DMCN 2016 highlights: cerebral palsy epidemiology, communication in autism, and more

As 2016 draws to a close, the continuing evolution of Developmental Medicine & Child Neurology – its remarkable content, podcasts, virtual issues, and the ever-increasing impact factor – encourages us to look to the future with excitement. The 2016 volume of the journal has been rich with new findings and developments in the fields of paediatric neurology and neurodisability: from more precise genotype–phenotype associations in Duchenne muscular dystrophy to specifics of health and functioning in cerebral palsy (CP); from validation of novel functional scales and classification systems to reappraisal of existing interventions and evaluation of new ones. We have had excellent systematic reviews and comprehensive meta-analyses of an array of hot topics. These include the constructs of participation currently used in intervention research in children with disabilities, prognostic factors in children born preterm, efficacy of suit therapy in CP, fatigue in paediatric multiple sclerosis, and outcomes of paediatric infectious encephalitis. We have had direct contributions from the academies and societies that have DMCN as their official journal, including the AACPDM’s care pathway on osteoporosis in CP, and abstracts from the inaugural meeting of the International Alliance of Academies of Childhood Disability (co-founded by the EACD, the AACPDM, and the AusACPDM). It is clear that a number of contributions to this year’s volume will be of lasting importance. A supplement presenting findings from Australian CP registers, and a comprehensive study of 20 population-based registers contributing to the Surveillance of CP in Europe, bring substantial insights to the epidemiology of the condition. These efforts set useful standards for networking registers and for extracting information from carefully pooled data. The latter study documents a steady decrease in the prevalence of CP – in particular in children with very low and moderate birthweight – and a reduction in overall severity, bringing optimism and enhanced justification for further development of neuroprotective strategies. The 2016 volume has also presented a valuable appraisal of a number of generic and preference-based multidimensional patient-reported outcome measures used in children with neurodisability. The authors identify a number of issues that currently limit meaningful utilization of these measures, and suggest the necessary steps that must be taken to quantify change in clinical practice and research. Another group addresses the challenges in engaging physical activity in children and adolescents with CP, and makes recommendations based on evidence across Gross Motor Function Classification System (GMFCS) levels I to III (i.e. ambulatory individuals). The group points to the importance of determining fitness level, and asks whether any ‘deconditioning’ is a result of inactivity, nutritional status, or other factors. Anti-N-methyl-d-aspartate receptor encephalitis has been the subject of a number of reports this year, underlining both the presentation and treatment of a condition that is increasingly recognized in children with behavioural, occasionally autistic-like symptoms, distinctive movement disorders, and other features. One report extensively evaluates symptomatic pharmacological management of behaviour, sleep, movement, seizure, and dysautonomic and psychiatric disorders in affected children. In this round-up of only a handful of outstanding contributions, I would like to call special attention to the development of the Autism Classification System of Functioning: Social Communication (ACSF:SC). This five-level tool for the classification of everyday communicative abilities builds on the language and concepts of the International Classification of Functioning, Disability and Health in a similar way to classifications systems developed and widely used in CP (e.g. GMFCS, Manual Ability Classification System, Communication Function Classification System). The ACSF:SC has the potential of becoming as influential on research in autism spectrum disorder as those tools have proved to be in CP.