Attention deficits and clumsiness in Swedish 7-year-old children

Motor signs distinguish children with high functioning autism and Asperger's syndrome from controls

While many studies of motor control in autism have focused on specific motor signs, there has been a lack of research examining the complete range of subtle neuromotor signs. This study compared performance on a neurologic examination standardized for children (PANESS, Physical and Neurological Exam for Subtle Signs, Denckla [1974 Developmental Medicine and Child Neurology, 16(6), 729-741]) between a group of 40 boys aged 6-17 with autism and average range IQs and a group of 55 typically developing boys. The Autism group was shown to have significant impairment on several measures of motor control compared to the Control group. Regression analyses revealed that a model including four PANESS variables offered a high level of discrimination in distinguishing boys with high-functioning autism from controls.

Associations of motor co-ordination and attention with motor-perceptual development in 3-year-old preterm and full-term children who needed neonatal intensive care

BACKGROUND

Children who have needed neonatal intensive care (NIC) are considered to be at risk for deficits such as developmental co-ordination disorder and attention-deficit/hyperactivity disorder. By assessing motor-perceptual development, motor co-ordination and attention already at 3 years of age, it might be possible to identify such deficits earlier than they are today.

AIM

To investigate the motor-perceptual development in a group of 202 NIC children but had no major impairments, to describe associations of deficits in co-ordination and attention with motor-perceptual delays, and to estimate the prevalence of NIC children with combined deficits together with a motor-perceptual delay.

METHOD

Co-ordination and attention in children born very preterm (n = 57), moderately preterm (n = 75) and full-term (n = 70) were observed according to a model for Combined Assessment of Motor Performance and Behaviour while they were assessed using a developmental scale, Motor-Perceptual Development, 0-7 years, MPU.

RESULTS

In two out of 14 MPU areas, a larger proportion of very preterm than of moderately preterm and full-term children had marked developmental delay. Overall, the proportion of NIC children having a motor-perceptual delay increased with increasing incoordination and especially increasing lack of attention. Twenty-one (11%) of the NIC children had different motor-perceptual delays combined with pronounced incoordination and pronounced lack of attention.

CONCLUSION

Deficits in co-ordination and attention were associated with motor-perceptual delays in areas important for daily living and development of academic skills. Therefore, to find children at risk for developmental co-ordination disorder and attention-deficit/hyperactivity disorder, assessments of co-ordination and attention should be added to assessments of motor-perceptual development in 3-year-old NIC children.

Evaluation of the Incredible Years Series - an open study of its effects when first introduced in Sweden

Behaviour management problems (BMP) are common among children (4-12%) and the prevalence seems to be rising. Persistent antisocial behaviour often leads to poor long-term psychosocial adjustment. Structured parent-training programmes have proven to be the most effective way of treating BMP in young children. The Incredible Years Series (IYS), which is a manual-based programme, was introduced in Sweden in 2001. The aim of the present study was to evaluate the effectiveness of IYS in diverse clinical settings in Sweden. Parents of 113 children (3-9 years), recruited through the IYS-trained group leaders' ordinary services, participated in the study. The parents answered various questionnaires regarding their children's symptoms and their own psychological well-being before and after participating in the parent-training groups. The results are very encouraging; significant reduction of BMP in the children was found on all relevant measures. A significant increase in the self-rated well-being of the mothers was also found. The IYS seems to work in Sweden, even when used by group leaders who are in training. The importance of using a well-documented manualized method when implementing new models is accentuated.

Effects of coexisting disorders on cognition and behavior in children with ADHD

OBJECTIVE

To determine whether the presence of coexisting disorders affects memory, visual-motor skills, and daily functioning in children with ADHD.

METHOD

Eighty-four boys and 18 girls (8 to 16 years old) participate in this study. Twenty children meet criteria for ADHD alone, 42 children for ADHD plus one other disorder, and 40 children for ADHD plus at least two other disorders (reading disability, developmental coordination disorder, oppositional defiant disorder, conduct disorder, anxiety, and depression). Children are assessed on memory and visual-motor skills. Parents complete measures of daily functioning.

RESULTS

No significant group differences emerge for age, socioeconomic status, or IQ. Poorer performance on tests of memory and visual-motor skills, more prevalent behavioral problems, and more impairment in everyday functioning are associated with a higher number of coexisting disorders in children with ADHD.

CONCLUSION

The presence of coexisting disorders has a significant influence on cognition and behavior of children with ADHD.

Comorbidity, co-occurrence, continuum: What's in a name?

BACKGROUND

Comorbidity, co-occurrence and continuum are three terms used when referring to developmental problems such as Developmental Coordination Disorder (DCD), but they can be confusing and misleading. Further, the terms can be upsetting to parents, and are not always helpful in guiding the selection of clinical interventions.

GOALS

The main purpose of this paper is to question some of the terminology we employ when referring to DCD and other developmental problems. A secondary purpose is to discuss some of the conceptual frameworks that have been proposed that attempt to address the issue of the interrelationships among developmental problems.

APPROACH

The terminology is examined by first referring to the basic dictionary definitions. Second, data we have published that relate to the issues of co-occurrence and continuum are reviewed in light of the terminology questions. Finally, we review some alternative conceptual frameworks which more accurately describe the relationships among developmental problems.

CONCLUSION

The term 'comorbidity' has limited relevance to developmental problems, and its use is questionable. In contrast, co-occurrence and continuum are more useful terms to use in regard to developmental problems. Concepts such as atypical brain development and minor neurological dysfunction provide some possible explanations for the increased levels of co-occurrence of developmental disorders in children who are more severely affected.

Fine motor skills in South African children with symptoms of ADHD: influence of subtype, gender, age, and hand dominance

BACKGROUND

Motor problems, often characterised as clumsiness or poor motor coordination, have been associated with ADHD in addition to the main symptom groups of inattention, impulsiveness, and overactivity. The problems addressed in this study were: (1) Are motor problems associated with ADHD symptoms, also in African cultures? (2) Are there differences in motor skills among the subtypes with ADHD symptoms? (3) Are there gender differences? (4) Is there an effect of age? (5) Are there differences in performance between the dominant and non-dominant hand?

METHOD

A total of 528 children (264 classified as having symptoms of ADHD and 264 matched comparisons) of both genders and from seven different South African ethnic groups participated in the study. They were assessed with three simple, easy to administer instruments which measure various functions of motor speed and eye-hand coordination: The Grooved Pegboard, the Maze Coordination Task, and the Finger Tapping Test. The results were analysed as a function of subtype, gender, age, and hand dominance.

RESULTS

The findings indicate that children with symptoms of ADHD performed significantly poorer on the Grooved Pegboard and Motor Coordination Task, but not on the Finger Tapping Test than their comparisons without ADHD symptoms. The impairment was most severe for the subtype with symptoms of ADHD-C (combined) and less severe for the subtypes with symptoms of ADHD-PI (predominantly inattentive) and ADHD-HI (predominantly hyperactive/impulsive). With few exceptions, both genders were equally affected while there were only slight differences in performance between the dominant and non-dominant hand. The deficiencies in motor control were mainly confined to the younger age group (6-9 yr).

CONCLUSION

An association between the symptoms of ADHD and motor problems was demonstrated in terms of accuracy and speed in fairly complex tasks, but not in simple motor tests of speed. This deficiency is found mainly in the children with ADHD-C symptoms, but also to a lesser degree in the children with symptoms of ADHD-PI and ADHD-HI.

Attention Processes in Children with Movement Difficulties, Reading Difficulties or Both

Reading difficulties (RD) and movement difficulties (MD) co-occur more often in clinical populations than expected for independent disorders. In this study, we investigated the pattern of association between attentional processes, RD and MD in a population of 9 year old school children. Children were screened to identify index groups with RD, MD or both, plus a control group. These groups were then tested on a battery of cognitive attention assessments (TEA-Ch). Results confirmed that the occurrence of RD and MD was greater than would be predicted for independent disorders. Additionally, children with MD, whether or not combined with RD, had poor performance on all attention measures when compared with typically developing children. Children with RD only, were no poorer on measures of attention than typical children. The results are discussed with respect to approaches proposed to account for the co-occurrence of disorders.

Oral health, dental anxiety, and behavior management problems in children with attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a common developmental disorder. The aim of this study was to investigate whether children with ADHD have a higher caries prevalence, a higher degree of dental anxiety, or more dental behavior management problems (BMP) than children of a control group. Twenty-five children with ADHD and a control group of 58 children, all aged 11 yr, were included in the study. The children underwent a clinical dental examination, and bitewing radiographs were taken. The parents completed the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS). Dental records from the subjects were obtained, and data regarding notes on behavior management problems (BMP) of the children when between 3 and 10 yr of age were compiled. Compared with controls, children with ADHD had significantly higher decayed, missing or filled surfaces (DMFS) (2.0 +/- 3.0 vs. 1.0 +/- 1.5) and significantly higher decayed surfaces (DS) (1.7 +/- 3.6 vs. 0.5 +/- 0.9). Differences between the groups regarding CFSS-DS scores were non-significant. In the ADHD group, the prevalence of BMP increased when the children were between 7 and 9 yr of age. In conclusion, children with ADHD exhibited a higher caries prevalence, did not exhibit a higher degree of dental anxiety, and had more BMP than children of a control group.

Motor persistence and inhibition in autism and ADHD

The present study compared performance of children with Attention-Deficit/Hyperactivity Disorder (ADHD) and high functioning autism (HFA) with that of controls on 4 tasks assessing 2 components of motor control: motor response inhibition and motor persistence. A total of 136 children (52 ADHD, 24 HFA, 60 controls) ages 7 to 13 years completed 2 measures of motor inhibition (Conflicting Motor Response and Contralateral Motor Response Tasks) and 2 measures of motor persistence (Lateral Gaze Fixation and NEPSY Statue). After controlling for age, IQ, gender, and basic motor speed, children with ADHD performed significantly more poorly than controls on the Conflicting Motor Response and Contralateral Motor Response Tasks, as well as on Statue. In contrast, children with HFA achieved lower scores than controls only on measures of motor persistence, with no concomitant impairment on either motor inhibition task. These results are consistent with prior research that has demonstrated relatively spared motor inhibition in autism. The findings highlight the utility of brief assessments of motor control in delineating the unique neurobehavioral phenotypes of ADHD and HFA.

Perceptuomotor functioning in preschool children with symptoms of attention deficit hyperactivity disorder

Given limited research on perceptual-motor functioning of preschool children with symptoms of ADHD, the purpose of this study was to compare the fine motor, gross motor, visuomotor, and oral-motor functioning of 49 4- to 6-yr.-old children with symptoms of Attention Deficit Hyperactivity Disorder and 48 typically developing children. Analysis showed scores of the ADHD group were significantly lower than those of the control group on all perceptuomotor measures. In addition, scores on all measures yielded significant correlations with scores on the Hyperactive-Inattentive scale of the Preschool Behavior Questionnaire. Regression analyses indicated that the scores of gross motor and visuomotor functioning were significant predictors of group classification (with and without ADHD). These findings extend the well documented findings of perceptuomotor deficits among school-age children with ADHD into the preschool period and emphasize the importance of early assessment and treatment of these deficits in young children with symptoms of ADHD.

Behavioural problems and autism in children with hydrocephalus : a population-based study

OBJECTIVE

To investigate the prevalence of behavioural problems and autism in a population-based group of children with hydrocephalus and to see whether learning disabilities, cerebral palsy (CP), epilepsy, myelomeningocele (MMC) or preterm birth increase the risk of these problems.

METHOD

In the 107 children with hydrocephalus born in western Sweden in 1989-1993, behaviour was assessed using the Conners' parent rating scales in 66 and the teacher's rating scales in 57. Autism was investigated using the Childhood Autism Rating Scale.

RESULTS

Parents rated 67% of the children and teachers 39% of the children as having behavioural problems (>1.5 SD, or T score >65). Learning disabilities increased the risk significantly and almost all the children with CP and/or epilepsy had behavioural problems. Autism was present in nine children (13%), in 20% of those without MMC and in one of 26 with MMC. Autism was significantly more frequent in children with learning disabilities (27% vs. 7%) and in children with CP and/or epilepsy (33% vs. 6%).

CONCLUSION

The majority of children with hydrocephalus have behavioural problems and many have autism. It is therefore important to assess and understand all the aspects of cognition and behaviour in these children in order to minimise disability and enhance participation for the child.

Fine motor skills and effects of methylphenidate in children with attention-deficit-hyperactivity disorder and developmental coordination disorder

The aims of this study were to investigate fine motor skills of children with both attention-deficit-hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) and those of a control group, and to examine the effects of methylphenidate on these skills. A group of 12 children with ADHD-DCD (11 males, one female; mean age 9y 8mo [SD 1y 7mo]) and 12 age- and sex-matched controls (mean age 9y 7mo [SD 1y 2 mo]) participated. The manual dexterity subtests of the Movement Assessment Battery for Children, the concise assessment method for children's handwriting, and a computerized graphomotor task were used. Results demonstrated that children with ADHD-DCD performed more poorly on the manual dexterity subtests, had poorer quality of handwriting, and drew more rapidly, more fluently, but less accurately than controls on the graphomotor task. On methylphenidate, manual dexterity and quality of handwriting improved, and strokes on the graphomotor task became less fluent but more accurate. ADHD is characterized by persistent symptoms of inattention, impulsivity, and hyperactivity, affecting 3 to 5% of school-age children. Up to 50% of children with ADHD also have motor coordination problems that are severe enough to meet criteria for DCD. In DCD, children demonstrate functional motor performance deficits not explained by the child's (chronological) age or intellect, or by other neurological or psychiatric disorders.

Measurement of attention and related functions in the preschool child

The goal of this review of the clinical and research literature is to identify, describe, and critique published methods for assessment of attention and related functions in preschool children (ages 6 and younger). The need for valid assessment of preschool children has grown dramatically in the past two decades following the implementation of special education services for infants, toddlers, and preschoolers under Public Law 99-457. At the same time, the number of preschool children presenting to clinicians for assessment of attention problems has grown at a steady rate. In contrast to assessment methods for school-age children, the availability of reliable and valid measures of attention for preschool children is much more limited. The majority of instruments developed to measure attention in preschoolers are described in the experimental literature, with fewer available commercially. Attention tests that can be appropriately used with children aged 3 and younger are scarce. Most preschool tests of attention report validity data involving sensitivity in contrasting clinical groups to controls, while the literature describing the utility of these measures in differentiating between clinical groups is much more limited. The review provides information on performance based tests (e.g., continuous performance, cancellation, auditory/visual span), as well as parent and teacher rating scales. The review concludes that valid assessment of attention and related skills can be effectively achieved in preschool children, with appropriate cautions.

Characteristics of the sensory-motor, verbal and cognitive abilities of preschool boys with attention deficit/hyperactivity disorder combined type

The purpose of this study is to clarify the characteristics of sensory-motor, verbal and cognitive abilities of preschool boys with attention-deficit/hyperactivity disorder (ADHD) in order to provide information for their treatment and education at preschool age by teachers and professionals. For this purpose, 46 Japanese boys with ADHD-combined type (ADHD-C) whose ages ranged from 45 to 72 months were examined using the Japanese version of the Miller Assessment for Preschoolers (JMAP), and were compared with 46 Japanese boys matched for age and gender in the normative samples that served as the standardizations for the JMAP. The results showed that the ADHD-C group was significantly lower than the normative sample group both on the Total score and on each Index score (P < 0.01) with the exception of the Non-verbal Index. In particular, the number of boys with ADHD-C scoring below the 5th percentile on the Foundation Index (i.e. fundamental sensory-motor tests) was the highest among all index scores. The ADHD-C group had significantly lower scores than the normative sample group in equilibrium, postural control, fine motor of hand and tongue, motor praxis, articulation, memory related to the comprehension of long sentences, and visual construction. Because fundamental sensory-motor abilities were notably lower in the ADHD-C group than in the normative sample group, it is suggested that preschool boys with ADHD-C should be examined and treated for sensory-motor disabilities.

The influence of developmental coordination disorder and attention deficits on associated movements in children

The relationship between associated movements (AMs) and level of motor performance is not well understood. In this study we investigated whether children with developmental coordination disorder (DCD), with (n = 10) and without (n = 10) attention deficit hyperactivity disorder (ADHD), and a control group (n = 10), differed in the severity of AMs. A total AM severity score was obtained for each child by rating their performance on AM tasks. Both groups with motor difficulties had significantly more severe AMs than the control group. A significant correlation was found between level of motor performance and total AM scores (r = -.62). Our results suggest that level of motor performance should be considered in future research attempting to understand individual differences in severity of AMs as a function of motor, learning, and behavioural disorders.

ADHD and DCD: A relationship in need of research

Although the connection between attention deficit hyperactivity disorder (ADHD) and developmental coordination disorder (DCD) has been recognized for several decades, little research has examined the relationship between these two disorders. This paper draws attention to the contribution the cognitive-energetic model (CEM) can make in determining the specific nature of these two disorders. An information processing approach such as the CEM is a useful model to identify specific and overlapping mechanisms that are disrupted in these two disorders. This paper describes the CEM and reviews the research so-far in relation to the model. The CEM has several advantages over other models: First, it predicts which task variables will be independent or may interact, thus enabling the investigator to determine the success/failure of the task manipulation(s) and identify spurious findings. Second, the CEM links energetic factors to task variables and predicts both additive and interactive effects. Third, the CEM enables executive processes such as selective attention, working memory and inhibition to be related to both energetic and lower level processes. Fourth, by employing the CEM in clinical research, taxonomy of deficits can be derived enabling further insight into the nature of the disorders and their specific neuropsychological dysfunction. Suggestions are made for future research into the neuropsychological deficits associated with ADHD and DCD.

Atypical motor and sensory cortex activation in attention-deficit/hyperactivity disorder: a functional magnetic resonance imaging study of simple sequential finger tapping

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) has been shown to be associated with anomalous motor development, including excessive overflow movements. The neurological basis of these deficits has not been established. Functional magnetic resonance imaging (fMRI) was used to determine whether differences in brain activation during sequential finger tapping are present in children with ADHD compared with typically developing control subjects.

METHODS

Twenty-two right-handed children between 8 and 12 years old, 11 with ADHD and 11 typically developing control subjects closely matched for age and gender, performed self-paced sequential finger tapping during fMRI acquisition.

RESULTS

There were no significant between-group differences in speed of sequential finger tapping. The between-group whole-brain comparison showed greater magnitude of activation for control subjects than children with ADHD in the right superior parietal lobe during both right-handed and left-handed finger tapping. The region-of-interest analysis within Brodmann Area 4 revealed that children with ADHD showed a significantly smaller extent of fMRI activation in the primary motor cortex contralateral to the finger-sequencing hand.

CONCLUSIONS

Despite similar speed of sequential finger tapping, children with ADHD showed decreased contralateral motor cortex and right parietal cortex activation during both right-handed finger sequencing (RHFS) and left-handed finger sequencing (LHFS). The fMRI findings suggest that children with ADHD have anomalous development of cortical systems necessary for execution of patterned movements.

Development of multi-agency referral pathways for attention-deficit hyperactivity disorder, developmental coordination disorder and autistic spectrum disorders: reflections on the process and suggestions for new ways of working

This article summarizes the rationale for multi-agency working when assessing children and young people with suspected neurodevelopmental disorders such as attention-deficit hyperactivity disorder, developmental coordination disorder and autistic spectrum disorders. Details of referral pathways that have been drawn up for each separate disorder are given and the process through which multi-agency agreement was reached is described. Key features thought to be common to all three pathways are discussed and factors thought to have contributed to successful multi-agency working highlighted. The work is described in the context of existing national policy documents in the UK.

Childhood onset neuropsychiatric disorders in adult eating disorder patients. A pilot study

BACKGROUND

Autism spectrum disorders (ASD) have been suggested to be overrepresented in anorexia nervosa. This study aimed to explore the comorbidity of ASD and other childhood onset neuropsychiatric disorders (COND) [attention-deficit/hyperactivity disorder (AD/HD) and tic disorders] in a group of severe eating disorder (ED) patients.

METHOD

Thirty female ED patients from a specialist hospital clinic were examined on measures tapping into COND and personality disorders.

RESULTS

In our group of longstanding ED, 53% had at least one COND diagnosis; 23% had ASD, 17% had AD/HD, and 27% had a tic disorder.

CONCLUSIONS

These preliminary data suggest that COND may be common in patients with severe ED and should be kept in mind when treating these patients.

Evaluation and assessment issues in the diagnosis of attention deficit hyperactivity disorder

This article discusses the availability and appropriateness of various assessment techniques for diagnosing ADHD. In terms of the interview/history, the necessity and viability of using formal structured, semi structured, computerized and informal interviews for making an ADHD diagnosis are critiqued. The pros and cons of the various questionnaires frequently used to diagnose ADHD are addressed. The conundrum raised by multiple informants who often disagree is discussed, as are the effects of age and gender. The contributions of the medical and neurological examinations to the diagnosis of ADHD are considered. The utility of a neuropsychological assessment and of continuous performance testing to diagnosis is critiqued. Finally the lack of need for laboratory tests and the lack of necessity of neurological workup, specifically EEG and imaging, are argued.

Cognition in African children with attention-deficit hyperactivity disorder

The aims of the study were: (1) to describe the performance of African children with symptoms of attention-deficit hyperactivity disorder on selected neuropsychologic tests and compare it with performance among peers of the same age without symptoms; (2) to explore through a factor analysis if the selected tests cover the same functions as known from studies in Europe and North America. A nested case-control approach was used to select the two groups of children. The tests were selected to measure aspects of executive functions, attention and memory functions as well as motor skills. A total of 185 schoolchildren (28 cases and 157 control subjects) aged 85 to 119 months old were included. The findings indicate only minor difference between children with symptoms of attention-deficit hyperactivity disorder and control subjects in most of the tasks. However, children with symptoms of attention-deficit hyperactivity disorder performed more poorly on tests of motor skills and had more violations of rules on the planning task. The factor analysis indicated a three-factor model, confirming that the selected tests could be used as measures of executive/motor functions, attention, and memory functions. Similar findings have been reported among children in Europe and North America.

Motor coordination difficulties in a municipality group and in a clinical sample of poor readers

The purpose of the study was to investigate incidence, severity and types of motor problems in two groups of poor readers compared to good reading controls. A group of children with severe dyslexia referred to specialist evaluation, a teacher selected municipality sample comprising the 5% poorest readers, and a control group consisting of the 5% best readers were all assessed applying a norm-based, standardized measure by Henderson and Sugden 1992; (The Movement Assessment Battery for Children. Kent: The Psychological Corporation). The three groups were compared with regard to total motor impairment scores as well as motor function within the areas of manual dexterity, ball-skills and balance. More than 50% of the children in both groups of poor readers showed definite motor coordination difficulties at or below the 5th centile, for which motor intervention is recommended. Children in both groups showed difficulties within the sub-area of manual dexterity in particular and also performed significantly worse than controls within the sub-area of balance, but not in ball-skills. The high incidence of motor coordination problems in the two groups of poor readers indicates that all children with reading difficulties should be screened for possible motor difficulties.

How do children with attention deficit hyperactivity disorder interact in a clinical dental examination? A video analysis

Attention deficit hyperactivity disorder (ADHD) is currently the most common behavioural disorder in school-age children. The aim of this study was to perform a detailed analysis of behavioural interactions between the dentist and the child patient with ADHD. All children born in 1991 (n = 555) in one Swedish municipality were screened for attention and learning problems, and assessed for ADHD. Twenty-two children with ADHD, and a control group of 47 children without attention and learning problems, were included in the study. The dental recall visit was recorded on video. The interaction between the dentist and the child was analysed in detail and scored as verbal and non-verbal initiatives and responses. Compared to the children in the control group, the children with ADHD made significantly more initiatives, especially initiatives that did not focus on the examination or the dentist. The children with ADHD had fewer verbal responses and more missing responses. In conclusion, the problems in communication resulted in less two-way communication between the dentist and the children with ADHD than the interaction between the dentist and the children in the control group. The children with ADHD had particular difficulties staying focused on the examination.

The occurrence of inattention, hyperactivity, impulsivity and coexisting symptoms in a population study of 471 6-8-year old children based on the FTF (Five to Fifteen) questionnaire

OBJECTIVE

To study the usefulness of a new parent questionnaire and to evaluate the prevalence of inattention, hyperactivity, impulsivity and co-existing problems in a group of 6-8-year-old children.

METHOD

A questionnaire comprising 179 three-score-items including the DSM-IV diagnostic symptom criteria on AD/HD and questions on motor function, executive functions, perception, memory, language and speech, learning, social skills and psychiatric problems was used (5-15 questionnaire, FTF). The answers given by parents of 6-8-year-old children in a community in Finland are presented.

RESULTS

The answers for 471 children, 230 boys and 241 girls, revealed a significantly higher rate of problems for boys than for girls in all developmental domains. The number of children with scores exceeding the mean +2 SD for inattention and/or hyperactivity-impulsivity subdomains were 42. About an half of these children had many coexisting problems, when the 90(th) percentile score for each domain was used as a measurement. Of the 42 children 11 fulfilled the DSM-IV symptom list criteria (6/9 for inattention and/or hyperactivity-impulsivity) for AD/HD and 9 children for subthreshold (5/9) AD/HD.

CONCLUSION

A community-based study revealed that 2.3% of 6-8-year-old children had the full symptom list criteria (6/9) of AD/HD according to DSM-IV, and another 1.9 % fulfilled the symptom criteria (5/9) for subthreshold AD/HD. Coexisting problems were common. The severity of symptoms of inattentiveness and hyperactivity-impulsivity correlated significantly with the severity of coexisting problems.

Developmental profiles on the basis of the FTF (Five to Fifteen) questionnaire-clinical validity and utility of the FTF in a child psychiatric sample

The Five to Fifteen parent questionnaire (FTF) was developed to offer a neuropsychological dimension to the assessment of children with Attention Deficit/Hyperactivity Disorder and other child psychiatric disorders. The domains included in the FTF were motor skills, executive functions, perception, memory, language, social skills and learning, in addition to a domain for emotional and behavioural problems. The aim of the present study was to test the clinical validity and utility of the FTF with a main focus on discriminant and criterion validity. The clinical sample consisted of 155 clinically diagnosed children (ICD-10 criteria), 102 were tested with WISC-III. The parents rated their children independent of the diagnostic evaluation. The results were presented as profiles. These clinical profiles were compared to those of a Swedish norm sample consisting of 854 children from the age of five to fifteen. Results demonstrated that the profiles for the clinical groups were similar in forms and levels to those of the upper 10 percent of the norm sample (those with most difficulties). Five out of eight FTF domains discriminated significantly between diagnostic groups in the clinical sample. Influence of IQ, gender and age on the results were low. Three out of four relevant FTF domains correlated significantly with corresponding WISC-III indexes/measures. The clinical utility of individual children's profiles were demonstrated. On the whole, the findings supported the clinical validity and utility of the FTF.

Clinical neuropsychiatric symptoms in perpetrators of severe crimes against persons

The objective of the study was to explore the possibility of common signs and symptoms of childhood-onset neuropsychiatric disorders and personality disorders, especially psychopathy, in a cohort of violent offenders. A structured neuropsychiatric status comprising features recorded in childhood-onset neuropsychiatric disorders and adult personality disorders was assessed in 89 perpetrators of severe crimes against other persons, analysed for factor structure, and compared to clinical diagnostics of neuropsychiatric disorders and independent assessments of psychopathy rated by the Psychopathy Checklist Revised (PCL-R). One or several childhood-onset neuropsychiatric disorders [autism, attention-deficit/hyperactivity disorder (AD/HD), tics and learning disability] affected the majority of adult offenders. A factor analysis yielded four higher-order problem constellations: Executive Dysfunction, Compulsivity, Social Interaction Problems and Superficiality. All four constellations were positively correlated with life histories of aggression, stressing the clinical importance of these problems in adult forensic psychiatry. Compulsivity and Social Interaction Problems were associated with autistic traits and tics, Executive Dysfunction with AD/HD, conduct disorder and psychopathic as well as autistic traits. Superficiality was a distinct aspect of AD/HD and psychopathic traits, especially the PCL-R factor reflecting interpersonal callousness. Neuropsychiatric disorders and personality disorders such as psychopathy share common symptoms. The various facets of psychopathy are associated with executive dysfunction and empathy deficits with superficial understanding of self, others and the rules of communication.

Co-existing disorders in ADHD -- implications for diagnosis and intervention

BACKGROUND

It is only recently that "comorbidity" in ADHD has come to the forefront as one of the most important aspects of the disorder. It is agreed that, often, these problems are at least as important as ADHD in contributing to the longer term outcome in the individual child.

OBJECTIVE

To provide the reader with basic information about clinics and treatment of "comorbidity" in ADHD.

METHOD

Review of the empirically based literature.

RESULTS

ADHD exists in a surprisingly high frequency together with a broad range of child neuropsychiatric disorders. This is accompanied with many still unresolved treatment problems.

CONCLUSION

It would not be appropriate to develop ADHD-services where clinicians would only have expertise in ADHD as such. Anyone working with children, adolescents and adults with ADHD would need to have training in general neuropsychiatry. Further research in this field is urgently needed.

Motorische Ungeschicklichkeit

Zusammenfassung. Das Kind mit koordinativen Problemen in der Motorik benötigt spezielle Aufmerksamkeit im frühen Kindesalter. Rechtzeitige Diagnose und konsequente Intervention der motorischen Ungeschicklichkeit (DCD) wirken sich positiv auf die weitere motorische Entwicklung aus. Darüber hinaus lässt sich durch eine frühe Intervention das psycho-soziale Stigma, das durch ungeschickte Bewegungen sowie dem Problem in Sport und Spiel mit anderen Kindern mitzuhalten, begegnen. Die Möglichkeit für diese Kinder, am Sport mit Gleichaltrigen teilzuhaben, hilft ihnen in ihrer Sozialisation. Das Ziel dieses Überblicksbeitrages ist es, motorische Ungeschicklichkeit zu definieren, typische Erscheinungsformen, Diagnosekriterien sowie bestehende Therapien vorzustellen.

A retrospective study of dental behavior management problems in children with attention and learning problems

Attention and learning problems in children are common. The aim of this study was to investigate whether children with attention and learning problems had more dental behavior management problems (BMP), more cancelled and missed appointments, and more traumatic dental injuries compared with a control group. All children born in 1991 attending mainstream schools (n = 555) in one Swedish municipality were screened for behavioral and learning problems. Conners' 10-item questionnaire and a questionnaire focused on executive and learning problems were used. A total of 128 screen-positive patients were index cases and 131 screen-negative patients control cases. The dental records of these children were studied from 1 yr of age until the child reached 10 yr. Behavior management problems on at least one occasion were more common in the index group (54% vs. 37%). The percentage of appointments at which the children exhibited BMP was higher in the index group (13% vs. 7%). No differences were found for cancelled or missed appointments or dental traumatic injuries between the two groups. In conclusion, the results of this study show that children with attention and learning problems had significantly more dental behavior management problems compared with a control group.

Attention-deficit hyperactivity disorder (ADHD)

Approaches to the diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) are undergoing a major change as a result of information from studies on the genetics of ADHD and the use of new neuroimaging technologies. Moreover, pharmacogenomics, although still in its infancy, will provide a basis for much more sophisticated treatment strategies for ADHD, particularly once more information is available about the genetics of ADHD. Even at this point in time, there is some pertinent information available that, although not ready for application in clinical settings, nonetheless provides a broader perspective for the clinician. In terms of etiology, ADHD is a neuropsychiatric disorder. There is a genetic basis in about 80% of the cases, involving a number of different genes, and in about 20% of the cases, ADHD is the result of an acquired insult to the brain. Some individuals likely have both genetic and acquired forms. Although medication works well in many cases of ADHD, optimal treatment of ADHD requires integrated medical and behavioral treatment. The family plays a crucial role in the management of children with ADHD. Because there is often a very high degree of comorbidity between ADHD and learning disabilities, teachers also have a great deal to contribute in the day-to-day management of these children. Early recognition and treatment prevent the development of more serious psychopathology in adolescence and adulthood.

Relationship between motor proficiency, attention, impulse, and activity in children with ADHD

The aim of this study was to investigate the relationship between motor performance, attention deficit, impulsiveness, and hyperactivity in children with attention-deficit--hyperactivity disorder (ADHD). Participants were 42 school-aged children with ADHD (36 males, 6 females; mean age 8 years 2 months, SD 1 year 2 months; range 6 years to 11 years), and 42 age- and sex-matched children without ADHD (mean age 8 years 3 months, SD 1 year 1 month; range 6 years to 11 years). Motor abilities were assessed with the Bruininks-Oseretsky Test of Motor Proficiency. Attention and impulse control were measured with the Gordon Diagnostic System, and assessment of activity level was based on two Activity Level Rating Scales that were completed by parents and teachers. Analysis by t-test revealed a significant difference between children with and without ADHD in fine and gross motor skills, impulse control, and attention. Stepwise regression indicated that attention, impulse control, and parent ratings of activity level were the three best predictors of gross motor skills for children with ADHD, accounting for 55.9% of the variance. Attention and impulse control were the two best predictors of fine motor skills, accounting for 45.7% of the variance. Attention and impulse control were consistently found to be important predictors of both fine and gross motor skills in children with ADHD. However, the fact that activity level was a predictor for gross motor proficiency but not for fine motor tasks suggests that different behavioral processes are involved in fine and gross motor performance to different extents.

Linkage of the dopamine receptor D1 gene to attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) has a strong genetic basis, and evidence from human and animal studies suggests the dopamine receptor D1 gene, DRD1, to be a good candidate for involvement. Here, we tested for linkage of DRD1 to ADHD by examining the inheritance of four biallelic DRD1 polymorphisms [D1P.5 (-1251HaeIII), D1P.6 (-800HaeIII), D1.1 (-48DdeI) and D1.7 (+1403Bsp1286I)] in a sample of 156 ADHD families. Owing to linkage disequilibrium between alleles at the four markers, only three haplotypes are common in our sample. Using the transmission/disequilibrium test (TDT), we observed a strong bias for transmission of Haplotype 3 (1.1.1.2) from heterozygous parents to their affected children (P=0.008). Furthermore, using quantitative trait TDT analyses, we found significant and positive relationships between Haplotype 3 transmission and the inattentive symptoms, but not the hyperactive/impulsive symptoms, of ADHD. These findings support the proposed involvement of DRD1 in ADHD, and implicate Haplotype 3, in particular, as containing a potential risk factor for the inattentive symptom dimension of the disorder. Since none of the four marker alleles comprising Haplotype 3 is predicted to alter DRD1 function, we hypothesize that a functional DRD1 variant, conferring susceptibility to ADHD, is on this haplotype. To search for such a variant we screened the DRD1 coding region, by sequencing, focusing on the children who showed preferential transmission of Haplotype 3. DNA from 41 children was analysed, and no sequence variations were identified, indicating that the putative DRD1 risk variant for ADHD resides outside of the coding region of the gene.

Overflow movements predict impaired response inhibition in children with ADHD

Neurologic models proposed to explain mechanisms underlying ADHD have emphasized deficits in response inhibition. Age-inappropriate overflow movements, e.g., mirror movements, are motor signs thought to reflect immaturity in cortical systems involved in automatically (unconsciously, without explicit effort) inhibiting extraneous movement. We investigated the hypothesis that the presence of excessive overflow movements would predict measures of conscious, effortful response inhibition (conflicting and contralateral motor response tests) in children with ADHD. 42 children with ADHD and 30 controls, ages 8 through 12 years, participated. Children with ADHD showed significantly more overflow movements than did controls and made more errors on the conflicting and contralateral motor response tests. Multiple linear regression analysis indicated that overflow movements predicted performance on measures of motor response inhibition. For one of those measures, the contralateral motor response test, there was a significant interaction with diagnosis, such that overflow predicted response inhibition in ADHD but not in controls. The findings suggest that overflow movements, which can be readily observed as part of clinical examination, are more evident in children with ADHD. Positive correlations between measures of overflow movements and measures of response inhibition suggest that closely associated neural mechanisms underlie these deficits and support hypotheses that age-inappropriate overflow reflects immaturity of cortical systems involved in automatic inhibition.

Motor co-ordination in a South Indian population of children

AIMS

To examine the associations of motor co-ordination in Kerala, South India.

METHODS

The Modified Oseretsky Test of motor co-ordination was administered to 1155 representative children during a door-to-door survey of 8-12 year olds. Reading, vocabulary and visuospatial reasoning were measured, as were height and weight. Information on medical history, socio-demographic background and behaviour was systematically collected.

RESULTS

Age was the major association of motor incoordination indicating the importance of maturation. Behaviour, vocabulary, visuospatial reasoning, material deprivation, perinatal complications, chronic physical symptoms and occupational status of the father were also independently associated with motor co-ordination. Using sibling pairs, evidence of familial aggregation of motor co-ordination was found.

Adult psychopathic personality with childhood-onset hyperactivity and conduct disorder: a central problem constellation in forensic psychiatry

To describe lifetime mental disorders among perpetrators of severe inter-personal crimes and to identify the problem domains most closely associated with aggression and a history of repeated violent criminality, we used structured interviews, clinical assessments, analyses of intellectual functioning, medical and social files, and collateral interviews in 100 consecutive subjects of pretrial forensic psychiatric investigations. Childhood-onset neuropsychiatric disorders [attention-deficit/hyperactivity disorder (AD/HD), learning disability, tics and autism spectrum disorders] affected 55% of the subjects and formed complex comorbidity patterns with adult personality disorders [including psychopathic traits according to the Psychopathy Checklist (PCL-R)], mood disorders and substance abuse. The closest psychiatric covariates to high Lifetime History of Aggression (LHA) scores and violent recidivism were the PCL-R scores and childhood conduct disorder (CD). Behavioral and affective PCL-R factors were closely associated with childhood AD/HD, CD, and autistic traits. The results support the notion that childhood-onset social and behavioral problems form the most relevant psychiatric symptom cluster in relation to pervasive adult violent behavior, while late-onset mental disorders are more often associated with single acts of violent or sexual aggression.

Deficits in attention, motor control, and perception: a brief review

The concept of DAMP (deficits in attention, motor control, and perception) has been in clinical use in Scandinavia for about 20 years. DAMP is diagnosed on the basis of concomitant attention deficit/hyperactivity disorder and developmental coordination disorder in children who do not have severe learning disability or cerebral palsy. In clinically severe form it affects about 1.5% of the general population of school age children; another few per cent are affected by more moderate variants. Boys are overrepresented; girls are currently probably underdiagnosed. There are many comorbid problems/overlapping conditions, including conduct disorder, depression/anxiety, and academic failure. There is a strong link with autism spectrum disorders in severe DAMP. Familial factors and pre- and perinatal risk factors account for much of the variance. Psychosocial risk factors appear to increase the risk of marked psychiatric abnormality in DAMP. Outcome in early adult age was psychosocially poor in one study in almost 60% of unmedicated cases. There are effective interventions available for many of the problems encountered in DAMP.

On the Intersection Between AD/HD and DCD: The DAMP Hypothesis

The paper by Gillberg, 'ADHD and DAMP', provides an analysis of the scientific status of the concept of Deficits in Attention Motor Control and Perception (DAMP) in the light of the overlap between Attention Deficit/Hyperactivity Disorder (AD/HD) and Developmental Co-ordination Disorder (DCD), and the current uncertainty surrounding the significance of AD/HD - DCD co-morbidity.

Fine and gross motor ability in males with ADHD

In the this study, both fine and gross motor ability of males with attention-deficit-hyperactivity disorder (ADHD) were compared with a group of control children. Three groups of males with the following ADHD subtypes: predominantly inattentive (ADHD-PI; n = 50), hyperactive/impulsive (ADHD-HI; n = 16), or combined (ADHD-C; n = 38) were compared with 39 control males. Mean ages for the control group were 10 years 4 months (SD 1 year 4 months, range 7 years 8 months to 12 years 11 months); for the ADHD-PI group, 10 years (SD 1 year 2 months, range 7 years 10 months to 13 years); for the ADHD-HI group, 9 years 11 months (SD 1 year 2 months), range 7 years 11 months to 12 years 6 months); and for the ADHD-C group 10 years 2 months (SD 1 year 4 months, range 8 to 13 years). The Australian Disruptive Behaviours Scale and Connors' Parent Rating Scale-Revised were used to assess ADHD symptomatology. Verbal IQ was estimated using two verbal subtests of the Wechsler Intelligence Scale for Children, and movement ability was assessed using the Movement Assessment Battery for Children (MABC) and the Purdue Pegboard test. Findings demonstrated that the children with ADHD had significantly poorer movement ability than control children. A high percentage of these children displayed movement difficulties consistent with developmental coordination disorder (DCD). In addition, the current study found that the type and degree of movement difficulty differed between subtypes. The Total Impairment score, as derived from the MABC, was less severe for the ADHD-HI group than the other two ADHD groups, but more severe than for the control group. Males with ADHD-PI and ADHD-C had significantly poorer fine motor ability (p < 0.001) than control males, whereas the ADHD-HI group did not differ significantly from any of the other groups. As children with ADHD only and the control group did not differ significantly on fine motor ability but were significantly better than children categorized with both ADHD and DCD, it was argued that poorer fine motor ability found in children with ADHD could not be attributed to deficits in attention and concentration, but rather to factors relating to their motor ability.

Developmental coordination disorder: associated problems in attention, learning, and psychosocial adjustment

This study investigated the problems of attention, learning and psychosocial adjustment evidenced by children with developmental coordination disorder (DCD). Forty-five children identified with DCD, 51 children identified as being suspect for DCD and 78 comparison children without motor problems on standardized tests of motor function participated in this study. Results revealed that both children with DCD and children suspect for DCD obtained significantly poorer scores on measures of attention and learning (reading, writing and spelling) than comparison children. Children with DCD and those suspect for DCD were also found to evidence a relatively high level of social problems and display a relatively high level of somatic complaints based on parent report. These findings indicate that all children with movement problems are at risk for problems in attention, learning and psychosocial adjustment. Assessment of children with movement problems, regardless of the degree or severity of these problems should examine a wide range of functions in addition to motor functioning. Such an approach, would assist in determining the types of intervention that would provide the most benefit to these children.

Neurodevelopmental status at 1 year predicts neuropsychiatric outcome at 14-15 years of age in very preterm infants

BACKGROUND

Neurodevelopmental and behavioural problems have been repeatedly reported in very preterm survivors, often showing themselves later in childhood as poor school performance. Early identification of problems would mean that appropriate remedial therapy can be implemented. We have previously shown that neurodevelopmental status at 1 year was predictive of outcome at 8 years in a cohort of preterm infants. The aim of this paper was to see if neurodevelopmental outcome in adolescence could be predicted by assessment by 1 year in the same cohort of preterm infants.

STUDY DESIGN

Prospective cohort study.

SUBJECTS

150 adolescents, born before 33 weeks gestation.

OUTCOME MEASURES

Neurological examination, developmental quotient, vision and hearing by 1 year. At 14-15 years, neurological examination, school performance questionnaire, Schonnell test of reading age, a premorbid adjustment score, Rutter behavioural score and for those born from 1981, cognitive tests (WISC-R).

RESULTS

A highly significant relationship existed between neurological status by 1 year and the need for extra educational provision, overall neurodevelopmental status, cognitive function in those that had their IQs measured and premorbid adjustment score of prepsychotic symptoms in adolescence. However, status at 1 year was not predictive of adolescent reading age or behavioural score.

CONCLUSIONS

Neurodevelopmental assessment at 1 year is predictive of school performance and outcome in the adolescent period.

The term comorbidity is of questionable value in reference to developmental disorders: data and theory

Over the last decade, there has been an enormous increase in the number of studies evaluating the overlap of developmental syndromes or disorders in both children and adults. This overlap of symptoms is often referred to as comorbidity, a term we criticize in this article because of its unsubstantiated presumption of independent etiologies. The premise of this article is that discrete categories do not exist in real life, and that it is misleading to refer to overlapping categories or symptoms as "comorbidities." We illustrate our point by presenting data from 179 school-age children evaluated with rigorous research criteria for seven disorders: reading disability (RD), attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD), oppositional defiant disorder (ODD), conduct disorder (CD), depression, and anxiety. Fully 50% of this sample met the criteria for at least two diagnoses. The children with ADHD were at higher risk of having at least a second disorder compared to the children with RD. Overall, the high rates of overlap of these behavioral, emotional, and educational deficits in this broadly ascertained sample support the idea that the concept of comorbidity is inadequate. We discuss the concept of atypical brain development as an explanatory idea to interpret the high rate of overlap of developmental disorders.

ADHD in Swedish 3- to 7-year-old children

OBJECTIVE

To study characteristics of attention-deficit/hyperactivity disorder (ADHD) in a representative group of clinically impaired young children in Sweden with the disorder.

METHOD

One hundred thirty-one children with ADHD (aged 3-7 years) were examined, and their parents were interviewed. Independent parent questionnaire data (Child Behavior Checklist, ADHD Rating Scale-IV, Conners) were collected. For comparison 131 children without ADHD were matched for age, gender, parents' marital status, child's adoption status, and social class.

RESULTS

Children with ADHD had extremely high ADHD symptom levels--on average four to eight times higher than the comparison group. Sociodemographic correlates of ADHD symptoms were more pronounced in parent questionnaire data than in parent interview data, underscoring the importance of diagnostic interview when dealing with clinical issues. Very few of the children with ADHD (6%) appeared "normal" with regard to attention/activity level at clinical examination.

CONCLUSIONS

Clinic children with a diagnosis of DSM-IV ADHD have typical and impairing symptoms already before starting school. The variance of ADHD in this age group appears to be accounted for by primary psychosocial factors only to a limited degree. It would seem reasonable to establish supportive and treatment measures for these young children so that the psychosocial and academic problems shown by so many individuals with ADHD later in their development might be reduced.

A pilot trial of a cognitive treatment for children with developmental coordination disorder

This pilot study compared a new treatment approach, the Cognitive Orientation to daily Occupational Performance (CO-OP) to the Contemporary Treatment Approach (CTA) to treating children with Developmental Coordination Disorder (DCD). CO-OP emphasises problem-solving strategies and guided discovery of child and task specific strategies. CTA encompasses a variety of approaches, such as neuromuscular, multi-sensory, and biomechanical, focusing on motor aspects of skill acquisition. Twenty children with a mean age of 9.05 years (S.D. = 1.23) participated in the study. All children had normal intelligence, scored below the 15th percentile on a standardised test of motor ability, and demonstrated motor difficulties significant enough to warrant referral for treatment. Pre- and post-measures included the Canadian Occupational Performance Measure (COPM), the Vineland Adaptive Behavior Scales (VABS), the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), the Developmental Test of Visual-Motor Integration-Revised (VMI), the motor items of the Self-Perception Profile for Children (SPPC), and the Performance Quality Rating Scale (PQRS). In both groups, treatment goals were child-chosen. Both treatments lead to improved COPM self-ratings of performance and satisfaction; however, improvements in the CO-OP group were greater than those in the CTA group. These results were paralleled by PQRS scores, and the Motor scores on the VABS, but not on the BOTMP measures. This outcome still needs replication as no control group was involved and because of the occurrence of pre-treatment differences between the CO-OP and CTA groups on relevant measures. Follow-up data indicated that children who received CO-OP tended to experience greater long-term maintenance of their motor goals and acquired strategies; follow-up parent-report rated CO-OP treatment as more useful than CTA treatment. Self-report, observer report, standardised assessment, and follow-up all demonstrated the effectiveness of the CO-OP approach, supporting the use of CO-OP and suggesting further investigation of this new cognitive intervention.

Clinical and research diagnostic criteria for developmental coordination disorder: a review and discussion

The aim of this review was to investigate the selection criteria used in the past in studies of children with developmental motor problems (excluding those suffering from neurological dysfunctions such as cerebral palsy, muscular dystrophy, etc.). We therefore conducted an extensive analysis of 176 publications. First, an overview of the main characteristics of these studies (terminology, population, type and purpose) and the selection criteria that are reported in these publications are presented. Following this, the DSM-IV selection criteria for developmental coordination disorder (DCD) are contrasted with the selection criteria reported in 41 publications that have used this terminology to classify the children. The results of this comparison show that the inclusion criteria are largely followed, albeit with little consistency concerning selection instruments and quantitative cut-offs, while adherence to the exclusion criteria is not common practice. Strengths and weaknesses of the DSM-IV criteria, complementary to the previous discussion by Henderson and Barnett in the HMS special issue on DCD in 1998 on this same topic, are discussed. The results of the review also show that many studies have used additional selection criteria related to the specific research questions of the study concerned. In the broader context of clinical practice as well as basic research, the latter result suggests the usefulness of a distinction between Clinical Diagnostic Criteria and Research Diagnostic Criteria. This distinction helps to develop a unifying view on the use of diagnostic criteria for research and clinical practice. We conclude with a number of recommendations concerning the selection criteria for children with DCD.