are at higher risk for poor cognitive and behavioral outcomes . These developmental outcomes are important determinants of success in adulthood . Yet , remarkably little is known about whether poverty-alleviation programs improve children 's developmental outcomes . We examine how a  government-run cash transfer program for poor mothers in rural Ecuador influenced the development of young children .  R and om assignment at the parish level is used to identify program effects . Our data include a set of measures of cognitive ability that are not typically included in experimental or quasi-experimental studies of the impact of cash transfers on child well-being , as well as a set of physical health measures that may be related to developmental outcomes . The cash transfer program had positive , although modest , effects on the physical , cognitive , and socioemotional development of the poorest children in our sample BACKGROUND Intracytoplasmic sperm injection ( ICSI ) was introduced as a new form of in-vitro fertilisation ( IVF ) in 1993 and is now accepted as the treatment of choice for severe male infertility in many centres around the world . However , there is little information about the long-term outcome of children conceived by ICSI .  We aim ed to find out the medical and developmental outcome of children conceived by ICSI  at age 1 year . METHODS In this prospect i ve study , we compared the medical and developmental outcome at 1 year of 89 children conceived by ICSI with 84 children conceived by routine IVF , and with 80 children conceived naturally .  Formal developmental assessment was done with Bayley Scales of Infant Development ( 2nd edition ) from which a mental development index ( MDI ) was derived . FINDINGS There was no significant difference in the incidence of major congenital malformations or major health problems in the first year of life . However , the mean Bayley MDI was significantly lower for the children conceived by ICSI than for the children conceived by routine IVF or naturally ( 95.9 [ SD 10.7 ] , 101.8 [ 8.5 ] , and 102.5 [ 7.6 ] , respectively , p < 0.0001 ) . 15 ( 17 % ) of 89 children conceived by ICSI experienced mildly or significantly delayed development ( MDI < 85 ) at 1 year compared with two ( 2 % ) of the 84 children conceived by IVF and one ( 1 % ) of the 80 children conceived by natural conception ( p < 0.0001 ) . INTERPRETATION Although most children conceived by ICSI are healthy and develop normally , there is an increased risk of mild delays in development at 1 year when compared with children conceived by routine IVF or conceived naturally . These findings support the need for ongoing developmental follow-up of children conceived by ICSI to see whether they are at increased risk of intellectual impairment or learning difficulties at school age S ystematic review s are relied upon by clinicians and policymakers as high- quality evidence for decision-making . In some hierarchies of evidence quality , systematic review s are ranked at the top , higher than r and omized controlled trials . A properly conducted systematic review that is based on high- quality articles provides very strong evidence ; policymakers recognize this value and solicit many such review s. Busy clinicians rely on well-executed systematic review s to quickly synthesize the literature and guide them in managing patients . However , there are important inherent weaknesses that can limit the quality of systematic review s and can lead to erroneous conclusions . Consumers of systematic review s should approach them with a healthy sense of skepticism . Unfortunately , many of these weaknesses may not be obvious to the various stakeholders who routinely invest their trust in such review s. The first bias one encounters is inherent in the research enterprise . Generally , research ers design studies to demonstrate maximum effect ; hence they are careful about the population selected , the interventions tested , and the outcomes assessed . For example , interventions are often tested in population s that are at high risk for experiencing the outcome in question and are likely to respond to the intervention . Not only can this make results difficult to generalize , but it often results in studies that overstate the benefit ; subsequent studies frequently find less benefit . This is particularly common when the pool of available studies consists of small , single-center investigations , trials that are particularly likely to show large effects . While usually not intentional , the combination of careful selection of population and outcomes can distort clinical research and obscure truth . This inherent bias in the research enterprise can not be fixed ; however , if there are a sufficient number of studies , conducted across different setting s and population s , this problem can be partially ameliorated with systematic review s. Systematic review s are vulnerable to a number of biases . First , the question may not be well-defined . A marker of a high- quality systematic review is the inclusion of a purpose statement in which the specific research question is clearly articulated . Specificity is key : what are they willing to accept as evidence , what population , what intervention , what duration , what doses , what outcomes and when ? Second , the search strategy should be broad enough to reassure readers that no studies were left out . Research ers commonly limit their search to English- language articles . However , there is no difference between the quality of articles in English and those in other language s , and limiting the search to English-only should be a red flag to readers . The bibliographies of retrieved articles should also be review ed . All search strategies should include input from an experienced medical librarian . Third , the quality of included articles must be carefully assessed . The higher the quality of articles that provide the bulk of the systematic review ’s conclusions , the more confident readers can be in those conclusions . Readers should be wary of review s that are based on observational data or uncontrolled clinical trials . A statistical package will analyze whatever data the analyst feeds it , and will provide an estimate of an overall effect and a 95 % confidence interval . This can mislead readers into believing that our underst and ing of the effect is more concrete than it is . Pooling of observational data can lead to answers that differ material ly from the results of r and omized controlled trials . Readers should also be wary of systematic review s built on low sample numbers , either few studies or small sample s within each study . The number of studies necessary to produce believable results is an area of ongoing debate . A recent article discussed the benefits of  Trial Sequential Analysis ( TSA )  , a method that allows metaanalysts to determine the likelihood that the review contains either a type I error ( finding a difference that does not exist ) or a type II error ( reporting no difference when in fact one exists ) . TSA theory is similar to the principles governing stopping rules for interventional trials . It takes the total sample size and the size of the effect , and establishes boundaries . These boundaries provide confidence that the sample size is large enough to avoid type I or II errors . We strongly recommend routinely including them in meta-analyses . Fourth , very careful attention must be paid to the issue of publication bias . Most readers recognize that studies with nonsignificant results face greater publication hurdles . This is a wellrecognized phenomenon ; protocol s with non-significant results are both less likely to be published and , when published , more likely to encounter significant delays than studies with significant Published online December 12 , An influential review in 2010 concluded that non-pharmacological multi-component interventions have positive effects on cognitive functioning , activities of daily living , behaviour and mood of people with dementia . Our aim here is to provide an up-to- date overview of research into psychosocial interventions and their impact on psychosocial outcomes . We focused on r and omised controlled trials , controlled studies and review s published between October 2008 and August 2015 , since the earlier review . The search of PsychInfo , Medline and the Cochrane data base of systematic review s yielded 61 relevant articles , organised into four themes echoing key phases of the care pathway : Living at home with dementia ( five review s , eight studies ) , carer interventions ( three review s , four studies ) , interventions in residential care ( 16 review s , 12 studies ) and end-of-life care ( three review s , two studies ) , along with an additional group spanning community and institutional setting s ( six review s , two studies ) . Community findings suggested that appointment of dementia specialists and attention to case management can produce positive outcomes ;  physical therapies , cognitive training and modified cognitive behaviour therapy also had a range of benefits . There was more limited evidence of positive benefits for people with dementia through interventions with family carers . Thirty-two articles focused on the management of ‘ behavioural symptoms ’ through a range of interventions all of which had some evidence of benefit . Also a range of multi-component and specific interventions had benefits for cognitive , emotional and behavioural well-being of people with dementia in residential setting s , as well as for quality of life . Overall , interventions tended to be short term with impact only measured in the short term . We recommend further research on interventions to promote living well in the community post-diagnosis and to address end-of-life care . Development of psychosocial interventions would benefit from moving beyond the focus on control of behaviours to focus on wider aspects of life for people with dementia Botulinum neurotoxin type-A ( BoNT-A ) has been used in association with other interventions in the management of  spasticity in children with cerebral palsy ( CP ) for almost two decades . This consensus statement is based on an extensive review of the literature by an invited international committee . The use of BoNT-A in the lower limbs of children with spasticity caused by CP is reported using the American Academy of Neurology Classification of Evidence for therapeutic intervention . R and omized clinical trials have been grouped into five areas of management , and the outcomes are presented as treatment recommendations . The assessment of children with CP and evaluation of outcomes following injection of BoNT-A are complex , and therefore , a range of measures and the involvement of a multidisciplinary team is recommended . The committee concludes that injection of BoNT-A in children with CP is generally safe although systemic adverse events may occur , especially in children with more physical limitations ( GMFCS V ) . The recommended dose levels are intermediate between previous consensus statements . The committee further concludes that injection of BoNT-A is effective in the management of lower limb spasticity in children with CP , and when combined with physiotherapy and the use of orthoses , these interventions may improve gait and goal attainment STUDY QUESTION Do preschool preimplantation genetic diagnosis ( PGD ) children differ in their cognitive and psychomotor development from children born after ICSI and spontaneous conception ( SC ) ? SUMMARY ANSWER The cognitive development of PGD pre-schoolers was comparable to children born after ICSI and SC but motor development differed between ICSI and SC groups . STUDY DESIGN , SIZE DURATION The cognitive abilities and motor skills of 5- to 6-year-old singletons born after PGD ( n = 47 ) were assessed in comparison with 49 ICSI and 48 SC children in a prospect i ve , case-controlled , matched follow-up study between April 2011 and May 2013 . PARTICIPANTS / MATERIAL S , SETTING , METHODS PGD singletons , ICSI and SC children of preschool age were examined with the Wechsler Preschool and Primary Scale of Intelligence ( WPSSI-III-NL ) and the Movement ABC ( M ABC ) . The WPSSI-III-NL revealed scores for Full IQ , Verbal IQ and Performance IQ . The M ABC yields a total score and comprising scores for measurements of balance , dexterity and ball skills . Since embryo biopsy is the only technical difference between the PGD and ICSI procedures , ICSI children were included as controls . These children were part of a Dutch-speaking cohort of children conceived after assisted reproduction technology ( ART ) at the Universitair Ziekenhuis Brussel ( UZ Brussel ) who received longitudinal follow-up . The SC children acted as a second control group similar to the fertile PGD sample and in contrast to the ICSI group . The SC group was recruited through announcements in a variety of media . The children were matched for age , gender , birth order and educational level of the mother . The assessment s carried out for the ART groups were blinded whenever possible . The data were analysed using analysis of covariance ( ANCOVA ) and partial eta squared ( η(2 ) ) , which was used as a measurement of effect size . MAIN RESULTS AND THE ROLE OF CHANCE The overall cognitive development of PGD singletons did not differ from controls [ P = 0.647 , η(2 ) = 0.006 ; 95 % confidence interval ( CI ) ( 0 , 0.043 ) ] . The partial IQ scores for Verbal and Performance intelligence revealed similar results . Analysis of motor development based on the total score as well as subscales did indicate a significant difference between the three conception groups [ P = 0.033 , η(2 ) = 0.050 , 95 % CI ( 0 , 0.124 ) ] . Post hoc analysis indicated that the significant difference was situated between performances of ICSI and SC children . Balance capacities [ P = 0.004 , η(2 ) = 0.079 , 95 % CI ( 0.025 , 0.163 ) ] and its post hoc analysis yielded equivalent results . Motor capacities of PGD singletons , however , did not differ from any of the two other conception groups . LIMITATIONS , REASONS FOR CAUTION Given that we only assessed Caucasian singletons born after PGD , caution is required when drawing more general inferences from our results . The small sample size may be a limitation . A priori power analysis , however , revealed that at least 52 children per group were needed to detect a medium effect and 80 % power using ANCOVA . Originally our sample met this threshold but we had to exclude six cases in order to remove outliers and due to missing data . WIDER IMPLICATION S OF THE FINDINGS Long-term follow-up of children born after embryo biopsy , in this case for PGD , is needed to confirm that the development of these children remains comparable to ICSI and SC children . Our findings do support the safety of the PGD technique and will reassure patients with hereditary genetic diseases regarding the health of their future offspring conceived with PGD . STUDY FUNDING /COMPETING INTERESTS Funding for this study was obtained from the OZR ( Research group of the Vrije Universiteit Brussel ) , the FWO ( Fonds Wetenschappelijk Onderzoek ) and the Wetenschappelijk Fonds Willy Gepts . The UZ Brussel and the Centre of Medical Genetics received funding from pharmaceutical firms for data collection . UZ Brussel and the Centre for Medical Genetics have received many educational grants for organizing the data collection , from IBSA , Ferring , Organon , Shering-Plough , Merck and Merck Belgium . M.B. has received consultancy and speaker 's fees from Organon , Serono Symposia and Merck IMPORTANCE An increasing percentage of births are conceived with assisted reproductive technology ( ART ) and other infertility treatment . Despite findings that such treatments may be associated with diminished gestation and birth size , scarce data exist regarding infertility treatments and children 's development in the United States . OBJECTIVE To assess the use and type of infertility treatment in relation to children 's development through age 36 months . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study ( conducted 2008 - 2014 ) that sample d based on infertility treatment and plurality . Included in the study were infants born between 2008 and 2010 in New York state ( excluding New York City ) whose parents completed developmental screening instruments through 36 months of age . A total of 4824 mothers ( 97 % of 4989 ) completed 1 or more  developmental screening instruments  for 5841 children , including 1830 conceived with infertility treatment and 2074 twins . EXPOSURES Maternal self-report of any infertility treatment was further categorized into ART and ovulation induction/intrauterine insemination . Assisted reproductive technology use was previously vali date d by linkage with the Society for Assisted Reproductive Technology- Clinical Outcome Reporting System . MAIN OUTCOMES AND MEASURES Five developmental domains ( fine motor , gross motor , communication , personal-social functioning , and problem-solving ability ) , as measured by the parental completion of the Ages and Stages Question naires at 4 , 8 , 12 , 18 , 24 , 30 , and 36 months of age . Generalized linear mixed modeling techniques estimated adjusted odds ratios ( aORs ) and 95 % CIs for use and type of infertility treatment in relation to failing a developmental domain . Data were stratified by plurality and weighted for the sampling scheme . RESULTS There were 1422 mothers ( 29.5 % ; mean [ SD ] , age , 34.1 [ 5.2 ] years ) who underwent infertility treatment .  Infertility treatment was not associated with risk of their children failing any developmental domain ( aOR , 1.33 ; 95 % CI , 0.94 - 1.89 ) . Assisted reproductive technology was associated with increased risk for failing any developmental domain but only when singletons and twins were evaluated together ( aOR , 1.81 ; 95 % CI , 1.21 - 2.72 ) . Adjustment for birth weight further attenuated this estimate ( aOR , 1.26 ; 95 % CI , 0.82 - 1.93 ) . After stratifying by plurality , type of treatment also was not significantly associated with failing any developmental domain for ovulation induction/intrauterine insemination ( aOR , 1.00 ; 95 % CI , 0.57 - 1.77 for singletons and aOR , 1.30 ; 95 % CI , 0.76 - 2.21 for twins ) or ART ( aOR , 1.38 ; 95 % CI , 0.78 - 2.43 for singletons and aOR , 1.58 ; 95 % CI , 0.94 - 2.65 for twins ) . CONCLUSIONS AND RELEVANCE After considering plurality , children 's development through age 3 years was similar irrespective of infertility treatment or specific type . To our knowledge , these findings are among the first to focus on non-ART treatments in the United States Objective . Voiding cystourethrography ( VCUG ) is a commonly performed radiologic procedure in children that can be both painful and frightening . Given the distress that some children experience during the VCUG and the need for children to be alert and cooperative during the procedure , finding a psychological intervention that helps children to manage anxiety , distress , and pain is clearly desirable . This study was design ed to examine whether relaxation and analgesia facilitated with hypnosis could reduce distress and procedure time for children who undergo this procedure . Methods . Forty-four children who were scheduled for an upcoming VCUG were r and omized  to receive hypnosis ( n = 21 ) or routine care ( n = 23 ) while undergoing the procedure . The sample consisted of 29 ( 66 % ) girls and 15 ( 34 % ) boys with a mean age of 7.6 years ( SD : 2.5 ; range : 4–15 years ) . Ethnic/racial background s were 72.7 % white , 18.2 % Asian , 4.5 % Latino , 2.3 % black , and 2.3 % Filipino . The mean number of previous VCUGs  was 2.95 ( SD : 2.51 ; mode : 2 ; range : 1–15 ) . Potential participants were identified through computerized hospital records of upcoming VCUGs . Parents were contacted by telephone and invited to participate if their child was eligible . To be eligible for the study , the child must have undergone at least 1 previous VCUG , been at least 4 years of age at that time , and experienced distress during that procedure , and both the child and the participating parent had to be English speaking . Each eligible child and parent met with the research assistant ( RA ) before the day of the scheduled procedure for an initial assessment . Children were queried regarding the degree of crying , fear , and pain that they had experienced during their most recent VCUG . Parents completed a series of parallel questions . Immediately after this assessment , those who were r and omized to the hypnosis condition were given a 1-hour training session in self-hypnotic visual imagery by a trained therapist . Parents and children were instructed to practice using the imaginative self-hypnosis procedure several times a day in preparation for the upcoming procedure . The therapist was also present during the procedure to conduct similar exercises with the child . The majority ( 83 % ) of those who were r and omized to the routine care control group chose to participate in a hospital-provided recreation therapy program ( offered as part of routine care ) . The program includes demonstration of the procedure with dolls , relaxation and breath work training , and assistance during the procedure . On the day of the VCUG , the RA met the family at the clinic before the procedure , and both the child and the parent rated the child 's present level of fearfulness . During the procedure , the RA recorded observational ratings of the child 's emotional tone and behavior and timed the overall procedure and its phases . Immediately after the VCUG , the child was asked how much crying , fear , and pain he or she had experienced during the procedure ; the parent rated the child 's experience on the same dimensions and also how traumatic the procedure had been ( both generally and compared with their previous one ) , and the medical staff rated the degree of procedural difficulty . Outcomes included child reports of distress during the procedure , parent reports of how traumatic the present VCUG was compared with the previous one , observer ratings of distress during the procedure , medical staff reports of the difficulty of the procedure overall , and total procedural time . Results . Results indicate significant benefits for the hypnosis group compared with the routine care group in the following 4 areas : ( 1 ) parents of children in the hypnosis group compared with those in the routine care group reported that the procedure was significantly less traumatic for their children compared with their previous VCUG procedure ; ( 2 ) observational ratings of typical distress levels during the procedure were significantly lower for children in the hypnosis condition compared with those in the routine care condition ; ( 3 ) medical staff reported a significant difference between groups in the overall difficulty of conducting the procedure , with less difficulty reported for the hypnosis group ; and ( 4 ) total procedural time was significantly shorter — by almost 14 minutes — for the hypnosis group compared with the routine care group . Moderate to large effect sizes were obtained on each of these 4 outcomes . Conclusions . Hypnotic relaxation may provide a systematic method for improving the overall medical care of children with urinary tract abnormalities and may be beneficial for children who undergo other invasive medical procedures . Because the VCUG is an essential part of the evaluation of urinary tract infections and vesicoureteral reflux in children , lower distress during the procedure may improve patient and family compliance with initial as well as follow-up evaluations . These findings augment the accumulating literature demonstrating the benefits of using hypnosis to reduce distress in the pediatric setting . The present findings are noteworthy in that this study was a controlled , r and omized trial conducted in a naturalistic medical setting . In this context , we achieved a convergence of subjective and objective outcomes with moderate to large effect sizes , including those that may have an impact on patient care and procedure cost , that were consistently supportive of the beneficial effects of hypnosis — a noninvasive intervention with minimal risk . The findings , therefore , have immediate implication s for pediatric care . Limitations of this study include the lack of participant and staff blindness to the child 's condition assignment , which could have introduced bias into reports . However , the objective procedural time differences between groups were consistent with the other , more subjective outcome findings . The sample was also small and primarily white in ethnic/racial makeup , which may have restricted our ability to detect some differences and may limit the generalizability of findings to more representative sample s. In addition , the sample comprised children who had already undergone at least 1 VCUG during which they had had difficulty . Consequently , additional research is needed to determine whether hypnosis would be helpful to those who are undergoing their first VCUG . Additional limitations , clinical observations , and directions for future research are also discussed PURPOSE The purpose of this paper is to present the development of LISTEN ( Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes ) , a new intervention for loneliness . METHODS LISTEN was developed using the Medical Research Council ( MRC ) framework for intervention development . Extensive literature review revealed that belonging , relating , placing in community , challenges , and meanings of coping were concepts significant to loneliness . Past interventions were limited but it was determined from a recent meta- analysis that enhanced effectiveness might result from interventions that targeted the poorly adapted cognitive processes of loneliness . These processes include social undesirability , stigma , and negative thoughts about self in relation to others . LISTEN is design ed to be delivered in a determined logical sequence of 5 sessions , each focusing on the concepts relevant to loneliness as derived from the literature . For each session , intervention delivery is guided by the concepts from story theory ( including intentional dialogue , nurse as listener , examination of self in relation to others and community , synthesizing concerns and patterns , and identifying messages ) and the principles of cognitive restructuring ( self- assessment of maladaptive cognitions , emotions , and behaviors , identifying challenges of changing , reconceptualization of self , new skill acquisition through group interaction , and identifying patterns of meaning in loneliness ) . RESULTS LISTEN is developed and the first r and omized trial is complete with a sample of 27 lonely , chronically ill , community dwelling , and older adults .  LISTEN was evaluated as feasible to deliver by the study team and acceptable for significantly diminishing loneliness by participants of the LISTEN groups who were compared to attention control groups ( p < 0.5 ) . CONCLUSIONS LISTEN has the potential to enhance health by diminishing loneliness which could result in improving the long-term negative known sequelae of loneliness . Future longitudinal r and omized trials are needed in varied population s to assess long term health and healthcare system benefit of using LISTEN to treat loneliness OBJECTIVE To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies ( ART ) and provide recommendations for their management , and to review investigations in the assessment of ovarian aging . OPTIONS This guideline review s options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility . OUTCOMES The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility . EVIDENCE Published literature was retrieved through search es of PubMed or Medline , CINAHL , and The Cochrane Library in June 2010 , using appropriate key words ( ovarian aging , ovarian reserve , advanced maternal age , advanced paternal age , ART ) . Results were restricted to systematic review s , r and omized controlled trials/controlled clinical trials , and observational studies . There were no date or language restrictions . Search es were up date d on a regular basis and incorporated into the guideline to December 2010 . VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care . Recommendations for practice were ranked according to the method described in that report ( Table ) . BENEFITS , HARMS , AND COSTS Primary and specialist health care providers and women will be better informed about ovarian aging and the age-related decline in natural fertility and about options for assisted reproductive technology . RECOMMENDATIONS 1 . Women in their 20s and 30s should be counselled about the age-related risk of infertility when other reproductive health issues , such as sexual health or contraception , are addressed as part of their primary well-woman care . Reproductive-age women should be aware that natural fertility and assisted reproductive technology success ( except with egg donation ) is significantly lower for women in their late 30s and 40s . ( II-2A ) 2 . Because of the decline in fertility and the increased time to conception that occurs after the age of 35 , women > 35 years of age should be referred for infertility work-up after 6 months of trying to conceive . ( III-B ) 3 . Ovarian reserve testing may be considered for women ≥ 35 years of age or for women < 35 years of age with risk factors for decreased ovarian reserve , such as a single ovary , previous ovarian surgery , poor response to follicle-stimulating hormone , previous exposure to chemotherapy or radiation , or unexplained infertility . ( III-B ) 4 . Ovarian reserve testing prior to assisted reproductive technology treatment may be used for counselling but has a poor predictive value for non-pregnancy and should be used to exclude women from treatment only if levels are significantly abnormal . ( II-2A ) 5 . Pregnancy rates for controlled ovarian hyperstimulation are low for women > 40 years of age . Women > 40 years should consider IVF if they do not conceive within 1 to 2 cycles of controlled ovarian hyperstimulation . ( II-2B ) 6 . The only effective treatment for ovarian aging is oocyte donation . A woman with decreased ovarian reserve should be offered oocyte donation as an option , as pregnancy rates associated with this treatment are significantly higher than those associated with controlled ovarian hyperstimulation or in vitro fertilization with a woman 's own eggs . ( II-2B ) 7 . Women should be informed that the risk of spontaneous pregnancy loss and chromosomal abnormalities increases with age . Women should be counselled about and offered appropriate prenatal screening once pregnancy is established . ( II-2A ) 8 . Pre-conception counselling regarding the risks of pregnancy with advanced maternal age , promotion of optimal health and weight , and screening for concurrent medical conditions such as hypertension and diabetes should be considered for women > age 40 . ( III-B ) 9 . Advanced paternal age appears to be associated with an increased risk of spontaneous abortion and increased frequency of some autosomal dominant conditions , autism spectrum disorders , and schizophrenia .  Men > age 40 and their partners should be counselled about these potential risks when they are seeking pregnancy , although the risks remain small . ( II-2C )
SUMMARY ANSWER The available high- quality evidence indicates that specific treatments may give rise to different effects on cognitive development , with certain treatments , including ICSI , associated with cognitive impairment .
STUDY QUESTION Does  fertility treatment  influence cognitive ability in school aged children , and does the impact vary with the type of treatment ?
WHAT IS KNOWN ALREADY Previous review s of the literature concerning cognitive outcomes among children conceived with medical assistance have concluded that study findings are generally ' reassuring ' , but limited attention has been paid to the quality of this research .
In addition , no review has separately assessed the range of treatment modalities available , which vary in invasiveness , and thus , potentially , in their effects on developmental outcomes .