Newborn minor physical anomalies predict short attention span, peer aggression, and impulsivity at age 3

Aggressiveness and hyperactive behaviour as related to adrenaline excretion

The central question concerns the relationship between aspects of behaviour and physiological reactions. Measures of sympathetic‐adrenal activity in terms of adrenaline excretion in a normal and a stressful situation as well as teacher ratings of behaviour were analysed for a representative group of 86 boys aged 13. Adrenaline excretion was in both situations significantly negatively related to ratings of aggressiveness, motor restlessness, and concentration difficulties and also to the sum of the latter two, used as an indicator of hyperactive behaviour. The association between hyperactive behaviour and adrenaline excretion persisted in the stressful situation when aggressiveness was controlled, whereas there was no significant relationship between aggressiveness and adrenaline output when hyperactive behaviour was controlled. Furthermore, hyperactive boys differed significantly from non‐hyperactive boys in displaying lower adrenaline excretion in both situations. The results are discussed in terms of low sympathetic‐adrenal reactivity to external demands as a risk factor and as a possible indicator of vulnerability for social and/or pervasive conduct disturbances.

Attention deficit hyperactivity disorder and intellectual giftedness: a study of symptom frequency and minor physical anomalies

OBJECTIVE

To evaluate the presence of symptoms of attention deficit and hyperactivity disorder (ADHD) in intellectually gifted adults and children.

METHODS

Two cross-sectional studies were performed in children and adults whose intelligence quotient (IQ) had been previously evaluated using Raven's Progressive Matrices (RPM) test. Seventy-seven adults displaying IQ scores above the 98th percentile were assessed using the Adult Self-Report Scale (ASRS-18) for signs of ADHD and a modified Waldrop scale for minor physical anomalies (MPAs). Thirty-nine children (grades 1-5) exhibiting IQ scores above the 99th percentile, as well as an equally matched control group, were assessed for ADHD by teachers using the Swanson, Nolan and Pelham IV Rating Scale (SNAP-IV) as used in the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA-SNAP-IV).

RESULTS

In gifted adults, the frequency of ADHD-positive cases was 37.8%, and the total MPA score was significantly associated with ADHD (p < 0.001). In children, the ADHD-positive case frequency was 15.38% in the gifted group and 7.69% in the control group (odds ratio [OR] = 2.18, p = 0.288).

CONCLUSIONS

The high frequency of ADHD symptoms observed, both in gifted adults and in gifted (and non-gifted) children, further supports the validity of this diagnosis in this population. Furthermore, the significant association between MPAs and ADHD suggests that a neurodevelopmental condition underlies these symptoms.

Quantitative Measures of Craniofacial Dysmorphology in a Family Study of Schizophrenia and Bipolar Illness

Several laboratories, including ours, have reported an overrepresentation of craniofacial (CF) anomalies in schizophrenia (SZ). How might this dysmorphology arise in a brain-based disorder? Because the brain and face derive from shared embryologic primordia and morphogenetic forces, maldevelopmental processes may result in both CF and brain dysmorphology.Our approach is 2-pronged. First, we have employed, for the first time in the study of psychiatric disorders, objective measures of CF morphology that utilize an extensive normative database, permitting computation of standardized scores for each subject. Second, we have rendered these findings biologically interpretable by adopting principles of embryology in the analysis of dysmorphology.Dependent measures in this investigation focused on derivatives of specific embryonic primordia and were contrasted among probands with psychotic disorders, their first-degree relatives, and normal controls (NC). Subject groups included patients with a diagnosis of SZ (N = 39) or bipolar (BP) disorder with psychotic features (N = 32), their clinically unaffected relatives (N = 82 and N = 41, respectively), and NC (N = 95) subjects.Anomalies involving derivatives of frontonasal and mandibular embryonic primordia showed a clear association with psychotic illness, as well as familial aggregation in relatives in both diagnostic groups. In contrast, one class of CF anomalies emerged only among SZ probands and their first-degree relatives: dysmorphology arising along the junction of the frontonasal and maxillary prominence derivatives, manifested as marked asymmetries. This class was not overrepresented among the BP patients nor among their relatives, indicating that this dysmorphology appears to be specific to SZ and not a generalized feature of psychosis. We discuss these findings in light of embryologic models that relate brain regions to specific CF areas.

Minor physical anomalies in adults with autism spectrum disorder and healthy controls

Minor Physical Anomalies (MPAs) are subtle abnormalities of the head, face, and limbs, without significant cosmetic or functional impact to the individual. They are assumed to represent external markers of developmental deviations during foetal life. MPAs have been suggested to indicate severity in mental illness and constitute external markers for atypical brain development. Higher frequencies of MPAs can be found in children with autism. The aims of the present study were to examine the prevalence and patterns of MPAs in adults with autism spectrum disorder (ASD) and to investigate whether MPAs are associated with symptom severity and overall functioning. Fifty adults with ASD and intelligence within the normal range and 53 healthy controls were examined with the Waldrop scale, an instrument for assessing MPAs. Face and feet were photographed enabling blinded assessment. Significant differences between the ASD and the control group were found on the MPA total scores, and also in the craniofacial region scores. Moreover, the shape of the ears was associated with autistic traits, in the ASD group. High MPA total scores were associated with poorer functioning. The findings suggest a link between MPAs, autistic traits, and level of functioning. Assessment of MPAs may assist in the diagnostic procedure of psychiatric disorders.

Neurocriminology

In the past several decades there has been an explosion of research into the biological correlates to antisocial behavior. This chapter reviews the state of current research on the topic, including a review of the genetics, neuroimaging, neuropsychological, and electrophysiological studies in delinquent and antisocial populations. Special attention is paid to the biopsychosocial model and gene-environment interactions in producing antisocial behavior.

Correlation between physical anomaly and behavioral abnormalities in Down syndrome

OBJECTIVE

The minor physical anomaly (MPA) is believed to reflect abnormal development of the CNS. The aim is to find incidence of MPA and its behavioral correlates in Down syndrome and to compare these findings with the other causes of intellectual disability and normal population.

MATERIALS AND METHODS

One-hundred and forty intellectually disabled people attending a tertiary care set-up and from various NGOs are included in the study. The age-matched group from normal population was also studied for comparison. MPA are assessed by using Modified Waldrop scale and behavioral abnormality by Diagnostic assessment scale for severely handicapped (DASH II scale).

RESULTS

The Down syndrome group had significantly more MPA than other two groups and most of the MPA is situated in the global head region. There is strong correlation (P < 0.001) between the various grouped items of Modified Waldrop scale. Depression subscale is correlated with anomalies in the hands (P < 0.001), feet and Waldrop total items (P < 0.005). Mania item of DASH II scale is related with anomalies around the eyes (P < 0.001). Self-injurious behavior and total Waldrop score is negatively correlated with global head.

CONCLUSION

Down syndrome group has significantly more MPA and a pattern of correlation between MPA and behavioral abnormalities exists which necessitates a large-scale study.

Physical manifestations of neurodevelopmental disruption: are minor physical anomalies part of the syndrome of schizophrenia?

The well-documented excess of minor physical anomalies (MPAs) among individuals with schizophrenia generally supports the neurodevelopmental model, which posits that both genetic and environmental factors contribute to structural and functional brain changes in the intrauterine and perinatal periods that predispose one to developing schizophrenia. This review synthesizes select areas of research findings on MPAs to address the question, Are MPAs part of the syndrome of schizophrenia? Although MPAs are not specific to schizophrenia, their presence in some patients indicates that aberrations in the development of the nervous system contribute to risk for the disorder. The broadly defined, heterogeneous MPA construct may be of limited value in further elucidating the specific pathophysiology of schizophrenia, though particular anomalies, such as those pertaining to nasal volumes, palatal abnormalities, or craniofacial morphology, may be informative. Given the availability of more sophisticated microarray technologies, and in light of recent findings on spontaneous mutations in patients with schizophrenia, it is possible that MPAs will prove to be useful in identifying etiologic subtypes and/or the loci of genetic risk factors. It remains to be determined whether MPAs-which, of course, are fixed markers present throughout childhood and adolescence well before the onset of the prodrome and psychosis-may have utility in terms of risk stratification for future preventive efforts. Taken together, research findings on MPAs indicate that these minor anomalies are indeed part of some schizophrenia syndromes, representing a stable systemic or physical set of manifestations of the underlying neurodevelopmental processes that lead to the illness.

Temperament and minor physical anomalies

Minor physical anomalies (MPAs) are an index of deviant embryological development due to genetic defects of insults to the fetus. A brief 10-minute examination an an individual makes it possible to establish a count that shown highly stable individual differences from the newborn period up to age seven years, the latest age studied longitudinally. For males, high MPA counts in the newborn period have shown strong predictive relationships to preschool temperament factors such as short attention span, high activity level, and aggressive-impulsive behaviour. For females, high anomaly scores showed relationships to short attention span and to inhibition. Such findings are in contrast with inconsistent results from genetic studies and with infrequent, weak relationships of neonatal variables to later behaviour. These results from the Bethesda longitudinal study have been confirmed in most cases by several cross-sectional studies. Sex differences in behaviour, usually considered to result from differential sex-role training, disappear in preschool samples from which high MPA individuals have been removed, but are much more pronounced than usual in samples with high MPAs.

Normal values for morphological abnormalities in school children

Clinical morphology has proven to be a strong tool in the delineation of many syndromes and a helpful instrument in molecular studies. Numerous studies have been performed investigating the prevalence of minor anomalies in various disorders; all concluding that minor anomalies can well be utilized as indicators of altered embryonic differentiation. However, for adequate evaluation, normal values for phenotypic abnormalities are essential. So far, only few studies on the frequency of phenotypic abnormalities in the normal population have been done having one thing in common: all were performed in newborn infants. We studied morphological characteristics in a group of 1,007 school children, representative for the Dutch population, through a body surface examination using detailed definitions for all morphological findings. The region of study and distribution of children over various school types was chosen in such a way that it represented the general Dutch population. The median age of the studied children was 11 years (range 8-14 years), sex ratio (M:F) was 0.93. Nine hundred twenty-three children were of Caucasian descent, 84 others of mixed ethnic backgrounds. The reliability of the examinations was tested by independent scoring of 111 children by two observers, showing a kappa score of 0.85. Normal values for the morphological findings are presented together with their age-adjusted classification. These normal values provide a valuable source for validation of classifications of phenotypic abnormalities, especially those that are depending on frequency, that is, minor anomalies and common variants. Furthermore, they will allow a proper evaluation of patterns of phenotypic abnormalities found in patient groups with specific disorders.

Evaluating the effects of birth complications on low self-control in a sample of twins

Gottfredson and Hirschi's general theory has generated an abundance of research examining the effects of low self-control on crime and analogous behaviors. Less research, however, has focused on the factors that contribute to the development of low self-control. Gottfredson and Hirschi maintain that ineffective parents are the sole cause for the emergence of low self-control. At the same time, they disregard the possibility that low self-control has a biological or genetic component. This article extends prior research and examines the effects of birth complications and parental involvement on low self-control. Using a sample of twin children, the authors find that parental involvement is only weakly and inconsistently related to low self-control. On the other hand, although most of the birth complications had no appreciable effect on low self-control, anoxia (oxygen starvation) emerged as the strongest and most consistent predictor of low self-control.

Relation of neonatal iron status to individual variability in neonatal temperament

The relation between indices of neonatal iron status and individual differences in neonatal temperament were investigated in a sample of 148 low-income Peruvian women and their newborn infants. Using cord blood, at birth we obtained measures of neonatal ferritin, serum iron, and hemoglobin. While neonates were still in the hospital, their behavior during a structured anthropometry examination was videotaped and subsequently coded on four temperament dimensions: activity level, negative emotionality, alertness, and soothability. The same dimensions were coded using a videotape obtained during a subsequent visit to the neonates' homes. Results indicated that lower levels of neonatal hemoglobin and serum iron were related to higher levels of negative emotionality and to lower levels of alertness and soothability. A similar pattern was found for ferritin, but only for females. For the most part, relations between neonatal iron measures and neonatal temperament were linear, operating across the full range of iron values. Our pattern of iron-temperament results could not be attributed to variation in family demographics, low birth weight, gestational age, maternal dietary intake, or markers of neonatal illness and maternal diabetes. Our findings are consistent with prior research with older infants relating iron deficiency to temperament. These results support the importance of increased research on the early functional-behavioral consequences of individual differences in iron status as well as on the mechanisms that underlie such consequences.

Perinatal and childhood risk factors for later criminality and violence in schizophrenia. Longitudinal, population-based study

BACKGROUND

Individuals with schizophrenia appear to be at increased risk for violent and criminal behaviour. Obstetric complications, neuromotor problems and intellectual deficits have variously been reported as increasing the risk for criminality in the general population.

AIMS

To investigate whether such risk factors are associated with criminal behaviour in an epidemiological cohort of patients with schizophrenia.

METHOD

We identified from health care registers all individuals with schizophrenia born in Helsinki between 1951 and 1960, and used the national criminal register to identify those with a criminal record by 1995. Childhood information was obtained from archived birth and school records.

RESULTS

Poor educational attainment, poor grades for attention at school, higher birth weight and larger head circumference were significantly associated with the risk of criminal offending in adulthood in this sample of patients with schizophrenia. An association between labour/delivery complications and later violent offending among male patients was of borderline significance.

CONCLUSIONS

Our hypotheses that birth complications and childhood neuromotor problems would increase the risk of criminal offending in schizophrenia were not upheld.

Annotation: the role of prefrontal deficits, low autonomic arousal, and early health factors in the development of antisocial and aggressive behavior in children

BACKGROUND

This article selectively reviews the biological bases of antisocial and aggressive behavior in children with a focus on low autonomic functioning, prefrontal deficits, and early health factors.

RESULTS

Low resting heart rate is thought to be the best-replicated biological correlate of antisocial and aggressive behavior in child and adolescent populations and may reflect reduced noradrenergic functioning and a fearless, stimulation-seeking temperament. Evidence from neuropsychological, neurological, and brain imaging studies converges on the conclusion that prefrontal structural and functional deficits are related to antisocial, aggressive behavior throughout the lifespan. A prefrontal dysfunction theory of antisocial behavior is advanced. This argues that social and executive function demands of late adolescence overload the late developing prefrontal cortex, giving rise to prefrontal dysfunction and a lack of inhibitory control over antisocial, violent behavior that peaks at this age. Birth complications and minor physical anomalies are selectively associated with later violent behavior, especially when combined with adverse psychosocial risk factors for violence. Cigarette smoking during pregnancy may increase the risk for antisocial and violent behavior in later life by disrupting noradrenergic functioning and enhancement of cholinergic receptors that inhibit cardiac functioning. Malnutrition during pregnancy is associated with later antisocial behavior and may be mediated by protein deficiency.

CONCLUSIONS

It is argued that early health intervention and prevention studies may provide the most effective way of reversing biological deficits that predispose to antisocial and aggressive behavior in children and adults.

Minor physical anomalies in schizophrenia and bipolar affective disorder

OBJECTIVE

The prevalence of minor physical anomalies (MPAs) (prenatal errors of morphogenesis) was evaluated in patients with schizophrenia and bipolar affective disorder.

METHOD

A new modification of the Waldrop-scale was used to detect the presence or absence of 57 MPAs in 30 patients with schizophrenia, 30 with bipolar disorder, and in 30 matched normal controls.

RESULTS

Patients with schizophrenia compared to normal controls had significantly higher rates of three minor malformations (furrowed tongue, flat occiput, primitive shape of ears) and those of one phenogenetic variant (wide distance between toes 1 and 2), and they also had a significantly higher rate of one minor malformation (primitive shape of ears), as compared to patients with bipolar disorder. In patients with bipolar disorder, furrowed tongue was significantly more common than in controls.

CONCLUSIONS

These results support an 'early' neuro-developmental model of schizophrenia.

How much does physical appearance say about the psychological adjustment of competent and dysfunctional children?

Presents a study in which three sets of photographs of socially competent, aggressive, and anxious preschoolers were rated by college students (n = 150 raters per set), blind to the children's group membership. This was done to assess the extent to which adults are able to make valid and reliable evaluations of children's psychological adjustment on the basis of physical appearance alone. Sets 1 and 2 were photographs of different children taken under the same conditions and providing both facial and nonfacial cues. Sets 2 and 3 were of the same children taken under conditions that varied as to the amount of nonfacial cues they provided. Results showed that (a) socially competent children were judged to be better adjusted than their dysfunctional peers (i.e., more competent, less aggressive, less anxious, and less likely to have emotional or behavioral problems); (b) within the dysfunctional group, aggressive and anxious children were distinguished in ways that correspond closely to what is known about them from behavioral and clinical research; (c) irrespective of group membership, girls and boys were generally distinguished in ways that reflect normative beliefs about gender differences from social and developmental research; (d) group differences in ratings of psychological adjustment were generally comparable across photograph sets and could not be accounted for by differences in the children's perceived physical attractiveness; and (e) raters reported that they relied mainly on the children's expression, eyes, and posture to make their judgments of adjustment. These results replicate and extend earlier findings based on 1 of the 3 photograph sets (Serketich & Dumas, 1997). They suggest that when first impressions matter, competent children are at an advantage and their dysfunctional peers at a disadvantage even before their actual behavior comes to confirm or to invalidate these impressions. Theoretical and clinical implications of the findings are discussed.

Early determinants of delinquency and violence

The past several decades have resulted in an explosion of knowledge about the development of young children, knowledge that is often underused in the policy-making process. This paper reviews established risk factors for later delinquency and violence that are present prior to school age. The results suggest that established population-based efforts in education and health should be expanded, in anticipation of reducing violent behavior. More intensive intervention efforts that provide a continuum of services for children and families during a vulnerable development period also are warranted. New research directions also are described.

The effects of prenatal exposure to phenytoin and other anticonvulsants on intellectual function at 4 to 8 years of age

Twenty phenytoin exposed children between 48 and 99 months of age had an evaluation of behavior and intelligence by a single examiner who was unaware of exposure status. The controls were 98 children identified at birth as having three or more minor anomalies. None of the children evaluated were mentally retarded. In both, a case-by-case comparison and a comparison of the two entire groups, the phenytoin-exposed children had significantly lower scores for both Performance IQ (PIQ), Full Scale IQ (FSIQ), and Visual Motor Integration Test (VMIT). Similar abnormalities have been found in studies of animals exposed to phenytoin in utero. These results suggest that the teratogenic effects of phenytoin may include an effect on cognitive function.

Multiple minor malformations as a marker for prenatal etiology of cerebral palsy

A consecutive series of 137 patients with cerebral palsy living in institutions and aged between 18 and 30 years was examined for minor malformations, using a modified Weighted Anomaly Score. After examination, the patients were divided into two groups, based on whether their cerebral palsy was prenatal or postnatal in onset. A further subset of prenatal-onset patients with unidentified etiology was also analysed. Both the prenatal group with known etiology and the subgroup with unknown etiology had significantly more minor malformations than the postnatal group. These results suggest that multiple minor malformations may indicate prenatal etiology of cerebral palsy.

Attention deficit disorder: association with familial-genetic factors

The etiology of attention deficit disorder and hyperactivity (ADDH) is controversial because both biologic and social factors have been postulated. To study such factors, we undertook a referral study based on an entire cohort (N = 6,950) of children born in Jerusalem in 1976. Of 479 children referred for learning disabilities, hyperactivity, and behavioral problems, 381 were available for study. Information regarding obstetric, developmental, and family histories was obtained by a detailed, structured interview. A DSM-III-based questionnaire for ADDH was completed by parents and teachers. Each child underwent neurologic examination and 133 had IQ testing. Of these children, 145 fulfilled the criteria for ADDH. Our results revealed a number of significant familial-genetic factors: boys outnumbered girls by 3:1, 30% of ADDH children had siblings with learning disabilities (P less than .001); and ADDH children clustered within families of North African descent (P less than .001). The only significant developmental factor was delayed language development. Of numerous pre- and peri-natal factors investigated, only intrauterine growth retardation was significantly associated with ADDH. No correlation was found between ADDH and IQ, parental age, years of education, profession, and language spoken at home. Our study supports the hypothesis that familial-genetic factors are contributory to ADDH.

Significance of prenatal, perinatal and postnatal factors in the development of AGA preterm infants at five to seven years

The effects of prenatal, perinatal and postnatal events on developmental outcome at five to seven years of preterm infants with birthweights appropriate for gestational age were investigated in two separate cohorts: one a longitudinal study of 97 infants, the other a cross-sectional study of 249 infants. Among the prenatal variables, the number of minor congenital anomalies was negatively correlated with neurological development, as was the deformation score. The pregnancy optimality score was not significantly related to outcome. Among the perinatal variables, gestational age and birthweight had some significant correlations with development, but birth and neonatal optimality scores were only inconsistently significant in relation to outcome. Socio-economic status was strongly related to language and intellectual development. Infants with gestations of 32 to 36 weeks had a more favourable neurological and intellectual outcome than those born before 32 weeks: however, the former group comprised about 80 per cent of the population studied, so the majority of children with lower function were found in that group.

Measures of attention deficit. Part II: Clinical perspectives and test interpretation

After a detailed behavioral and developmental history has been supplemented by the use of formal questionnaires, the diagnosis of an attentional disorder can be further clarified by the judicious selection of psychoeducational and pediatric physical and neurodevelopmental examinations. The most common difficulty in the interpretation of psychoeducational test subscores and profiles is the significant overlap between the patterns generated by attentional deficits and those associated with memory-based learning disabilities. Certain other medical and behavioral conditions need to receive careful consideration prior to finalizing the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). A thorough but focused general examination coupled with the pediatric neurodevelopmental examination can contribute to this differentiation.

Minor physical anomalies and recidivistic adult violent criminal behavior

Minor physical anomalies (MPA) result from disruptions of gestation, and may be used as signs of central nervous system defects in development. Utilizing a Danish birth cohort, we tested the hypothesis that MPA predict adolescent and adult recidivistic violent criminal behavior. The number of MPA was measured at 11 to 13 years of age and police records of criminal behavior were ascertained at 20 to 22 years of age. Recidivistic violent offenders evidenced an elevated level of MPA compared with subjects with one violent offense or subjects with no violent offenses.

Iris pigmentation and behavioral inhibition

Two independent investigations of the association between the temperamental dimensions of inhibition and lack of inhibition to the unfamiliar, on the one hand, and the degree of pigmentation of the iris, on the other, revealed a statistically significant relation in Caucasian children between behavioral inhibition to the unfamiliar and blue irises and uninhibited behavior and brown irises. Several biochemical interpretations of this association were discussed and it was suggested that these behavioral styles might be influenced by biological factors that are partially marked by eye color in Caucasian populations.

Predictive value of minor anomalies. I. Association with major malformations

We examined 4305 white newborn infants for 114 minor physical features and major malformations to evaluate the hypothesis that the presence of three or more minor anomalies is highly predictive of a major malformation. We confirmed that the infant with three or more minor anomalies is at increased risk for a major malformation. However, this risk (19.6%) was much lower than the risk of 90% popularized by Smith and based on the study of Marden et al. (J Pediatr 1964;64:357). Analysis of the findings in the two studies showed that the lower predictive value was probably related to differences in study design. Nevertheless, some minor anomalies remain essential to the early recognition of several serious malformation syndromes.

Language development of term and preterm children during the first five years of life

Language development during the first five years is reported for 114 high-risk preterm children (20 with varying degrees of cerebral palsy) and 97 healthy term children. Most stages of language development occurred at slightly later ages among the neurologically unimpaired preterm children than among those born at term. Preterm children with cerebral palsy were more delayed and had more articulation defects compared with neurologically unimpaired preterm children. Girls were more advanced in early language development and showed less articulation defects than boys. The perinatal optimality score was significantly correlated with the ages at which the stages of language development were reached, and with language performance at five years in preterm children, but much less in term children. Birthweight and gestational age were negatively correlated with language development at all ages. Socio-economic status and birth order had an age-related influences on language development, but no correlation was found with the number of minor congenital malformations.

Attention deficit disorder with hyperactivity: a critique

The DSM III category of Attention Deficit Disorder with Hyperactivity is considered within a framework of Rutter's (1977) outline of criteria for adequacy of psychiatry classification. Discussion of problems with the operationalization and definition of 'attention deficit' and the difficulty of using this rubric in distinguishing between ADDH and other related childhood disorders, along with the consequent failure to meet other important criteria, leads to the conclusion that the concept needs re-appraisal.

Hyperactive behavior and minor physical anomalies

Minor physical anomalies (MPAs) are congenital abnormalities of body structure which reflect fetal maldevelopment. They originate in the same embryonic layer that produces the central nervous system, and it is reasoned that MPAs are markers of nervous system anomalies. High MPA counts have been associated with hyperactive behavior in normal and clinical populations of boys, and with inhibited behavior in normal groups of girls. The present sample of children from a longitudinal study of a Danish birth cohort show no significant sex differences in mean number of MPAs, but the male hyperactivity-MPA relation and the female inhibition-MPA relation is supported in this non-clinical sample. MPAs are not recommended for use in clinical screening or diagnosis at this time, but the evidence of a congenital, biological component to hyperactive behavior may eventually have useful implications for prevention and/or intervention.

Diagnosis and management of attention deficit disorder: a pediatric perspective

Recent progress in the nosology of neuropsychiatric disorders in general, and attention deficit disorder in particular, have produced parallel advances in our understanding of the etiology of these disorders, enhanced their accurate recognition, and clarified appropriate management strategies. This article provides a detailed overview of these advances.

Minor physical anomalies and behavior in children: a review

The recent literature concerning minor physical anomalies (MPA) and their relation to behavior is reviewed. Research seems to indicate that for males there is considerable consistency in the results but the finding with females is tenuous at best. It appears that a high number of MPA are evident in several pathological groups of boys, as compared with normal controls. In addition, there is a suggestion that MPA are correlated with severity of hyperactivity, IQ, and school achievement. Furthermore, there is also a relationship between a high number of MPA and obstetrical complications. The etiology of MPA and their utility in predicting pathological behavior is discussed.

Minor physical anomalies, footprints, and behavior: was the Buddha right?

A relationship between an anomaly of the footprint suggested by 5th Century Abhidhamma meditations and Minor Physical Anomalies Scale of Waldrop and Halverson was observed in a sample of 46 pre-school and school-age children. The footprint anomalies correlated with the reported activity levels of children in the same way as the scores on the scale and in a manner consistent with prior research using the scale.

Cultural and national differences in the epidemiology of behavior problems of preschool children

Results from two epidemiological surveys, one British and the other American, examining the prevalence of behavior problems in preschool children are compared. Using the same interview technique, prevalence rates were found to be similar despite national, cultural and demographic differences. These surveys constitute the first stage in projects to examine the causes and persistence of childhood psychiatric disorder arising during the preschool years. The relevance of this work to anthropology is discussed.

Biological validation of the hyperkinetic syndrome

Biological evidence for the hyperkinetic syndrome is reviewed and evaluated. Research data from anatomical, genetic, physiological and pharmacological studies consistently yield weak or non-specific relationships between biological factors and hyperactivity. While such findings suggest an organic basis for at least some subgroups of hyperactive children, criteria for selection of subjects in past research have not been sufficiently well-established to allow such biological factors to be linked with specific behavioral symptoms. Thus there is no compelling evidence for the existence of the syndrome; there is merely an array of general correlations between biological alteration and non-specific deviant behavior. Alternative interpretations of this situation are presented.