Behaviour problems in children with dyslexia

The association between behaviour problems and dyslexia was assessed in a population sample of 10- to 12-year-old children. Twenty-five dyslexic children and a matched control group were recruited through a screening in primary schools in the city of Bergen, Norway. For the assessment of behaviour problems the Child Behavior Checklist (CBCL), Teacher Self Report (TRF), and Youth Self Report (YSR) were filled out by parents, teachers, and children, respectively. Information on health and developmental factors were obtained from parents on a separate questionnaire designed for the study. The dyslexic group had significantly more behaviour problems than the control group according to both the CBCL and the TRF. On the YSR there was no significant difference between the groups. Dyslexic children had higher CBCL and TRF scores on the Total Behaviour Problem scale, the Internalizing and Externalizing subdomains, and the Attention problem subscale. The groups differed in social background, prenatal risk factors, birth weight, preschool language problems, and IQ, but these variables showed no relationship to the level of behaviour problems in the present sample. We conclude that pre-adolescent dyslexic children show a wide range of behaviour problems that cannot be attributed to social or developmental background variables.

Parents' and teachers' ratings of problem behaviours in children: genetic and contrast effects

We obtained ratings on the Conners' scales from teachers (CTRS-28) and parents (CPRS-48) for 61 monozygotic and 64 dizygotic twin pairs, aged between 7 and 11 years. Model-fitting analyses were carried out to estimate the extent of genetic and environmental influences on problem behaviours, and to explore possible contrast effects in ratings by parents and teachers. Confirming previous findings with other measures, there was evidence of moderate to strong genetic effects on a range of problem behaviours. Parents' ratings on the Anxiety, Impulsive-Hyperactive and Learning Problem sub-scales showed significant evidence of contrast effects. There was no evidence of such rater bias or competitive sibling interaction effects in ratings by teachers, or in parents' ratings on the Conduct Problem and Psychosomatic sub-scales.

Frozen chips: an unusual cause of severe frostbite injury

A case of severe frostbite injury to the right foot is presented. This was caused by the inappropriate application of a bag of frozen chips to the foot in an attempt to ease non-specific pain. No specific acute traumatic injury was identified. As the patient was a teacher of physical education, the pain had initially been assumed to originate from a minor musculoskeletal injury. Full recovery ensued after surgical excision of necrotic tissue and split skin grafting. The danger of inappropriate overenthusiastic use of ice packs or other frozen material to treat soft tissue injuries is emphasised. The need for education to prevent similar future injuries is discussed.

Gamma hydroxybutyric acid (GHB): an increasing trend in drug abuse

The use of recreational drugs in society is becoming a widespread problem increasing the workload of all the emergency services. Gamma hydroxybutyric acid (GHB) is one of these, a drug used primarily for its euphoric effect. Toxic effects of ingestion include bradycardia, slow respiration or apnoea, coma and death. We present seven cases, all of which had consumed GHB either alone or in conjunction with other drugs and alcohol. The presentation, clinical features and management of these cases are described. All health care personnel involved in the emergency setting need to know of its existence, toxic effects and initial management with particular reference to airway control and possible assisted ventilation.

Drug-like index: a new approach to measure drug-like compounds and their diversity

Combinatorial organic synthesis (combinatorial chemistry or CC) and ultrahigh-throughput screening (UHTS) are speeding up drug discovery by increasing capacity for making and screening large numbers of compounds. However, a key problem is to select the smaller set of "representative" compounds from a virtual library to make or screen. Our approach is to select drug-like as well as structurally diverse compounds. The compounds, which are not very drug-like, are less taken into account or excluded even if they contribute to the diversity of the collection. Hence, the first step in the compound selection is to rank compounds in drug-like "degree". To quantify the drug-like "degree", drug-like index (DLI) is introduced in this paper. A compound's DLI is calculated based upon the knowledge derived from known drugs selected from Comprehensive Medicinal Chemistry (CMC) database. The paper describes the way of this knowledge base is formed and the procedure for selecting drug-like compounds.

The status of immunization measurement and feedback in the United States

BACKGROUND

A large body of scientific and programmatic data has demonstrated that provider measurement and feedback raises immunization coverage. Starting in 1995, Congress required that all states measure childhood immunization coverage in all public clinics, and federal grant guidelines encourage private practice measurements.

OBJECTIVES

To determine state immunization measurement rates and examine risk factors for high rates.

METHODS

Review of 1997 state reports, with correlation of measurement rates to birth cohort and provider numbers, public/private proportions, and vaccine distribution systems.

RESULTS

Of the 9505 public clinics, 48% were measured; 4 states measured all clinics; 29 measured a majority. Measurement rates were highest for Health Department clinics (67%), lower for community/migrant health centers (39%), and lowest for other clinics (22%). Rates were highly correlated among categories of clinics (r>+0.308, P<.03), and the fewer the clinics, the higher the measurement rates (r = -0.351, P =. 01), but other factors were not significant. Of the 41,378 private practices, 6% were measured; no state measured all its practices; 1 measured a majority. Private practice measurement rates were not correlated to public clinic measurement rates or other factors examined. Of the 50,883 total providers, 14% were measured; no state measured all providers; 2 measured a majority. A trend toward higher measurement rates was found in states with fewer providers (r = -0. 266, P =.06).

CONCLUSIONS

Three years after the congressional mandate, only a minority of public clinics and very few private practices had their immunization coverage measured. Greater efforts will be needed to assure implementation of the intervention. Arch Pediatr Adolesc Med. 2000;154:832-836

Specific life events and chronic experiences differentially associated with depression and anxiety in young twins

Behavioral genetic analyses indicate that environmental influences associated with depression and anxiety are specific to each symptom type; however, this has not been tested specifically in children. Sixty-one (61) child twin pairs in which at least one twin had a very high anxiety or depression score, and 29 nonanxious, nondepressed pairs were interviewed about life events and chronic stressors in the previous 12 months. Loss events, schoolwork stressors, family relationship problems, and friendship problems were all significantly associated with depression but not anxiety. Threat events were significantly associated with anxiety but not depression. Loss events and schoolwork stressors appeared to act as shared environment influences in that they made twin pairs resemble one another. Threat events, friendship problems, and family relationship problems were individual specific and accounted for differences within the pairs. These results clarify the associations between life events and depressive and anxious symptoms in children and adolescents and reveal specific associations previously unidentified in this age range.

Genetic and environmental covariation between verbal and nonverbal cognitive development in infancy

Despite cognitive neuroscience's emphasis on the modularity of cognitive processes, multivariate genetic research indicates that the same genetic factors largely affect diverse cognitive abilities, at least from middle childhood onward. We explored this issue for verbal and nonverbal cognitive development in infancy in a study of 1,937 pairs of same-sex 2-year-old twins born in England and Wales in 1994. The twins were assessed by having their parents use a measure of productive vocabulary (the MacArthur Communicative Development Inventory) and a novel measure of nonverbal cognitive abilities (Parent Report of Children's Ability). Verbal and nonverbal development correlated .42. A multivariate genetic analysis indicated that genetic factors were responsible for less than half of this phenotypic correlation. Moreover, the genetic correlation between verbal and nonverbal abilities was only .30, which indicates that genetic effects on verbal and nonverbal abilities are largely independent in infancy. These multivariate genetic results suggest that genetic effects on cognitive abilities are modular early in development and then become increasingly molar. The implications of this result for theories of cognitive development are discussed.

Non-dipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus

AIMS

To assess the relevance of circadian blood pressure variation to future morbidity and mortality in patients with diabetes mellitus.

METHODS

A retrospective descriptive 4 year follow-up study of data collected after ambulatory blood pressure monitoring in a clinic setting.

RESULTS

Seventy-five patients (46 male; 29 female) of whom 41 % had Type 1 diabetes and 59% Type 2 were followed up for a median of 42 months (11-56). The median creatinine for the whole group at baseline was 101 (56-501) micromol/l. The median circadian blood pressures for the total study population were 147 (110-194)/87 (66-109) mmHg during daytime and 132 (86-190)/77 (50-122) mmHg during night-time. Half of the patients exhibited a fall in night-time pressures to 10% lower than daytime pressures (dippers). Dippers were younger, 47 (32-75) years, than non-dippers, 57 (35-79) years, P = 0.03. Over time, dippers had a lower mortality than non-dippers, with 8% deaths in the cohort of dippers, 26% deaths in the cohort of non-dippers, P = 0.04. Cox regression analysis revealed significant contributions from age, duration of diabetes and baseline renal function to subsequent mortality in non-dippers. Analysing current degree of renal impairment and original dipper status together revealed that, of those patients whose creatinine remained normal, 7% of patients whose blood pressure dipped had subsequently died and 10% of non-dipping patients had died; of those patients whose creatinine unequivocally rose, 10% of dipping patients had died and 42% of non-dipping patients had died, P = 0.03

CONCLUSIONS

Loss of circadian variation in blood pressure is associated with an increased mortality rate, regardless of diabetes type. The combination of non-dipping and subsequent renal impairment leads to the highest mortality rate. The study suggests a role for ambulatory blood pressure monitoring in day-to-day clinical practice to select patients with nephropathy who are at greatest risk, in an effort to alter outcome.

Family-based association mapping provides evidence for a gene for reading disability on chromosome 15q

Family-based association mapping was used to follow up reports of linkage between reading disability (RD) and a genomic region on chromosome 15q. Using a two-stage approach, we ascertained 101 (stage 1) and 77 (stage 2) parent-proband trios, in which RD was characterized rigorously. In stage 1, a set of eight microsatellite markers spanning the region of putative linkage was used and a highly significant association was detected between RD and a three-marker haplotype (D15S994/D15S214/D15S146: P and empirical P < 0.001). A significant association with the same three-marker haplotype was also observed in the second-stage sample (P = 0.009, empirical P = 0.006). Our data therefore provide strong evidence for one or more genes contributing to RD being located in the vicinity of the region including D15S146 and D15S994. In addition, our results provide support for association analysis being a useful method to map susceptibility loci for complex disorders.

Hyperactivity in children: a focus on genetic research and psychological theories

Hyperactivity has attracted a large amount of research interest in recent years. Here we review developments in genetic research and in research testing psychological theories of the condition. Family, adoptee and twin studies indicate a strong role for genetic factors in the etiology of hyperactivity. Evidence is emerging also from molecular genetic studies, implicating specific genes that may be involved. At the level of cognitive functioning, a divided, focused or sustained attention deficit does not seem to be a 'core' deficit in hyperactivity. Although children with hyperactivity often perform poorly on certain executive function tasks, there is disagreement about the interpretation of these findings. The association reported in some studies between a slow inhibitory process and hyperactivity may reflect a generally slow, variable in speed and inaccurate pattern of responding. Hypotheses about psychological mechanisms such as state regulation or delay aversion provide alternative, and particularly encouraging, interpretations of the findings. We discuss the possible integration of the two lines of research--those of genetic research and research on psychological mechanisms.

Using genetic analyses to clarify the distinction between depressive and anxious symptoms in children

Self-report measures of depression and anxiety in children are highly correlated and distinguishing between shared and independent factors in their etiologies is therefore problematic. The aim of this article was to test whether less correlated measures of depression and anxiety could be produced and, if so, what genetic and environmental factors would account for the variance in these symptoms. Second-order factor analysis of the items from two standardized self-report questionnaires of depression and anxiety collected from 395 pairs of same-sex twins aged 8 to 16 years resulted in purer dimensions of depression and anxiety. Behavioral genetic analyses confirmed the distinction between these two dimensions, and bivariate analyses revealed that the association between the two was primarily accounted for by shared genetic factors.

A Jacksonian and biopsychosocial hypothesis concerning borderline and related phenomena

OBJECTIVE

The aim of this paper is to develop an aetiological model for borderline personality disorder.

METHOD

The postulates of Hughlings Jackson are used to provide a preliminary explanatory framework for borderline phenomena. As a necessary background to this discussion, the findings concerning abuse in the early history of borderline personality disorder (BPD) and other conditions, notably somatisation disorder and dissociative states, are briefly reviewed. Other data, including family studies, which might have significance in the aetiology of BPD are also reviewed.

RESULTS

The hypothesis is put forward that the symptoms of BPD are due to the failure of 'experience-dependent' maturation of a cascade of neural networks, with prefrontal connections, which become active relatively late in development and which coordinate disparate elements of central nervous system function. These networks subserve higher psychological functions, including attentional focus and affect regulation. They also underpin the reflective function necessary to the emergence of self as the stream of consciousness, which appears at about the age of 4 years.

CONCLUSION

Adverse developmental circumstances may produce an interrelated set of symptom clusters, with associated neural network disturbances that are amenable to investigation with psychometric and brain imaging techniques. Since these disturbances are seen as 'experience-dependent', they are considered reversible, at least in part.

Exploring the covariation between anxiety and depression symptoms: a genetic analysis of the effects of age and sex

Self-reported anxiety and depression symptoms in children and adolescents have been shown to be heritable, and are also highly correlated. Furthermore, there have been indications in the literature of sex and age differences in the aetiologies of these two types of symptoms. This study set out to ascertain to what extent the genetic and environmental factors that influence anxiety symptoms also influence depression symptoms, and whether these are the same in children and adolescents, and males and females. Four hundred and ninety pairs of twins aged 8 to 16 years completed the Children's Depression Inventory and the Trait scale of the State-Trait Anxiety Inventory for Children. There were significant effects of age and sex on the variance in and covariance between these two types of symptom. Bivariate genetic analyses of the measures indicated that the genetic influences on anxiety and depression were shared for all four groups, a finding that has been consistently demonstrated for adults.

Cognitive sequelae of severe malaria with impaired consciousness

Although cerebral malaria is the most common acute encephalopathy arising in children in Africa little is known of its effect upon the longer-term cognitive development of survivors. In Kenya, we compared the performance of 87 survivors of severe malaria with impaired consciousness to matched community controls on a wide range of tasks, not less than 42 months post illness episode. The presence of cognitive impairment was then related to both the pattern of symptoms at the time of the acute illness and the presence of gross neurological impairment on discharge. Significant group differences were found in areas of cognitive functioning suggestive of widespread impairment in the development of the ability to initiate, plan and carry out tasks (the executive functions). On tasks of more discrete cognitive skills (information processing) there were no significant group differences, although impaired performance was found more frequently in the severe malaria group. The odds ratio associated with the development of cognitive impairment following severe malaria with impaired consciousness was found to be 4.48 (95% CI 1.22, 16.47). A combination of 4 signs (coma, hypoglycaemia, seizures, and absence of hyperpyrexia) proved to have greater accuracy than the presence of gross neurological sequelae in predicting cognitive impairment (95% vs 93% specificity, 67% vs 58% sensitivity).

A randomised comparison of the effects of oral versus transdermal 17beta-oestradiol, each combined with sequential oral norethisterone acetate, on serum lipoprotein levels

OBJECTIVE

To investigate the effects of oral versus transdermal 17beta-oestradiol, given in both cases with sequential addition of oral norethisterone acetate, on serum lipid and lipoprotein levels in postmenopausal women.

DESIGN

Open, randomised, parallel groups study.

SETTING

University Clinical Research Group.

POPULATION

Sixty-four postmenopausal women with climacteric complaints who were otherwise healthy were screened. Of these, 58 fulfilled the entry criteria.

METHODS

Fifty-eight postmenopausal women were randomised to receive either oral 17beta-oestradiol/oestriol (Trisequens) or transdermal 17beta-oestradiol (Estrapak) together with cyclical addition of norethisterone acetate for 48 weeks.

MAIN OUTCOME MEASURES

Serum levels of total cholesterol, triglycerides, high density lipoproteins (HDL), low density lipoproteins (LDL), very low density lipoproteins (VLDL), apolipoproteins, and lipoprotein(a) at baseline, and after 46 weeks (oestrogen-alone phase), and 48 weeks (oestrogen-progestogen phase) of treatment.

RESULTS

Oral oestradiol therapy did not affect serum total cholesterol levels during the oestrogen-alone phase, but during the combined phase there was a 5% fall (P < 0.05) due to a 7% decrease in LDL cholesterol levels (P < 0.01). Oral therapy also increased serum triglyceride levels by 9.4% during the oestrogen-alone phase (P < 0.05). During the combined phase of transdermal therapy, there was a 19% fall in serum triglyceride levels (P < 0.05) and a 6% fall in HDL levels (P < 0.05). Oral oestradiol reduced lipoprotein(a) levels by 31% during the oestrogen-alone phase and by 37% with norethisterone acetate addition (P < 0.05). Transdermal therapy had no significant effect on lipoprotein(a).

CONCLUSIONS

Other than a minor fall in HDL3 in women receiving transdermal 17beta-oestradiol, coadministration of oral progestogen in general improved, rather than worsened, this serum lipoprotein profile.

Changes in clinic vaccination coverage after institution of measurement and feedback in 4 states and 2 cities

BACKGROUND

Since 1995, states and jurisdictions receiving federal immunization funds have been required to perform annual measurements of vaccination coverage in their public clinics, based on data from Georgia where clinic coverage increased after the institution of a measurement and feedback intervention.

OBJECTIVE

To determine if clinic vaccination coverage improved in localities that used the Georgia intervention model.

DESIGN

Retrospective examination of clinic vaccination coverage data.

PARTICIPANTS

Children aged 19 to 35 months enrolled in clinics in localities that had applied the intervention for 4 years or longer.

INTERVENTION

The Georgia intervention model: assessment of clinic vaccination coverage, feedback of the information to the clinic, incentives to clinics, and promotion of exchange of information among clinics (AFIX).

MAIN OUTCOME MEASURE

Change in median clinic coverage rates, based on the primary (4-3-1) vaccine series, with comparison to results of the National Immunization Survey.

RESULTS

Four states and 2 cities that had applied the AFIX intervention for 4 years or longer were identified. The number of clinic records reviewed annually was 4639 to 18000 in 73 to 116 clinics for states, and 714 to 5276 in 8 to 25 clinics for cities. Median clinic coverage rose in all localities: Missouri, 44% (1992) to 93% (1997); Louisiana, 61% (1992) to 83% (1997); Colorado, 55% (1993) to 75% (1997); Iowa, 71% (1994) to 89% (1997); Boston, Mass, 41% (1994) to 79% (1997); and Houston, Tex, 28% (1994) to 84% (1997). The increase in clinic coverage exceeded that of the general population in 5 localities and was identical in the sixth. The average annual coverage rise attributable to the intervention was +5 percentage points per year (Georgia, +6 per year). The average crude direct program cost was $49533 per locality per year.

CONCLUSION

The Georgia intervention model (AFIX) can be reproduced elsewhere and is associated with improvements in clinic vaccination coverage.

Psychotherapy with borderline patients: I. A comparison between treated and untreated cohorts

OBJECTIVE

The aim of this study is to compare the clinical outcome of patients with borderline personality disorder (BPD) who had received outpatient psychotherapy for 1 year with BPD patients who received no formal psychotherapy for the same period.

METHOD

Thirty patients with BPD were treated by trainee psychotherapists working according to clearly described therapeutic principles. They received intensive audiotaped supervision. Patients were seen twice weekly for 1 year. They were compared with 30 patients subsequently referred to the clinic, for whom no therapist was available and who remained on a waiting list for 1 year, receiving their usual treatment. The outcome measure was a score derived from DSM criteria. It was taken at the beginning and end of the year's treatment, in the former case, and after at least 1 year on the waiting list in the latter. (The average waiting period was 17.1 months.)

RESULTS AND CONCLUSIONS

Patients who received psychotherapy were significantly improved in terms of the DSM score. Thirty percent of treated patients no longer fulfilled DSM-III criteria for BPD. The untreated patients were unchanged.

Psychotherapy with borderline patients: II. A preliminary cost benefit study

OBJECTIVE

The aim of this study was to conduct a preliminary cost benefit study of the effect of outpatient psychotherapy, twice a week for 1 year, in 30 borderline patients.

METHOD

Costs to the health system in terms of inpatient care for the year before treatment were compared with the costs for the year following treatment.

RESULTS

The cost of hospital admissions for the 30 patients for the year before treatment was $684 346 (range = $0-$143 756/patient). The cost of hospital admissions for the year after treatment was $41 424 (range = $0-$12 333/patient). These figures represent an average decrease in costs per patient of $21 431. By using the schedule fee as the basis, the estimated cost of therapy per patient was approximately $13 000, representing a saving/patient of $8431 or approximately $250 000 over the total cohort in the first year after treatment.

CONCLUSION

This study suggests that there is a significant cost benefit in the appropriate treatment of borderline patients.

Genetic and environmental origins of verbal and performance components of cognitive delay in 2-year-olds

The authors investigated the etiology of several measures of cognitive delay. Verbal (V) and performance (P) abilities were assessed in over 3,000 pairs of 2-year-old twins. Group-differences heritability for general delay (the lowest 5% of the V and P composite) was 35%. However, V and P delays considered independently showed large differences in group heritability (77% for V vs. 40% for P). Specific delays with comorbid cases eliminated showed an even greater difference in group heritability (78% vs. 22%, respectively). The small sample comorbid for both V and P delay also yielded high group heritability for both V (77%) and P (93%) scores. Shared environmental factors also differed in magnitude for V (20%) and P (41%) delays. Because the genetic and environmental origins of V and P delays in infancy differ, they are better considered separately rather than combined into a composite measure of general cognitive delay.

The structure of genetic influences on general cognitive, language, phonological, and reading abilities

The etiology of individual differences in literacy, phonological awareness, and language ability is reported in 126 pairs of monozygotic and dizygotic twins. At age 6 and 7 years, more than 60% of the variance in literacy was heritable. Heritabilities for 6- and 7-year-olds were .52 and .62, respectively, for phonological awareness and .43 and .50, respectively, for language ability. After genetic effects on IQ were controlled, a separate genetic influence was identified that acted on literacy, phonological awareness, and language. No genetic link between phonological awareness and literacy independent of general language ability was found; such covariance was mediated through environmental influences. Individual differences in literacy ability are substantially influenced by genetic factors, some of which also act on phonological awareness and general language ability.

Assessing immunization performance of private practitioners in Maine: impact of the assessment, feedback, incentives, and exchange strategy

INTRODUCTION

A provider-based vaccination strategy that has strong supportive evidence of efficacy at raising immunization coverage level is known as Assessment, Feedback, Incentives, and Exchange. The Maine Immunization Program, and the Maine Chapter of the American Academy of Pediatrics collaborated on the implementation and evaluation of this strategy among private providers.

METHODS

Between November 1994 and June 1996, the Maine Immunization Program conducted baseline immunization assessments of all private practices administering childhood vaccines to children 24 to 35 months of age. Coverage level assessments were conducted using the Clinic Assessment Software Application. Follow-up assessments were among the largest practices, delivering 80% of all vaccines.

RESULTS

Of the 231 practices, 58 were pediatric and 149 were family practices. The median up-to-date vaccination coverages among all providers for 3 doses of diphtheria-tetanus-pertussis vaccine and 2 doses of oral polio vaccine, and 4 doses of diphtheria-tetanus-pertussis vaccine, 3 doses of oral polio vaccine, and 1 dose of measles-mumps-rubella vaccine at age 12 and 24 months were 90% and 78%, respectively, and did not vary by number of providers in a practice or by specialty. Urban practices had higher coverage than rural practices at 12 months (92% vs 88%). The median up-to-date coverage for 4 doses of diphtheria-tetanus-pertussis vaccine, 3 doses of oral polio vaccine, and 1 dose of measles-mumps-rubella vaccine at 24 months of age improved significantly among those practices assessed 1 year later (from 78% at baseline to 87% at the second assessment). On average, the assessments required 21/2 person-days of effort.

CONCLUSIONS

We document the feasibility and impact of a public/private partnership to improve immunization delivery on a statewide basis.

IMPLICATIONS

Other states should consider using public/private partnerships to conduct private practice assessments. More cost-effective methods of assessing immunization coverage levels in private practices are needed.

Central auditory processing, MRI morphometry and brain laterality: applications to dyslexia

We review data from our laboratory related to a view of dyslexia as a biological disorder, or deficit, caused by both structural and functional brain abnormalities. The review is focused on central auditory processing in dyslexia, and the possibility that impairments in the auditory or acoustic features of the phonological code may be at the heart of the impairments seen in dyslexia. Three methodological approaches by which to investigate central auditory processing deficits are outlined: dichotic listening (DL) to consonant-vowel syllables; magnetic resonance imaging (MRI), and the use of event-related potentials (ERPs). Consonant-vowel syllable DL is a technique for probing the functional status of phonological processing areas in the superior temporal gyrus, particularly in the left hemisphere. MRI is a corresponding structural, or morphological, measure of anatomical abnormalities in the same brain region, particularly covering the planum temporale area. The ERP technique, and particularly the mismatch negativity (MMN) component, reveals cortical dysfunctions in sensory processing and memory related to basic acoustic events. For all three approaches, the dyslexic children were seen to differ from their control counterparts, including absence of modulation of the right ear advantage (REA), in DL through shifting of attention, smaller left-sided planum temporale asymmetry, and prolonged latency in the MMN ERP complex, particularly in the time-deviant stimulus condition.