Perceptual, motor and attentional deficits in seven-year-old children. Paediatric aspects

Sleep Macrostructure and NREM Sleep Instability Analysis in Pediatric Developmental Coordination Disorder

Developmental Coordination Disorder (DCD) is considered to be abnormal motor skills learning, identified by clumsiness, slowness, and/or motor inaccuracy impairing the daily-life activities in all ages of life, in the absence of sensory, cognitive, or neurological deficits impairment. The present research focuses on studying DCD sleep structure and Cyclic Alternating Pattern (CAP) parameters with a full overnight polysomnography and to study the putative correlations between sleep architecture and CAP parameters with motor coordination skills. The study was a cross-sectional design involving 42 children (26M/16F; mean age 10.12 ± 1.98) selected as a DCD group compared with 79 children (49M/30F; mean age 9.94 ± 2.84) identified as typical (no-DCD) for motor ability and sleep macrostructural parameters according to the MABC-2 and polysomnographic (PSG) evaluations. The two groups (DCD and non-DCD) were similar for age (p = 0.715) and gender (p = 0.854). More significant differences in sleep architecture and CAP parameters were found between two groups and significant correlations were identified between sleep parameters and motor coordination skills in the study population. In conclusion, our data show relevant abnormalities in sleep structure of DCD children and suggest a role for rapid components of A phases on motor coordination development

Constraints and facilitators to participation in physical activity in teenagers with Developmental Co-ordination Disorder: an exploratory interview study

BACKGROUND

Despite their movement difficulties, youngsters with Developmental Co-ordination Disorder (DCD) generally have sufficient capability for physical activity. However, they tend to be less physically active and less physically fit than their well co-ordinated age peers. The aim of this study was to use qualitative research methods to understand which factors constrain and facilitate participation in physical activity in teenagers with DCD, in order to help inform future health promotion programmes.

METHOD

Semi-structured interviews were conducted with eight teenagers with DCD (aged 13-15) and their parents. The interviews focused on how much physical activity was typically undertaken by the child and the perceived constraints and facilitators to being physically active. Interviews were transcribed and subjected to categorical-content analysis.

RESULTS

Half of the children and all but one of the parents reported that the children did little physical activity. Although most children disliked competitive team games, they reported many physical activities that they did enjoy and they reported wanting to be more physically active. Perceived internal constraints to participation included poor motor skill, lack of motivation and reports of fatiguing easily. Perceived external constraints included difficulty travelling to activities, negative comments from peers and teachers' lack of understanding of DCD.

CONCLUSIONS

Reports of low levels of physical activity support previous literature and are a cause for concern for this group. The teenagers expressed the desire to be more active, yet the interviews revealed both personal and environmental constraints to engagement in physical activity. It is clear that these factors interact in a dynamic way and that teachers, schools and communities play an important role in creating a motivational environment for youngsters with DCD to engage in physical activity and learn to maintain an active lifestyle as they move into adulthood.

Sleep behaviour in children with developmental co-ordination disorder

BACKGROUND

Children with developmental co-ordination disorder (DCD) experience significant difficulty in the performance of everyday movement skills in the absence of obvious neurological, sensory or intellectual impairment. They often underachieve academically and have higher rates of anxiety than their typically developing peers. Such factors are known to be associated with sleep problems in other clinical populations but the sleep patterns of children with DCD have not been examined. Information about the frequency and nature of sleep problems in DCD will aid our understanding of this developmental disorder. It may also be clinically helpful, alerting clinicians to potential difficulties so that these can be identified early and appropriate support offered.

OBJECTIVE

To examine sleep behaviour of children with DCD compared with typically developing control children.

METHODS

Two groups of 16 boys aged 8 to 12 years (M = 10.28, SD = 1.28) participated: (1) the DCD group had Movement ABC-2 Checklist scores below the 5th percentile; (2) an age-matched control group of typically developing children had Movement ABC-2 Checklist scores above the 15th percentile. Parents of children from both groups completed the Children's Sleep Habits Questionnaire.

RESULTS & DISCUSSION

The total sleep disturbance score was significantly higher for children with DCD compared with the control group (U= 24, P < 0.001). Subscale scores indicated particular problems with bedtime resistance (U= 77.5, P < 0.05), parasomnias (U= 28.5, P < 0.001) and daytime sleepiness (U= 58.00, P < 0.01). There were no differences between the groups for sleep onset delay, sleep duration, night wakings and sleep-disordered breathing. These preliminary results suggest that sleep patterns of children with DCD may be of clinical relevance and are worthy of further investigation.

An immunoreactive theory of selective male affliction

Males are selectively afflicted with the neurodevelopmental and psychiatric disorders of childhood, a broad and virtually ubiquitous phenomenon that has not received proper attention in the biological study of sex differences. The previous literature has alluded to psychosocial differences, genetic factors and elements pertaining to male “complexity” and relative immaturity, but these are not deemed an adequate explanation for selective male affliction. The structure of sex differences in neurodevelopmental disorders is hypothesized to contain these elements: (1) Males are more frequently afflicted, females more severely; (2) disorders arising in females are largely mediated by the genotype; in males, by a genotype by environment interaction; (3) complications of pregnancy and delivery occur more frequently with male births; such complications are decisive and influence subsequent development. We hypothesize that there is something about the male fetus that evokes an inhospitable uterine environment. This “evocative principle” is hypothesized to relate to the relative antigenicity of the male fetus, which may induce a state of maternal immunoreactivity, leading either directly or indirectly to fetal damage. The immunoreactive theory (IMRT) thus constructed is borrowed from studies of sex ratios and is the only explanation consistent with negative parity effects in the occurrence of pregnancy complications and certain neurodevelopmental disorders. Although the theory is necessarily speculative, it is heuristic and hypotheses derived from it are proposed; some are confirmed in the existing literature and by the authors' research.

Routine developmental screening at 5.5 and 7 years of age is not an efficient predictor of attention-deficit / hyperactivity disorder at age 10

AIM

The aim of this study was to assess the efficiency of developmental screening for deficits in attention, motor control and perception or attention-deficit/hyperactivity disorder (DAMP/ADHD) at 5.5 and 7 years of age for diagnosing ADHD in grade 4.

METHOD

The study population consisted of 442 children from a cohort study of ADHD in 10-year olds in one municipality in Stockholm County. Sensitivity, specificity and positive predictive value of a developmental screening at 5.5 and at 7 years of age for being diagnosed with ADHD at 10 years of age was calculated.

RESULTS

The sensitivity was 44%, the specificity 85% and the positive predictive value for having a diagnosis of pervasive ADHD in 4th grade was 15%, when at least two deviations in nine items was used as the cut-off point in 5.5-year screening at Child Health Centres (CHCs). With a cut-off score of at least two deviations in four items rated by parents or and teachers in 1st grade, these estimates were 58%, 81% and 15% respectively.

CONCLUSION

This study demonstrates that developmental screening for DAMP/ADHD at 5.5 and 7 years of age does not identify children who are diagnosed with ADHD in grade 4 with a high degree of selectivity.

Health complaints in children with attention-deficit/hyperactivity disorder

AIM

To assess recurrent subjective health complaints in Swedish schoolchildren with attention-deficit/hyperactivity disorder (ADHD).

METHODS

Cohort study of 577 fourth-graders (10-y-olds) in one municipality in Stockholm County. All children were screened for attention and behaviour problems through interviews with their parents and teachers. Children with high scores underwent further clinical and cognitive assessments. Information about health complaints was collected from the children themselves in a classroom questionnaire. The 516 children for whom there was information from all three data sources were included in the final study population. Hypotheses were tested in multivariate analyses with adjustment for sex and parental education.

RESULTS

Recurrent abdominal pain (RAP), sleeping problems and tiredness were associated with ADHD (stratified relative risks: 2.2 [1.4-3.4], 1.7 [1.1-2.7] and 2.7 [1.7-4.1], respectively), while there was no association with headache.

CONCLUSION

This study indicates that treatment strategies for children with ADHD need to include an effective evaluation and treatment of RAP, tiredness and sleeping disturbances. Evaluation of ADHD should be considered in children with recurrent health complaints.

Long-term neurological dysfunction and neonatal hypoglycaemia after diabetic pregnancy

AIM

To determine if children born to mothers with diabetes mellitus during pregnancy, who subsequently developed neonatal hypoglycaemia, experienced long-term neurological dysfunction.

METHODS

Thirteen children with, and 15 without, neonatal hypoglycaemia (blood glucose < 1.5 mmol/l) were randomly selected from a larger cohort and investigated at the age of 8 years. They were also compared with 28 age matched healthy controls.

RESULTS

Children with neonatal hypoglycaemia had significantly more difficulties in a validated screening test for minimal brain dysfunction than controls and were also more often reported to be hyperactive, impulsive, and easily distracted. On psychological assessment, they had a lower total development score than normoglycaemic children born to diabetic mothers, and control children.

CONCLUSIONS

Neonatal hypoglycaemia in diabetic pregnancy was associated with long-term neurological dysfunction related to minimal brain dysfunction/deficits in attention, motor control, and perception.

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.

Screening for minimal brain dysfunction (MBD/DAMP) at six years of age: results of motor test in relation to perinatal conditions, development and family situation

The aim of this study was to investigate if children aged 6 years of age, classified as having minimal brain dysfunction (MBD) or deficit in attention, motor control and perception (DAMP), exhibit special medical problems, specific developmental features or if special psychosocial conditions exist in the family. The screening program, using the psychoneurological part of the method developed by Gillberg et al., included 234 children who were followed-up prospectively from pregnancy and birth. The results were related to the physical and mental development of the children, to the psychosocial and socioeconomic conditions of the families, to pre- and postnatal conditions and to "reduced optimality score", as defined by Prechtl. Mental development was assessed by the use of Griffiths' test at 10-14 months and at 4-5 years of age. At the second Griffiths' test, the mother was also interviewed about the presence of aggressiveness and other symptoms of childhood psychopathology in her child, as defined by the DSM-III criteria, and a psychological observation was also made. In addition to screening for MBD/DAMP, at 6 years of age the parents were asked to complete a questionnaire aimed at identifying attention deficit disorder (ADD). No medical or psychological intervention was made before this stage. Fourteen children (9M, 5F) (6%) were identified as having a positive MBD/DAMP screening result. The results of the screening procedure showed a weak correlation with those obtained using the questionnaire based on the DSM-III criteria for ADD.(ABSTRACT TRUNCATED AT 250 WORDS)

Routine ultrasonography in utero and subsequent handedness and neurological development

OBJECTIVE

To examine any associations between routine ultrasonography in utero and subsequent brain development as indicated by non-right handedness at primary school age and neurological development during childhood.

DESIGN

Follow up of 8 and 9 year old children of women who took part in two randomised, controlled trials of routine ultrasonography during pregnancy.

SETTING

Clinics of 60 general practitioners in Norway during 1979-81. Maternal and child health centres.

SUBJECTS

2161 (89%) of 2428 eligible singletons were followed up, partly through a questionnaire to their parents and partly through information from health centres.

MAIN OUTCOME MEASURES

The dominant hand of the child was assessed by 10 questions. Deficits in attention, motor control, and perception were evaluated by five questions. Impaired neurological development during the first year of life was assessed by an abbreviated version of the Denver developmental screening test.

RESULTS

The odds of non-right handedness were higher among children who had been screened in utero than among control children (odds ratio 1.32; 95% confidence interval 1.02 to 1.71). No clear differences were found between the groups with regard to deficits in attention, motor control, and perception or neurological development during the first year of life.

CONCLUSION

Our data suggest a possible association between routine ultrasonography in utero and subsequent non-right handedness, whereas no association with impaired neurological development was found. As the question on non-right handedness was one of six initial hypotheses, the observed results may be due to chance. None the less, the results suggest that the hypothesis may have some merit and should be tested in future studies.

Screening methods, epidemiology and evaluation of intervention in DAMP in preschool children

This report describes a population-based study of deficits in attention, motor control and perception (DAMP) in six-year-old Swedish urban children. The point prevalance was 2.8% and the boy:girl ratio 5.3∶1. A questionnaire and motor examination screening device is described and evaluated. In a group of 25 children with DAMP, interventions of various kinds were made when the children were 6-7 years old. These cases were followed up at age 10-11 years and compared with 42 cases who had received no intervention. The follow-up study was fraught with problems and the data obtained could only be used for highly preliminary conclusions. However, it appears that information to parents, children and teachers about the nature of the child's condition might be helpful.

Perinatal risk factors in the aetiology of hearing loss in preschool children

In order to assess the importance of pertinent perinatal risk factors in causing hearing loss (HI), a retrospective evaluation was made of the records of 146 affected children born in the city of Göteborg between 1970 and 1979. The incidence among six-year-olds born between 1970 and 1974 was 3.8 per 1000 newborns. If only HI of more severe degree was taken into account (above 40dB in the best ear), the remaining incidence was 1.4/1000. Sensorineural HI (SNHI) accounted for 87 per cent of the cases. A positive hereditary tendency for HI was found in 55 per cent. In 61 per cent the origin of the HI was presumably prenatal, either positive heredity alone or in the form of facio-auricular anomalies, syndromes and toxic influences (infection and alcohol) during early pregnancy. Postnatal infections (meningitis, parotitis and secretory otitis media) could be ascertained as causes in about 20 per cent of the cases. For 12 per cent no aetiology could be determined. Perinatal aetiology was probable or possible in about 10 per cent of the children. The frequency of SNHI was found to be increased among survivors of neonatal intensive care, VLBW, LBW and SFD infants. Caesarean section, ventouse and breech delivery were not associated with increased rates, nor were hyperbilirubinaemia, exchange transfusion or birth asphyxia. No cases could be traced to aminoglycoside treatment. Neonatal sepsis/meningitis may have been the cause in two of the 146 cases. Hypoxia as a consequence of apnoea and respiratory distress syndrome necessitating mechanical ventilation appeared to be the major risk-factor in the neonatal period. However, in comparison with genetic predisposition, potentially damaging perinatal factors appeared to be of minor importance.

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

Sixty-one children selected from a total population study of six-year-old children in Gothenburg and diagnosed as suffering from minimal brain dysfunction (MBD), motor perception dysfunction (MPD) or attention deficit disorder (ADD), and 51 normal control children were followed up at age 10 for behavioural problems. According to teachers', parents' and self-rating questionnaires, the index children, especially those with MBD, showed extremely high rates of severe behavioural/experiential problems at follow-up. None had been treated with stimulants or other drugs directed at alleviating the symptoms of the neurodevelopmental disorder. It is argued that the high rates of disturbances according to the questionnaire ratings are a true reflection of the psychiatric ill-health in these children.

Perceptual, motor and attentional deficits in seven-year-old children: neurological and neurodevelopmental aspects

This study presents the results of neurological assessments of a representative sample of seven-year-old Swedish children with perceptual, motor and attentional deficits and their controls (N = 141). Among those children diagnosed as suffering from minimal brain dysfunction (MBD), the majority showed neurodevelopmental deviations indicative of the "clumsy child syndrome'. However, 20 per cent had slight signs of choreoathetosis, diparesis, hemiparesis or ataxia. Other associated neurodevelopmental deviations are considered. The correlation between neurological findings and background factors is discussed: the MBD group had higher scores for various "organic' background factors than the comparison children, and the children with neurological syndromes had somewhat higher scores than the remaining children with MBD. The difficulties in distinguishing MBD from mental retardation, cerebral palsy and childhood psychoses is clearly illustrated. Long-term follow-up will indicate the prognostic significance of these findings.