Clinical Characteristics of Developmentally Delayed Children based on Interdisciplinary Evaluation

Sex difference contributes to phenotypic diversity in individuals with neurodevelopmental disorders

Objective

Gain a better understanding of sex-specific differences in individuals with global developmental delay (GDD), with a focus on phenotypes and genotypes.

Methods

Using the Deciphering Developmental Disorders (DDD) dataset, we extracted phenotypic information from 6,588 individuals with GDD and then identified statistically significant variations in phenotypes and genotypes based on sex. We compared genes with pathogenic variants between sex and then performed gene network and molecular function enrichment analysis and gene expression profiling between sex. Finally, we contrasted individuals with autism as an associated condition.

Results

We identified significantly differentially expressed phenotypes in males vs. females individuals with GDD. Autism and macrocephaly were significantly more common in males whereas microcephaly and stereotypies were more common in females. Importantly, 66% of GDD genes with pathogenic variants overlapped between both sexes. In the cohort, males presented with only slightly increased X-linked genes (9% vs. 8%, respectively). Individuals from both sexes harbored a similar number of pathogenic variants overall (3) but females presented with a significantly higher load for GDD genes with high intolerance to loss of function. Sex difference in gene expression correlated with genes identified in a sex specific manner. While we identified sex-specific GDD gene mutations, their pathways overlapped. Interestingly, individuals with GDD but also co-morbid autism phenotypes, we observed distinct mutation load, pathways and phenotypic presentation.

Conclusion

Our study shows for the first time that males and females with GDD present with significantly different phenotypes. Moreover, while most GDD genes overlapped, some genes were found uniquely in each sex. Surprisingly they shared similar molecular functions. Sorting genes by predicted tolerance to loss of function (pLI) led to identifying an increased mutation load in females with GDD, suggesting potentially a tolerance to GDD genes of higher pLI compared to overall GDD genes. Finally, we show that considering associated conditions (for instance autism) may influence the genomic underpinning found in individuals with GDD and highlight the importance of comprehensive phenotyping.

Application of symbolic play test in identification of autism spectrum disorder without global developmental delay and developmental language disorder

BACKGROUND

Children with autism spectrum disorders (ASD) usually experience difficulty regarding symbolic play. However, studies on whether symbolic play test (SPT) can differentiate between ASD and other developmental disorders are inconsistent, and evaluating the application value of the SPT in the identification of ASD without global developmental delay (GDD) and developmental language disorder (DLD) is necessary.

METHODS

A total of 200 children were selected as the research participants. There were 100 cases of ASD without GDD and 100 cases of DLD. All children were tested by SPT and Children Neuropsychological and Behavioral Scale-Revision (CNBS-R2016). Binomial logistic regression was used for multivariate analysis. The receiver operating characteristic (ROC) curve was used to evaluate the value of SPT in identifying ASD without GDD and DLD.

RESULTS

SPT equivalent age was lower than chronological age in the two groups, the difference between the ASD without GDD group was greater than that in the DLD group, and the proportion of SPT equivalent age retardation was higher than that in the DLD group; the differences were statistically significant. Logistic regression analysis showed that there was a difference in SPT equivalent age between DLD and ASD without GDD. When the cut-off value of the SPT was 8.5, the largest area under the ROC curve was 0.723, and the sensitivity and specificity for the diagnosis of ASD without GDD were 0.720 and 0.620 respectively.

CONCLUSIONS

Symbolic play ability in ASD children is worse than that of DLD children at comparable development levels. SPT may be helpful to distinguish ASD without GDD from children with DLD.

Prediction of cord blood leptin on infant's neurodevelopment: A birth cohort in rural Yunnan, China

BACKGROUND

Leptin, one of the peptide hormones secreted by adipocytes, plays a vital part in metabolism, but its role in early-life neurodevelopment remains poorly understood.

METHODS

We performed leptin analysis on 323 cord blood samples collected from a birth cohort in Yunnan rural area, China, and assessed infants' neurodevelopment at one year of age by the Bayley Scales of Infant and Toddler Development-Third Edition (BSID-III). Multiple linear regression and binary logistic regression models were used to explore the associations between cord blood leptin (CBL) concentrations and infants' neurodevelopment and the ability of CBL to predict the probabilities of infants' neurodevelopment delay.

RESULTS

Overall, 323 infants were included in this study. The median concentration of CBL was 4.7 ng/ml. The proportion of 1-year-old infants identified as being neurodevelopmental delayed was 34.5%, and delays in cognitive, language, and motor domains were 11.1%, 26.6%, and 13.9%, respectively. Multiple linear regression analyses manifested that the CBL concentration (log10-transformed) was positively correlated with the cognitive, language, and motor composite scores in infants, respectively (β = 7.76, 95%CI: 3.81-11.71; β = 6.73, 95%CI: 3.41-10.06; and β = 6.88, 95%CI: 3.48-10.29, respectively). Binary logistic regression analysis showed that compared with the higher, lower CBL (< 4.7 ng/ml) yielded a 1.41-fold increase in the risk of language development delay (OR = 2.41，95%CI: 1.42-4.09), a 1.49-fold higher risk of motor development delay (OR = 2.49, 95%CI: 1.25-4.96), and a 1.71-fold higher risk of neurodevelopment delay (OR = 2.71, 95%CI: 1.64-4.48) among infants. The prediction models showed that the probabilities of development delay in infants' language, motor, and neurodevelopment increased with the decline of CBL concentrations [r_s = -0.63 (95% CI: -0.71, -0.56), r_s = -0.46 (95% CI: -0.55, -0.38), r_s = -0.55 (95% CI: -0.63, -0.46), respectively].

CONCLUSION

The decline of CBL was associated with the decrease in infants' neurodevelopment scores at one year of age. CBL below 4.7 ng/ml may increase the risk of infants' neurodevelopment delay. The probabilities of infants' neurodevelopment delay increased with the decrease of CBL concentrations. CBL may be a predictor of the probability of children's neurodevelopment delay.

Developmental Milestones of Infancy and Associations with Later Childhood Neurodevelopmental Outcomes in the Adolescent Brain Cognitive Development (ABCD) Study

The age at attaining infancy developmental milestones has been associated with later neurodevelopmental outcomes, but evidence from large and diverse samples is lacking. We investigated this by analyzing data of 5360 singleton children aged 9-10 from 17 states in the US enrolled in the Adolescent Brain Cognitive Development (ABCD) study during 2016-2020. Delays in four milestones (first roll over, unaided sitting, unaided walking, and speaking first words) were defined using the 90th percentile of age at attainment reported by children's biological mothers. Childhood neurocognitive function was measured by research assistants using the NIH toolbox, and children reported their behavioral problems using the Brief Problem Monitor. Linear mixed-effects models were employed to investigate the association between delays in single or multiple milestones and childhood neurobehavioral outcomes. Delays in first roll over, unaided sitting, or walking were associated with poorer childhood neurocognitive function, while delay in speaking first words was associated with both poorer neurocognitive function and behavioral problems. Children who had delays in both motor and language milestones had the worst neurocognitive function and behavioral outcomes. Our results suggest that delays in motor and language milestone attainment during infancy are predictive of childhood neurobehavioral outcomes.

Changes in social functioning and engagement during canine-assisted intervention for children with neurodevelopmental disorders in the context of an early intervention service

PURPOSE

The objectives were to evaluate the feasibility of early implementation of a canine-assisted intervention (CAI) for children with neurodevelopmental disorders, and to determine the changes in social functioning and in engagement experienced by the participants.

MATERIALS AND METHODS

A CAI consisting of 24 sessions was piloted in an intra-subject quasi-experimental longitudinal design. The outcome measures were the Assessment of Communication and Interaction Skills (ACIS) and Individual Child Engagement Record-Revised (ICER-R).

RESULTS

No adverse events or side-effects were noted. The sample consisted of 44 participants (median age 37 months). A total of 33 children (75%) attended all sessions. Main results showed that after completing the intervention, the overall ACIS score improved significantly (p < 0.001); the effect size was large. There was a significant improvement in the scales of the ICER-R from baseline to the final assessment: overall engagement (p < 0.001), frequency of repetitive behaviours (p < 0.001), frequency of interaction between the child and adults (p < 0.001), and the quality of this interaction (p < 0.001); the effect sizes ranged from medium to large.

CONCLUSIONS

The early application was feasible. The results in the areas of social functioning and engagement suggest that this CAI may be a useful complementary strategy in early therapeutic intervention with these children. WHAT THIS PAPER ADDS?: The results of implementation of a canine-assisted intervention (CAI) at an early therapeutic intervention unit for children with neurodevelopmental disorders are not known. This research supported the feasibility and positive impact of a CAI in a population consisting of children with neurodevelopmental disorders in the earliest stages of their life, with similar proportions of participants with global developmental delay and autism spectrum disorder. The study was pioneering in the development of this form of actions in an early intervention service for children with these health conditions. The intervention appears feasible and the results extend the existing evidence base for this intervention modality. The findings suggest significant improvements of a medium to large size in the domains of communication skills and social relations, engagement levels, frequency and quality of interaction with adults and repetitive behaviours after 12 and 24 weekly CAI sessions.

Prevalence and Developmental Profiles of Autism Spectrum Disorders in Children With Global Developmental Delay

BACKGROUND

Previous studies have mostly explored the comorbidities of Global developmental delay (GDD) in children with Autism Spectrum Disorders (ASD) from the perspective of ASD. The study focus on the perspective of GDD to investigate the prevalence and developmental profiles of ASD in GDD and to explore the correlation between the developmental level and symptoms of autism.

METHODS

Clinical data of 521 children with GDD aged from 24 to 60 months were retrospectively analyzed. Analyses were performed first for the whole sample and then subdivided into two subgroups (GDD⁺ASD^-, GDD⁺ASD⁺) according to whether had ASD. Symptoms of autism were evaluated by the Autism Behavior Checklist and the Childhood Autism Rating Scale. The Chinese version of the Gesell Developmental Schedules was used to evaluate the level of children's mental development.

RESULT

The prevalence of ASD in children with GDD was 62.3%. The total average developmental quotient (DQ) of GDD was mildly deficient and was negatively correlated with symptoms of autism (p < 0.05); language ability was severe and extremely severe deficient (P < 0.05). GDD⁺ASD^- group and GDD⁺ASD⁺ group have some common points as well as differences in the developmental features. The language delay of children in both subgroups was the most obviously defected, thereafter followed by the item of personal social activity. In the GDD⁺ASD⁺ group, the DQ of gross motor skills>fine motor skills>adaptability (p < 0.05). There were no significant differences among the DQ of gross motor skills, fine motor skills and adaptability in GDD⁺ASD^- group (p > 0.05). The GDD⁺ASD^-group had better adaptability, fine motor skills, language ability, personal social activity than that of the GDD⁺ASD⁺ group, but the gross motor skills in GDD⁺ASD^- group were worse (p < 0.05).

CONCLUSION

GDD children have a high proportion of comorbid ASD, and GDD children with poorer developmental levels are more likely to have ASD symptoms. Development profiles in both GDD⁺ASD^- children and GDD⁺ASD⁺ children have common features but there are also differences. GDD⁺ASD⁺ group is worse than GDD⁺ASD^- group in terms of the overall development level.