bluuebunny/crossref_metadata_2025 huggingface dataset:
Bullying and attention‐deficit– hyperactivity disorder in 10‐year‐olds in a Swedish community
Authors: Holmberg Kirsten , Hjern Anders
Published: June 2009

The association of attention‐deficit—hyperactivity disorder (ADHD) with bullying in the peer group in school was studied in an entire population of 577 fourth graders (10‐year‐olds) in one municipality in Stockholm, Sweden. The schoolchildren were screened for ADHD in a two‐step procedure that included Conners’ratings of behavioural problems: teacher and parent interviews in a first step; and a clinical assessment in the second. Information about bullying was collected from the children themselves in a classroom questionnaire. Five‐hundred and sixteen children (89.4%; 252 females, 264 males), for whom there was information from all data sources, were included in the study population. Conners’ratings that were collected from parents early in first grade were available for 382 of these children. Hypotheses were tested by multivariate analyses with adjustment for sex and parental education. Pervasive ADHD was diagnosed in 9.5% (95% confidence interval [CI] 5.6‐12.8) of the males and 1.6% (CI 0.1‐3.1) of the females. ADHD was associated with bullying other students (adjusted odds ratios (OR) 3.8 [CI 2.0‐7.2]) as well as being bullied (often, OR 10.8 [CI 4.0‐29.0]; sometimes, OR 2.9 [CI 1.5‐5.7]). Bullying other students in fourth grade was associated with high scores in parental reports of behavioural problems at entry into first grade, suggesting a causal link to the ADHD syndrome. Being bullied, on the other hand, was not linked to behavioural problems at school entry. This study demonstrates a connection between ADHD and bullying in the peer group at school. Evaluation and treatment strategies for ADHD need to include assessment and effective interventions for bullying. Evaluation of ADHD should be considered in children involved in bullying.
Prenatal and family risks of children born to mothers with epilepsy: effects on cognitive development
Authors: Titze Karl , Koch Sabine , Helge Hans , Lehmkuhl Ulrike , Rauh Hellgard , Steinhausen Hans‐Christoph
Published: June 2009

The offspring of mothers with epilepsy are considered to be at developmental risk during pregnancy from: (1) generalized maternal seizures (hypoxia); (2) teratogenicity of antiepileptic drugs (AEDs); and (3) adverse socio‐familial conditions associated with having a chronically sick mother. Sixty‐seven children of mothers with epilepsy and 49 children from non‐affected mothers, matched for control variables, were followed from birth to adolescence (53 males, 63 females; mean age 14y 2mo, range 10‐20y). Prediction of intellectual performance of these children during adolescence was calculated from the following variables: maternal generalized seizures, prenatal exposure to AEDs, and quality of family stimulation (HOME Inventory) assessed in children at 2 years of age. Children who were prenatally exposed to AEDs achieved lower IQs than control children at adolescence. This effect was moderately significant for children who had been exposed to monotherapy (6 IQ points lower), but was considerable in those exposed to polytherapy (12 IQ points lower). Generalized seizures during pregnancy, observed in half the mothers, did not exacerbate this effect. Relative to prenatal risk status, the quality of the family environment had varied effects on intellectual development. Children with prenatal risks appeared to be more vulnerable to environmental disadvantage than control children, but they also showed longer‐lasting effects of environmental support.
Assistive devices for children with functional impairments: impact on child and caregiver function
Authors: Henderson Stacey , Skelton Heather , Rosenbaum Peter
Published: June 2009

Functional impairments can limit a child's ability to participate in the experiences of childhood. This‘deprivation’can, in turn, have a negative effect on such children's development, academic performance, and quality of life, as well as on the lives of their caregivers and families. Many adults use assistive devices to overcome functional impairments and enable them to participate in daily activities; however, such devices may be underutilized by children. Each of the 54 studies reviewed in this report identified one or more functional impairments towards which an assistive device was targeted: accessing a computer (n=3 [studies]), activity assistance (n=2), behaviour changes (n=3), communication (n=30), independent feeding (n=1), living skills (n=1), mobility (n=9), modifying the environment (n=1), nutrition (n=4), and postural stability (n=2). The aim of this review was to determine the impact of assistive devices on the components of functioning defined by the World Health Organization's International Classification of Functioning, Disability and Health. The impact of these devices was found to be overwhelmingly positive. Study outcomes reported were mainly child‐focused and could be classified as influencing activity, participation, and personal contextual factors, with relatively little attention paid to caregiver‐focused outcomes. Few studies provided either qualitative evidence or experimentally‐based quantitative research evidence using controls.
Sex differences in tactile defensiveness in children with ADHD and their siblings
Authors: Bröring Tinka , Rommelse Nanda , Sergeant Joseph , Scherder Erik
Published: June 2009

Tactile defensiveness (TD) is a disturbance in sensory processing and is observed in some children with attention‐deficit‐hyperactivity disorder (ADHD). TD has been examined in male children with ADHD and in children with ADHD without differentiating by sex. As males and females with ADHD may differ in the clinical expression of the disorder and associated deficits, the aim of this study was to examine sex differences in TD in males and females with ADHD. Non‐affected siblings were also examined to investigate familiality of TD. The Touch Inventory for Elementary‐School‐Aged Children was administered to 47 children with ADHD (35 males, 12 females; mean age 9y 8mo [SD 1y 11mo]), 36 non‐affected siblings (21 males, 15 females; mean age 8y 10mo [SD 2y 4mo]), and 35 control children (16 males, 19 females; mean age 9y 5mo [SD 6mo]). Results indicated that females with ADHD displayed higher levels of TD than males with ADHD (who did not differ from control males). This suggests that TD is sex specific and may contribute to the identification of ADHD in females, thus improving diagnostic and therapeutic strength in this under‐referred group. Non‐affected siblings were unimpaired, regardless of sex, which suggests that TD is specific to the disorder and not part of a familial risk for ADHD.
Development of rostral prefrontal cortex and cognitive and behavioural disorders
Authors: Dumontheil Iroise , Burgess Paul W , Blakemore Sarah‐Jayne
Published: June 2009

Information on the development and functions of rostral prefrontal cortex (PFC), or Brodmann area 10, has been gathered from different fields, from anatomical development to functional neuroimaging in adults, and put forward in relation to three particular cognitive and behavioural disorders. Rostral PFC is larger and has a lower cell density in humans than in other primates. It also has a large number of dendritic spines per cell and numerous connections to the supramodal cortex. These characteristics suggest that rostral PFC is likely to support processes of integration or coordination of inputs that are particularly developed in humans. The development of rostral PFC is prolonged, with decreases in grey matter and synaptic density continuing into adolescence. Functions attributed to rostral PFC, such as prospective memory, seem similarly to follow a prolonged development until adulthood. Neuroimaging studies have generally found a reduced recruitment of rostral PFC, for example in tasks requiring response inhibition, in adults compared with children or adolescents, which is consistent with maturation of grey matter. The examples of autism, attention‐deficit‐hyperactivity disorder, and schizophrenia show that rostral PFC could be affected in several disorders as a result of the susceptibility of its prolonged maturation to developmental abnormalities.
Neuropathology of a 4‐month‐old infant born to a woman with phenylketonuria
Authors: Koch Richard , Verma Shalini , Gilles Floyd H
Published: June 2009

We evaluated the brain of a 4‐month‐old male infant whose mother had inadequately controlled maternal phenylketonuria (MPKU). At autopsy his brain was normally developed but underweight. We found ventriculomegaly, hypoplastic cerebral white matter, and delay of myelination in late myelinating tracts without white matter astrocytosis and without chronic lesions in any gray matter structure. We compared the development of the infant's white matter tracts with published data on infant myelination. Congenital heart disease complicated the case. Abnormalities in developmental white matter may account for neurological abnormalities in infants with MPKU.
Stability of motor impairment in children with cerebral palsy
Authors: Shevell Michael I , Majnemer Annette , Poulin Chantal , Law Mary
Published: June 2009

Classification of the quality and topographical pattern of motor impairment is used to describe cerebral palsy (CP). As an adjunct to a study characterizing the quality of life and participation of school‐age children with C P, initial and follow‐up classification of CP were compared. A cohort of 93 children (58 males, 35 females) were initially assessed at a mean age of 2 years 6 months (SD 2y 2mo) and re‐assessed at 9 years 4 months (SD 2y 2mo) with a mean interval of 6 years 6 months (SD 2y 4mo) between assessments. Sixty children had Gross Motor Function Classification System levels I‐III. All but one of the children were still classified has having CP at follow‐up. Type of CP documented remained constant in 67 children (72%; 95% confidence interval 62‐80). Clinical factors that were statistically significant (p<0.05) as possible predictors of CP subtype change were original classification of a non‐spastic subtype or a non‐spastic quadriparetic subtype. Change in CP subtype occurs in an appreciable minority of children with CP, which is likely to reflect a combination of intrinsic and extrinsic influences. Such change may challenge efforts to monitor the effects of interventions in this population.
Measuring children's attitudes towards peers with disabilities: a review of instruments
Authors: Vignes Céline , Coley Nicola , Grandjean Hélène , Godeau Emmanuelle , Arnaud Catherine
Published: June 2009

This study aimed to identify instruments for measuring children's attitudes towards their peers with disabilities that are suitable for use in epidemiological studies and to report on their psychometric properties. A literature review was conducted to identify instruments measuring at least one of the three components of children's attitudes (affective, behavioural, or cognitive measures) towards peers with disabilities and which are intended for self‐completion by children. Criteria used to appraise these instruments were appropriateness, acceptability, validity, reliability, internal consistency, and test‐retest reliability. Of the 19 instruments matching the inclusion criteria, 16 measured only one attitude component (affective, n=4; behavioural, n=5; cognitive, n=7); one measured cognitive and behavioural components; and two (Acceptance Scale and Chedoke‐McMaster Attitudes Towards Children with Handicaps Scale [CATCH]) measured all three components. The majority of instruments, and those most widely used, were developed in the 1970s and 80s and so do not cover some aspects relevant to current culture, although they are still being used in research. Acceptable levels of validity and reliability were reported. Detailed descriptions of the initial validation process were available for the Acceptance Scale, Adjective Checklist, CATCH, and Peer Attitudes Towards the Handicapped Scale. The Acceptance Scale and CATCH seem to be the most complete instruments among those identified as they include all three attitude components and have appropriate psychometric properties.
Neurophysiological strategies for the diagnosis of disorders of the neuromuscular junction in children
Authors: Pitt Matthew
Published: June 2009

The disorders of the neuromuscular junction seen in children, the congenital myasthenic syndromes and autoimmune myasthenia gravis, are very rare. Their clinical symptoms and signs may be variable, most notably in the neonate and infant. They should enter the differential diagnosis of many different clinical presentations, such as ‘floppy infant’ or attacks of episodic apnoea. Many molecular genetic abnormalities have been discovered in congenital myasthenic syndromes, but screening for these is impracticable without confirmation of a disorder of the neuromuscular junction. In this review, the different neurophysiological tests that can be used are discussed, with their merits and contraindications in children. After consideration of the acceptability of the different techniques, it has been found that stimulation single‐fibre electromyography (stimSFEMG) of orbicularis oculi seems to be the best choice in children. In most instances it can be performed on the conscious child and it has a good specificity and high sensitivity. A protocol for using stimSFEMG is described.
Test–retest reliability of the 10‐metre fast walk test and 6‐minute walk test in ambulatory school‐aged children with cerebral palsy
Authors: Thompson Patricia , Beath Tricia , Bell Jacqueline , Jacobson Gabrielle , Phair Tegan , Salbach Nancy M , Wright F Virginia
Published: June 2009

Short‐term test‐retest reliability of the 10‐metre fast walk test (10mFWT) and 6‐minute walk test (6MWT) was evaluated in 31 ambulatory children with cerebral palsy (CP), with subgroup analyses in Gross Motor Function Classification System (GMFCS) Levels I (n=9), II (n=8), and III (n=14). Sixteen females and 15 males participated, mean age 9 years 5 months (SD 3y 7mo, range 4y 3mo‐18y 2mo). Twenty had spastic diplegia, while the others had another form of CP. Retest interval varied from 1 to 4 weeks (mean 10.6d [SD 6.4]). Intraclass correlation coefficients (ICCs) estimated reliability. The 10mFWT ICC was 0.81 (95% confidence interval [CI] 0.65–0.90) across participants, and >0.59 in GMFCS subgroups (95% CI lower bound >0.01). The 6MWT ICC was 0.98, and >0.90 in GMFCS subgroups (95% CI lower bound >0.64). Bland‐Altman plots indicated bias towards higher 6MWT retest distances in GMFCS Level I. Minimum detectable change (95% CI) was 61.9, 64.0, and 47.4m for the 6MWT within GMFCS Levels I, II, and III respectively. The conclusion is that while the 10mFWT showed inadequate test‐retest reliability given its wide 95% CI, the 6MWT demonstrated good to excellent reliability. Investigation of the need for a practice walk when administering the 6MWT with children in GMFCS Level I is recommended to establish their fastest pace.
Diversity of participation in children with cerebral palsy
Authors: Imms Christine , Reilly Sheena , Carlin John , Dodd Karen
Published: June 2009

The aim of this study was to investigate the participation of children with cerebral palsy (CP) in activities outside school and to compare their participation with a large representative sample of children. A population‐based survey was conducted of children with CP born in Victoria, Australia in 1994 and 1995. Of 219 living children identified, 114 (52.1%) returned completed surveys. The children (65 males, 49 females) were aged between 10 years 9 months and 12 years 9 months (mean age 11y 9mo, SD 6mo). Thirty‐eight per cent had hemiplegia, 23% diplegia, 4% triplegia, 34% quadriplegia, and 1% was of unknown topography. Distribution according to the Gross Motor Function Classification System (GMFCS) was 22.8% Level I, 36% Level II, 10.5% Level III, 8.8% Level IV, and 21.9% Level V. Distribution according to the Manual Ability Classification System (MACS) was: 19.3% Level I, 38.6% Level II, 14.0% Level III, 8.8% Level IV, and 19.3% Level V. Participation was measured using the Children's Assessment of Participation and Enjoyment. Participation in selected sport, cultural, and quiet leisure activities was compared with population‐based data for 11‐year‐olds from the Australian Bureau of Statistics. Children with CP undertook a median of 26.5 activities (interquartile range 10) in 4 months which were commonly informal rather than formal. Intensity of participation was low. Diversity and intensity of participation was similar for children in each level of the MACS and the GMFCS, except for participants in Level V. More children with CP participated in organized sports (p<0.001) compared with other Australian children, although with lower frequency (p<0.001). Participation diversity and level of intensity of Australian children with CP were similar to those reported in a Canadian study.
Probable acute disseminated encephalomyelitis due to Haemophilus influenzae meningitis
Authors: Beleza Pedro , Ribeiro Manuel , Pereira João , Ferreira Carla , Jordão Maria José , Almeida Fátima
Published: June 2009

We report the case of a 17‐year‐old male on long‐term steroid therapy for minimal lesion glomerulopathy who, after an upper respiratory infection, presented with Haemophilus influenzae type b meningitis. Twenty‐four hours later he developed depression of consciousness which progressed to coma and left hemiparesis. Brain magnetic resonance imaging (MRI) revealed multiple lesions (hyperintense on T2 and slightly hypointense on Tl) involving mainly white matter suggestive of inflammation. MRI features were compatible with acute disseminated encephalomyelitis (ADEM), although a differential diagnosis included cerebritis or vasculitis, secondary to bacterial meningitis. The patient was treated with high‐dose steroids which resulted in a gradual improvement followed by complete clinical recovery. We propose a diagnosis of ADEM was the best diagnosis because of the radiological features and response to steroids. The occurrence of ADEM associated with acute meningitis, however rare, represents an important diagnostic challenge for the clinician.
A milk‐free diet downregulates folate receptor autoimmunity in cerebral folate deficiency syndrome
Authors: Ramaekers Vincent T , Sequeira Jeffrey M , Blau Nenad , Quadros Edward V
Published: June 2009

In cerebral folate deficiency syndrome, the presence of autoantibodies against the folate receptor (FR) explains decreased folate transport to the central nervous system and the clinical response to folinic acid. Autoantibody crossreactivity with milk FR from different species prompted us to test the effect of a milk‐free diet. Intervention with a milkfree diet in 12 children (nine males, three females; mean age 6y [SD 4y 11mo], range 1‐19y), decreased autoantibody titer significantly from 2.08pmol of FR blocked per ml of serum (SD 2.1; range 0.24‐8.35) to 0.35pmol (SD 0.49; range 0‐1.32; p=0.012) over 3 to 13 months, whereas FR autoantibody titer increased significantly to 6.53 (SD 6.08; range 0.54‐14.07; p=0.013) in nine children who were reexposed to milk for 6 to 14 weeks. In 12 children on a normal diet (eight males, four females; mean age 5y 5mo [SD 4y 1mo], range 1y 6mo‐16y 4mo), the antibody titer increased significantly from 0.84pmol of FR blocked per ml (SD 0.39; range 0.24‐1.44) to 3.04pmol (SD 1.42; range 0.84‐6.01; p=0.001) over 10 to 24 months. Decreasing the autoantibody titer with a milk‐free diet in conjunction with folinic acid therapy may be advocated for these patients.
Co‐activity during maximum voluntary contraction: a study of four lower‐extremity muscles in children with and without cerebral palsy
Authors: Tedroff Kristina , Knutson Loretta M , Soderberg Gary L
Published: June 2009

This study was designed to determine whether children with cerebral palsy (CP) showed more co‐activity than comparison children in non‐prime mover muscles with regard to the prime mover during maximum voluntary isometric contraction (MVIC) of four lower‐extremity muscles. Fourteen children with spastic diplegic CP (10 males, four females; age range 4–10y), seven children with spastic hemiplegic CP (five males, two females; age range 5–10y), and 14 comparison children (eight males, six females; age range 4–11y) participated in the study. Gross Motor Function Classification System levels of the children with CP were as follows: eight children at Level I, seven children at Level II, five children at Level III, and one child at Level I V. Surface electromyographic recordings were made simultaneously from the vastus lateralis (VL), medial hamstrings (MH), tibialis anterior, and lateral gastrocnemius (LG) muscles during maximal voluntary contraction. Children with CP showed higher co‐activity than the comparison children in both antagonist and adjacent muscles. This was particularly true when VL, MH, or LG muscles were engaged in MVIC. These findings may contribute to the weakness and abnormal movement patterns seen in CP, and they have implications for treatment.
Intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a cost‐effectiveness analysis
Authors: Hoving M A , Evers S M A A , Ament A J H A , Van Raak E P M , Vles J S H ,   On behalf of the Dutch Study Group on Child Spasticity.
Published: June 2009

In a Dutch national study, we recently established the effectiveness and safety of continuous intrathecal baclofen infusion (CITB) in children with intractable spastic cerebral palsy (CP). Because prospective studies on the cost‐effectiveness of CITB in children with spastic CP are lacking, we conducted a cost‐effectiveness analysis alongside our prospective national study. We compared the costs and health effects of CITB with those of standard treatment only, from the health care perspective for a 1‐year period. Health effects were expressed in terms of a visual analogue scale for individual problems and quality‐adjusted life years (QALYs). We included eight females and seven males, aged between 7 and 17 years (mean age 13y 8mo [SD 3y]). Eleven children had spastic CP and four had spastic‐dyskinetic CP. One child was clsssified on the Gross Motor Function Classification System at Level III, two at Level IV, and 12 at Level V. CITB was more effective and more costly than standard treatment only. Gaining one QALY cost on average €32 737. We conclude that based on the threshold‐willingness to pay for one QALY in the Netherlands (€80 000), our results confirm the cost‐effectiveness of CITB for carefully selected children with intractable spastic CP.
Speech, language, and cognition in preschool children with epilepsy
Authors: Selassie G Rejnö‐Habte , Viggedal G , Olsson I , Jennische M
Published: June 2009

We studied expressive and receptive language, oral motor ability, attention, memory, and intelligence in 20 6‐year‐ old children with epilepsy (14 females, six males; mean age 6y 5mo, range 6y–6y 11mo) without learning disability, cerebral palsy (CP), and/or autism, and in 30 reference children without epilepsy (18 females, 12 males; mean age 6y 5mo, range 6y–6y 11mo). Ten children had partial, six primarily generalized, and four unclassified epilepsy. Fourteen were having monotherapy and six were taking two or more antiepileptic drugs; 13 children were free from seizures 3 months before the assessment. Results show no statistically significant difference between the groups concerning Verbal IQ, expressive and receptive grammar, and receptive vocabulary. The children with epilepsy had a significantly lower Performance IQ and lower scores in tests of oral motor ability, articulation, emerging literacy, auditory attention, short‐term memory, and rapid word retrieval. Parent ratings revealed no significant difference in communicative ability. Polytherapy and early onset of epilepsy influenced some results. Preschool children with epilepsy without learning disability, CP, and/or autism may have receptive verbal ability within the normal range but visuoperceptual, auditory attentional, and speech‐language difficulties that could affect school achievement. Careful testing of children with epilepsy who appear to be functioning within the normal range is needed because this may reveal specific impairments that require appropriate professional input.
The puzzle of human emotions: some historical considerations from the 17th to the 19th centuries
Authors: Albano Caterina
Published: June 2009

Emotions are both central to life experience itself and highly pertinent to various disciplines, including neuroscience, psychology, social studies, philosophy, and the arts. The definition of emotion lies at the interface of nature and culture reflecting an understanding of the components that shape emotional states and experiences across time and cultures. This review describes how the concept of emotion developed in Western thought, from the Renaissance notion of the passions to the 19th century idea of ‘emotion’.
Relationship between parental PODCI questionnaire and School Function Assessment in measuring performance in children with CP
Authors: Gates Philip E , Otsuka Norman Y , Sanders James O , McGee‐Brown Jeanie
Published: June 2009

Little data exists assessing the relationship between functional limitations in children with cerebral palsy (CP) and their participation in everyday activities. This prospective study evaluates the relationship between the Pediatric Outcomes Data Collection Instrument (PODCI), a functional health‐related quality of life instrument for children and their parents, and the School Function Assessment (SFA), a school‐based functional assessment. One hundred and two children with CP (80.4% dipliegia; 10.8% hemiplegia; 3.9% triplegia; 2.0% quadriplegia; 2.9% unspecified; 60 males, 42 females, mean age 11 years 8 months (SD 3y 3mo, range 6–8y), Gross Motor Function Classification System levels I to IV (13.7% Level I 50% Level II 35.3% Level III 1% Level IV), had complete PODCI and SFA assessments. Significant relationships were noted among multiple PODCI subscales and subscales of the SFA, as well as among individual questions. PODCI predicted performance in all 31 subscales of the SFA when comorbidity subscales were included (r =0.35–0.64). The PODCI in‐clinic questionnaire provides an accurate reflection of the child’s actual participation in the community setting, as assessed by the SFA. PODCI can reliably be used to help ensure that outcomes assessed in the clinic setting reflect function within the community, and can be used to help with treatment planning, goal setting, and improved patient care.
Delays in investigation and management of acute arterial ischaemic stroke in children
Authors: McGlennan Catherine , Ganesan Vijeya
Published: June 2009

The aim of this study was to investigate the timing and course of investigation and diagnosis in children with acute arterial ischaemic stroke (AIS) and factors influencing this using a retrospective case‐note review. Participants comprised 50 children (26 males, 24 females; median age at presentation 3y 4mo, range 2mo–16y 10mo). Although all had brain infarction, symptoms resolved in less than 24 hours in 21 children (transient ischaemic attack [TIA] group). Thirty‐seven children saw a doctor within 6 hours of the attack; 32 did not see a paediatric neurologist until after 24 hours. Initial neuroimaging (computed tomography or magnetic resonance imaging) occurred in less than 6 hours in 13/46 children and in more than 24 hours in 18/46 children. Brain magnetic resonance imaging occurred in more than 24 hours in 43/47 children. Time to clinical diagnosis (data available on 42 children) was less than 6 hours in 14 children, 6 to12 hours in six, 12 to 24 hours in eight, and more than 24 hours in 14 children. In multiple regression analysis, patients with stroke were more likely to have shorter time to diagnosis than those with TIA.

Our results show that most children with acute AIS are seen within 6 hours but definitive imaging and specialist assessment take more than 24 hours. Time to diagnosis is significantly longer in children with TIA (p=0.001). Trials of acute treatment being designed for childhood AIS will require rapid transfer to tertiary centers and access to definitive neuroimaging, but these data suggest that this will challenge existing practice.
Childhood chronic daily headache: a biopsychosocial perspective
Authors: Seshia S S , Phillips D F , Von Baeyer C L
Published: June 2009

The aim of our observational study was to highlight some clinical observations on chronic daily headache (CDH) in children and adolescents. Data on patients ≤18 years aged presenting with CDH to the Pediatric Headache Clinic at the Royal University Hospital, Saskatoon, Canada, were collected prospectively and sequentially from February 2004 to July 2006. Standardized data sheets and definitions were used. Follow‐up information on the 70 participants (22 males, 48 females) was current to February 2007. Fifty‐four participants (77%) had had recurrent headaches before transformation to CDH. Comorbid chronic migraine and chronic tension‐type headache was the most frequent subtype of CDH (37 participants; 53%). Anxiety and mood disorders were diagnosed in 17 and 15 children respectively. Stressors that precipitated or contributed to the maintenance of CDH were judged important in 44 (63%). The possibility of a somatoform disorder was considered in five children, a factitious disorder in one, and malingering in another. We suggest that CDH be viewed from a biopsychosocial rather than a narrow biomedical perspective and the classification improved to enhance clinical utility.
Impact of congenital talipes equinovarus etiology on treatment outcomes
Authors: Gurnett Christina A , Boehm Stephanie , Connolly Anne , Reimschisel Tyler , Dobbs Matthew B
Published: June 2009

Although congenital talipes equinovarus (CTEV) is often idiopathic, additional birth defects occur in some patients that may have an impact on the treatment of this disorder. The purpose of this study was to determine the prevalence of associated malformations, chromosomal abnormalities, or known genetic syndromes, and to compare treatment outcomes of children with idiopathic CTEV with children with non‐idiopathic CTEV. Of 357 children evaluated, 273 (76%) had idiopathic CTEV (179 males, 94 females; mean age 2y 1mo [SD 1y 2mo], range 0–18y) and 84 (24%) had non‐idiopathic CETV (51 males, 33 females; mean age 2y 5mo [SD 2y], range 0–16y). Disorders affecting the nervous system were found in 46 (54%) children with non‐idiopathic CTEV. In a subgroup of patients treated entirely at our institution (n=196), children with non‐idiopathic CTEV (n=47) required more casts for correction than those with idiopathic CTEV (n=149; 5.3 vs 4.6; p=0.016). There was also a greater risk of recurrence in non‐idiopathic CTEV (14.9% vs 4%; p=0.009), but no significant difference in the need for extensive surgery (2.7% vs 8.5%; p=0.096). Treatment was initiated at a mean age of 13 weeks (range 1wk to 2y 6mo) for both idiopathic and non‐idiopathic patients, and treatment was assessed during a minimum 2‐year follow‐up. Non‐idiopathic CTEV can be successfully treated with the Ponseti method of serial casting, with low recurrence rates or need for surgery.
Impact of modafinil on spasticity reduction and quality of life in children with CP
Authors: Murphy Anne M , Milo‐Manson Golda , Best Adrienne , Campbell Kent A , Fehlings Darcy
Published: June 2009

This randomized double blind AB/BA cross‐over trial evaluates the effect of oral modafinil versus placebo on spasticity, function, and quality of life in children with cerebral palsy (CP). Outcomes were measured at the start and end of both 8‐week treatment periods (modafinil and placebo). The order of the treatment periods was randomly assigned. There was a 4‐week wash‐out period between treatments. Primary outcomes include the Modified Ashworth Score (MAS), and the Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD), a disorder‐specific quality of life measure. Ten children were randomized and eight children completed the study. The mean age of participants was 11 years 5 months (SD 1y 5mo, range 8y 8mo–12y 11mo). Five of the participants were male and three female. Seven children had a diagnosis of spastic quadriplegic CP and one child had spastic diplegia with overflow tone to the upper extremities. The Gross Motor Function Classification System ranged from Level III to V with one child at Level III, six children at Level IV, and one at Level V. The CPCHILD pre‐ to post‐total scores showed a slight improvement in quality of life during the placebo period and a slight deterioration in the modafinil period (overall mean change of 7.1, SD 7.6). A t‐test between post differences was statistically significant (t=2.65, p=0.03) in favor of the placebo period. The MAS for elbow flexors, ankle flexors, and hip adductors did not show any significant reduction post‐modafinil or post‐placebo (p values ranged from 0.41–0.79). This study did not find evidence that modafinil reduces spasticity or has a positive impact on quality of life in children with spastic CP.
Parent and professional reports of the quality of life of children with cerebral palsy and associated intellectual impairment
Authors: White‐Koning Melanie , Grandjean Hélène , Colver Allan , Arnaud Catherine
Published: June 2009

To examine parent‐professional agreement in proxy‐reports of child quality of life (QoL) and the factors associated with low child QoL in children with cerebral palsy (CP) and associated intellectual impairment. Professional (teacher, therapist, or residential carer) and parent reports of QoL for 204 children (127 males, 77 females, mean age 10y 4mo [SD 1y 6mo]; range 8–12y) with CP and IQ≤70 were obtained in 2004 to 2005 in nine European regions, using the KIDSCREEN questionnaire. Parent‐professional agreement was studied using correlation and mean differences; multilevel logistic regression was used to determine factors influencing QoL reports and agreement. The mean parent‐reported scores of child QoL were significantly higher than the professional reports in the Psychological well‐being domain and significantly lower for Social support. The average frequency of disagreement (parent‐professional difference >0.5SD of scores) over all domains was 62%. High levels of stress in parenting negatively influenced parent reports of child QoL compared with professional reports, while child pain was associated with professionals rating lower than parents. Proxies do not always agree when reporting the QoL of children with severe disabilities. Parental well‐being and child pain should be taken into account in the interpretation of QoL reports in such children.
Serotonin and dopamine transporter binding in children with autism determined by SPECT
Authors: Makkonen Ismo , Riikonen Raili , Kokki Hannu , Airaksinen Mauno M , Kuikka Jyrki T
Published: June 2009

Disturbances in the serotonergic system have been recognized in autism. To investigate the association between serotonin and dopamine transporters and autism, we studied 15 children (14 males, one female; mean age 8y 8mo [SD 3y 10mo]) with autism and 10 non‐autistic comparison children (five males, five females; mean age 9y 10mo [SD 2y 8mo]) using single‐photon emission computed tomography (SPECT) with [123I] nor‐β‐CIT. The children, with autism were studied during light sedation. They showed reduced serotonin transporter (SERT) binding capacity in the medial frontal cortex, midbrain, and temporal lobe areas. However, after correction due to the estimated effect of sedation, the difference remained significant only in the medial frontal cortex area (p=0.002). In the individuals with autism dopamine transporter (DAT) binding did not differ from that of the comparison group. The results indicate that SERT binding capacity is disturbed in autism. The reduction is more evident in adolescence than in earlier childhood. The low SERT binding reported here and the low serotonin synthesis capacity shown elsewhere may indicate maturation of a lesser number of serotonergic nerve terminals in individuals with autism.
Effect of visual impairment on goal‐directed aiming movements in children
Authors: Reimer Annemieke M , Cox Ralf F A , Boonstra Nienke F , Smits‐Engelsman Bouwien C M
Published: June 2009

This study investigated potential differences in motor control between children with a visual impairment (diagnosed albinism; n=11, mean age 8y 4mo [SD 7mo]; seven males, four females,) and children with normal vision (n=11, mean age 8y 4mo [SD 7mo]; six males, five females). Mean near visual acuity in the albinism group was 0.19 (SD 0.07, Snellen: 20/104). Children performed two types of movements (discrete and cyclic) in two orientations (azimuthal and radial, i.e. along the viewing and lateral direction), and with two amplitudes (10 and 20cm). All movements were performed in two subsequent target conditions: with and without visual information on the target location. Overall, children with visual impairment displayed larger endpoint variability. Discrete movements and movements over large distances were less fluent in both groups, but especially in the children with visual impairment. Children with visual impairment seemed to have more difficulties with calibrating the sensory information. Specifically, they made larger errors along the lateral direction, when the target was not visible. Results suggest that children with visual impairment have specific differences in motor control compared with children with normal vision, which are not all directly related to their poorer vision.
Differences in motor imagery between children with developmental coordination disorder with and without the combined type of ADHD
Authors: Lewis Matthew , Vance Alasdair , Maruff Paul , Wilson Peter , Cairney Sheree
Published: June 2009

It has been proposed, and questioned, whether motor impairments in attention‐deficit‐hyperactivity disorder, combined type (ADHD‐C) alone, developmental coordination disorder (DCD) alone, and ADHD‐C and comorbid DCD (ADHD‐C/DCD) may arise from disruption to a common set of cognitive functions and their related neural substrate. This study examined movement durations for real and imagined movements in a visually guided pointing task in 58 prepubertal children aged 8 to 12 years old with ADHD‐C alone (n=14), ADHD‐C/DCD (n=14), DCD alone (n=15), and an age‐, sex‐, and Full‐scale IQ‐matched healthy comparison group (n=15). There were 10 males and 4 or 5 females in each group. The DCD alone group demonstrated an inability to generate imagined movements that was not present in the ADHD‐C group, with or without comorbid DCD, or healthy comparison participants. These findings add to the emerging literature characterizing intended and actual motor impairments associated with DCD alone.
Comprehensive short‐term outcome assessment of selective dorsal rhizotomy
Authors: Trost Joyce P , Schwartz Michael H , Krach Linda E , Dunn Mary E , Novacheck Tom F
Published: June 2009

This study retrospectively evaluated the safety and efficacy of selective dorsal rhizotomy (SDR) in participants who underwent a rigorous selection process, uniform surgical procedure, and a standardized postoperative rehabilitation process. Outcome measures assessed were the Ashworth scale for spasticity, the Gillette Gait Index (GGI) for overall gait pathology, oxygen cost for gait efficiency, and the Gillette Functional Assessment Questionnaire (functional walking ability scale; [FAQ]) for functional mobility. Outcomes were evaluated for 136 children (81 males, 55 females; mean age 7y 3mo [SD 2y 1mo], range 3y 5mo–18y 9mo) for an average of 18.3 months (SD 4.4mo) postoperatively. All participants had a diagnosis of cerebral palsy (CP): 10 quadriplegia, 19 triplegia, and 107 diplegia. Preoperative Gross Motor Function Classification System levels were: Level I n=6; Level II n=64; Level III n=59, and Level IV n=7. All outcome measures improved for the group as a whole. Spasticity improved with 66 to 92% of possible gain in Ashworth scores; GGI was 7.5 times more likely to have a good as opposed to a poor outcome; energy efficiency improved in over half of the participants, and the FAQ demonstrated a statistically significant improvement of 0.9 levels (p<0.001). The rate of complications was low, with peri‐ and postoperative complications resolved by time of discharge.
Aicardi‐Goutières syndrome: description of a late onset case
Authors: D’Arrigo Stefano , Riva Daria , Bulgheroni Sara , Chiapparini Luisa , Lebon Pierre , Rice Gillian , Crow Yanick J , Pantaleoni Chiara
Published: June 2009

Aicardi‐Goutières syndrome (AGS) is a genetically determined encephalopathy usually inherited as an autosomal recessive trait. The syndrome can be caused by mutations in the AGS1 gene encoding the exonuclease TREX1, or in any of the AGS2, AGS3, or AGS4 genes that encode the three subunits of the human ribonuclease H2 (RNaseH2) complex. Typically, AGS has an early onset, usually manifesting by the age of 4 months. We describe a female infant in whom the onset of the neurological symptoms of AGS occurred after the age of 12 months, and her younger brother who was identified to be affected by AGS at the age of 8 months on the basis of the presence of non‐neurological features alone. This paper is important in providing a detailed description of the late‐onset presentation of AGS in patients with proven pathogenic mutations and highlights the occurrence of both chilblains and abnormal neuroimaging many months before the onset of neurological features. Our paper also considers the possible value of immunomodulatory therapy in AGS.
Does sex influence outcome in ambulant children with bilateral spastic cerebral palsy?
Authors: Gough M , Shafafy R , Shortland AP
Published: June 2009

To investigate the effect of sex on the phenotype of bilateral spastic cerebral palsy (CP) we reviewed the gait analysis data of 116 children (78 males, mean age 8y 1mo [SD 3y 1mo] and 38 females, mean age 8y 9mo [3y 1mo]) with bilateral spastic CP (Gross Motor Function Classification System [GMFCS] Levels I [four males, six females]; II [41 males, 19 females]; III [26 males, 12 females]; and IV [7 males, 1 female]) who had been referred for gait analysis to inform treatment. Although there were no differences between males and females in terms of gestational age, chronological age, or GMFCS level, males were more likely to have had nonoperative intervention before the referral (p=0.024), had a greater degree of knee flexion in stance phase when walking (p=0.003), and had a higher Gillette Gait Index (p<0.001) when compared with females. Males were also more likely to have surgery recommended on the basis of gait analysis (p<0.001). Sex seems to influence the development of the musculoskeletal system and mobility in ambulant children with bilateral spastic CP, and this may need to be considered when planning intervention or when assessing the outcome of intervention.
Prevalence and characteristics of autistic spectrum disorders in the ALSPAC cohort
Authors: Williams Emma , Thomas Kate , Sidebotham Helen , Emond Alan
Published: June 2009

The aim of this study was to determine the prevalence of autistic spectrum disorder (ASD) within a large representative population sample: the Avon Longitudinal Study of Parents and Children (ALSPAC). Cases of ASD were identified from the clinical notes of children in the ALSPAC with a suspected developmental disorder and from the Pupil Level Annual Schools Census (PLASC) for England in 2003. Seventy‐one cases of ASD diagnosed after a multidisciplinary assessment were identified from health records. There were an additional 15 cases from PLASC data in which ASD was mentioned as a principal difficulty, thus giving a total of 86 children diagnosed by the age of 11 years. Prevalence of ASD per 10 000 population at 11 years was 51.1 for those with a multi‐professional diagnosis, and 61.9 if cases from education were included, made up of 21.6 for childhood autism, 10.8 for atypical autism, 16.6 for Asperger syndrome, and 13.0 for unspecified ASD. The male:female ratio was 6.8:1. Median age at diagnosis ranged from 45 months in childhood autism to 116 months in Asperger syndrome. A comorbid developmental disorder was recorded in 33.8% of cases, including learning disability* in 14.7%, epilepsy in 10.3%, and mixed developmental disorder in 4.4%. We conclude that the prevalence of ASD diagnosed at 11 years in a UK representative population‐based sample is at least 51.1/10 000.
A longitudinal study of neurological soft signs from late childhood into early adulthood
Authors: Martins Isabel , Lauterbach Martin , Slade Peter , Luís Henriques , DeRouen Timothy , Martin Michael , Caldas Alexandre , Leitão Jorge , Rosenbaum Gail , Townes Brenda
Published: June 2009

Neurological examination of children includes the screening for soft neurological signs (NSS). There is little knowledge about their evolution during adolescence, except that their lasting presence has been associated with developmental, psychological, and cognitive disorders.

We report the results of a NSS exam (assessing gross and fine motor function and the presence of hyperactivity and motor impersistence) over a 5‐year period, among a group of healthy children who were followed annually as part of a dental study. Their ages ranged from 11 to 15 years at onset to 14 to 18 years at the end. Participants were divided into four groups by age (younger and older) and sex.

At the first evaluation there were 191 males and 150 females. NSS score diminished both with increasing age and follow‐up time in both groups, but at different rates in males and females. Females reached the lowest scores two years before the younger subgroup of males.

These results show that NSS change rapidly in adolescence and at different rates in males and females, which must be taken into account in clinical contexts. The evolution of NSS suggests that they are a signature of neural development.
Magnetic resonance imaging and developmental outcome following preterm birth: review of current evidence
Authors: Hart Anthony R , Whitby Elspeth W , Griffiths Paul D , Smith Michael F
Published: June 2009

Preterm birth is associated with an increased risk of developmental difficulties. Magnetic resonance imaging (MRI) is increasingly being used to identify damage to the brain following preterm birth. It is hoped this information will aid prognostication and identify neonates who would benefit from early therapeutic intervention. Cystic periventricular white matter damage has traditionally been associated with abnormal motor developmental and cerebral palsy, but its presence on MRI does not preclude normal cognitive development. This has led to increasing interest in the identification of diffuse periventricular white matter damage with conventional and sophisticated MRI. However, the correlation between these appearances and developmental outcome remains unclear. Measurements of the size, volumes, and growth rates of many regions of the brain, such as the corpus callosum, ventricular system, cortex, deep grey matter, and cerebellum, are all also altered following preterm birth, but there is insufficient evidence to use this data in the clinical setting. This article is a review of the current evidence on MRI and developmental outcome, suggesting possible indications for the use of MRI following preterm birth.