Quantifying infant physical interactions using sensorized toys in a natural play environment

Infants with developmental delays must be detected early in their development to minimize the progression of motor and neurological impairments. Our objective is to quantify how sensorized toys in a natural play environment can promote infant-toy physical interactions. We created a hanging elephant toy, equipped with an inertial measurement unit (IMU), a pressure transducer, and multiple feedback sensors, to be a hand-grasping toy. We used a 3 DoF robotic model with inputs from the IMU to calculate multiple kinematic metrics and an equation to calculate haptic metrics from the pressure transducer. Six typical infants were tested in the gym set-up. Three infants interacted with the toy for more than half the trial time. The youngest infant exhibited the largest toy displacement with ΔD = 27.6 cm, while the oldest infant squeezed the toy with the largest mean pressure of 4.5 kPa. More data on on both typical and atypical infants needs to be collected. After testing atypical infants in the SmarToyGym set-up, we will be able to identify interaction metrics that differentiate atypical and typical infants.

Can the Children's Communication Checklist differentiate autism spectrum subtypes?

The study explored whether children with high functioning autism (HFA), Asperger syndrome (AS), and pervasive developmental disorder not otherwise specified (PDD-NOS) can be differentiated on the Children's Communication Checklist (CCC). The study also investigated whether empirically derived autistic subgroups can be identified with a cluster analytic method based on the Autism Diagnostic Interview–Revised. Fifty-seven children with HFA, 47 with AS, 31 with PDD-NOS, and a normal control group of 47 children between 6 and 13 years participated. Children with HFA,AS, and PDDNOS showed pragmatic communication deficits in comparison to the controls. Little difference was found between the three subtypes with respect to their CCC profile.A three-cluster solution explained the data best.The HFA cluster showed most autism characteristics, followed by the combined HFA + AS cluster, and then the PDD-NOS cluster. The findings support the autism spectrum concept based on severity of symptom impairment rather than distinct categories.

Environmental needs in childhood disability analysed by the WHO ICF, Child and Youth Version

INTRODUCTION

The WHO has launched a common classification for disabilities in children, the International Classification of Functioning, Disability and Health, Child and Youth Version (ICF-CY). We wanted to determine whether cat-egories of the environmental (e) and the body functions (b) components of the classification could address environmental needs in children with different disorders and various disability severities.

METHODS

A set of 16 e categories and 47 b categories were selected and worded to best enable parents to describe children's everyday support needs and environmental influences through interviews in their own homes.

RESULTS

Of the 367 invited parents, 332 (90.5%) participated, providing data on children with spina bifida, spinal muscular atrophy, muscular disorders, cerebral palsy, visual impairments, hearing impairments, mental disability and disabilities following brain tumour treatment. The mean age of children across disabilities was 9.4 years (range: 1.0-15.9). The mean e code score was 35.7 (range: 4.0-64.0), and the mean b code score was 32.2 (range: 0.0-159.0). The most urgent needs as detected by qualifier 4 environmental categories scores were common among children with complex disorders and issues related to health professionals, legal services and health services.

CONCLUSIONS

Parents understand the environmental and body function components in a meaningful manner and the codes seem to be valid. Special emphasis should be given to environmental issues for children with more complex disabilities. There was no correlation between the severity of a disability and environmental issues, indicating that each child's needs were basically met, irrespective of disability severity.

FUNDING

partnership project § 16, 21, 31 administered by the Danish Health Authority.

TRIAL REGISTRATION

not relevant.

Comparison of the Kyoto Scale of Psychological Development 2001 with the parent-rated Kinder Infant Development Scale (KIDS)

OBJECTIVE

The purpose of the study was to extend our understanding of the Kyoto Scale of Psychological Development (KSPD) by comparison with a parent-rated scale, the Kinder Infant Development Scale (KIDS).

METHODS

The participants of this study were 229 children aged 0-4, who were referred to the Developmental Evaluation Center of the National Center for Child Health and Development, due to a suspected developmental disorder/delay. The participants were divided into subgroups, depending on age and overall DQ. For each group separately, correlation analyses were conducted between the Developmental Quotient (DQ) of each KSPD domain and DQ of each KIDS subscale.

RESULTS

For high DQ group, in all ages, the KSPD Postural-Motor (P-M) domain DQ demonstrated a high correlation with the KIDS Physical-Motor DQ, and at young ages, it was also found to be moderately or strongly associated with the KIDS Manipulation DQ. For high DQ group, the KSPD Cognitive-Adaptive (C-A) domain DQ was most consistently related to the KIDS Manipulation DQ, and was also moderately correlated with the KIDS Physical-Motor DQ, Receptive Language DQ, Social Relationship with Adults DQ, Discipline DQ, and Feeding DQ, depending on age. For high DQ group, the KSPD Language-Social (L-S) DQ most consistently showed a moderate or high correlation with the KIDS Receptive Language DQ and the Manipulation DQ, and also related to Physical-Motor DQ, Expressive Language DQ, Language Conception DQ, Social Relationship with Adults DQ, and Social Relationship with Children DQ for some age groups. The low DQ group demonstrated stronger relationships on many of the pairs of the DQ of a KSPD subdomain and the DQ of a KIDS subscale, regardless of the type of subdomains and subscales.

CONCLUSIONS

For high DQ group, the KSPD P-M domain was consistently related to parent-reported physical/motor development, the C-A domain primarily reflected a child's fine motor skills and his/her ability to understand and follow verbal instructions provided by adults, while the L-S domain was associated with parent-reported language ability. For low DQ group, the effect of global delay increased overall correlations between each domain and subscale. Further studies are necessary to replicate the findings in a larger sample including typical children.

Two kinds of autism: a comparison of distinct understandings of psychiatric disease

In this article, I argue that the history and philosophy of autism need to account for two kinds of autism. Contemporary autism research and practice is structured, directed and connected by an 'ontological understanding of disease'. This implies that autism is understood as a disease like any other medical disease, existing independently of its particular manifestations in individual patients. In contrast, autism in the 1950s and 1960s was structured by a psychoanalytical framework and an 'individual understanding of disease'. This implied that autism was not a distinct disease but an idiosyncratic and meaningful response of the child to a disturbed development of the ego. These two kinds of autism are embedded in and reveal two very different 'styles of psychiatric thought'.

[The differential diagnosis of asymmetry in infants]

Asymmetry in infants is a clinical condition in which abnormal body shape, posture or mobility is observed. It is characterized by diverse etiology, localization and severity. The most frequently noted kind is idiopathic asymmetry. Symptomatic asymmetry is less frequent and a variety of structural or systemic disorders underlie this disease. The dynamics of child development in the first year of life makes it necessary for clinicians to give an early diagnosis of asymmetry, which has a significant impact on the expected course of its development and intervention strategies. The aim of the study is to present the definitions, classification and differential diagnosis of asymmetry in infants.

[ESSENCE gathers the diagnoses into a whole]

Co-existence of attention-deficit/hyperactivity disorder, oppositional defiant disorder, tic disorders, developmental coordination disorder, language disorder, learning problems, and autism spectrum disorder and sharing of symptoms across disorders, contribute to the typical clinical presentation in child psychiatry as well as in developmental medicine. The acronym ESSENCE refers to Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations. Affected children are brought for clinical assessment because of impairing symptoms that raise concern before the age of about 5 years in general development, communication and language, social inter-relatedness, motor coordination, attention, activity, behaviour, mood, and/or sleep. Such children are usually in need of a range of expert assessments, but a holistic approach is rarely taken from the start. Major problems in at least one ESSENCE domain before 5 years of age predict poor mental health later in life. Expert ESSENCE centres for assessment, habilitation and treatment of these children are needed.

High incidence of sleep problems in children with developmental disorders: results of a questionnaire survey in a Japanese elementary school

OBJECTIVE

The aim of the present school-based questionnaire was to analyze the sleep problems of children with developmental disorders, such as pervasive developmental disorder and attention deficit hyperactivity disorder.

METHODS

The sleep problems of 43 children with developmental disorders were compared with those of 372 healthy children (control group). All children attended one public elementary school in Kurume, Japan; thus, the study avoided the potential bias associated with hospital-based surveys (i.e. a high prevalence of sleep disturbance) and provided a more complete picture of the children's academic performance and family situation compared with a control group under identical conditions. Children's sleep problems were measured with the Japanese version of the Children's Sleep Habits Questionnaire (CSHQ).

RESULTS

Children with developmental disorders had significantly higher total CSHQ scores, as well as mean scores on the parasomnias and sleep breathing subscales, than children in the control group. The total CSHQ score, bedtime resistance, sleep onset delay, and daytime sleepiness worsened with increasing age in children with developmental disorders; in contrast, these parameters were unchanged or became better with age in the control group. In children with developmental disorders, there was a significant association between a higher total CSHQ score and lower academic performance, but no such association was found in the control group. For both groups, children's sleep problems affected their parents' quality of sleep. There were no significant differences in physical, lifestyle, and sleep environmental factors, or in sleep/wake patterns, between the two groups.

CONCLUSIONS

Children with developmental disorders have poor sleep quality, which may affect academic performance. It is important for physicians to be aware of age-related differences in sleep problems in children with developmental disorders. Further studies are needed to identify the association between sleep quality and school behavioral performance.

Instability of delay classification and determination of early intervention eligibility in the first two years of life

The purpose of this study was to determine the effectiveness of the Bayley Scales of Infant Development, Third Edition (Bayley-III) to track development and classify delays in low- and high-risk infants across the first two years of life. We assessed cognitive, language, and motor development in 24 low-risk full-term and 30 high-risk preterm infants via seven assessments performed between 3 and 24 months corrected age. The Bayley-III resulted in highly unstable delay classifications, low sensitivities, and poor positive predictive values across time. The results highlight that early intervention professionals, researchers, and policy makers should: (1) emphasize clinical opinion and prevalence of risk factors rather than standardized assessment findings when classifying delays and determining eligibility for services, and (2) develop more effective developmental assessments for infants and young children.

[Intellectual disability - a frequent reason for referral to medical genetics]

Mental retardation affects about 2-3% of the population and is often associated with comorbidities. So far, more than 450 different medical conditions are known with mental retardation as a sign and it is assumed that there are many more yet to be defined. The diagnosis of the underlying entity allows for a few specific optimization of cognitive function, but usually improves the treatment of comorbidities. Furthermore, the detection of the underlying genetic defect allows the specification of the risk of recurrence and enables prenatal diagnosis for future pregnancies of persons at risk in the family. Recent findings suggest that especially in diseases that are associated with defective synaptic signal transduction may be targeted by specific drugs for improvement of cognitive performance in the near future.

Dentistry's intrinsic link to provision of services for persons with disabilities

This article provides the dentist with a background on disabilities, education, practice and provision of services related to statutory and regulatory requirements, particularly the Americans with Disabilities Act anrid the California Fair Employment and Housing Act.

Reactive attachment disorder in the general population: a hidden ESSENCE disorder

Reactive attachment disorder (RAD) is a severe disorder of social functioning. Previous research has shown that children with RAD may have poor cognitive and language abilities; however, findings mainly come from biased, institutionalised samples. This paper describes the characteristics of all children who were given a suspected or likely diagnosis of reactive attachment disorder in an epidemiological study of approximately 1,600 children investigating the prevalence of RAD in the general population. We found that children with RAD are more likely to have multiple comorbidities with other disorders, lower IQs than population norms, more disorganised attachment, more problem behaviours, and poorer social skills than would be found in the general population and therefore have a complex presentation than can be described as ESSENCE. We discuss the clinical and educational implications.

[The genetic bases of neurodevelopmental disorders]

In the last decade, progress made in genetics is questioning the current implicit nosological model in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) and the International Classification of Diseases, tenth revision. Both the categorical nature and the comorbidity detected on applying diagnostic criteria become unsustainable in the light of the genetic architecture that is emerging from studies being conducted on the genetics of mental disorders. The classical paradigms -one gene for one disease- or even a specific distinctive genetic pattern for each condition, are concepts restricted to specific cases. In this review the objective is to describe the current scenario that has arisen following the latest advances in genetics. The lines of work being traced by research both in the present and in the near future include: the identification of variations in the number of copies (both frequent and rare), indiscriminately linked to different disorders; the concurrence of multiple variants for a single disorder; the double hit phenomenon; and epigenetic modulation. The new version of the DSM, fully aware of the deficiencies in the current model, will mark a turning point that, while somewhat timid, is decidedly oriented towards incorporating a dimensional conception of mental disorders.

Assessment of the relationship between diagnoses of ASD and caregiver symptom endorsement in adults diagnosed with intellectual disability

Individuals diagnosed with an intellectual disability (ID) share overlapping traits with those diagnosed with both ID and an Autism Spectrum Disorder (ASD). Therefore, the purpose of this study was to determine if caregivers' reports of symptoms of ASD are of value (i.e., when comparing them to clinical diagnoses of ASD) and to determine which symptoms of ASD best differentiate those with ASD from those with ID only. It was hypothesized that a subset of items would emerge using the Autism Spectrum Disorders-Diagnostic for Adults (ASD-DA) which would differentiate the two groups utilize in this study. One hundred eighty-six adults diagnosed with ID with and without diagnosis of ASD were assessed for core symptoms and other behavioral differences using the ASD-DA. Most of the individuals in the ID group (n = 93) and the ID plus ASD group (n = 93) were in the profound range of ID. The items which were most likely to distinguish individuals with ASD were in socialization domain. Furthermore, adults with ASD were more likely to be male and to be non-verbal.

[An analysis of the first international classifications of mental health and developmental disorders of infancy and early childhood]

The content of the first international classifications of mental health and developmental disorders of infancy and early childhood (DC:0-3 and DC:0-3R) is described. Both classifications are made as multiaxial systems and include the following axes of pschopathological diagnosis, abnormal relations, concomitant somatoneurological disturbances and developmental disorders as well as axes of psychosocial stressors and emotional and social functioning. Short descriptions of each axis with the focus at the axis of clinical disorders (DC:0-3R) are shown. This axis consists of 7 diagnostic items: 1) posttraumatic stress disorder and deprivation/maltreatment disorder); 2) disorders of affect, 3) adjustment disorders; 4) regulatory disorders of sensory processing; 5) sleep behavior disorders; 6) feeding behavior disorders; 7) disorders of relating and communication. Clinical parallels with the diagnosis of psychopathology of early age accepted by Russian specialists are analyzed.

[Polish version of the ADOS (autism diagnostic observation schedule-generic)]

The article presents the Polish version of the autism diagnostic observation schedule-generic (ADOS), which together with the autism diagnostic interview-revised (ADI-R) is cited as the "gold standard" for the diagnosis of autism. The ADOS is a standardised, semistructured observation protocol appropriate for children and adults of differing age and language levels. It is linked to ICD-10 and DSM-IV-TR criteria. The ADOS consists of four modules, ranging from module 1 for nonverbal individuals to module 4 for verbally fluent adults. The adequate inter-rater reliability for items has been established. The protocol has high discriminant validity and distinguishes children with pervasive developmental disorders from children, who are outside of the spectrum. Although it does not enable to distinguish individuals with pervasive developmental disorder, unspecified from individuals with childhood autism. The paper presents subsequent steps of the translation process of the original version into Polish, as well as a chosen adaptation strategy of the Polish version. The ADOS is a very useful tool both for clinical diagnosis and for the scientific purpose diagnosis. In this last case it is extremely important to use a standardised method. Until now, there was no standardised diagnostic tool for autism in Poland.

[Polish version of the ADI-R (Autism Diagnostic Interview-Revised)]

Childhood autism belongs to pervasive developmental disorders and is characterised by qualitative abnormalities in reciprocal social interactions, communication, and by restricted, repetitive interests and behaviours. Until now there was no standardised tool for a diagnosis of autism in Poland. The paper presents the Polish version of the Autism Diagnostic Interview - Revised (ADI-R), which is the "gold standard" for the diagnosis of autism in Europe, United States and Australia. It describes the translation process and adaptation of the original version into Polish, as well as differences between the two versions. ADI-R is a complex, standardised, semi-structured investigator-based interview for parent or caregiver of person with autism, linked to ICD-10 and DSM-IV-TR criteria and appropriate for both adults and children, who have the minimum mental age of 24 months. Moreover ADI-R consists of, beside diagnostic algorithms, the current behaviour algorithms, which enable to assess and compare various levels of functioning during planning and implementation of treatment and therapy. ADI-R is also a very useful tool in the diagnosis for scientific purposes due to its standardisation.

[The challenge of staging developmental disorders]

BACKGROUND

On the basis of our current knowledge, developmental disorders can be divided into the following stages: stage 0: normal variation, stage 1: simple disorder of moderate severity, stage 2: complicating co-morbidity and/or harmful background circumstances, and stage 3: serious disorder with harmful background circumstances.

AIM

To describe the current views on prognostic aspects of staging from a developmental perspective.

METHOD

The study is based on a critical review of the relevant literature.

RESULTS

The current division into stages is still insufficiently predictive, partly because development is a flexible process with risks, chances and second chances. All psychiatric disorders are in essence developmental disorders that arise in the course of development as a result of the interaction between predisposition and background circumstances. As from the very first meiosis the hereditary predisposition is subject to influences in the womb environment. The forming of networks in the brain, the distribution of neurotransmitters and the neurological profile are influenced by the genetic potential for chances and risks and are all a result of interactions. This complicated developmental history raises questions about the specificity of current clinical syndromes.

CONCLUSION

In time there is likely to be a much more accurate staging system. This will come about if, as a result of the analysis of large pooled databases, it becomes possible to make a better assessment of the relative risks of genetic configurations, brain connections, stress regulation in the brain, neuropsychological profiles and behavioural and emotional forms of expression in the light of the interactions that occur with the aforementioned background circumstances.

Does the individualized reference outperform a simple ultrasound-based reference applied to birth weight in predicting child neurodevelopment?

OBJECTIVES

Being small-for-gestational age (SGA) is associated with an increased risk of morbidity, but questions remain about how best to diagnose SGA, and thus, predict poor health consequences. The authors sought to compare an individualized reference for defining SGA with simple birth weight-based and ultrasound-based references applied to birth weight in predicting poor cognitive development at age five.

METHODS

The authors used data from the Successive SGA Births Study, a prospective study including 699 Alabaman and 618 Scandinavian women recruited from 1986 to 1988, and whose children had cognitive development scores measured at age five using the Wechsler Preschool and Primary Scale of Intelligence-Revised Intelligence Quotient. Sensitivity, specificity and positive predictive value (PPV) were estimated for each reference applied to birth weight using adverse cognitive development (score < 10(th) percentile) as the outcome. Relative risk of poor neurodevelopment was calculated, comparing infants classified as SGA by either the individualized or the simple ultrasound-based reference with infants not classified as SGA.

RESULTS

The individualized reference had higher specificity and PPV in predicting poor neurodevelopment. Neonates defined as SGA by the individualized reference alone had a higher risk (RR=2.20, 95% CI: 1.20, 4.00) of poor cognitive outcome, while those identified by the ultrasound-based reference alone did not (RR=0.95, 95% CI: 0.45, 2.01). None of the references could predict poor neurodevelopment well at age five.

CONCLUSIONS

The individualized birth weight reference modestly outperforms the simple ultrasound-based reference in identifying SGA infants with poor child neurodevelopment. However, neither reference can predict child neurodevelopment well.

A description of adaptive and maladaptive behaviour in children and adolescents with Cri-du-chat syndrome

BACKGROUND

Psychological tests can be useful to record adaptive and maladaptive behaviours of children with intellectual disability. The objective of this study was to describe the adaptive and maladaptive behaviour of children and adolescents with Cri-du-chat syndrome.

METHODS

The sample consisted of 10 children and adolescents with Cri-du-chat syndrome (mean chronological age=11.3 years, mean mental age=18 months). The developmental quotient was calculated through the Psychoeducational Profile - Revised. An observational protocol was used to record adaptive and maladaptive behaviours.

RESULTS

The number of maladaptive behaviours observed was different among participants. However, all of them had high rates of adaptive behaviours, such as rule-following.

CONCLUSIONS

These results, though preliminary, justify that we continue to think about the need for psychoeducational interventions aimed at stimulating the repertoire of adaptive behaviours, in people with Cri-du-chat syndrome.

The contribution of rare diseases to understanding the epidemiology of neurodevelopmental disabilities

Our objective is to describe the contribution of rare diseases to our understanding of the epidemiology of neurodevelopmental disabilities (NDDs) by comparing and contrasting the epidemiologic features of NDDs classified according to key characteristics of developmental delay or deviance in such areas as behavior or cognition (the phenotypic approach; autism spectrum disorders and intellectual disability as examples) versus classification based on the identification of an etiologic diagnosis (the etiologic approach; 22q11.2 deletion syndrome and fragile X syndrome as examples). We suggest specific applications in which consideration of rare etiology-based NDDs might further our understanding of NDD epidemiology overall; what is needed to integrate the two classification approaches; and identify practical challenges in achieving that integration. Understanding commonalities and differences in the epidemiologic features of the phenotypically and etiologically defined NDD classifications provides a useful framework for furthering our understanding of the prevalence, distribution, and causes of NDDs, as well as delivering appropriate diagnostic resources, appropriate treatments, accurate prognostic information, and estimates of recurrence risk for these disorders.

Autism spectrum conditions in individuals with Möbius sequence, CHARGE syndrome and oculo-auriculo-vertebral spectrum: diagnostic aspects

As part of multidisciplinary surveys of three Behavioural Phenotype Conditions (BPCs); Möbius sequence (Möbius), CHARGE syndrome (CHARGE) and oculo-auriculo-vertebral spectrum (OAV), autism spectrum conditions (ASCs) was diagnosed in 45%, 68% and 42% of the individuals, respectively. Diagnostic difficulties due to additional dysfunctions such as mental retardation (MR), impaired vision, reduced hearing and cranial nerve dysfunction, were experienced in all three BPC groups. The applicability of current autism diagnostic instruments, such as the Autism Diagnostic Interview-Revised (ADI-R), the Childhood Autism Rating Scale (CARS) and the Autistic Behaviour Checklist (ABC), in individuals with ASCs and Möbius/CHARGE/OAV was analysed. Use of an extensive battery of diagnostic instruments, including both observational schedules and parent interviews, and, if possible, independent judgements from two clinicians, is essential in the diagnostics of ASCs in these individuals. Further, in individuals who are deaf and blind the applicability of current autism diagnostic instruments is highly questionable.

Korean Academy of Medical Sciences Pediatric Impairment Guideline for brain lesion

The permanent impairment evaluation for children in developmental stage is very difficult and it is even impossible in some cases. The impairment evaluation for developing children has not yet been included in the guideline of the American Medical Association. Due to frequent medical and social demands in Korea, we developed an impairment evaluation guideline for motor impairment, intellectual disability/mental retardation, developmental speech-language disorder and epilepsy caused by pediatric cerebral injuries, or cerebral lesions other than the developmental disorders such as autism. With the help of various literature and foreign institutions, we developed our in order to develop a scientific guideline for pediatric impairment that is suited to Korean cultural background and social condition.

Adaptation of CSHCN instrument for the use in assessing the prevalence of chronic diseases in children and adolescents in Poland

There are several methods for assessment the prevalence of chronic diseases among children and adolescents in population surveys. Recently developed consequence-based approach seems to be more powerful to identify individual impact of chronic condition on child and family by comparison to the traditional, disease-specific method. The aim of this study was to describe the structure and validity of parent-reported CSHCN (Children with Special Health Care Needs) questionnaire and to test the performance of this screener in Polish population of children who normally attend schools. The survey was conducted in KIDSCREEN project in 2003 on the sample of 1718 children aged 8-18 years. The overall prevalence of CSHCN was 14.5% (16.5% among boys and 13.5% among girls). CSHCN status was not related to age of child and there was a tendency to higher prevalence of chronic diseases in poor families. Urban residents and children of parents with higher education more often met overall CSHCN criteria. Children identified as CSHCN were more likely to report poor self-rated health and frequent visits to doctor, which underlines validity of this instrument. The Polish version of the CSHCN questionnaire seems to be a convenient instrument that should be applied in further population studies.

A replication of the Autism Diagnostic Observation Schedule (ADOS) revised algorithms

OBJECTIVE

To replicate the factor structure and predictive validity of revised Autism Diagnostic Observation Schedule algorithms in an independent dataset (N = 1,282).

METHOD

Algorithm revisions were replicated using data from children ages 18 months to 16 years collected at 11 North American sites participating in the Collaborative Programs for Excellence in Autism and the Studies to Advance Autism Research and Treatment.

RESULTS

Sensitivities and specificities approximated or exceeded those of the old algorithms except for young children with phrase speech and a clinical diagnosis of pervasive developmental disorders not otherwise specified.

CONCLUSIONS

Revised algorithms increase comparability between modules and improve the predictive validity of the Autism Diagnostic Observation Schedule for autism cases compared to the original algorithms.

How well do care providers know the children with developmental disabilities they care for?

AIM

To assess the knowledge from memory of caregivers about the most significant impairments contributing to additional care needs in children with developmental disabilities in therapeutic toddler groups.

METHODS

Children's needs for additional care due to impairments of physical health, motor, sensory, mental and voice and speech functions were separately classified using the capacity profile (CAP). Twenty-three therapists and teachers of toddler groups in two regional centres for paediatric rehabilitation assessed the CAP individually, unprepared and without consulting their notes or the clinical record. These CAP scores (150 CAPs of 44 children) were compared with those based on the clinical record using weighted kappa statistics.

RESULTS

Weighted kappa values for the two sets of CAP scores ranged from 0.22-0.74 (median 0.53), with the lowest scores for the sensory domain (median 0.32, range 0.22-0.52) and the highest scores for the motor domain (median 0.62, range 0.56-0.74).

CONCLUSION

Team members in general had only moderate remembered knowledge of the current impairments determining need of additional care. Remembered knowledge was the poorest for domains not easily observable, such as sensory functions. As this knowledge is essential for optimizing the child's daily environment, improvement of this type of knowledge should be facilitated.

Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study

BACKGROUND

The increasing survival rates of children who are born very preterm raise issues about the risks of neurological disabilities and cognitive dysfunction. We aimed to investigate neurodevelopmental outcome and use of special health care at 5 years of age in a population-based cohort of very preterm children.

METHODS

We included all 2901 livebirths between 22 and 32 completed weeks of gestation from nine regions in France in Jan 1-Dec 31, 1997, and a reference group of 667 children from the same regions born at 39-40 weeks of gestation. At 5 years of age, children had a medical examination and a cognitive assessment with the Kaufman assessment battery for children (K-ABC), with scores on the mental processing composite (MPC) scale recorded. Data for health-care use were collected from parents. Severe disability was defined as non-ambulatory cerebral palsy, MPC score less than 55, or severe visual or hearing deficiency; moderate deficiency as cerebral palsy walking with aid or MPC score of 55-69; and minor disability as cerebral palsy walking without aid, MPC score of 70-84, or visual deficit (<3/10 for one eye).

FINDINGS

In total, 1817 (77%) of the 2357 surviving children born very preterm had a medical assessment at 5 years and 396 (60%) of 664 in the reference group. Cerebral palsy was diagnosed in 159 (9%) of children born very preterm. Scores for MPC were available for 1534 children born very preterm: 503 (32%) had an MPC score less than 85 and 182 (12%) had an MPC score less than 70. Of the 320 children in the reference group, the corresponding values were 37 (12%) and 11 (3%), respectively. In the very preterm group, 83 (5%) had severe disability, 155 (9%) moderate disability, and 398 (25%) minor disability. Disability was highest in children born at 24-28 completed weeks of gestation (195 children [49%]), but the absolute number of children with disabilities was higher for children born at 29-32 weeks (441 children [36%]). Special health-care resources were used by 188 (42%) of children born at 24-28 weeks and 424 (31%) born at 29-32 weeks, compared with only 63 (16%) of those born at 39-40 weeks.

INTERPRETATION

In children who are born very preterm, cognitive and neuromotor impairments at 5 years of age increase with decreasing gestational age. Many of these children need a high level of specialised care. Prevention of the learning disabilities associated with cognitive deficiencies in this group is an important goal for modern perinatal care for children who are born very preterm and for their families.

Outcome of extremely low birth weight survivors at school age: the influence of perinatal parameters on neurodevelopment

Extremely low birth weight (ELBW) is associated with impaired neurodevelopmental outcome in infancy. Information on the long-term cognitive and neurological consequences of ELBW is scarce. We aimed to identify the perinatal and neonatal factors of ELBW infants associated with adverse cognitive and neurological outcome at school age. A regional cohort of 135 ELBW infants born between 1993 and 1998 was prospectively evaluated at 3, 6, 12, and 18 months postmenstrual age and at yearly intervals up to age 10 years. The comprehensive follow-up programme for high-risk infants included neurological examinations and psychometric evaluations. According to the overall results of these tests, children were classified as either being normal or having minor or major impairment. At a mean age of 8.4 (SD: 1.6) years, 43% of children had survived without any impairment. Minor impairment was diagnosed in 39% and major impairment in 18% of assessed children. The proportion of disabled school children rose with decreasing gestational age. The following neonatal complications were significant risk factors for developing major or minor impairment at school age: an increase in head circumference < 6 mm per week (OR 4.0, 95% CI: 1.1-14.8), parenteral nutrition > or = 6 weeks (OR 2.5, 95% CI: 1.1-6.0), and mechanical ventilation > 14 days (OR 2.3, 95% CI: 1.0-5.1). High-grade intraventricular haemorrhage (IVH) and/or PVL (OR 13.3, 95% CI: 4.0-44.9), neonatal seizures (OR 5.2, 95% CI: 1.2-22.4) and bowel perforation, and/or necrotizing enterocolitis (OR 4.4, 95% CI: 1.1-17.0) were significant risk factors for developing major impairment. In spite of the relatively large proportion of normal children, ELBW remains an important risk factor for neurodevelopmental impairment at school age. Thus, measures to prevent complications such as necrotizing enterocolitis, cerebral haemorrhage, and undernutrition remain important goals for neonatal intensive care.

Individuals with developmental disabilities and their caregivers

Adults with Developmental Disabilities (DD) are experiencing increased longevity and the projected number of older persons with DD is expected to double by 2020. As a result, concerns have been raised that agencies and professional staff are ill-prepared to address the increased needs of an older population with lifelong disabilities. The caregiving life of familis of person with DD now spans multiple decades and is increasingly a feature of advanced age for parents and grandparents, and of old age for siblings. Problem behaviors, onset or poor management of mental health concerns and inadequate planning for their aging years are the biggest barriers to successful aging for persons with developmental disabilities. However, psychosocial interventions have the potential to alleviate these barriers and promote positive aging for older persons with developmental disabilities. The evidence for the effectiveness of such interventions will be examined within this article.

School-aged children with SLI: the ICF as a framework for collaborative service delivery

Reports of associated disabilities among children with specific language impairment (SLI) and children with other developmental disabilities are widespread. Clinicians require a broader definition of SLI that recognizes associated disabilities because it is their goal to impact children's everyday functioning. In this paper, we explore SLI from a broader perspective in which consideration is given to features known to be common across different developmental disabilities. The World Health Organization's (2001) International Classification of Functioning, Disability and Health (ICF) is utilized as an organizational and conceptual framework for considering how knowledge of commonalities across developmental disabilities may be used to promote collaborative service delivery in an educational setting. This framework can potentially provide a coherent and comprehensive approach to treating SLI and its associated disabilities without overburdening clinical services.

LEARNING OUTCOMES

As a result of this activity, the reader will be able to: (1) describe the potential role of the ICF in facilitating collaborative service delivery in the school setting; (2) identify and describe the commonalities among SLI and its associated disabilities; and (3) describe how knowledge of commonalities may inform approaches to service delivery.

Tracing syndrome-specific trajectories of attention across the lifespan

This paper maintains that studies of atypical attention targeting one particular age group are unlikely to be informative of syndrome-specific deficits and their developmental changes. We propose a new approach to the study of attentional deficits in genetic disorders, arguing for tracing cross-syndrome developmental trajectories from infancy through childhood to adulthood. Few studies have incorporated a developmental approach to determine whether the pattern of deficits and proficiencies remains constant across developmental time. Fewer still have included a cross-syndrome perspective to address these issues. Focusing on the cognitive domain of attention and its component parts, and using a cross-syndrome developmental perspective, the present set of studies compared the trajectories of different aspects of attention in three developmental disorders: Fragile X syndrome (FXS), Down syndrome (DS) and Williams syndrome (WS). Hitherto, these syndromes have all been reported as displaying serious "attentional deficits" above those expected in the general population. We predicted that, when one considers in greater detail subcomponent processes of attention, then ostensibly common difficulties do not necessarily emerge from common developmental pathways. We addressed this question with two studies. The first focused on inhibitory control, orienting and selective attention in infants and toddlers, and the second concentrated on selective attention, sustained attention and inhibitory control in mid-late childhood. The current results and their integration with earlier findings in adults point both to commonalities and to important syndrome-specific differences in attentional component processes, questioning whether profiles remain constant across developmental time.

The Capacity Profile: a method to classify additional care needs in children with neurodevelopmental disabilities

The aim of this study was to determine the interrater reliability and stability over time of the Capacity Profile (CAP). The CAP is a standardized method for classifying additional care needs indicated by current impairments in five domains of body functions: physical health, neuromusculoskeletal and movement-related, sensory, mental, and voice and speech, in children from 3 to 18 years of age. The intensity of care in each domain is defined from 0 (no need for additional care) to 5 (needs help with every activity). The intensity of additional care in each of the five separate domains indicates the CAP for the individual child. We developed the CAP to inform the parents and other caregivers of children with non-progressive, permanent neurodevelopmental disabilities, such as cerebral palsy and myelomeningocele, about the consequences of these conditions. To determine interrater agreement and stability over time, the CAPs of 67 children (39 males, 28 females) with a neurodevelopmental disability (mean age 18y [SD 1.2y]; range 14-22y) were assessed based on a semi-structured interview. In addition, the CAPs of the same individuals at the age of 3 years were determined based on a chart review. Interrater agreement of the CAP at the age of 3 was good to very good (weighted kappa 0.64-0.92). Agreement between the CAP at the age of 18 and the CAP at the age of 3 (providing evidence for stability over time) was also good (weighted kappa 0.68-0.77), except for the domain 'physical health functions', about which agreement was relatively poor (0.47). We conclude that the CAP is a reliable instrument for classifying the additional needs of a child with a non-progressive, permanent neurodevelopmental disability. The preliminary evidence for the stability over time of such needs according to the CAP should be validated in a prospective study.

[Measurement of activities of daily living in children--standardisation of a screening questionnaire]

BACKGROUND

Especially at preschool age, but also at school age, it is a major issue to what extent developmental problems are relevant for activities of daily living. This should be important for the prescription of therapeutic interventions. Previous instruments require training and/or they are time-consuming (e. g. interviews, direct observation and testing) or they are not suitable for the target group. The objective of the presented screening questionnaire for parents and professionals is a quick and standardised instrument for the status of everyday activities, particular in children with physical and mental delays or handicaps. The study examines the interrater and the retest reliability.

PATIENTS AND METHODS

A questionnaire (M-ADL) with the subscales eating and drinking, hand skill in everyday life, toiletting and mobility was tested. The ratings were carried out on two levels: first, a global rating from 0 to 10 had to be given on each subscale. Secondly, a rating based on a defined scale had to be given. The average time for evaluation is about 5 minutes. We examined 28 children with cerebral palsy for the test-retest-reliability, and 48 children for the interrater reliability. The children had all types of cerebral palsy and all degrees of severity rated according to the Gross Motor Function Classification Scale cerebral palsy.

RESULTS

The M-ADL total scores showed an excellent interrater reliability (r=0.84 to r=0.89) and test-retest-reliability (r=0.91 to r=0.97). Each subscale had a good reliability (at least r=0.73).

CONCLUSION

The M-ADL is a reliable, economic measure for activities of daily living for children with physical and mental delays or handicaps. The instrument may serve as a tool for quick information on the level of activities according to the International Classification of Functioning (ICF).

A report: the definition and classification of cerebral palsy April 2006

For a variety of reasons, the definition and the classification of cerebral palsy (CP) need to be reconsidered. Modern brain imaging techniques have shed new light on the nature of the underlying brain injury and studies on the neurobiology of and pathology associated with brain development have further explored etiologic mechanisms. It is now recognized that assessing the extent of activity restriction is part of CP evaluation and that people without activity restriction should not be included in the CP rubric. Also, previous definitions have not given sufficient prominence to the non-motor neurodevelopmental disabilities of performance and behaviour that commonly accompany CP, nor to the progression of musculoskeletal difficulties that often occurs with advancing age. In order to explore this information, pertinent material was reviewed on July 11-13, 2004 at an international workshop in Bethesda, MD (USA) organized by an Executive Committee and participated in by selected leaders in the preclinical and clinical sciences. At the workshop, it was agreed that the concept 'cerebral palsy' should be retained. Suggestions were made about the content of a revised definition and classification of CP that would meet the needs of clinicians, investigators, health officials, families and the public and would provide a common language for improved communication. Panels organized by the Executive Committee used this information and additional comments from the international community to generate a report on the Definition and Classification of Cerebral Palsy, April 2006. The Executive Committee presents this report with the intent of providing a common conceptualization of CP for use by a broad international audience.

Diagnostik und Klassifikation von Verhaltensauffälligkeiten bei Säuglingen und Kleinkindern von 0-5 Jahren

The Article is working on developmental psychopathology, diagnosis, and treatment of behavioral problems in infants and toddlers age 0 to 5. An overview of the literature about the international discussion is given. In particular diagnostic classification is elaborated by mentioning the revision of "Diagnostic Classification 0-3 (DC: 0-3R)" and "Research Diagnostic Criteria-Preschool Age (RDC-PA)". State of the art and clinical implication is reported on the basis of principal considerations on infant psychiatry. The american practice parameters become adapted and a working title for diagnostic formulation is given. More research should be done against the background of the introduced standards.

Associations between preschool attendance and developmental impairments in pre-school children in a six-year retrospective survey

BACKGROUND

Many school-aged children suffer physical and mental impairments which can adversely affect their development and result in significant morbidity. A high proportion of children in western countries attend pre-school, and it is likely that the preschool environment influences the prevalence and severity of these impairments. Currently there is insufficient data available on the prevalence of these impairments and their causal associations. The influence that location of a pre-school and the duration of preschool attendance have on the prevalence of these impairments is not known.

METHODS

In a retrospective survey spanning six years (1997-2002) we reviewed the records of 6,230 preschool children who had undergone routine school entry assessments. These children had been assessed utilising a modified manual of the "Bavarian Model" for school entry examinations. This model outlines specific criteria for impairments of motor, cognitive, behavioural and psychosocial functioning. Prevalence rates for physical and behavioural impairments were based on the results of these assessments. The relationship between the prevalence of impairments and the duration of preschool attendance and the location of the preschool attended was estimated utilizing logistic regression models.

RESULTS

We found that 20.7% of children met the criteria for at least one type of impairment. Highest prevalence rates (11.5%) were seen for speech impairments and lowest (3.5%) for arithmetic impairments. Boys were disproportionately over represented, with 25.5% meeting the criteria for impairment, compared to 13.0% for girls. Children who had attended preschool for less than one year demonstrated higher rates of impairment (up to 19.1% for difficulties with memory, concentration or perseverance) compared to those who had attended for a longer duration (up to 11.6% for difficulties with pronunciation). Children attending preschool in an urban location had slightly elevated rates of impairment (up to 12.7%), compared to their rural counterparts (up to 11.1%).

CONCLUSION

Our results demonstrate that there are high prevalence rates for physical and mental impairments among preschool children. Furthermore, children without preschool experience are a risk group for struggling with educational successes. The associations between the duration of preschool attendance and location of preschool attended and rates of impairment need replication and further exploration. Larger prospective studies are needed to examine if these relationships are causal and may therefore lend themselves to specific intervention strategies.

Health-related quality of life of children with vision impairment or blindness

The aims of the study were to describe the functional ability, health status, and health-related quality of life (HRQL) of young children with a vision impairment or blindness (VI/BL) and to examine the effect of different types of ophthalmic condition and the presence of other impairments or systemic disorders. A cross-sectional community survey of children aged 3 to 8 years with VI/BL was conducted in four areas of England using the Health Utilities Index Mark 3 system. Seventy-nine children (47 males, 32 females; mean age 6 y 2 mo [SD 1 y 6 mo]) met the selection criteria: 43% had a visual pathway condition, 38% a condition of the eye, and 19% nystagmus alone; and 61% had additional impairments/disorders. Eighty per cent had functional limitations on at least two of the following attributes: vision, hearing, speech, cognition, ambulation, dexterity, emotion, and pain. Forty-four per cent had functional limitations on four or more attributes. Children with nystagmus alone had significantly higher mean HRQL utility scores (0.80 [SD 0.26]) than children with a condition of the eye (0.45 [SD 0.33]), who, in turn, had higher scores than children with a visual pathway condition (0.05 [SD 0.33], p=0.002). Children with an isolated VI/BL had significantly higher mean scores (0.73 [SD 0.21]) than those with additional impairments/disorders (0.09 [SD 0.34], p<0.001). These findings underline the need for a broad assessment of each child with VI/BL and a multidisciplinary approach to care.

Neurodevelopmental Outcomes of Infant Multivisceral Transplant Recipients: A Longitudinal Study

This longitudinal investigation compares cognitive and physical capabilities of transplant recipients, both before and after receiving an intestinal transplant.

METHODS

Using the Bayley Scales of Infant Development, we conducted pretransplant and posttransplant assessments on nine children (4 males, 5 females) who received either an isolated intestine, combined intestine and liver, or multivisceral transplants, with a mean age at transplant of 18 months (range 8-29) and a mean time posttransplant of 2 months (range 1-4 months).

RESULTS

Scores on the Mental Developmental Index reflected that a majority (55.6%) of patients who scored in the significantly delayed range prior to transplant remained in the significantly delayed classification after receiving a transplant. In addition, 33.3% showed a decrease in their mental classification; either from "mildly delayed" to "significantly delayed" or from "within normal limits" to "mildly delayed". Results on the Motor Developmental Index demonstrated that 78% of recipients had significant delays both before and after receiving a transplant, while 11.1% fell one standard deviation after transplantation. We found that the majority of children who experience developmental delays prior to transplant are still experiencing delays when they are discharged from inpatient care. In addition, those children receiving multivisceral transplantations, as opposed to an isolated bowel, may be at a much greater risk of developing and retaining both cognitive and physical delays. Early neurodevelopmental evaluations of these patients is essential for early parental education and compliance with early intervention services to maximize potential recovery and ability to obtain normal development.

Are pervasive developmental disorders and attention-deficit/hyperactivity disorder distinct disorders?

We studied the relationship between patients with attention-deficit/hyperactivity disorder (ADHD) and those with pervasive developmental disorders (PDD), using the High-Functioning Autism Spectrum Screening Questionnaire (ASSQ) and ADHD Rating Scale-IV. The ASSQ scores of the PDD group and the ADHD group were significantly higher than the control group. Furthermore, the PDD group scored higher than the ADHD group. Both groups also showed higher scores than the control group in all three domains, that is, restricted and repetitive behavior, social interaction, and communication problem. The PDD and the ADHD group showed no significant difference in the domains of communication problem, and restricted and repetitive behavior. The PDD group had a higher score than the ADHD group only in the social interaction domain. In total score, inattention score, and hyperactivity/impulsivity score on the ADHD Rating Scale-IV, both groups were significantly higher than the control group. Between the ADHD and the PDD groups, there was no significant difference in the three scores. The patients with strictly diagnosed ADHD had many PDD-related symptoms, and the patients with PDD had many ADHD-related symptoms. It therefore seems difficult to make a distinction between ADHD and PDD by using the present diagnostic criteria in the DSM-IV. We should evaluate each patient in terms of both sets of criteria.

Early screening for autism spectrum disorders: update on the modified checklist for autism in toddlers and other measures

Early intervention for autism spectrum disorders necessitates early detection. This need has led to widespread agreement across disciplines that screening is critical in very young children. Two screening issues are highlighted in this review. Level of screening refers to the type of sample: Level I is defined as an unselected sample, and Level II consists of selected children already identified as being at risk for a developmental disorder. Breadth or scope of screening refers to the range of difficulties the screening tool attempts to identify: broad screening instruments identify multiple range of developmental difficulties, whereas disorder-specific tools focus on a single disorder or class of disorders. Broad developmental instruments reviewed include the Parents' Evaluation of Developmental Status and the Ages and Stages Questionnaires; autism-specific tools reviewed include the Checklist for Autism in Toddlers, the Modified Checklist for Autism in Toddlers (M-CHAT), the Pervasive Developmental Disorders Screening Test, Second Edition, and the Screening Tool for Autism in Two-year-olds. The development of the M-CHAT, a Level I and Level II screening instrument, is described, and current research and clinical use of the M-CHAT are reviewed, including description of the structured follow-up interview which reduces the false-positive rate of the parent-report M-CHAT.

Developmental screen or developmental testing?

Given the high risk for residual disability in preterm infants, outcome monitoring is a crucial function of neonatal care. Provision of neurodevelopmental follow-up to at least 2 years of age corrected for prematurity forms part of national recommendations for neonatal services. This should include a developmental assessment at 2 years to identify disability. Although screening tools are cost and time efficient measures, they are not diagnostic and have less utility in high-risk populations. In contrast, standardised developmental tests are ideally suited for follow-up purposes and have become widely accepted as outcome measures. We highlight the properties of standardised tests and review the most commonly used tools for assessment in infancy. We also outline a number of practical issues in the use of standardised tests with preterm infants in identifying morbidity and predicting later impairment. Parental reports are also discussed and key guidelines for developmental testing at 2 years are provided.

Classification of abnormal neurological outcome

When we engage in the systematic follow-up of high-risk neonates it is important to avoid the temptation to assume that any variations in development in this population reflect 'abnormality.' In this chapter I first present some personal reflections and hobby horses to argue that we need to be aware of our possible biases toward interpreting developmental or functional differences in infants as evidence of developmental pathology. Second, I stress the challenges associated with making early 'diagnoses' of developmental disabilities. Instead I suggest that identification of differences and variations in development should be interpreted cautiously, taking account of natural variations in early development and the chance to observe children over time rather than needing to make a decision on the basis of a single assessment. Finally, I discuss cerebral palsy and illustrate the arguments I have presented with discussion of current thinking about diagnosis and classification of CP.