Analyse d’une population de 100 enfants adressés pour troubles d’apprentissage scolaire

Numerical Processing Impairment in 22q11.2 (LCR22-4 to LCR22-5) Microdeletion: A Cognitive-Neuropsychological Case Study

Although progress has been made, the cognitive, biological and, particularly, the genetic underpinnings of math learning difficulties (MD) remain largely unknown. This difficulty stems from the heterogeneity of MD and from the large contribution of environmental factors to its etiology. Understanding endophenotypes, e.g., the role of the Approximate Number System (ANS), may help understanding the nature of MD. MD associated with ANS impairments has been described in some genetic conditions, e.g., 22q11.2 deletion syndrome (22q11.2DS or Velocardiofacial syndrome, VCFS). Recently, a girl with MD was identified in a school population screening. She has a new syndrome resulting from a microdeletion in 22q11.2 (LCR22-4 to LCR22-5), a region adjacent to but not overlapping with region 22q11.2 (LCR22-2 to LCR22-4), typically deleted in VCFS. Here, we describe her cognitive-neuropsychological and numerical-cognitive profiles. The girl was assessed twice, at 8 and 11 years. Her numerical-cognitive performance at both times was compared to demographically similar girls with normal intelligence in a single-case, quasi-experimental study. Neuropsychological assessment was normal, except for relatively minor impairments in executive functions. She presented severe and persistent difficulties in the simplest single-digit calculations. Difficulties in commutative operations improved from the first to the second assessment. Difficulties in subtraction persisted and were severe. No difficulties were observed in Arabic number writing. Difficulties in single-digit calculation co-occurred with basic numerical processing impairments in symbolic and non-symbolic (single-digit comparison, dot sets size comparison and estimation) tasks. Her difficulties suggest ANS impairment. No difficulties were detected in visuospatial/visuoconstructional and in phonological processing tasks. The main contributions of the present study are: (a) this is the first characterization of the neuropsychological phenotype in 22q11.2DS (LCR22-4 to LCR22.5) with normal intelligence; (b) mild forms of specific genetic conditions contribute to persistent MD in otherwise typical persons; (c) heterogeneity of neurogenetic underpinnings of MD is suggested by poor performance in non-symbolic numerical processing, dissociated from visuospatial/visuoconstructional and phonological impairments; (d) similar to what happens in 22q11.2DS (LCR22-2 to LCR22-4), ANS impairments may also characterize 22q11.2DS (LCR22-4 to LCR22-5).

[Screening sensory and developmental disorders in nursery school children by the Maternal and Infant Protection Service in the Vaucluse (France) department: results, orientations, limits]

The aim of this study was to determine whether to continue the recommendations given by the doctors of the Maternal and Infant Protection (PMI) service within the medical check-ups given to nursery school children in the Vaucluse department in France. This was a longitudinal study conducted based on an observation grid from January to June 2009. A total of 2079 files were retained. This study revealed that more than one-quarter of the children for whom recommendations had been given no longer had care 3 months later; the main cause was the absence of adherence on the part of the family. This result emphasizes the limitation of the mass screenings conducted by the PMI in nursery schools: it raises the problem of access to healthcare for certain children and opens an opportunity for reflection on professional practices to optimize the mission of prevention and the promotion of health.

[EVAL MATER: Proposal for a paediatric evaluation of linguistic and psychomotor competences during the 1st medical check-up in nursery school]

OBJECTIVES

To prevent learning disorders, the authors propose a standardized approach of linguistic competences and psychomotor development in young children.

POPULATION AND METHODS

Children were evaluated during the systematic examination that was carried out in nursery school between 3 years and 6 months and 4 years and 6 months of age. 2 investigations were led: investigation of prevalence led in 2660 children and evaluation of performance of the tests in 99 children among them.

RESULTS

The statistical analyses of their results made it possible to determine scores helping with the decision of a request for assessment to diagnostic aiming. The sensitivity and the specificity of the tests increased with the age and were better within the framework of the tests of language. This new assessment was appreciated by the doctors users.