Infant Motor Delay and Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations in Japan

Visuomotor tracking strategies in children: associations with neurodevelopmental symptoms

Children with neurodevelopmental disorders (NDDs) often display motor problems that may impact their daily lives. Studying specific motor characteristics related to spatiotemporal control may inform us about the mechanisms underlying their challenges. Fifty-eight children with varying neurodevelopmental symptoms load (median age: 5.6 years, range: 2.7-12.5 years) performed an interactive tablet-based tracking task. By investigating digit touch errors relative to the target's movement direction, we found that a load of neurodevelopmental symptoms was associated with reduced performance in the tracking of abrupt alternating directions (zigzag) and overshooting the target. In contrast, reduced performance in children without neurodevelopmental symptoms was associated with lagging behind the target. Neurodevelopmental symptom load was also associated with reduced flexibility in correcting for lateral deviations in smooth tracking (spiral). Our findings suggest that neurodevelopmental symptoms are associated with difficulties in motor regulation related to inhibitory control and reduced flexibility, impacting motor control in NDDs.

The Use of the Alberta Infant Motor Scale (AIMS) as a Diagnostic Scale for Infants with Autism

Autism spectrum disorder (ASD) is a group of developmental disabilities presenting difficulties in social interaction and language and an increased occurrence of cognitive, sensory, and motor gaps. Early intervention has been reported to improve the function of children with ASD. However, motor screening for children with ASD is difficult, as there are no specific tools for identifying this specific population. This study reports the results of using the Alberta Infant Motor Scale (AIMS), which assesses gross infant motor skills from ages 0 to 18 months, as a screening tool for detecting motor developmental delay (MDD) in small children with ASD. Methods: This retrospective cohort study included all children registered at one health care organization in Israel born between 2011 and 2017 (N = 240,299). Early childhood MDD was defined as having at least one recorded developmental physiotherapy (DPT) visit before the age of 2 years. Reasons for referral to DPT and the results of using AIMS as an appropriate tool for revealing developmental delays in infants with ASD are presented. Results: ASD diagnosis was reported in 1821 children (prevalence rate 0.75%). Of those, 388 (odds ratio 4.1, 95% CI 3.6–4.6) children were referred to DPT. Children with ASD mostly received DPT for motor delays (46.19%), torticollis (19.52%), developmental delay (15.48%), and preterm birth (7.38%). The use of AIMS as an early detection tool suggests that more than 87% of children with ASD and MDD present with a developmental delay or risk for one when using this scale. Conclusions: The prevalence of ASD among children referred to DPT for MDD is higher than its prevalence within the general population. The most common reasons for a child with ASD to be referred for DPT services are MMDs. AIMS was found to be a sensitive tool to pinpoint relevant candidates for ASD screening among children treated in DPT. Possible effects of the study: The use of AIMS as a relevant assessment scale for this group of clients is recommended. Training DPTs in identifying initial ASD signs and developing their clinical reasoning abilities will increase the chance of implementing early intervention with this group of clients.

Family wellbeing in general practice: a study protocol for a cluster-randomised trial of the web-based resilience programme on early child development

BACKGROUND

Social, emotional and behavioural problems in early childhood are associated with increased risk for a wide range of poor outcomes associated with substantial cost and impact on society as a whole. Some of these problems are rooted in the early mother-infant relationship and might be prevented. In Denmark, primary health care has a central role in preventive care during pregnancy and the first years of the child's life and general practice provides opportunities to promote a healthy mother-infant relationship in early parenthood.

OBJECTIVE

In the context of standardised antenatal and child development assessments focused on psychosocial wellbeing, we examine the impact of a complex intervention designed to improve maternal mentalisation skills, involving training of general practice clinicians and signposting towards a web-based resource. Joint main outcomes are child socio-emotional and language development at age 30 months measured by parentally reported questionnaires (Communicative Development Inventory and Strengths and Difficulties Questionnaire).

METHODS

The study is a cluster-randomised controlled trial based in general practices in the Capital Region and the Zealand Region of Denmark. Seventy practices were included. Practices were randomised by a computer algorithm in a ratio of 1:1 to intervention or control groups. Each practice was asked to recruit up to 30 women consecutively at their first scheduled antenatal assessment. Clinicians in both groups received one day of training in preventive antenatal and child development consultations with added focus on parental psychosocial well-being, social support, and parent-child interaction. These preventive consultations delivered in both trial arms require enhanced data recording about psychosocial factors. In intervention clinics, clinicians were asked to signpost a web page at three scheduled antenatal consultations and at four scheduled consultations when the child is 5 weeks, 5 months, 1 and 2 years.

DISCUSSION

We hypothesise that the intervention will increase mothers' ability to be sensitive to their child's mental state to an extent that improves the child's language and mental state at 30 months of age measured by parent-reported questionnaires.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04129359. Registered on Oct 16 2019.

[Formula: see text]Is active video gaming associated with improvements in social behaviors in children with neurodevelopmental disorders: a systematic review

Active video gaming (AVG) is a way that children with neurodevelopmental disorders can participate in social play and could be associated with improvements in social behaviors. However, limited research has investigated if AVG is associated with improvements in social behaviors in children and adolescents with neurodevelopmental disorders. A systematic literature search was conducted in Medline, Embase, Psycinfo, Cinahl, and Eric, Web of Science, and Scopus. Three main concepts were searched: exergaming, neurodevelopmental disorders, and social behaviors. Keywords and subject headings were used for each concept. 3080 articles were identified in the initial search in 2019; in January 2021, 167 additional articles were identified. Of these, 8 studies with 242 children with autism spectrum disorder, cerebral palsy, or developmental coordination disorder were included in this review. Six studies reported that participation in AVG was associated with improved social functioning, social interaction, emotional well-being, and social/emotional skills in children with ASD, CP, and DCD. In contrast, two studies that included children diagnosed with ASD did not find any association between AVG participation and social behaviors. The findings of this systematic review suggest that participation in an AVG intervention may be associated with improved social behaviors in children and adolescents with ASD, CP, and DCD. However, due to the limited number of studies included, this finding must be interpreted with caution. Future research is needed that examines the treatment fidelity of AVG in improving social behavior skills in children with neurodevelopmental disorders and the generalizability of these skills to real-life social situations.

Dynamics of changes in motor development depending on the quality in the 3rd month of life

The aim of the study was to show that the quantitative and qualitative motor development from the 3rd month of life is key to achieving milestones and that it may be an early warning signal in children at risk of cerebral palsy (CP). The study population included 93 children (69 born at term). Children were born at week 38 ± 4, the mean body weight was 3,102 ± 814 g. All children were evaluated after reaching the 3rd month of life (quantitative and qualitative assessment), and then the 4.5th, 7th, and 12th of life (quantitative assessment). In case of suspected CP, children were followed until the 18th month, when the diagnosis was confirmed. If at the age of 3 months, a child achieved a quadrangle of support and symmetrical support, then its development at the 4.5th month of life was correct, it would creep, and it would assume a crawl position, then in the final assessment (12th month of life), the child would start to walk. If a child failed to achieve a quadrangle of support and symmetrical support and the dynamics of its development were incorrect, the development would be delayed (12th month of life), or CP would develop. A correct qualitative assessment in the 3rd month of life with a high probability guarantees corrects quantitative development at the 4.5th, 7.5th, and 12th months of life. If the qualitative assessment in the 3rd month of life was very low the child would probably be diagnosed with CP at 18 months.

How Accurately Does the Information on Motor Development Collected During Health Checkups for Infants Predict the Diagnosis of Neurodevelopmental Disorders? - A Bayesian Network Model-Based Study

PURPOSE

We investigated to what extent early motor development problems predict a future diagnosis of neurodevelopmental disorders (NDDs)/Early Symptomatic Syndromes Eliciting Neurodevelopmental Examinations (ESSENCE) by using a Bayesian network model (BN).

SUBJECTS AND METHODS

Subjects were the children who had participated in the 18- and 36-month checkups in two cities in Japan between April 2014 and March 2015. Their motor development data at the 4-, 10- and 18-month-checkups were collected with ethical consideration. The diagnosis was confirmed at the age of six, after regular assessment in all developmental areas at a neurodevelopmental clinic. The accuracy of prediction of NDD based on posterior probabilities determined using the BN was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The posterior probability (the optimal cut-off value) yielding the maximum Youden Index (sensitivity + specificity - 1) is determined with the ROC curve, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and utility index (UI) were computed.

RESULTS

BN models showed associations between early motor items and developmental coordination disorders, borderline intelligence/intellectual disability, and speech and language disorder. The ROC curve for any NDD had an AUC of 0.735. The posterior probability with the maximal Youden Index was 0.138; at the optimal cut-off value, the sensitivity, specificity, PPV, NPV, UI+, and UI- were 0.619, 0.761, 0.250, 0.940, 0.155 and 0.715, respectively.

CONCLUSION

We utilized a novel approach in detailing the associations between certain early motor problems and specific NDDs. We showed that the presence of motor development problems early in development increases the probability of a future diagnosis of any NDD. Still, the sensitivity of early motor development problems as a screening tool was not high enough to be the sole instrument for detecting NDDs. The need for a broad, holistic ESSENCE perspective when looking at the course of motor development problems was stressed.

Early Motor Function of Children With Autism Spectrum Disorder: A Systematic Review

CONTEXT

Early motor impairments have been reported in children with neurodevelopmental disorders (NDD), but it is not clear if early detection of motor impairments can identify children at risk for NDD or how early such impairments might be detected.

OBJECTIVE

To characterize early motor function in children later diagnosed with NDD relative to typically developing children or normative data.

DATA SOURCES

The Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, PsycINFO, and Scopus electronic databases were searched.

STUDY SELECTION

Eligible studies were required to include an examination of motor function in children (0-24 months) with later diagnosis of NDD by using standardized assessment tools.

DATA EXTRACTION

Data were extracted by 4 independent researchers. The quality of the studies was assessed by using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields checklist.

RESULTS

Twenty-five studies were included in this review; in most of the studies, the authors examined children with later autism spectrum disorder (ASD). Early motor impairments were detected in children later diagnosed with ASD. The meta-analysis results indicated that differences in fine, gross, and generalized motor functions between the later ASD and typically developing groups increased with age. Motor function across different NDD groups was found to be mixed.

LIMITATIONS

Results may not be applicable to children with different types of NDD not reported in this review.

CONCLUSIONS

Early motor impairments are evident in children later diagnosed with ASD. More research is needed to ascertain the clinical utility of motor impairment detection as an early transdiagnostic marker of NDD risk.

Age of First Walking and Associations with Symptom Severity in Children with Suspected or Diagnosed Autism Spectrum Disorder

Age of first walking (AOW) is reported to be later in autism spectrum disorder (ASD) compared with typical development. However, the relationship between AOW and variations in ASD symptoms across different neurodevelopmental disorders is largely unknown. This study investigated AOW and its association with autism symptom severity in a large sample of children (N = 490, 23% females) clinically evaluated for suspected ASD, differentiated into ASD (n = 376) and non-ASD (n = 114) diagnoses. Children with ASD achieved independent walking significantly later than children with non-ASD diagnoses. AOW was significantly associated with ASD symptom severity, and females had a non-significant later AOW. The current findings suggest that in cases with delayed AOW, ASD should be considered as an actual differential diagnosis, perhaps particularly in girls.

Psychometric properties of observational tools for identifying motor difficulties - a systematic review

BACKGROUND

Early identification of children with motor difficulties, such as developmental coordination disorder (DCD), is essential. At present only a fraction of children with DCD are identified. The purpose of the study was to systematically review the literature from 1994 to 2017 on observational screening tools and to evaluate the validity, reliability and usability of the questionnaires used.

METHODS

The review of the literature was conducted to synthesize the data from five electronic databases for children aged 6-12 years. The following databases were searched: Academic search Elite (EBSCO), ERIC (ProQuest), MEDLINE (Ovid), PsycINFO (ProQuest), and SPORTDiscus with Full Text (EBSCO). The studies meeting our inclusion criteria were analyzed to assess the psychometric properties and feasibility of the measures.

RESULTS

The literature search retrieved 1907 potentially relevant publications. The final number of studies that met the inclusion criteria of our systematic review was 45. There were 11 questionnaires for parents, teachers and children. None of the questionnaires was valid for population-based screening as the only measurement tool.

CONCLUSIONS

There are many challenges in using initial screening tools to identify children with motor difficulties. Nevertheless, many promising questionnaires are being developed that can provide information on functional skills and limitations across a variety of tasks and settings in the daily lives of children with DCD. The review provides much needed information about the current scales used in many clinical, educational and research settings. Implications for assessing psychometric properties of the developed questionnaires and further research are discussed.

TRIAL REGISTRATION

PROSPERO, CRD42018087532 .

Phase 3 diagnostic evaluation of a smart tablet serious game to identify autism in 760 children 3-5 years old in Sweden and the United Kingdom

INTRODUCTION

Recent evidence suggests an underlying movement disruption may be a core component of autism spectrum disorder (ASD) and a new, accessible early biomarker. Mobile smart technologies such as iPads contain inertial movement and touch screen sensors capable of recording subsecond movement patterns during gameplay. A previous pilot study employed machine learning analysis of motor patterns recorded from children 3-5 years old. It identified those with ASD from age-matched and gender-matched controls with 93% accuracy, presenting an attractive assessment method suitable for use in the home, clinic or classroom.

METHODS AND ANALYSIS

This is a phase III prospective, diagnostic classification study designed according to the Standards for Reporting Diagnostic Accuracy Studies guidelines. Three cohorts are investigated: children typically developing (TD); children with a clinical diagnosis of ASD and children with a diagnosis of another neurodevelopmental disorder (OND) that is not ASD. The study will be completed in Glasgow, UK and Gothenburg, Sweden. The recruitment target is 760 children (280 TD, 280 ASD and 200 OND). Children play two games on the iPad then a third party data acquisition and analysis algorithm (Play.Care, Harimata) will classify the data as positively or negatively associated with ASD. The results are blind until data collection is complete, when the algorithm's classification will be compared against medical diagnosis. Furthermore, parents of participants in the ASD and OND groups will complete three questionnaires: Strengths and Difficulties Questionnaire; Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations Questionnaire and the Adaptive Behavioural Assessment System-3 or Vineland Adaptive Behavior Scales-II. The primary outcome measure is sensitivity and specificity of Play.Care to differentiate ASD children from TD children. Secondary outcomes measures include the accuracy of Play.Care to differentiate ASD children from OND children.

ETHICS AND DISSEMINATION

This study was approved by the West of Scotland Research Ethics Service Committee 3 and the University of Strathclyde Ethics Committee. Results will be disseminated in peer-reviewed publications and at international scientific conferences.

TRIAL REGISTRATION NUMBER

NCT03438994; Pre-results.

Additive effect of congenital heart disease and early developmental disorders on attention-deficit/hyperactivity disorder and autism spectrum disorder: a nationwide population-based longitudinal study

In this retrospective nationwide population-based case-control study, we investigated the impact of congenital heart disease (CHD) on the development of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), which remains unclear. Children aged <18 years that were diagnosed with CHD (n = 3552) between January 1, 1997 and December 31, 2009 were identified from the National Health Insurance Research Database in Taiwan. Non-CHD controls (n = 14,208) matched for age and sex (1:4) were selected from the same dataset. All subjects were observed until December 31, 2011 or their death. Comorbid perinatal conditions and early developmental disorders (EDD) that were diagnosed before ADHD and ASD diagnosis were also analyzed. The incidence rates of perinatal comorbidities, EDD, ADHD, and ASD were higher in the CHD group than in the control group. Multivariate Cox regression analysis revealed that the CHD group had an increased risk of developing ADHD (adjusted hazard ratio [aHR] 2.52, 95% confidence interval CI 1.96-3.25) and ASD (aHR 1.97, 95% CI 1.11-3.52) after adjusting for confounding comorbidities. EDD, but not perinatal comorbidities were also independent risk factors for ADHD and ASD after adjustment. Subgroup analysis indicated that the risk for ADHD (HR 16.59, 95% CI 12.17-22.60) and ASD (HR 80.68, 95% CI 39.96-176.12) was greatly increased in CHD subjects with EDD than in non-CHD subjects without EDD. These findings suggested that CHD at birth and EDD during early childhood were two independent risk factors for ADHD and ASD and that concurrent CHD and EDD might additively increase these risks.

Early motor delays as diagnostic clues in autism spectrum disorder

Early identification of autism facilitates referral for early intervention services, shown to be effective in enhancing parent-child interaction as well as adaptive behavior, communication, and socialization. Traditional hallmarks for the diagnosis of autism spectrum disorder (ASD) include deficits in social communication and social interaction as well as stereotypic or repetitive behavioral patterns. Research during the past decade suggests that developmental motor delays during early childhood may also be important predictors of this difficult-to-make diagnosis. The purpose of this short communication is to describe specific research findings about developmental motor delays and other neuromotor concerns that may contribute to the early diagnosis of ASD and thus hasten referral for early therapeutic intervention.

CONCLUSION

In that there is reasonable consensus that motor delays during the first year of life may represent a prodrome of ASD, pediatricians should not rule out the possibility of ASD in infants with concerning motor behaviors. What is Known: • Early identification of autism facilitates referral for early intervention services. • Traditional hallmarks for diagnosis of autism spectrum disorder (ASD) include deficits in social communication and social interaction as well as repetitive patterns of behavior. What is New: • Recent research suggests that developmental motor delays during early childhood may also be important predictors of ASD. • Pediatricians should consider the possibility of ASD in infants with motor delays or other concerning motor behaviors.

Clinical utility of the Structured Observation of Motor Performance in Infants within the child health services

AIM

This study aimed to evaluate the clinical utility of the Structured Observation of Motor Performance in Infants (SOMP-I) when used by nurses in routine child healthcare by analyzing the nurses' SOMP-I assessments and the actions taken when motor problems were suspected.

METHOD

Infants from three child health centers in Uppsala County, Sweden, were consecutively enrolled in a longitudinal study. The 242 infants were assessed using SOMP-I by the nurse responsible for the infant as part of the regular well-child visits at as close to 2, 4, 6 and 10 months of age as possible. The nurses noted actions taken such as giving advice, scheduling an extra follow-up or referring the infant to specialized care. The infants' motor development was reassessed at 18 months of age through review of medical records or parental report.

RESULTS

The assessments of level of motor development at 2 and 10 months showed a distribution corresponding to the percentile distribution of the SOMP-I method. Fewer infants than expected were assessed as delayed at 4 and 6 months or deficient in quality at all assessment ages. When an infant was assessed as delayed in level or deficient in quality, the likelihood of the nurse taking actions increased. This increased further if both delay and quality deficit were found at the same assessment or if one or both were found at repeated assessments. The reassessment of the motor development at 18 months did not reveal any missed infants with major motor impairments.

INTERPRETATION

The use of SOMP-I appears to demonstrate favorable clinical utility in routine child healthcare as tested here. Child health nurses can assess early motor performance using this standardized assessment method, and using the method appears to support them the clinical decision-making.

ASD Validity

ASD research is at an important crossroads. The ASD diagnosis is important for assigning a child to early behavioral intervention and explaining a child’s condition. But ASD research has not provided a diagnosis-specific medical treatment, or a consistent early predictor, or a unified life course. If the ASD diagnosis also lacks biological and construct validity, a shift away from studying ASD-defined samples would be warranted. Consequently, this paper reviews recent findings for the neurobiological validity of ASD, the construct validity of ASD diagnostic criteria, and the construct validity of ASD spectrum features. The findings reviewed indicate that the ASD diagnosis lacks biological and construct validity. The paper concludes with proposals for research going forward.