Perceptual, motor and attentional deficits in seven-year-old children: background factors

Children with preschool minor neurodevelopmental disorders. IV: Behaviour and school achievement at age 13

A cohort of children with deficits in attention, motor control and perception at seven years, drawn from a total population sample of such children in Göteborg, Sweden, was compared at 13 years with a group of normal children with regard to behaviour and school achievement. The index group showed persisting high rates of severe behavioural problems, as judged by teachers', parents' and self-rating questionnaires. None had been treated with stimulants or other drugs to reduce the symptoms of their neurodevelopmental disorders. It seems that these children's problems were slightly less in the early teen years than they were at 10 years, but the rates were still much in excess of those in the comparison group.

Neonatal risk factors and later neurodevelopmental disturbances

Background factors of developmental outcome in a group of 386 neonatal 'at-risk' infants and 107 controls were examined in a prospective nine-year follow-up study. Dichotomized outcome variables were computed for each of the assessments; neurodevelopmental, motor, psycholinguistic, cognitive and school progress. In the study group, 17 to 29 per cent were found to have significant problems, compared with 10 to 17 per cent of the control group. Children with low birthweight, neonatal neurological symptoms or several neonatal disorders were found to have most problems at the age of nine years. In stepwise logistic regression analyses, smallness for gestational age, neonatal signs of cerebral depression and low social-class were found to be the most significant predictors of neurodevelopmental problems at age nine. Factors suggesting intra-uterine hypoxia or poor nutrition were also associated with developmental problems. The background pathology of the neonatal conditions seemed to be of more importance than the neonatal manifestations themselves.

Perinatal correlates of major and minor neurological dysfunction at school age: a multivariate analysis

A prospective study was carried out on 747 infants: 147 neurologically abnormal, 300 with mild neurological abnormalities and 300 normal infants. They were re-examined at nine years of age, with special attention being paid to minor neurological dysfunction (MND). Extensive data on obstetrical history, neonatal course and interval complications were collected. Neurological handicap was not found on follow-up in the group of normal newborns. Other than neonatal neurological abnormality, risk factors contributing significantly to later handicap were low one-minute Apgar scores, a disturbed neonatal course, low social-class and interval complications; obstetrical events were conspicuous by their absence. Two aetiologically and clinically distinct kinds of MND were distinguished on the basis of a neurological cluster profile: MND-1 (one or two abnormal clusters) was only associated with a birthweight below the 2.3 centile and male gender, and MND-2 (more than two abnormal clusters) was associated with neonatal neurological findings, social class, obstetrical optimality score and gender.

The neurological condition of the newborn infant with maternal hypertension, examined at term

The aim of this prospective study was to examine the effect of maternal hypertension on the neurological condition of the newborn infant. Of the babies born between April 1984 and March 1986, 54 preterm, 151 full-term AGA and 24 full-term SGA neonates with maternal hypertension were compared, respectively, with 128 preterm, 144 full-term AGA and 73 full-term SGA neonates without maternal hypertension. Preterms were examined at term +/- 1 week and full-term neonates at 3-5 days postpartum by the Dubowitz method (Clinics in Developmental Medicine, Vol. 79, Heinemann, London, 1981). The respective full-term groups differed mostly in regard to movement and tone, with preterm groups differing in the predominant state and in auditory orientation. The differences were clearest between preterm AGA groups. The neurological condition of the infants was affected more by pre-eclampsia than by hypertension as such. Statistical analysis was carried out with the t-test, chi2-test and stepwise discriminant analysis.

Evaluating the significance of minimal brain dysfunction--results of an epidemiological study

An epidemiological field investigation of 399 8-yr-old children was unable to support basic assumptions of the clinical MBD concept (existence of a homogeneous syndrome, specific psychopathology, evidence of increased perinatal risks). Using a multi-level case definition procedure and factor-analytic data aggregation, nearly complete independence was found among the diagnostical levels of neurophysiology, neuropsychology and specific skills. Main results were replicated after the application of several alternative models of case definition and were further confirmed by data from a clinical sample. Present findings emphasize the necessity to reconsider the concept of MBD and its practical consequences.

Neurodevelopmental outcome and school performance of very-low-birth-weight infants at 8 years of age

The neurodevelopmental outcome and school performance of 50 appropriate for gestational age (AGA) and 33 small for gestational age (SGA) very-low-birth-weight (VLBW) infants, compared to a control group (41 Term infants) were assessed at 8 years of age. The incidence of major handicaps among AGA and SGA/VLBW infants respectively, was 16% and 6%. No major handicap was found in the control group. The incidence of neurodevelopmental abnormalities (NDA) among AGA's (40%) and SGA's (57.6%) compared with the control group (31.7%) was found to be significantly higher. School failure occurred more frequently among VLBW infants (22.9%) and was related in children with NDA--and more particularly among AGA's--to the presence of language disorders or associated NDA. Evaluation of the consequences of NDA and school problems for later academic and professional achievement now requires further follow-up studies.

Teenage psychoses--epidemiology, classification and reduced optimality in the pre-, peri- and neonatal periods

This is a population-based survey from Göteborg, Sweden, of all youngsters treated as in-patients for operationally defined 'psychotic disorders' during their teens. It was shown that 0.54% of all teenagers in Göteborg had been treated for such disorders at least once during the 13- to 19-year-old age period. Boys and girls were about equally affected, but schizophreniform disorders tended to be much more common among the boys and affective disorders more common among the girls. Child psychiatric services had been consulted much less frequently than adult ones, in spite of the many developmental aspects of the psychotic disorders. Scores for reduced optimality in the pre- and perinatal periods were marginally, though significantly, more common in the psychosis groups than in an age-, sex- and maternity clinic-matched control group.

Handedness in Swedish 10-year-olds. Some background and associated factors

Forty-five left-handed and 46 right-handed 10-year-old children were subjected to a limited set of neurological tests and a square tracing task. 'Pathological' handedness was diagnosed in cases showing poor performance with the non-preferred hand on the squares task. The frequency of left-handedness in the population was estimated at 9.2%. The boy : girl ratio was 1.6:1. 'Pathological' handedness was twice as common among left-handers as among right-handers. Neurological dysfunction was more common in 'pathological' handers, especially left-handers. Reduced pre-. peri- and neonatal optimality was seen in boys with 'pathological handedness'. School achievement problems and behaviour problems were much more common in left-handed boys than in other study groups. The results lend partial support for the extended pathological left-handedness model recently hypothesized by Bishop, but it is suggested that left-handedness in boys is more often a symptom of pathological shift of handedness than is left-handedness in girls.

Neurologic examination of children with learning disorders

The author delineates essential parts of the neurologic examination, discusses the value of various subtle neurologic signs, suggests a differential diagnosis, and recommends guidelines for communication of the findings to parents and referring school personnel as well as the indications for referral to a neurologist.

Autistic children's hand preferences: results from an epidemiological study of infantile autism

Twenty-six autistic children, constituting a total population sample of children diagnosed in accordance with Rutter's criteria as suffering from infantile autism, were assessed with regard to handedness and certain associated factors. They were compared with 52 age-, sex-, and IQ-matched controls. Sixty-two percent of the autistic children were non-right-handed compared with 37% of the controls. Left-handedness in autism was associated with an abundance of delayed echolalia. Heredity for left-handedness in some cases, and assumed brain damage and immature patterns of lateralization in others, were considered the cause of non-right-handedness in the autistic children. Computed tomographic (CT) brain scans and other neurobiological examinations did not provide evidence indicating clear-cut unilateral left hemisphere dysfunction in autism. Rather, a slight trend in the opposite direction (i.e., an association with right hemisphere dysfunction) was seen in the left-handed autistic children. The result points toward the need for further studies of handedness in autism.

Infantile autism: a total population study of reduced optimality in the pre-, peri-, and neonatal period

Twenty-five autistic children, constituting a total population sample of children with infantile autism, were compared with 25 sex- and maternity-clinic-matched controls for occurrence of reduced optimality in the pre-, peri, and neonatal period, as noted in medical records. Autistic children showed greatly increased scores for reduced optimality, especially with regard to prenatal factors. The findings are at odds with early reports that children with autism had not suffered potential brain injury. The reasons for the discrepancy are discussed.

Mental retardation in Swedish urban children: some epidemiological considerations

The total population of children born in 1971 and living in Gothenburg, Sweden, by the end of 1977 was screened in order to estimate prevalence figures for various neurodevelopmental disorders. Ninety-four percent of all children assessed attended public preschools. Questionnaires aimed at detecting perceptual, conceptual, motor, and attentional deficits were completed by preschool teachers for 72% of children in these schools. Samples of children with and without problems on the questionnaire were given neuropsychiatric examinations. National registers were searched to identify mentally retarded children not in public preschools. The total population frequency figure for unequivocal mental retardation was almost 1% with an additional 1% of the total population deemed to be of borderline intelligence.

Social class and infantile autism

Twenty infantile autistic children, constituting what is likely to be the majority of the total population of autistic children born in the years 1962 through 1973 and living in Göteborg, Sweden, by the end of 1978, were compared with a random population sample of 59 7-year-old Göteborg children with regard to social class. Two different social classification systems were used, one that takes account only of the father's occupation and one that includes several other parameters. The distributions of social class were almost identical in the infantile autism group and in the random group. With respect to some other social circumstances the two groups were very similar. Thus, the present results lend no support for the view that autistic children tend to come from high social classes.