The new approach to early diagnosis of handicaps in childhood

Early identification of cerebral palsy in high risk infants

This study of high risk infants aimed to identify which signs at the corrected ages of 1, 4 and 8 months were important for distinguishing those infants who later developed hypertonic cerebral palsy (CP). From a total cohort of 450 infants (350 of birthweight less than 1500 g and 100 of birthweight greater than 1500 g), 26 infants were later diagnosed as having CP and formed the study group. A control group of 26 infants from the same initial cohort who did not develop CP was matched to the study group. Both groups were followed for a minimum of 2 years. At each assessment (1, 4, 8, 24 months corrected age), all children were assessed using a standard medical examination and a detailed neurosensorimotor developmental scale that evaluated neurological signs, motor attainments, primitive reflexes and postural reactions. Each test response was graded as normal, suspect or abnormal and the results for the two groups were compared. Assessment at 1 month failed to identify a number of the CP infants whereas at 4 months there was some overidentification. At 8 months, assessment was highly predictive of cerebral palsy. Individual signs of abnormality were found to be of limited value but the presence of three or more abnormal signs at 8 months was highly predictive of CP.

Severe mental retardation in children from socially disadvantaged families

Children receiving ESN(S) education, attending special day schools, and living at home, were categorized into those whose handicap had been medically recognized in infancy and those of unknown aetiology, 'non-specific'. Information obtained from interviews with their families was used to identify a subgroup of those who were relatively socially disadvantaged. Both factors, medical and social, are shown to have a significant effect on early provisions for special needs. The non-specific cases from disadvantaged families tended to have been recognized at a later age than the rest; their parents had less information, less access to services, and less contact with others who could provide aid and support. It is argued that the theoretical model which distinguishes pathogenic and subcultural aetiologies of severe mental subnormality is inappropriate. It may be wrongly applied by fieldworkers, especially those serving families with a developmentally backward preschool child. The result may discriminate against socially disadvantaged families with a child whose handicap is not medically diagnosed.

The effect of a 'containing' position in a hammock versus the supine position on the cutaneous oxygen level in premature and term babies

We evaluated the influence of positioning, and particularly a containing position in a hammock compared with the supine position, on the respiration of the newborn. Recordings of the transcutaneous oxygen level of 40 preterm babies and 10 full-term babies placed in their incubators alternately in the two positions have been analyzed. We found no significant differences between the means of the oxymetric indexes in the hammock and in the supine position, even when the babies had different gestational ages and birth weights. The advantages of the containing position for the neuromotor and relational development of the newborn in the first year of life in comparison with the effects of supine placement, which should be avoided as much as possible in the premature, are pointed out.

The diagnostic value of the neurodevelopmental examination

The neurodevelopmental examination is a pediatric approach to developmental diagnosis that relies on evaluation of multiple streams of development. The value of the neurodevelopmental examination for the early diagnosis of cerebral palsy and mental retardation was studied by a retrospective analysis of prospectively (longitudinally) collected data. Both conditions were found to be accurately diagnosed in the first year of life. For cerebral palsy, sensitivity was 0.81 and specificity 1.00; for mental retardation, sensitivity was 0.56 and specificity 0.96. The trained pediatrician can make early diagnoses of developmental disabilities.

Identification of severe mental handicap

Parents of 212 severely educationally handicapped children ESN(S) were asked about the circumstances of the identification of their child's handicap. Findings for the group as a whole were similar to those quoted in other studies but varied significantly according to the clinical group of the child. The 'no specific pathology' group gives cause for most concern: identification of these children occurs later, and is further delayed from the time that parents become anxious, than it is for children in other groups. Since 'no specific pathology' children may benefit as much or perhaps more from early intervention as do children in the more easily identifiable groups, attention should be paid to means of recognition and of giving appropriate help and support to their parents.