Three-year follow-up at age 10 of children with minor neurodevelopmental disorders. I: Behavioural problems

Early life events and motor development in childhood and adolescence: a longitudinal study

AIM

Few studies have reported on early life risk factors for motor development outcomes past childhood. Antenatal, perinatal and neonatal factors affecting motor development from late childhood to adolescence were explored. As sex differences in motor development have been previously reported, males and females were examined separately.

METHODS

Participants (n = 2868) were from the Western Australian Pregnancy Cohort Study. Obstetric and neonatal data were examined to determine factors related to motor development at 10 (n = 1622), 14 (n = 1584) and 17 (n = 1221) years. The Neuromuscular Development Index (NDI) of the McCarron Assessment of Motor Development determined offspring motor proficiency. Linear mixed models were developed to allow for changes in motor development over time.

RESULTS

Maternal pre-eclampsia, Caesarean section and low income were negatively related to male and female motor outcomes. Lower percentage of optimal birthweight was related to a lower male NDI. Younger maternal age, smoking during early pregnancy and stress during later pregnancy were related to lower female NDIs.

CONCLUSION

Events experienced during pregnancy were related to motor development into late adolescence. Males and females were influenced differently by antenatal and perinatal risk factors; this may be due to sex-specific developmental pathways.

Response inhibition and academic abilities in typically developing children with attention-deficit-hyperactivity disorder-combined subtype

Research in Attention-Deficit/Hyperactivity Disorder (ADHD) generally utilizes clinical samples or children with comorbid psychiatric diagnoses. Findings indicated that children with ADHD experience academic underachievement and poor performance on measures of response inhibition (RI). Less is known, about the neuropsychological profile of typically developing children with ADHD. The aim of the current study was twofold: (1) determine if academic skills and RI were impaired in typically developing children with ADHD-combined subtype (ADHD-C) and (2) determine to what extent RI may predict academic abilities. Children with ADHD-C did not differ on any academic domain from controls. Children with ADHD-C performed more poorly than controls on RI measures. Regression analyses suggest that Written Expression ability was significantly influenced by RI. No other academic domain was related to RI. Results suggest that children with ADHD-C may experience impairments in RI despite adequate academic functioning. Impaired RI is not solely responsible for difficulties found in academic skills in ADHD-C.

Stability and change in children with Developmental Coordination Disorder

BACKGROUND

Children with Developmental Coordination Disorder (DCD) are a heterogeneous group who have a marked impairment in the performance of functional motor skills. Provision for these children is usually made via a paediatrician through occupational or physiotherapy; though with a prevalence rate of 5%, regular provision is rarely possible because of limited professional resources.

METHODS

This study covers a period of nearly 4 years and initially examined a group of 31 children first identified as having DCD at 7-9 years of age. The children were observed and assessed before, during and after a total of 16 weeks of intervention carried out by parents and teachers. This was followed by a period of monitoring of performance for 26 of the children in the motor domain plus other abilities such as educational progress and self-concept. Individual children were tracked using a variety of qualitative and quantitative approaches, building up longitudinal whole child profiles.

RESULTS

Following intervention, 14 of the 26 children have shown improvement and stability in all areas and no longer display DCD symptoms. Eight children have profiles which have shown variability, with the children moving in and out of the DCD classification, while the remaining four children have consistently scored poorly in their movement skills and in addition received ongoing support in school for academic subjects.

CONCLUSIONS

The study has confirmed that children with DCD show varying profiles over a period of time and that the profiles have distinct characteristics related to events in the child's life. This approach to examining stability and change in the progressions of children's difficulties is in keeping with an ecological approach to explaining development with its multilayered influences creating changes.

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.

Neurological soft signs and disruptive behavior among children of opiate dependent parents

The present study investigates the relationship between neurological soft signs and psychiatric symptoms among children of opiate dependent parents. A consecutive series of 102 children of opiate dependent parents received standardized psychiatric and neurological assessments. Symptoms of externalizing but not internalizing disorders associated with poor performance on the soft sign exam, controlling for age, intelligence, and socioeconomic status. Given the importance of externalizing disorders in the development of substance use disorders, studies of children at high risk for substance use disorder should also consider screening and assessment of children for soft neurological signs.

Developmental coordination impairments in adulthood

The aim of this study was to extend the understanding of Developmental Coordination Disorder (DCD) into adulthood. We recruited 19 adults aged between 18 and 65 who had received diagnoses of DCD or dyspraxia or who self-reported as having motor impairments consistent with a history of DCD, together with age- and gender-matched controls. Participants were given tests of manual dexterity, handwriting, construction, obstacle avoidance, dynamic balance, static balance, dual task performance, ball skills, reaction time, movement time and sequencing. As a group, adults with DCD performed more poorly than controls across all tasks. Slowness and variability of movement was a pervasive feature of their performance and many individuals had considerable problems with sequencing and with dual task performance. A discriminant function analysis conducted using six performance measures correctly classified participants as car drivers or non-drivers. Adults do retain motor difficulties and these can exclude them from important activities of daily living.

Psychosocial implications of poor motor coordination in children and adolescents

Utilising Harter's theory of competence motivation (Harter, S. The determinants and mediational role of global self-worth in children. In: N. Eisenberg, Contemporary topics in developmental psychology, Wiley, New York, 1987, pp. 219-242.), the current study examined perceived competence and social support, and their influence on self-worth and anxiety in children and adolescents with and without developmental coordination disorder (DCD). A group of children aged 8-10 years, and a group of adolescents aged 12-14 years, with significant movement problems were compared with matched control groups on measures of perceived competence, perceived social support, self-worth and anxiety. Those with DCD were found to perceive themselves as less competent in several domains, and having less social support than control participants. Overall, DCD groups had lower self-worth and higher levels of anxiety than the control groups. Adolescents also perceived themselves as less competent with poorer social support and lower self-worth than younger children. In addition, anxiety was significantly higher for the adolescent group compared to their younger counterparts.

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.

Natural outcome of ADHD with developmental coordination disorder at age 22 years: a controlled, longitudinal, community-based study

OBJECTIVE

There is a need for controlled longitudinal studies in the field of attention disorders in the general population.

METHOD

In a community-based follow-up study, 55 of 61 subjects aged 22 years, who had attention-deficit/hyperactivity disorder (ADHD) with and without comorbid developmental coordination disorder (DCD) at initial workup at age 7 years, were compared, on a multitude of outcome variables, with 46 of 51 age-matched subjects without such diagnoses. None of the subjects had received stimulant treatment. Psychiatrists performing the follow-up study were blind to original diagnostic group status.

RESULTS

In the ADHD/DCD group 58% had a poor outcome compared with 13% in the comparison group (p < .001). Remaining symptoms of ADHD, antisocial personality disorder, alcohol abuse, criminal offending, reading disorders, and low educational level were overrepresented in the ADHD/DCD groups. The combination of ADHD and DCD appeared to carry a particularly gloomy outlook.

CONCLUSIONS

Childhood ADHD and DCD appears to be a most important predictor of poor psychosocial functioning in early adulthood. It would seem appropriate to screen for such disorders in schools and clinics so that therapies may be started early.

Behavior and personality characteristics of children and young adults with Prader-Willi syndrome: a controlled study

OBJECTIVE

To analyze (1) which behavior and personality characteristics in Prader-Willi syndrome (PWS) are primarily linked to the syndrome and not to mental retardation or being overweight, (2) how early in life such traits appear, and (3) whether current therapies affect behavior.

METHOD

Parents of a group of 44 individuals with PWS and of a comparison group were interviewed and completed questionnaires about their children's behavior and personality.

RESULTS

Individuals with PWS had more behavior problems than those in the comparison group. Some behaviors were specific to PWS. Younger PWS cases had fewer behavior problems than older PWS cases. Treated individuals had approximately the same degree of behavior problems as those untreated, even though a few symptoms occurred at lower rates.

CONCLUSIONS

PWS is associated with behavior correlates that are not related to weight or IQ. In the first few years of life, children with PWS do not demonstrate the characteristic profile of preoccupation with food, ritualism, irritability, temper tantrums, and skin-picking which is typical of older individuals with PWS. Current therapies (including treatment with growth hormone) do not seem to radically affect the behavioral expression of the disorder, even though some problems tended to abate with treatment.

Eye movement abnormalities in anorexia nervosa

The aim of the present study is to investigate smooth pursuit eye movement and saccadic performance in anorexia nervosa during a restored weight period and to determine if functional links can be made between eye movement performance and clinical features. SPEM parameters were recorded for 28 female anorectic out-patients (DSM IV), who had a body weight loss of up to 20% of ideal body weight. Twenty-eight comparison subjects were also tested. Clinically, each patient was assessed using the Eating Disorder Inventory (EDI), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Structured Interview for Personality Disorders (SCID II), the Symptom Checklist-90-Revised (SCL-90-R) and the Hamilton Scale for Depression (HRSD). The anorectic patients performed slightly worse than the comparison subjects on a number of SPEM measures. No relationship was found between SPEM impairment and a global severity index of psychopathology (SCL 90-R GSI) or depressive symptoms. Moreover, OCD symptoms and scores on some EDI scales (such as perfectionism) appear related to the severity of the eye movement alterations. The evidence of SPEM abnormalities in a subgroup of anorectic patients during the remitted state and the relationship of the abnormalities to obsessive-compulsive symptoms are discussed. Results are in agreement with the hypothesis regarding the persistence of neurophysiological as well as psychopathological traits of disorder in anorectic patients.

Boys with Asperger's disorder, exceptional verbal intelligence, tics, and clumsiness

Five boys with both Asperger's disorder and Tourette syndrome, exceptional verbal intelligence, and clumsiness are reported. Each presented at early elementary school age with a prominent complaint of social difficulties with peers. History was notable for a flapping stereotypy and the neurological examination revealed motor and/or vocal tics and numerous motor soft signs. Highly specialized interests were characteristics. Language prosody and/or pragmatics was impaired. Despite exceptional verbal intelligence, the children were not, according to their teachers and parents, faring well either socially or academically. Motor difficulties, manifested psychometrically as a significant performance IQ disadvantage, interfered with school performance and social adjustment. Tics, although not noted by parents in the clinical history, compounded their social difficulties. Asperger's disorder in these highly verbal children overlaps with pervasive developmental disorder (PDD) on account of the socioemotional difficulties and stereotypies seen in both. Asperger's disorder and Tourette syndrome overlap in these children on account of the tics. Finally, Asperger's disorder and the right-hemisphere-based learning disorders overlap on account of the visuoperceptual and attentional deficits that can occur in both.

ADHD, DAMP and other neurodevelopmental/psychiatric disorders in 6-year-old children: epidemiology and co-morbidity

A total population of 589 6-year-old children were screened for neurodevelopmental/neuropsychiatric disorders by questionnaires to parents and preschool teachers, and by examination of motor abilities at the Child Health Center. Fifty screen-positive and fifty screen-negative children were assigned for complete neuropsychiatric assessment comprising a detailed history, psychiatric and neurodevelopmental assessment, neuropsychological examination and speech/language evaluation. Comprehensive diagnoses were made on the basis of all the available information. In the total population, 63 children (10.7%) with disorders were identified, 10 of whom had a diagnosis established before the study. The prevalence rates for deficits in attention, motor control and perception (DAMP) were 5.3 to 6.9%, for attention deficit hyperactivity disorder (ADHD) they were 2.4 to 4.0% and for mental retardation, 2.5%. Co-morbidity was established for ADHD on the one hand and DAMP, mental retardation and Tourette syndrome on the other. The findings suggest the need for a school entrant screening examination for the types of problems examined in this study.

Psychometrics of neurological soft signs

OBJECTIVE

To examine the psychometrics of neurological soft signs in young children.

METHOD

In a sample of 42 children from the community, two examiners simultaneously rated soft signs using a standardized examination. A subsample (n = 33) was reexamined twice over the next week to estimate test-retest reliability.

RESULTS

Total score exhibited acceptable internal consistency as well as interrater and test-retest reliability. Psychometrics for individual items appeared less satisfactory than for the total score.

DISCUSSION

Although examiners can reliably rate a variety of soft signs, more research examining test-retest reliability is needed. A reliable examination might be useful in future efforts to document the neuropsychiatric correlates of soft signs.

Associations between the mental health and social networks of children and parents in single-parent families. A comparison between a clinical group and a control group

The parents and children in single-parent families were studied. A group of 39 children ages 9-16 years who had been patients at a child and adolescent psychiatric clinic and a control group with an equal number of children were interviewed together with their single parent regarding social network and mental health. The networks of children and parents in the control group were more similar to each other than the networks of parents and children in the patient group. The crosswise influence of parents' mental health, children's behavioral disturbances and social networks showed associations between parents' mental health and children's behavioural disturbances, between parents's social networks and children's behavioural disturbances and between parents' mental health and their social networks. There was, on the other hand, no association between parents' mental health and the social networks of their children.

Children with deficits in attention, motor control and perception (DAMP) almost grown up: general health at 16 years

One hundred and one children (56 with and 45 without deficits in attention, motor control and perception (DAMP)), originally diagnosed at six or seven years of age and belonging to a representative cohort of children from the general population were followed up at 16 and 17 years of age. There was a significant excess of substance abuse, fractures and other accidents in the DAMP group than among controls, in addition to more motor co-ordination problems, clumsiness, and height and weight problems. Mean complex visual reaction time was significantly longer in the DAMP group, accounted for by the number of boys in the group. It appears that 10-year outcome for children who had attention problems and clumsiness during the preschool period is considerably poorer than for those who did not have such problems.

A follow-up study of child psychiatric clinic attenders with minor neurological dysfunction

Thirty-two child psychiatric patients with minor neurological dysfunction (MND) were followed-up after a mean interval of 5.3 years. Six clusters were analyzed that measured posture and muscle tonus, reflexes, coordination and balance, fine manipulative ability, choreiform dyskinesia, and associated movements. In the majority of cases, remission occurred for posture and muscle tonus, and choreiform dyskinesia and reflexes. Problems with fine manipulative ability and associated movements, however, persisted in most cases. Change in the total MND-abnormality score was also analyzed. Elevated scores and greater age at the initial assessment, and longer intervals between the initial assessment and follow-up were associated with greater improvement, indicating that biological maturation is an important factor in symptom remission. Slow background activity was the predominant EEG-pattern that tended to persist rather than to remit over time. A wide spectrum of psychiatric diagnoses was recorded on both occasions. In general, the tendency for remission of psychiatric disorders was stronger than that of persistence and new manifestation. In addition, with regard to behavioural abnormalities, the total score and subscore for emotional disorders diminished over time.

Dyslexia; ophthalmological aspects 1991

Dyslexia or specific reading disability is an important and frequent handicap afflicting 5-10% of the population. It is basically a disorder of acquisition of written language, probably due to a poorly developed phonological awareness, which in turn may be neurologically related. As anatomical correlates symmetry of the planum temporale and ectopies in the cerebral cortex have been suggested. Functional correlates are discovered with brain electrical mapping and stimulation of brain structures during neuro surgery. From an ophthalmological point of view there are no relations between dyslexia and ocular problems including refractive errors and accommodation, problems of binocular control and stereopsis, eye dominance instability etc. However, contrast sensitivity seems to be reduced in dyslexics for the middle range of spatial frequencies, which may be related to impaired function of the 'transient' visual system. With regard to eye movements, there is no firm experimental proof for any disturbances in dyslexia, be it with the different movement systems or in the best movement direction. 'Backward saccades' or regressions are typical not only for dyslexic reading but in all types of reading when comprehension is poor. Although there is no treatment for dyslexia itself that can be based on ophthalmological findings, the ophthalmologist must after careful examination discover and treat any ocular, orthoptic or neuroophthalmological problem that may make reading difficult for the dyslexic child. The ophthalmologist must explain to the child and the parents that dyslexia usually has no ophthalmological or visual cause but is a disability with a neurobiological background, still unknown, in which the only efficient treatment is within the area of pedagogy.

Background factors in anorexia nervosa : A controlled study of 51 teenage cases including a population sample

Fifty-one adolescents with anorexia nervosa and 51 sex-, age- and school-matched comparison cases were psychiatrically and physically examined. Twenty-four of the anorexia cases constituted the total population of anorexia nervosa cases born in 1970. The cases were examined at a mean age of 16 years. The mothers were interviewed in detail concerning hereditary and other family factors, child's early physical and temperamental development, and the family's overall social situation. Medical records pertaining to the pre-, peri- and neonatal periods were analysed blind to diagnosis. Thirty-five of the anorexia cases (69%) had a reasonably plausible background factor which could have contributed to the development of the eating disorder. Similar background factors were encountered in 2 (4%) of the comparison cases. The findings are discussed as they pertain to anorexia nervosa etiology.

Psychiatric morbidity among children with sickle-cell disease

The prevalence of psychiatric morbidity was investigated among 84 children with sickle-cell disease (SCD) and 84 healthy matched controls, using Rutter's Behaviour Questionnaires. The prevalence of psychiatric morbidity on the parents' and teachers' scales, respectively, was 26.2 and 22.6 per cent for children with SCD and 4.8 and 6.0 per cent for controls. Boys with SCD had significantly higher mean scores than girls, with older children having higher scores than younger ones. Behavioural deviance in seven children occurred both at home and in school, while in 27 it was situational. 34 children had psychiatric morbidity: 14 were neurotic, 11 were antisocial, six were antisocial and neurotic, and the diagnostic category for each of the remaining three differed. Behavioural problems among children with SCD and implications for therapy and prevention are discussed.

Coordination of low birthweight seven-year-olds

The coordination and laterality of a group of 171 seven-year-old children, free from major disability, with a birthweight of 2,000 g or less, were examined and compared with those of normal birthweight peers. More low birthweight children were left-handed and of mixed or undetermined hand, foot and eye dominance. Left-handedness may adversely affect some areas of performance of normal birthweight but not of low birthweight children. Low birthweight children performed significantly less well in tests of both fine and gross motor coordination. Girls tended to perform better than boys in fine motor tests. In the low birthweight group there was a correlation between IQ and coordination.

What causes stress for mothers of children with MBD?

Adapting the paradigm developed by Richard Lazarus, parenting stress and coping were studied among mothers of 6-9-year-old children (n = 42) with different symptoms of Minimal Brain Dysfunction (MBD) (hyperkinesis, perceptual or motor deficits, learning disabilities or speech disorders) and among mothers of non-disabled children (n = 42) matched for age, sex, social status of the family and marital status. Mothers of children with MBD were found to experience more parenting difficulties and more negative cognitive appraisals of their stakes in parenting than their matched controls. The mothers of children with hyperkinesis and perceptual or motor deficits considered their mastery lower and experienced less positive affects than their matched controls. The mothers of children with speech disorders experienced less positive affects than their matched controls. Mothers of children with both few and several symptoms experienced more parenting difficulties in the child domain than their matched controls. Mothers of children with several symptoms considered their mastery lower and experienced less positive affects; mothers of children with few symptoms appraised their stakes in parenting more negatively than their matched controls. No significant differences were found between mothers of children with MBD with few and several symptoms.

Phobic anxiety and clumsiness in a 10-year-old girl

During assessment of a girl with a long-standing phobic state, it was found that she also had previously unrecognised perceptuo-motor problems, which were associated with continuing problems in balance and spatial awareness. Her phobia improved after a desensitisation programme, but the physical disorder persisted, despite physiotherapy. The authors conclude that the girl's phobic anxiety may have had its origin in her experience of the perceptual disorder during development.

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

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

Children with preschool minor neurodevelopmental disorders. V: Neurodevelopmental profiles at age 13

A cohort of children diagnosed at age seven as suffering from deficits in attention, motor control and perception was compared at age 13 with a group of children without such problems. More than two-thirds of the index children no longer had any clearly detectable motor problems at 13, but they still had significantly prolonged complex reaction times. These results suggest that children with these deficits in the early school years have a fair biological prognosis by the early teen years.

Perinatal risk factors and minor neurological dysfunction: significance for behaviour and school achievement at nine years

A prospective study was carried out on 133 neurologically deviant infants, 205 with mild abnormalities and 230 normal newborns to compare behavioural and cognitive development with neonatal and nine-year-old neurological condition. Overtly handicapped children were excluded. Major determinants of school failure were the severity of minor neurological dysfunction (MND) and social class. Main risk factors for distractable and clumsy behaviour were MND classification and male sex; for troublesome behaviour male sex and interval complications after two years of age; and for timid behaviour, family adversity. Definite neonatal neurological deviancy contributed both directly and by its association with MND to problems in behaviour and scholastic abilities. Mild neonatal neurological abnormalities and adverse obstetrical events contributed only indirectly to behavioural and learning problems. Preterm birth (less than 34 weeks) was the sole obstetric variable directly related to some of the outcome variables. The difference between home and school perception of the children's behaviour is emphasized.

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

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

Neurologically deviant newborns: neurological and behavioural development at the age of six years

Of 1655 newborns examined neurologically at term, 80 were found to be abnormal. 76 were traced at six years of age, together with a control group of 77 neonatally normal children. In the study group five children had died, six were severely handicapped and 21 had minor neurological dysfunction (MND). In the control group two had died and four had MND. Obstetrical and neonatal paediatric effects, as well as complications in the intervening years, appeared to have a cumulative effect on the relationship between the neonatal neurological condition and the neurological findings at six years. There were no large differences in behaviour between the study group and the controls, but the study-group MND children showed a stronger tendency for undesirable behaviour and poor school achievements. Although environmental influences are preponderant for the development of behaviour and school performance, a contribution of both neonatal and later neurological conditions seems likely.

Three-year follow-up at age 10 of children with minor neurodevelopmental disorders. II: School achievement problems

Part I of this paper considered the behavioural problems at age 10 of groups of children from a total population study of six-year-old children in Gothenburg and diagnosed according to strict criteria as suffering from minimal brain dysfunction (MBD), motor perception dysfunction (MPD) or attention deficit disorder (ADD), and a comparison group of normal children. Part II considers school achievement problems at age 10 among the same groups of children. 80 per cent of MBD children had obvious problems in school achievement, compared with 16 per cent in the comparison group. The MPD and ADD groups did not differ significantly from the comparison group in this respect. There was a considerable overlap between behaviour problems and school achievement problems, and the results indicate a gloomy prognosis for both types of problem among children with MBD.