The predictive value of 'red flags' as milestones of psychomotor development of premature babies - preliminary study

INTRODUCTION

Premature babies are a special group at risk of persistent brain damage caused by diseases, the most serious of which are cerebral palsy(CP), autism spectrum disorders (ASD) and mental retardation, among others. These conditions may occur concurrently, but appear more often as separate disease syndromes in the same group of at-risk children. Long-term observation of psychomotor development by an interdisciplinary medical team closely cooperating with parents is necessary. It is important to detect the risk of developing these diseases as soon as possible in all development spheres.

MATERIAL AND METHODS

The research was conducted to demonstrate the prognostic value of 'red flags' of developmental milestones and the ability to detect early signs of risk of developing CP and ASD in extremely premature babies. In this preliminary study, 42 preterm babies, born after less than 32 weeks pregnancy participated.

RESULTS

The occurrence of 'red flags'in the spheres: gross motor, fine motor and cognitive at 9 months was strongly associated with their presence at 24 months. The sensitivity and specificity were: gross motor - 0.91 (95% CI: 0.59, 1.00) and 0.94 (95% CI: 0.79, 0.99); fine motor - 0.83 (95% CI 0.36-1.00) and 1.00 (95% CI: 0.90-1.00); cognitive - 1.00 (0.40, 1.00) and 0.97 (0.86, 1.00). Other spheres had lower sensitivity but high specificity.

CONCLUSIONS

The conclusion is that the 'red flags'at the 9 months milestones already predict the normal or developmental delay of premature babies, and predict the risk of CP and ASD. Due to the availability and lack of the need for specialized and costly training, it is worth considering their use in everyday life medical practice.

Playback of 50-kHz ultrasonic vocalizations overcomes psychomotor deficits induced by sub-chronic haloperidol treatment in rats

RATIONALE

In rodents, acute haloperidol treatment induces psychomotor impairments known as catalepsy, which models akinesia in humans and is characterized as an animal model of acute Parkinsonism, whereas sub-chronic haloperidol reduces exploratory behavior, which resembles bradykinesia. Haloperidol-induced catalepsy in rats can be ameliorated by playback of 50-kHz ultrasonic vocalizations (USV), an emotionally and motivationally relevant appetitive auditory stimulus, representing an animal model of paradoxical kinesia. In a condition like PD where patients suffer from chronic motor impairments, it is paramount to assess the long-term symptom relief in an animal model of Parkinsonism.

OBJECTIVES

We investigated whether 50-kHz USV playback ameliorates psychomotor deficits induced by haloperidol in a sub-chronic dosing regimen.

METHODS

In phase 1, distance traveled and number of rearing behavior were assessed in an activity chamber in order to investigate whether sub-chronic haloperidol treatment induced psychomotor impairments. In phase 2, we investigated whether 50-kHz USV playback could overcome these impairments by assessing exploratory behaviors and approach behavior towards the sound source in the 50-kHz USV radial maze playback paradigm.

RESULTS

Sub-chronic haloperidol treatment led to psychomotor deficits since the distance traveled and number of rearing behavior were reduced as compared to saline control group or baseline. These psychomotor impairments were ameliorated during playback of 50-kHz USV, with haloperidol treated rats showing a clear social approach behavior towards the sound source exclusively during playback.

CONCLUSIONS

This study provides evidence that 50-kHz USV playback induces paradoxical kinesia in rats exhibiting motor deficits after sub-chronic haloperidol, as we previously showed after acute haloperidol treatment.

How Consistent Is Competent? Examining Variance in Psychomotor Skills Assessment

PURPOSE

Direct assessment of trainee performance across time is a core tenet of competency-based medical education. Unlike variability of psychomotor skills across levels of expertise, performance variability exhibited by a particular trainee across time remains unexplored. The goal of this study was to document the consistency of individual surgeons' technical skill performance.

METHOD

A secondary analysis of assessment data (collected in 2010-2012, originally published in 2015) generated by a prospective cohort of participants at Montreal Children's Hospital with differing levels of expertise was conducted in 2017. Trained raters scored blinded recordings of a myringotomy and tube insertion performed 4 times by junior and senior residents and attending surgeons over a 6-month period using a previously reported assessment tool. Descriptive exploratory analyses and univariate comparison of standard deviations (SDs) were conducted to document variability within individuals across time and across training levels.

RESULTS

Thirty-six assessments from 9 participants were analyzed. The SD of scores for junior residents was highly variable (5.8 out of a scale of 30 compared with 1.8 for both senior residents and attendings [F(2,19) = 5.68, P < 0.05]). For a given individual, the range of scores was twice as large for junior residents than for senior residents and attendings.

CONCLUSIONS

Surgical residents may display highly variable performances across time, and individual variability appears to decrease with increasing expertise. Operative skill variability could be underrepresented in direct observation assessment; emphasis on an adequate amount of repetitive evaluations for junior residents may be needed to support judgments of competence or entrustment.

Melancholia as Predictor of Electroconvulsive Therapy Outcome in Later Life

OBJECTIVES

In clinical practice, particularly melancholic depression benefits from electroconvulsive therapy (ECT), albeit research melancholia criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM) is not conclusive. We compared clinical characteristics and ECT outcome of melancholic and nonmelancholic depression, here defined by psychomotor symptoms.

METHODS

One hundred ten depressed older in-patients treated with ECT were included in the Mood Disorders in Elderly treated with ECT study. The CORE was used for the assessment of psychomotor symptoms, with a score of 8 or higher defining melancholic depression. Depression severity was measured before, during, and after ECT. Characteristics were compared across melancholic and nonmelancholic patients. Regression analysis was used to assess the relation between psychomotor symptoms and remission/response, and survival analysis was used to examine the difference in time.

RESULTS

Patients with melancholic depression had higher severity, lower cognitive and overall functioning, and lower prevalence of cardiovascular disease. However, no significant relations were found between CORE scores and remission/response. Because psychotic symptoms are a positive predictor of ECT response and remission, we examined whether CORE score was a predictor of response in the nonpsychotic group (n = 49). In nonpsychotic patients, remission was 62%, and the association between CORE scores and remission almost reached significance (P = 0.057).

DISCUSSION

Although melancholically and nonmelancholically depressed patients differed significantly on several clinical characteristics, ECT outcome did not differ. Analyses may be hampered by a high prevalence of psychotic features. In nonpsychotic patients, CORE scores neared significance as predictor of remission, suggesting that CORE scores might be a distinguishing characteristic of melancholia in nonpsychotic patients and a clinical useful predictor of ECT response.

Influence of Attentional Focus Instructions on Motor Performance Among Adolescents With Severe Visual Impairment

Substantial research has demonstrated that an external (vs. internal) attentional focus enhances motor performance among various populations. Interest has recently grown in examining the effects of attentional focus among individuals with visual impairments (VI), and, to date, research results have been conflicting with some studies supporting a potential benefit to an external focus among adults with VI, while a study of children with severe VI was inconclusive regarding this benefit. The present investigation compared the effects of an internal versus an external attentional focus on a discrete throwing task among adolescents with severe VI. We recruited 13 participants with a visual acuity score of less than 6/60 and had them throw a Goalball (25 cm ball with bells often used in competitive sports designed for people with VI) as fast as possible for three familiarization trials, three internal focus trials, and three external focus trials. These participants threw the ball with significantly higher velocity when using an external focus than in other conditions, indicating a benefit from an external focus for this population when performing this discrete task.

Optimized and Predictive Phonemic Interfaces for Augmentative and Alternative Communication

Purpose We empirically assessed the results of computational optimization and prediction in communication interfaces that were designed to allow individuals with severe motor speech disorders to select phonemes and generate speech output. Method Interface layouts were either random or optimized, in which phoneme targets that were likely to be selected together were located in proximity. Target sizes were either static or predictive, such that likely targets were dynamically enlarged following each selection. Communication interfaces were evaluated by 36 users without motor impairments using an alternate access method. Each user was assigned to 1 of 4 interfaces varying in layout and whether prediction was implemented (random/static, random/predictive, optimized/static, optimized/predictive) and participated in 12 sessions over a 3-week period. Six participants with severe motor impairments used both the optimized/static and optimized/predictive interfaces in 1-2 sessions. Results In individuals without motor impairments, prediction provided significantly faster communication rates during training (Sessions 1-9), as users were learning the interface target locations and the novel access method. After training, optimization acted to significantly increase communication rates. The optimization likely became relevant only after training when participants knew the target locations and moved directly to the targets. Participants with motor impairments could use the interfaces with alternate access methods and generally rated the interface with prediction as preferred. Conclusions Optimization and prediction led to increases in communication rates in users without motor impairments. Predictive interfaces were preferred by users with motor impairments. Future research is needed to translate these results into clinical practice. Supplemental Material https://doi.org/10.23641/asha.8636948.

Exercise Interventions in Children and Adolescents With ADHD: A Systematic Review

OBJECTIVE

Exercise has attracted attention as a potential helpful intervention in children with ADHD. Effects are emphasized on cognition, social-emotional, and motor development.

METHOD

A systematic literature search was conducted using the electronic databases Web of Science, PubMed, Scopus, and ERIC to analyze the efficacy of different types of exercise interventions in children and adolescents with ADHD. Seven studies examining the acute and 14 studies examining the long-term effects were included.

RESULTS

The largest effects were reported for mixed exercise programs on ADHD symptomatology and fine motor precision. However, because of the large differences in the study designs, the comparability is limited.

CONCLUSION

At this time, no evidence-based recommendation can be formulated regarding frequency, intensity, or duration of exercise. Nevertheless, some first trends regarding the effects of certain types of exercise can be identified. When focusing on long-term health benefits in children and adolescents with ADHD, qualitative exercise characteristics might play an important role.

Individual and Combined Associations of Cognitive and Mobility Limitations on Mortality Risk in Older Adults

OBJECTIVE

To evaluate the potential independent and combined associations of cognitive and mobility limitations on risk of all-cause mortality in a representative sample of the US older adult population who, at baseline, were free of cardiovascular and cerebrovascular disease.

PATIENTS AND METHODS

Data from the 1999 to 2002 National Health and Nutrition Examination Survey were used to identify 1852 adults (age, 60-85 years) with and without mobility and/or cognitive limitations. Hazard ratios (HRs) for mortality risk were calculated for 4 mutually exclusive groups: no limitation (group 1 as reference), mobility limitation only (group 2), cognitive limitation only (group 3), both cognitive and mobility limitations (group 4).

RESULTS

Compared with group 1, the adjusted HRs (95% CI) for groups 2, 3, and 4 were 1.72 (1.24-2.38), 2.00 (1.37-2.91), and 2.18 (1.57-3.02), respectively. The mortality risk when comparing group 4 (HR, 2.18) with group 3 (HR, 2.00), however, was not statistically significant (P=.65). Similarly, the mortality risk when comparing group 4 (HR, 2.18) with group 2 (HR, 1.72) was not statistically significant (P=.16).

CONCLUSION

Although the highest mortality risk occurred in those with both limitations (group 4), this point estimate was not statistically significantly different when compared with those with cognitive or mobility limitations alone.

The properties and utility of the CORE measure of melancholia

BACKGROUND

The CORE measure was designed to assess a central feature of melancholia - signs of psychomotor disturbance (PMD) - and so provide an alternate non-symptom based measure of melancholia or of its probability. This review evaluates development and application studies undertaken over the last 25 years to consider how well it has met its original objectives.

METHODS

All studies published using the CORE measure as either the only or an adjunctive measure of melancholia were obtained and are considered in this review.

RESULTS

Findings suggest high reliability in quantifying CORE scores can be achieved and that it has construct validity as a measure of PMD. A number of application studies assessing socio-demographic factors, cognitive and motor impairment, dexamethasone suppression and thyrotropin-releasing hormone, response to psychotherapy and to electroconvulsive therapy support its validity as a measure of melancholia, while functional brain imaging studies suggest that the measure identifies regions of decreased connectivity.

LIMITATIONS

Use of the CORE benefits from rater training and for subjects to be assessed at or near nadir of their depressive episode. There have been insufficient studies evaluating genetic factors, and the treatment response of CORE-defined melancholic patients to antidepressant drugs of differing classes.

CONCLUSIONS

The CORE, either as a proxy or direct measure of melancholia, provides a strategy for assigning depressed subjects a diagnosis or melancholic or non-melancholic depression or for estimating the probability of melancholia.

Socialization and Behavioral Problems of Elementary School Pupils with Developmental Coordination Disorder

The present study examined the role of the developmental coordination disorder in 154 children's socialization and the expression of deviant behaviors in the context of Greek primary education. For assessment of their motor coordination, the Movement Assessment Battery for Children of Henderson and Sugden was used. The peer nomination method (sociogram) was used for the estimation of children's social status, and the expression of deviant behaviors was assessed via Conners' Teacher Questionnaire. Analyses showed that developmental coordination disorder was associated with poor socialization and the expression of deviant behaviors. These findings support the development of educational programs to include children with poor motor coordination.

Motor and Visuomotor Skills of Children with Asperger's Disorder: Preliminary Findings

While motor clumsiness is frequently described as an associated feature of Asperger's Disorder, little research has examined specific motor skills and the relation among aspects of motor performance in this population. The present purpose was to present preliminary findings for three aspects of Asperger's: the presence and magnitude of gross motor and fine motor deficits, the presence and magnitude of visuomotor deficits, and the relation between motor functioning and visuomotor skills. 17 boys, 6 to 13 years old, with Asperger's were tested using standardized measures of gross, fine, and visuomotor skills. Statistically significant deficits were found for the sample's scores compared with values for the general population (using one-sample t tests), but none for fine motor vs gross motor skills (using a dependent sample t test). Significant positive correlations were found for gross motor skills with visuomotor skills (.73) and for fine motor skills with visuomotor skills (.71). Tentative suggestions for clinical assessment were proposed.

Excessively High Magnetic Resonance Signal in Preterm Infants and Neuropsychobehavioural Follow-up at 2 Years

The diffuse excessive high-signal intensity (DEHSI) findings in the T2 weighted scans of white matter (WM), besides the corresponding low signal in the T1 weighted images, are usually more evident around the periventricular regions. It is not clear whether the DEHSI should be considered as a diffuse WM injury rather than a sign of delayed maturation of the WM. Eighty nine preterm infants at the full-term equivalent age (FEA) were studied using conventional Magnetic Resonance (MR) imaging of the brain. Based on the MR findings, the infants studied were divided into three groups: the control group presenting normal WM, the DEHSI group and the group with other WM lesions. Ten newborns were not included in the statistical analysis because they presented evidence of precedent germinal matrix hemorrhage (GMH-IVH) which cannot be considered as WM lesions. Seventy nine infants were enrolled in a program of neuropsychobehavioural study follow-up until 24 months of age. Each infant was evaluated for those variables which mostly affect the occurrence of neuropsychomotor disability. In the DEHSI infant group, significantly lower mean pH and mean base excess (BE) values were found in comparison to controls, while the mean birth weight (BW) was significantly higher. No significant difference was observed between the mean 1st minute Apgar Score, mean birth gestational age (GA) and assisted ventilation mean duration of controls and DEHSI groups. Finally, no significant difference between the parameters studied was found by comparing the WM lesion infants group to the DEHSI infants one. Our observations, together with follow-up studies, even up to school age, confirm that DEHSI has a clinical significance and cannot be considered as a simple indicator of delayed WM maturation.

[Postural control characteristics in elderly women with fallers]

Using computer posturografic (stabilometric) complex a study of postural control peculiarities was carried out in 108 women aged 65-74 years who had experienced two or more falls during the year (fallers). These tests were: Sensory Organization Test, Motor Control Test, Rhythmic Weight Shift. It was found that elderly women with fallers had a decrease of sensory information (somatosensory - by 1,8 %, of the visual - by 6 %, and of the vestibular - by 10,1 %), the neurophysiological mechanisms of postural control (by 5,7 points), violation of adaptation possibilities of sensory and motor components of the legs to respond quickly to changes in the center of gravity within the support base of its footing (7,3 ms), as well as reducing balance control in the frontal (by 7,2 %) and sagittal (by 23,2 % ) planes compared with the women of the same age without fallers.

[Do psychomotor symptoms predict the treatment response of patients with depressive disorders?]

BACKGROUND

Patients with depressive disorders may present with typical psychomotor symptoms such as retardation and/or agitation. So far, however,the prognostic significance of these symptoms is unclear.

AIM

To present an overview in which we assess to what extent psychomotor symptoms can predict the effect of the type of treatment that patients with depressive disorders receive.

METHOD

We searched the literature using Medline.

RESULTS

Psychomotor symptoms might predict that the patient will respond more favourably to treatment with dopaminergic antidepressants and broad-spectrum antidepressants (TCAs) and particularly to electroconvulsive therapy than to 'single-acting serotonergic antidepressants' - but, so far, the scientific evidence for the foregoing is limited.

CONCLUSION

In our view psychomotor symptoms do have a predictive value with regard to treatment response, but further research is needed.

[The development of the body schema]

The body schema as an acquired structure enables individuals to gain a representation of the different parts of their body without relying on external stimulations. When its development is disrupted a certain number of disorders can arise which have significant repercussions on the patients' daily lives. These dysfunctions can be managed in the framework of psychomotor rehabilitation.

Age and CGG-repeat length are associated with neuromotor impairments in at-risk females with the FMR1 premutation

Recent studies report a higher risk of dementia and motor symptoms in females with the fragile X mental retardation 1 premutation (PM-carriers) than has hitherto been appreciated. Here, we use dual-task gait paradigms to identify potential markers of cognitive and motor decline in female PM-carriers. Spatiotemporal gait characteristics and variability of gait were assessed during single- and dual-task conditions in 28 female PM-carriers (mean age 41.32 ± 8.03 years) and 31 female controls with normal fragile X mental retardation 1 alleles (mean age 41.61 ± 8.30 years). Despite comparable gait characteristics at baseline, gait performance was significantly poorer for PM-carriers when performing concurrent working memory tasks (counting backwards by 3's or 7's) when compared with controls. Correlational analyses showed that low working memory capacity was significantly associated with dual-task interference for the gait domains of pace (speed, step length) and variability (step time, swing time) in PM-carriers. Multiple regression analyses further showed that the interaction between age and CGG repeat length was strongly predictive of gait variability during dual-task performance. These findings indicate for the first time that vulnerability in specific domains of gait control may act as sensitive surrogate markers of future decline in female PM-carriers.

[The aged and the test of folding a rhombus Psychometric and chronopsychological aspects]

This study highlights the incongruence of geriatric institutions to set up activities for elderly people without taking into account the circadian fluctuations of cognitive processes related to circadian rhythms. By example, rehabilitation for falls is based on the indication given by the therapist (instruction), its integration and assimilation by the patient (comprehension), and the resulting action (execution). However, the recorded information and the execution may present a shift of phase and even an opposition of phase. The Test of Folding a Rhombus (TFR) was conceived to assess the fluctuation and articulation of these processes. It was proposed to 60 elderly individuals divided into 2 groups (30 subjects with cognitive disorders - case group - and 30 subjects without cognitive disturbance - control group -), and was applied at different time schedules of the day (8:00, 11:00, 15:00 and 18:00 h) once a week during 4 weeks. Its purpose was to quantify the relationship between automatic and controlled processes. Statistical analysis indicates significant circadian differences during the evolution of the two processes between the case and control groups. Simple, fast and easy to use, the TFR can also help professionals to choose the best automatic or controlled processes activity according to the need of patients.

Psychopathological characteristics of bipolar and unipolar depression - potential indicators of bipolarity

BACKGROUND

Establishing whether a depressive episode is part of a unipolar or bipolar disorder is essential for treatment planning. Over recent years, a growing number of publications have discussed psychopathological characteristics that might serve as indicators of bipolarity in patients with a history of depression dominated by unipolar symptoms. Our primary aim was to verify the adequacy of these indicators in contributing to a precise diagnosis in everyday clinical practice.

SUBJECTS AND METHODS

We investigated 104 patients diagnosed with major depressive episode at the time of examination. 52 patients had major depressive disorder and 52 patients had bipolar disorder. The patients were then assessed for the presence of potential bipolarity indicators: psychomotor slowing, self-view (self-blaming, feelings of worthlessness), hypersomnia, increased appetite, leaden paralysis/loss of physical energy, weight increase, interpersonal sensitivity, and early morning insomnia, using the Inventory of Depressive Symptomatology. We analysed the correlations between these indicators and the presence of unipolar or bipolar affective disorder.

RESULTS

Psychomotor slowing, self-blaming/feelings of worthlessness, increased appetite, leaden paralysis/loss of physical energy, and weight increase were significantly more frequent in bipolar depression than in unipolar depression (p<0.05). Early morning insomnia was significantly more frequent in unipolar depression (p<0.05). There was no statistically significant correlation between hypersomnia or interpersonal sensitivity and either of the affective disorders.

CONCLUSIONS

It would be worthwhile identifying the relative importance of clinical indicators for probable BP in large-scale prospective studies. These would contribute to the better diagnostic assessment of major depressive episodes and therapeutic decision-making.

Clinical differences between melancholic and nonmelancholic depression as defined by the CORE system

BACKGROUND

The definition and delineation of melancholia have remained elusive for an extended period. A longstanding signal of psychomotor disturbance has been operationalized via the observer-rated CORE measure and with CORE-assigned melancholic and nonmelancholic compared in several Australian studies. Replication studies in other regions have not previously been reported. This study compares Brazilian patients with melancholic and nonmelancholic depression according to the CORE measure of psychomotor disturbance in terms of clinical characteristics, suicide ideation, stressful life events, quality of life, parental care, and personality styles.

METHODS

A total of 181 patients with unipolar major depression attending a tertiary care outpatient service in Brazil were evaluated in relation to melancholic status and study variables.

RESULTS

The CORE-assigned melancholic patients presented higher symptom severity, greater prevalence of suicide ideation, and Axis I comorbidities than nonmelancholics. Scores of dysfunctional personality styles and dysfunctional parental care measures were also higher among melancholics. Quality-of-life scores were low in both groups.

LIMITATIONS

The absence of a criterion standard for the diagnosis of melancholia and the use of medication can be potential limitations of the study.

CONCLUSION

Differences suggest that CORE-assigned melancholia defines a distinct group of patients and probably a disorder distinct from nonmelancholic depression not only in quantitative but also in qualitative aspects.

Matching accuracy in hemiparetic cerebral palsy during unimanual and bimanual movements with (mirror) visual feedback

In the present study participants with Spastic Hemiparetic Cerebral Palsy (SHCP) were asked to match the position of a target either with the impaired arm only (unimanual condition) or with both arms at the same time (bimanual condition). The target was placed at 4 different locations scaled to the individual maximum reaching distance. To test the effect of mirror visual feedback of the less-impaired arm on the matching accuracy, an opaque screen or a mirror was placed in between the arms which masked vision of the impaired arm. Absolute endpoint error was smaller in the bimanual condition compared to the unimanual condition, but there was no effect of mirror visual feedback. Inspection of the individual data, however, showed that 13 out of 23 participants did experience a positive effect of mirror visual feedback. A positive correlation between the baseline error (screen) and the improvement in accuracy with mirror visual feedback seems to suggest that individuals with lower proprioceptive accuracy in the baseline condition may benefit more from mirror visual feedback. Together these findings indicate that bimanual therapy and therapy with mirror visual feedback might be valuable approaches for rehabilitation for a subset of the individuals with SHCP.

Promoting adaptive behavior in persons with acquired brain injury, extensive motor and communication disabilities, and consciousness disorders

These two studies extended the evidence on the use of technology-based intervention packages to promote adaptive behavior in persons with acquired brain injury and multiple disabilities. Study I involved five participants in a minimally conscious state who were provided with intervention packages based on specific arrangements of optic, tilt, or pressure microswitches (linked to preferred environmental stimuli) and eyelid, toe and finger responses. Study II involved three participants who were emerging from a minimally conscious state and were provided with intervention packages based on computer presentations of stimulus options (i.e., preferred stimuli, functional caregiver's procedures, and non-preferred stimuli) and pressure microswitches to choose among them. Intervention data of Study I showed that the participants acquired relatively high levels of microswitch responding (thus engaging widely with preferred environmental stimuli) and kept that responding consistent except for one case. Intervention data of Study II showed that the participants were active in choosing among preferred stimuli and positive caregivers' procedures, but generally abstained from non-preferred stimuli. The results were discussed in terms of the successful use of fairly new/infrequent microswitch-response arrangements (Study I) and the profitable inclusion of functional caregiver's procedures among the options available to choice (Study II).

Central processing energetic factors mediate impaired motor control in ADHD combined subtype but not in ADHD inattentive subtype

Participants with attention-deficit/hyperactivity disorder (ADHD) are often impaired in visuomotor tasks. However, little is known about the contribution of modal impairment in motor function relative to central processing deficits or whether different processes underlie the impairment in ADHD combined (ADHD-C) versus ADHD inattentive (ADHD-I) subtype. The present study analyzes performance on the Visual Motor Integration Test relative to less effortful motor tests as well as on measures of energetics. Both ADHD groups showed evidence of impaired motor function on both visual-motor integration (VMI) and the less effortful motor tests. The ADHD-C group performed below the ADHD-I group on VMI, but their performance correlated highly with the measures of the energetic pools of arousal and effort. Different mechanisms may underlie impaired fine motor skills in ADHD. Central processing deficits contribute significantly to the deficit of ADHD-C but do not explain the motor impairment in ADHD-I.

The effect of institutionalization on psychomotor development of preschool aged children

Development can be altered by several factors which can either facilitate or obstruct development. The aim of the current study was the examination and the detection of differences in the developmental profiles of preschool aged children living in conventional institution facilities (N=28), in SOS villages (N=20) and in natural family environment (N=48). The psychomotor development of the 96 children, aged 4-6 years old, was assessed using the six scales of the Griffiths Test No II. Two-way analysis of variance designs showed that family reared children had better performance in all scales of the Griffiths test compared with children of the other two groups and that children living in a SOS village had better scores on all domains of development examined compared to children living in a conventional institution (p<.05). The findings reinforce the need to transform institution environments into more supportive ones for the most benefit of children's development and mental health.

Patterns of participation and enjoyment in adolescents with Down syndrome

This study aimed to determine participation and enjoyment in young people with Down syndrome (DS) in Taiwan and to assess how participation varies across gender, cognitive, and motor function variables. Using the Children's Assessment of Participation and Enjoyment, data on participation were collected from 997 adolescents with DS and their families. Findings indicated limited diversity and intensity of participation, with proportionately greater involvement in informal activities. Youth with better cognitive and motor functions participated more often in activities and reported higher enjoyment and social engagement with these. These findings provide a foundation for an improved understanding of activity participation of youth with DS. Service providers and families could provide and plan activities to ensure more satisfying and meaningful participation.

[Psychomotor therapy in paediatric palliative care]

Present for around ten years in specialised paediatric departments, most psychomotor therapists have already been confronted with children approaching the end of life. In this context, psychomotor therapy takes into account the individuality of each child within his/her family dynamics, for global and personalised support.

Psychogenic movement disorders and motor conversion: a roadmap for collaboration between neurology and psychiatry

BACKGROUND

There are a host of vague terms to describe psychologically-mediated symptoms that mimic neurological disease, such as "functional," "non-organic," "psychogenic," or "medically unexplained." None of these terms has a direct translation in psychiatric classification, and psychiatrists are often faced with patients who do not believe in a psychological origin for their symptoms.

OBJECTIVE

Within the framework of psychogenic movement disorders, we discuss the roadblocks to effective collaboration and treatment in these patients and the current state of the literature regarding diagnosis and treatment.

RESULTS

We describe the approach to these patients from the perspective of neurology and psychiatry, illustrating the differences in terminology and categorization.

CONCLUSION

Psychogenic movement disorders represent a unique opportunity for these fields to collaborate in the care of a potentially curable but significantly disabling disorder.

Comparison of a linear and a non-linear model for using sensory-motor, cognitive, personality, and demographic data to predict driving ability in healthy older adults

This study compared the ability of binary logistic regression (BLR) and non-linear causal resource analysis (NCRA) to utilize a range of cognitive, sensory-motor, personality and demographic measures to predict driving ability in a sample of cognitively healthy older drivers. Participants were sixty drivers aged 70 and above (mean=76.7 years, 50% men) with no diagnosed neurological disorder. Test data was used to build classification models for a Pass or Fail score on an on-road driving assessment. The generalizability of the models was estimated using leave-one-out cross-validation. Sixteen participants (27%) received an on-road Fail score. Area under the ROC curve values were .76 for BLR and .88 for NCRA (no significant difference, z=1.488, p=.137). The ROC curve was used to select three different cut-points for each model and to compare classification. At the cut-point corresponding to the maximum average of sensitivity and specificity, the BLR model had a sensitivity of 68.8% and specificity of 75.0% while NCRA had a sensitivity of 75.0% and specificity of 95.5%. However, leave-one-out cross-validation reduced sensitivity in both models and particularly reduced specificity for NCRA. Neither model is accurate enough to be relied on solely for determination of driving ability. The lowered accuracy of the models following leave-one-out cross-validation highlights the importance of investigating models beyond classification alone in order to determine a model's ability to generalize to new cases.

Action planning in typically and atypically developing children (unilateral cerebral palsy)

In the present study, we investigated the development of action planning in children with unilateral Cerebral Palsy (CP, aged 3-6 years, n=24) and an age matched control group. To investigate action planning, participants performed a sequential movement task. They had to grasp an object (a wooden play sword) and place the sword in a hole in a wooden block. Our main dependent variable was the grip type that participants used, i.e., did they adapt their initial grip choice such that they would reach a comfortable posture at the end of the action? This end-state comfort effect has been abundantly shown in research on action planning, and is taken as evidence for anticipatory planning. The first aim of the study was to investigate the development of action planning in the unilateral CP group and the control group. Our hypothesis was that action planning improves with age in the control group, but not in the unilateral CP group. The results showed that planning was impaired in the unilateral CP group compared with the control group. Consistent with our hypothesis, we found an age effect in the control group, but not in the unilateral CP group. In the control group 5 and 6 years olds showed more anticipatory planning compared with the 3 and 4 years olds. The second aim of this study was to examine whether an intervention for children with unilateral CP (i.e., constrained induced movement therapy combined with bimanual training) affected action planning. The children with unilateral CP were therefore measured on the experimental task before and after an 8-week intervention period. The results showed that planning improved after the intervention. This finding suggests that action planning ability in young children with unilateral CP may be sensitive to improvement. These findings are discussed within the context of typical and atypical development of action planning and further guidelines for intervention in children with unilateral CP are given.

Cognitive and motor functional activity in non-demented community-dwelling essential tremor cases

BACKGROUND

Many investigators have observed mild cognitive deficits in essential tremor (ET), yet the functional significance of these deficits is unclear. Also, there are very few data in which functional activity in ET has been divided into cognitively based activities (remembering appointments) versus motor-based activities (writing cheques).

OBJECTIVE

The authors (1) compared functional level in ET cases versus controls, assessing functional activities that are cognitively based and those that are dependent upon both motor and cognitive factors, and (2) determined whether lower mini mental status test scores in ET cases have a functional correlate.

METHODS

In a population-based study of people > or = 65 years in central Spain (NEDICES), a 37-item version of the Mini-Mental State Examination (37-MMSE) and an 11-item version of the Pfeffer Functional Activities Questionnaire (FAQ) were administered to non-demented ET cases and controls.

RESULTS

The FAQ was 55.5% higher (ie, lower function) in 208 cases than 3616 controls (2.8+/-4.8 vs 1.8+/-4.2, p<0.001). Cases reported more difficulty (ie, higher FAQ scores) with FAQ items that were cognitive measures as well as FAQ items that were cognitive-motor in nature. In cases, a lower 37-MMSE was associated with more difficulty on both cognitively based and cognitive-motor-based FAQ items (p<0.001).

DISCUSSION

In this large, population-based study, ET cases reported more functional difficulty than controls, and this functional difficulty was present in both cognitive and cognitive-motor domains. Lower cognitive test scores were associated with more reported functional difficulty, indicating that lower cognitive test scores in ET, rather than being inconsequential, have a clear clinical-functional correlate.

The catatonia conundrum: evidence of psychomotor phenomena as a symptom dimension in psychotic disorders

To provide a rational basis for reconceptualizing catatonia in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), we briefly review historical sources, the psychopathology of catatonia, and the relevance of catatonic schizophrenia in contemporary practice and research. In contrast to Kahlbaum, Kraepelin and others (Jaspers, Kleist, and Schneider) recognized the prevalence of motor symptoms in diverse psychiatric disorders but concluded that the unique pattern and persistence of certain psychomotor phenomena defined a "catatonic" subtype of schizophrenia, based on intensive long-term studies. The enduring controversy and confusion that ensued underscores the fact that the main problem with catatonia is not just its place in Diagnostic and Statistical Manual of Mental Disorders but rather its lack of conceptual clarity. There still are no accepted principles on what makes a symptom catatonic and no consensus on which signs and symptoms constitute a catatonic syndrome. The resulting heterogeneity is reflected in treatment studies that show that stuporous catatonia in any acute disorder responds to benzodiazepines or electroconvulsive therapy, whereas catatonia in the context of chronic schizophrenia is phenomenologically different and less responsive to either modality. Although psychomotor phenomena are an intrinsic feature of acute and especially chronic schizophrenia, they are insufficiently recognized in practice and research but may have significant implications for treatment outcome and neurobiological studies. While devising a separate category of catatonia as a nonspecific syndrome has heuristic value, it may be equally if not more important to re-examine the psychopathological basis for defining psychomotor symptoms as catatonic and to re-establish psychomotor phenomena as a fundamental symptom dimension or criterion for both psychotic and mood disorders.

Is the antidepressive effect of second-generation antidepressants a myth?

Two recent meta-analyses on second-generation antidepressants versus placebo in mild to moderate forms of major depression, based on data on all randomized clinical trials using the Hamilton Depression Scale (HAMD) submitted to FDA, have shown an effect size of approximately 0.30 in favour of antidepressants in the acute therapy of major depression. The clinical significance of an effect size at this level was found to be so poor that these meta-analyses have subscribed to the myth of an exclusively placebo-like effect of second-generation antidepressants. A re-allocation of HAMD items focusing on those items measuring severity of clinical depression, the HAMD6, has identified effect sizes of >or=0.40 for second-generation antidepressants in placebo-controlled trials for which even a dose-response relationship can be demonstrated. In the relapse-prevention phase during continuation therapy of patients with major depression, the advantage of second-generation antidepressants over placebo was as significant as in the acute therapy phase. To explore a myth is not to deny the facts but rather to re-allocate them.

The neuropsychology of 22q11 deletion syndrome. A neuropsychiatric study of 100 individuals

The primary objective of this study was to study the impact of ASD/ADHD on general intellectual ability and profile, executive functions and visuo-motor skills in children and adults with 22q11 deletion syndrome (22q11DS). A secondary aim was to study if gender, age, heart disease, ASD, ADHD or ASD in combination with ADHD had an impact on general intellectual ability and profile. One hundred consecutively referred individuals aged 1-35 years with 22q11DS were given in-depth neuropsychological assessments. Mean full scale IQ was 71 with a normal distribution around this mean. Higher IQ for females than males, and a negative trend for IQ with higher age were found. Intellectual impairment, as well as visuo-motor dysfunction, was found to be related to 22q11DS per se and not to ASD/ADHD. In the area of executive function, the presence of ASD/ADHD predicted poor planning ability in the children in the study.

Neurocognitive profile in children with fetal alcohol spectrum disorders

The question of whether children with fetal alcohol spectrum disorders (FASD) exhibit a unique neurocognitive profile has received considerable attention over the past three decades. The identification of a syndrome-specific neurocognitive profile would aid in diagnosing prenatally exposed children with cognitive deficits who do not exhibit clinically discernable physical anomalies. The current review of the literature, therefore, focuses on the studies of higher-order cognitive skills in children with FASDs with a view towards delineating a pattern of cognitive functioning. Researchers have documented that children with FASDs show diminished intellectual functioning, with average IQ scores falling within the borderline to low average ranges. Slow information processing and disturbances of attention have been observed from infancy through adulthood in individuals with FASDs. Clinical and experimental reports on individuals with FASD have documented marked deficits in executive functioning, particularly in tasks that involve holding and manipulating information in working memory. Studies examining specific domains of cognitive functioning such as language, visual perception, memory and learning, social functioning, and number processing in individuals with FASDs have revealed performance decrements associated with increased task complexity. The above findings converge on the conclusion that children with FASDs have a generalized deficit in the processing and integration of information. We recommend the study of developmental trajectories of both elementary and higher-order functions in future research on FASD to elucidate the development of this cognitive profile.

Sepiapterin reductase deficiency in a 2-year-old girl with incomplete response to treatment during short-term follow-up

Sepiapterin reductase (SR) catalyses the last step in the tetrahydrobiopterin biosynthesis pathway; it converts 6-pyruvoyl-tetrahydropterin (6-PTP) to BH(4) in an NADPH-dependent reaction. SR deficiency is a very rare autosomal recessive disorder with normal phenylalanine (Phe) concentration in blood and diagnostic abnormalities are detected in CSF. We present a 16-month-old girl with SR deficiency. From the newborn period she presented with an adaptation regulatory disorder. At the age of 3 months, abnormal eye movements with dystonic signs and at 4.5 months psychomotor retardation were noticed. Since that time axial hypotonia with limb spasticity (or rather delayed reflex development), gastro-oesophageal reflux and fatigue at the end of the day has been observed. Brain MRI was normal; EEG was without epileptiform discharges. Analysis of biogenic amine metabolites in CSF at the age of 16 months showed very low HVA and 5-HIAA concentrations. Analysis of CSF pterins revealed strongly elevated dihydrobiopterin (BH(2)), slightly elevated neopterin and elevated sepiapterin levels. Plasma and CSF amino acids concentrations were normal. A phenylalanine loading test showed increased Phe after 1 h, 2 h and 4 h and very high Phe/Tyr ratios. SR deficiency was confirmed in fibroblasts and a novel homozygous g.1330C>G (p.N127K) SPR mutation was identified. On L-dopa and then additionally 5-hydroxytryptophan, the girl showed slow but remarkable progress in motor and intellectual ability. Now, at the age of 3 years, she is able to sit; expressive speech is delayed (to 1 1/2 years), passive speech is well developed. Her visual-motor skills, eye-hand coordination and social development correspond to the age of 2 1/2 years.

A cognitive neuropsychiatric analysis of psychomotor symptoms in major depression and schizophrenia

A cognitive neuropsychiatric analysis will be proposed by presenting recent research on -1-motor control, and -2-action monitoring in two psychiatric disorders i.e. major depression and schizophrenia. Motor control is best studied from the broader cognitive neuropsychological perspective of action control. Even very simple actions implicate quite diverse brain activities reflecting the cognitive processes of planning, selection, visuomotor integration, timing, force adjustment, and action monitoring. The extent to which deficits in these cognitive processes cause slowed or stereotypic actions can be experimentally studied in clinical settings by means of graphic tasks, as will be illustrated. A central process in motor/action control is error monitoring. The last decade research on this higher cognitive control process has been booming, also because the detection of errors is accompanied by a clear peak in the EEG, known as the error-related negativity (ERN). Deficient error monitoring has been observed in several psychiatric disorders. ERN studies in major depression and schizophrenia will be discussed. Psychiatric disorders can best be understood by considering three perspectives, i.e. psychopathology, cognitive neuropsychology and neuroscience. The findings support the view that cognitive neuropsychiatry should involve the combined study of psychiatric symptoms, cognitive dimensions and neurological structures.

Neurodevelopmental disorders: cluster 2 of the proposed meta-structure for DSM-V and ICD-11

BACKGROUND

DSM-IV and ICD-10 are atheoretical and largely descriptive. Although this achieves good reliability, the validity of diagnoses can be increased by an understanding of risk factors and other clinical features. In an effort to group mental disorders on this basis, five clusters have been proposed. We now consider the second cluster, namely neurodevelopmental disorders.

METHOD

We reviewed the literature in relation to 11 validating criteria proposed by a DSM-V Task Force Study Group.

RESULTS

This cluster reflects disorders of neurodevelopment rather than a 'childhood' disorders cluster. It comprises disorders subcategorized in DSM-IV and ICD-10 as Mental Retardation; Learning, Motor, and Communication Disorders; and Pervasive Developmental Disorders. Although these disorders seem to be heterogeneous, they share similarities on some risk and clinical factors. There is evidence of a neurodevelopmental genetic phenotype, the disorders have an early emerging and continuing course, and all have salient cognitive symptoms. Within-cluster co-morbidity also supports grouping these disorders together. Other childhood disorders currently listed in DSM-IV share similarities with the Externalizing and Emotional clusters. These include Conduct Disorder, Attention Deficit Hyperactivity Disorder and Separation Anxiety Disorder. The Tic, Eating/Feeding and Elimination disorders, and Selective Mutisms were allocated to the 'Not Yet Assigned' group.

CONCLUSION

Neurodevelopmental disorders meet some of the salient criteria proposed by the American Psychiatric Association (APA) to suggest a classification cluster.

Profiles and cognitive predictors of motor functions among early school-age children with mild intellectual disabilities

BACKGROUND

The purpose of the study was to describe sensorimotor profile in children with mild intellectual disability (ID), and to examine the association between cognitive and motor function.

METHODS

A total of 233 children with mild ID aged 7 to 8 years were evaluated with measures of cognitive, motor and sensory integrative functioning.

RESULTS

Children with mild ID performed significantly less well on all test measures. 44.2% of children scored in the impaired range on seven out of 22 sensorimotor measures. They had weaker fine motor skills than gross motor skills. Sensory integrative functions were only mildly impaired. Total IQ substantially predicted overall performance on each motor test. Specifically, verbal comprehension and processing speed indexes were significant predictors of gross and fine motor function.

CONCLUSIONS

Sensorimotor dysfunctions were found to be very frequent in children with mild ID. Early identification of sensorimotor impairments is essential to prompt early intervention and facilitate better integration into regular school settings.

Visuo-motor coordination deficits and motor impairments in Parkinson's disease

Background

Visuo-motor coordination (VMC) requires normal cognitive executive functionality, an ability to transform visual inputs into movement plans and motor-execution skills, all of which are known to be impaired in Parkinson's disease (PD). Not surprisingly, a VMC deficit in PD is well documented. Still, it is not known how this deficit relates to motor symptoms that are assessed routinely in the neurological clinic. Such relationship should reveal how particular motor dysfunctions combine with cognitive and sensory–motor impairments to produce a complex behavioral disability.

Methods and Findings

Thirty nine early/moderate PD patients were routinely evaluated, including motor Unified Parkinson's Disease Rating Scale (UPDRS) based assessment, A VMC testing battery in which the subjects had to track a target moving on screen along 3 different paths, and to freely trace these paths followed. Detailed kinematic analysis of tracking/tracing performance was done. Statistical analysis of the correlations between measures depicting various aspects of VMC control and UPDRS items was performed. The VMC measures which correlated most strongly with clinical symptoms represent the ability to organize tracking movements and program their direction, rather than measures representing motor-execution skills of the hand. The strong correlations of these VMC measures with total UPDRS score were weakened when the UPDRS hand-motor part was considered specifically, and were insignificant in relation to tremor of the hand. In contrast, all correlations of VMC measures with the gait/posture part of the UPDRS were found to be strongest.

Conclusions

Our apparently counterintuitive findings suggest that the VMC deficit pertains more strongly to a PD related change in cognitive-executive control, than to a reduction in motor capabilities. The recently demonstrated relationship between gait/posture impairment and a cognitive decline, as found in PD, concords with this suggestion and may explain the strong correlation between VMC dysfunction and gait/posture impairment. Accordingly, we propose that what appears to reflect a motor deficit in fact represents a multisystem failure, dominated by a cognitive decline.

Characterizing major depression phenotypes by presence and type of psychomotor disturbance in adolescents and young adults

Major depressive disorder (MDD) is phenomenologically heterogeneous, which has prompted investigation of intermediate MDD phenotypes based on specific key symptoms. Presence and type of psychomotor disturbance may be an important psychopathologic feature that differentiates clinically distinct forms of juvenile MDD. This study examined the phenotypic status of three putative MDD phenotypes in a community sample of 941 youths: (1) agitated depression (MDD with psychomotor agitation), (2) retarded depression (MDD with psychomotor retardation), and (3) agitated-retarded depression (MDD with psychomotor agitation and retardation within an episode). Hasler et al.'s [2004: Neuropsychopharmacology 29:1765-1781] criteria of specificity (degree of association with relevant symptoms and conditions related to the disease of interest versus other psychiatric conditions), stability (degree of stability over time), and heritability (degree of familial aggregation with relevant conditions) were used to evaluate the phenotypic significance of these subtypes. Results were suggestive that agitated depression was a relatively specific phenotypic syndrome characterized by irritability, arousal, physical complaints, and vulnerability to anxiety disorders and alcohol dependence; low stability across depressive episodes; and low heritability. Agitated-retarded depression was relatively specific and characterized by increased severity, recurrence, vegetative symptoms, suicidal ideation, social impairment, endogeneity, and vulnerability to anxiety disorders and bulimia; low stability across episodes; and modest heritability. Although retarded depression was associated with some specific distinguishing characteristics, most associations were explained by the increased severity of this phenotype. Retarded depression evidenced little stability or heritability. These findings offer partial support of the phenotypic status of agitated and agitated-retarded depression in youths.

Does catatonia influence the phenomenology of childhood onset schizophrenia beyond motor symptoms?

Childhood onset schizophrenia (COS) and catatonia (C) are rare and severe psychiatric disorders. The aim of this study was to compare the phenomenology of COS with and without catatonia. We examined 33 cases consecutively referred to two major public university hospitals in Paris. There were 18 cases of COS (age=15.9+/-0.8 years) and 15 of COS+C (age=15.4+/-1.4 years). Patients were referred over the course of 3 and 9 years, respectively. Psychiatric assessment included socio-demographic, clinical and psychometric variables: the Brief Psychiatric Rating Scale (BPRS), the Scales for the Assessment of Positive (SAPS) and Negative Symptoms (SANS), and a catatonia rating scale. Patients with COS+C appeared to be more severely ill at admission and discharge compared with COS in nearly all clinical scores. They also exhibited significantly longer episode duration (50.8 weeks+/-4.8 vs 20.6+/-19.5). On the basis of multivariate logistic regression, the only clinical measure which significantly predicted group membership was the SANS Affective Flattening score (odds ratio=1.24; 95% CI=1.06-1.43). Our findings strongly suggest that catatonic COS differs from COS in ways that extend beyond motor symptoms. The SANS and SAPS scales, commonly used in schizophrenia, are not detailed enough to accurately describe catatonia in COS. The use of a catatonia rating scale is recommended to enhance recognition of and research into COS with catatonia.

Experimental evidence for a motivational origin of cognitive impairment in major depression

BACKGROUND

Diagnostic criteria and empirical evidence support the existence of cognitive deficits in depression. However, depressed mood, loss of interest and low self-efficacy might influence cognitive performance.

METHOD

Goal-setting instructions were used to promote motivation in depressed patients and control subjects during neuropsychological assessment. The resulting performance was compared with performance using standard instructions. Sixty in-patients with non-psychotic unipolar depression and 60 age- and education-matched healthy control subjects were assessed with standard neuropsychological tests [the Auditory Verbal Learning Test (AVLT), the Digit Symbol Test (DST), the Regensburg Word Fluency Test (RWT), and the Number Combination Test (Zahlen-Verbindungs-Test, ZVT)] using either goal-setting or standard test instructions.

RESULTS

Depressed patients showed lower baseline performance and lower generalized self-efficacy (p<0.0005) than controls. However, goal-setting instructions significantly improved patients' memory performance by 10% [AVLT: F(5, 54)=3.611, p=0.007] and psychomotor performance by 13% [ZVT: F(3, 56)=3.667, p=0.017]. Consequently, patients and control subjects demonstrated similar results when goal-setting instructions were applied. Goal-setting instructions showed a statistical trend, increasing patients' performance in the DST by 12% [F(1, 58)=2.990, p=0.089], although their verbal fluency measured by the RWT did not increase. No significant correlations of increased performance with generalized self-efficacy were found.

CONCLUSIONS

Cognitive deficits in depressed patients are influenced by motivational shortcomings. Because generalized self-efficacy failed to correlate to increased test performance, future research needs to disentangle the effective components of goal-setting instructions. Task-specific self-efficacy as well as enhancement of task-focused attention might underlie the significant goal-setting effect in depressed patients.

Neurological evaluation of patients with Gaucher disease diagnosed as type 1

Type 1 Gaucher disease (GD1) is characterised by lack of central nervous system involvement; however, there are several reports of associated neurological manifestations. The aim of this study was to systematically evaluate neurological manifestations in 31 patients with GD1 (12 males and 19 females; mean age 39.4 (range 5-77) years). Participants underwent a complete neurological examination and cognitive tests. Investigation of symptoms and medication intake, and motor and sensory electroneurograms were obtained. 30.7% of adult patients had neurological deficits, including psychomotor delay, parkinsonism, dementia, impaired saccadic ocular movements and peripheral nerve dysfunction. Three patients were redefined as type 3 GD. Electrodiagnosis was performed on 15 patients; 26.7% had reduced amplitude and/or abnormal waveforms in at least three nerves, 33.3% had a mild reduction in amplitude of two nerves and 40% had amplitude reduction in one nerve. Patients with three or more affected nerves had additional neurological symptoms. Our results demonstrate that neurological alterations occur in patients diagnosed with GD1, and subclinical peripheral neuropathy is a frequent finding.

[Specific disturbances of psychomotor development in children with thymomegaly]

Ninety children, aged from 2 month to 3 years, with thymomegaly and 25 aged-matched controls were studied. Most children with thymomegaly had disturbances of psychomotor development. Depending on their types, the cohort of children was stratified into 4 subgroups: 1st - 36 patients (40%) with schizotypal signs; 2nd - 30 hyperactive children (33%); 3rd - 19 children with hyperthymia signs (21%); 4th - 5 normal children (6%). The deviations of locomotion and psychiatric development were correlated with the extent of thymus enlargement and activation of innate and adaptive immunity.

Mathematics learning disabilities in girls with fragile X or Turner syndrome during late elementary school

The present study focuses on math and related skills among 32 girls with fragile X (n = 14) or Turner (n = 18) syndrome during late elementary school. Performance in each syndrome group was assessed relative to Full Scale IQ-matched comparison groups of girls from the general population (n = 32 and n = 89 for fragile X syndrome and Turner syndrome, respectively). Differences between girls with fragile X and their comparison group emerged on untimed arithmetic calculations, mastery of counting skills, and arithmetic problem verification accuracy. Relative to girls in the comparison group, girls with Turner syndrome did not differ on untimed arithmetic calculations or problem verification accuracy, but they had limited mastery of counting skills and longer response times to complete the problem verification task. Girls with fragile X or Turner syndrome also differed from their respective comparison groups on math-related abilities, including visual-spatial, working memory, and reading skills, and the associations between math and those related skills. Together, these findings support the notion that difficulty with math and related skills among girls with fragile X or Turner syndrome continues into late elementary school and that the profile of math and related skill difficulty distinguishes the two syndrome groups from each other.

The impaired hypothyroid patient: ethical considerations and obligations

OBJECTIVES

Analyze the ethical duties and dilemmas involved in treating the severely hypothyroid patient.

DESIGN

A critical review of the literature was conducted with respect to clinical ethics issues pertaining to severe hypothyroidism; legal and ethical guidelines for consent and capacity in the context of severe hypothyroidism; health case law involving the duty to warn third parties; and comparable clinical conditions resulting in impaired driving and the performance of critical tasks.

MAIN OUTCOME

Neuropsychological studies and accepted clinical experiences verify the variable degrees of intellectual and neurological impairment consequent to severe hypothyroidism. Thus, severely hypothyroid patients are considered impaired in the performance of specific tasks, such as driving. Consequent to that, they may be agents of harm as a result of their impairment if they are not warned against driving or performing other duties affecting public safety. Severely hypothyroid patients may lack the capacity to make an informed decision, even when warned against driving or other tasks, and some may ignore such warnings.

CONCLUSIONS

The legal and ethical "duty to warn" may trump confidentiality and HIPAA in cases where the activity of impaired patients seriously affects public safety. Not only do health care providers have a clear duty to warn patients not to drive, but in some extreme cases, may have a duty to warn third parties when a patient's driving or occupational duties place the public in harm's way.