Enhancing emotion recognition in young autistic children with or without attention-deficit/hyperactivity disorder in Hong Kong using a Chinese App version of The Transporters

TRIAL REGISTRATION

This study was registered with the German Clinical Trials Register - Deutschen Register Klinischer Studien (DRKS) on 23 December 2018. The Trial Registration Number (TRN) is DRKS00016506.

LAY ABSTRACT

The Transporters App is an intervention programme with 15 animated episodes that teach emotion recognition skills to autistic children between 4 and 6 years of age. Each episode contains a story depicting social interactions between characters in the form of a vehicle, with human faces grafted on to each of them. Each episode teaches a specific emotion in a story context. Autistic children watched at least three episodes at home for about 15 min daily for a month, with parental guidance. Its automated, home-based format is cost-saving and readily accessible. This study translated The Transporters to a Cantonese-Chinese version. Results showed a significant improvement in emotion recognition following viewing The Transporters in a group of Hong Kong Chinese autistic children, between 4 and 6 years of age, with and without attention-deficit/hyperactivity disorder (n = 48) relative to a control group (n = 24). A non-autistic group (n = 23) showed that the autistic children scored lower in emotion recognition pre-intervention. Post-intervention, the autistic children had improved in emotion recognition to the level of the non-autistic children. The autistic children in the intervention groups also generalized their learning to novel situations/characters not taught within The Transporters. There was no dosage effect, with the standard recommended number of episodes viewed being sufficient to achieve significant improvement. This study confirms the effectiveness of The Transporters for Chinese autistic children and contributes to the literature/practice by expanding the range of applicability of The Transporters to autistic children with attention-deficit/hyperactivity disorder, which is important given the high rate of co-occurrence between autism and attention-deficit/hyperactivity disorder.

Multi-source multi-modal markers for Bayesian Networks: Application to the extremely preterm born brain

The preterm phenotype results from the interplay of multiple disorders affecting the brain and cognitive outcomes. Accurately characterising these interactions can reveal prematurity markers. Bayesian Networks (BNs) are powerful tools to disentangle these relationships, as they inherently measure associations between variables while mitigating confounding factors. We present Modified PC-HC (MPC-HC), a Bayesian Network (BN) structural learning algorithm. MPC-HC employs statistical testing and search-and-score techniques to explore equivalent classes. We employ MPC-HC to estimate BNs for extremely preterm (EP) young adults and full-term controls. Using MRI measurements and cognitive performance markers, we investigate predictive relationships and mutual influences through predictions and sensitivity analysis. We assess the confidence in the estimated BN structures using bootstrapping. Furthermore, MPC-HC's validation involves assessing its ability to recover benchmark BN structures. MPC-HC achieves an average prediction accuracy of 72.5% compared to 62.5% of PC, 64.5% of MMHC, and 71.5% of HC, while it outperforms PC, MMHC, and HC algorithms in reconstructing the true structure of benchmark BNs. The sensitivity analysis shows that MRI measurements mainly affect EP cognitive scores. Our work has two key contributions: first, the introduction and validation of a new BN structure learning method. Second, demonstrating the potential of BNs in modelling variable relationships, predicting variables of interest, modelling uncertainty, and evaluating how variables impact each other. Finally, we demonstrate this by characterising complex phenotypes, such as preterm birth, and discovering results consistent with literature findings.

Myelination of preterm brain networks at adolescence

Prematurity and preterm stressors severely affect the development of infants born before 37 weeks of gestation, with increasing effects seen at earlier gestations. Although preterm mortality rates have declined due to the advances in neonatal care, disability rates, especially in middle-income settings, continue to grow. With the advances in MR imaging technology, there has been a focus on safely imaging the preterm brain to better understand its development and discover the brain regions and networks affected by prematurity. Such studies aim to support interventions and improve the neurodevelopment of preterm infants and deliver accurate prognoses. Few studies, however, have focused on the fully developed brain of preterm born infants, especially in extremely preterm subjects. To assess the long-term effect of prematurity on the adult brain, myelin related biomarkers such as myelin water fraction and g-ratio are measured for a cohort of 19-year-old extremely preterm born subjects. Using multi-modal imaging techniques that combine T2 relaxometry and neurite density information, the results show that specific brain regions associated with white matter injuries due to preterm birth, such as the posterior limb of the internal capsule and corpus callosum, are still less myelinated in adulthood. Furthermore, a weak positive relationship between myelin water fraction values and Full-Scale Intelligence Quotient (FSIQ) scores was found in multiple brain regions previously defined as less myelinated in the Extremely Preterm (EPT) cohort. These findings might suggest altered connectivity in the adult preterm brain and explain differences in cognitive outcomes.

Health-Related Quality of Life from Adolescence to Adulthood Following Extremely Preterm Birth

OBJECTIVE

To examine self-reported and parent-reported health-related quality of life (HRQL) in adults born extremely preterm compared with control participants born at term and to evaluate trajectories of health status from adolescence to early adulthood.

STUDY DESIGN

The EPICure study comprises all births <26 weeks of gestation in the United Kingdom and Ireland in 1995 and control participants born at term recruited at age 6 years. In total, 129 participants born extremely preterm and 65 control participants were followed up at the 19-year assessment. HRQL was measured by the Health Utilities Index Mark 3 multiattribute utility (MAU) scores. Only parent-reported HRQL was available at 11 years of age.

RESULTS

Participants born extremely preterm without neurodevelopmental impairment had significantly lower MAU scores at 19 years than controls (median [IQR]: 0.91 [0.79, 0.97] vs 0.97 [0.87, 1.00], P = .008); those with impairment had the lowest scores (0.74 [0.49, 0.90]). A 0.03-0.05 difference is considered clinically significant. Parent-reported findings were similar. Participants born extremely preterm with impairment rated their health significantly better than their parents did (0.74 vs 0.58, P = .01), in contrast to those without impairment and controls. Between 11 and 19 years, median parent-reported MAU scores decreased from 0.87 to 0.77 for participants born extremely preterm (P = .01) and from 1.00 to 0.97 for control participants (P = .02).

CONCLUSIONS

Among young adults born extremely preterm, both participants and parents rated their health status less favorably than control participants born at term. The decline in MAU scores from adolescence to early adulthood following extremely preterm birth indicates continuing health issues in young adult life.

A Systematic Review of the Risk Factors for Autism Spectrum Disorder in Children Born Preterm

Preterm birth is associated with an increased risk for autism spectrum disorder, with various factors proposed to underlie this relationship. The aim of this systematic review was to provide a narrative synthesis of the literature regarding the prenatal, perinatal and postnatal factors associated with autism spectrum disorder in children born preterm. Medline, Embase and PsycINFO databases were searched via Ovid to identify studies published from January 1990 to December 2019. Original studies in which a standardized diagnostic tool and/or clinical assessment was used to diagnose autism, along with a risk factor analysis to identify associated predictors, were included. A total of 11 eligible studies were identified. Male sex, being born small for gestational age and general cognitive impairment were the most robust findings, with each reported as a significant factor in at least two studies. Comparisons across studies were limited by variation in risk factor measurement and gestational age ranges investigated.

Extremely preterm birth and autistic traits in young adulthood: the EPICure study

Background

A high prevalence of autism spectrum disorder is reported in children born extremely preterm (EP), but an even larger proportion of survivors are affected by subclinical difficulties than meet diagnostic criteria. The aims of this study were to investigate autistic traits associated with the broader autism phenotype in a cohort of young adults born EP, and explore how these traits relate to emotion recognition, empathy and autism symptom presentation in childhood. The prevalence of autism diagnoses was also investigated.

Methods

One hundred and twenty-nine young adults born before 26 weeks of gestation and 65 term-born controls participated in the 19-year follow-up phase of the EPICure studies. In addition to a clinical interview, participants completed the Broader Autism Phenotype Questionnaire (BAPQ), the Empathy Quotient questionnaire, and the Frankfurt Test and Training of Facial Affect Recognition. The Social Communication Questionnaire (SCQ) was completed by the participants’ parents at age 11 years.

Results

EP born young adults scored significantly higher on the BAPQ in comparison with their term-born peers, indicating greater autistic traits. Among EP participants, BAPQ scores were correlated with SCQ scores in childhood (r = 0.484, p < 0.001). EP young adults had significantly lower scores in emotion recognition and empathy in comparison with controls; however, this effect was mediated by IQ. At 19 years, a diagnosis of autism was reported by 10% of EP participants versus 1.6% of controls, whereas 31% of EP participants scored above the cut-off for the broader autism phenotype in comparison with 8.5% of term-born controls.

Limitations

The high attrition of EP participants from lower socio-economic backgrounds and with lower cognitive functioning may have led to an underrepresentation of those presenting with difficulties associated with autism.

Conclusions

A larger proportion of EP survivors are affected by difficulties associated with autism than have confirmed diagnoses, with a moderate correlation between autism symptom scores in childhood and autistic traits in young adulthood. EP young adults had significantly higher autism symptom scores and a larger proportion had a diagnosis of autism than controls. Screening for autistic traits at set points throughout childhood will help identify those EP individuals at risk of social difficulties who may benefit from intervention.

Supplementary information

The online version contains supplementary material available at 10.1186/s13229-021-00414-0.

Testing the neurodevelopmental, trauma and developmental risk factor models of psychosis using a naturalistic experiment

BACKGROUND

The neurodevelopmental and trauma theories are two widely cited models of psychosis. A third - the developmental risk factor model (DRFM) - recognises the combined role of neurodevelopmental risks and trauma. Our objective was to test these theories using preterm populations as a natural experiment, given the high prevalence of neurodevelopmental deficits and exposure to trauma.

METHODS

Two population-based preterm birth cohorts, the Bavarian Longitudinal Study (BLS; N = 399) and EPICure Study (N = 184), were included with term-born controls. Peer victimisation in childhood was assessed by parent and child report and psychotic experiences (PE) were assessed in early adulthood. Different models of psychosis were tested using regression and mediation analyses.

RESULTS

There was support for the trauma and DRFM in the BLS. Peer victimisation increased the risk of PE for preterm and term-born participants equally [odds ratio = 4.87, 95% confidence interval (CI) 1.96-12.08]. There was an indirect effect where preterm children were more likely to be victimised, which subsequently increased risk of PE [β = 1.12 (s.e. = 0.61), 95% CI 0.11-2.48]. The results were replicated in EPICure.

CONCLUSIONS

Exposure to trauma which is experienced more often by neurodevelopmental risk children rather than neurodevelopmental risk per se increases the risk of PE. The findings are consistent with the trauma model and DRFM. Interventions focused on reducing trauma may reduce the development of PE.

Alcohol Use Disorder and Comorbid Depression: A Randomized Controlled Trial Investigating the Effectiveness of Supportive Text Messages in Aiding Recovery

AIM

The aim of this randomized controlled trial was to examine the impact of daily supportive text messages over a 6-month treatment period on mood and alcohol consumption in individuals with a dual diagnosis of alcohol use disorder (AUD) and depression following completion of an inpatient treatment programme.

METHOD

Ninety-five adult participants with AUD and comorbid depression were recruited into this randomized control trial, which took place after completing a 30-day rehabilitation programme. The intervention group (n = 47) received twice-daily supportive text messages over 6-months while control participants (n = 48) had treatment as usual for a 6-month period, with an added 6-month post-treatment follow-up for both groups. Drinking history in the previous 90 days as well as symptoms of depression, anxiety and stress were measured at baseline, 3- and 6-month treatment points and 6-month post treatment follow up.

RESULTS

Depression scores (P = 0.02) and perceived stress scores (P < 0.01) were significantly reduced at 3-month treatment point in the intervention group relative to control participants with small to medium effect. The intervention group also showed a significantly greater reduction in units per drinking day from baseline to 6-month treatment point compared to the control group with a medium effect size (P = 0.03). There were no differences in drinking or mood measures at 6-month post treatment follow-up.

CONCLUSIONS

Supportive text messages provide an early initial benefit in decreasing symptoms of depression and stress, with a further positive impact on alcohol consumption following a longer treatment period. Benefits did not persist six months after the intervention ended.

Neuropsychological Outcomes at 19 Years of Age Following Extremely Preterm Birth

BACKGROUND AND OBJECTIVES

Children born extremely preterm (EP) (<26 weeks' gestation) have lower cognitive scores and an increased rate of cognitive impairment compared with their term-born peers. However, the neuropsychological presentation of these EP individuals in adulthood has not been described. The aim of this study was to examine neuropsychological outcomes in early adulthood after EP birth in the 1995 EPICure cohort and to investigate if the rate of intellectual impairment changed longitudinally.

METHODS

A total of 127 young adults born EP and 64 term-born controls had a neuropsychological assessment at 19 years of age examining general cognitive abilities (IQ), visuomotor abilities, prospective memory, and aspects of executive functions and language.

RESULTS

Adults born EP scored significantly lower than term-born controls across all neuropsychological tests with effect sizes (Cohen's d) of 0.7 to 1.2. Sixty percent of adults born EP had impairment in at least 1 neuropsychological domain; deficits in general cognitive functioning and visuomotor abilities were most frequent. The proportion of EP participants with an intellectual impairment (IQ <70) increased by 6.7% between 11 and 19 years of age (P = .02). Visuospatial functioning in childhood predicted visuomotor functioning at 19 years.

CONCLUSIONS

Adults born EP continue to perform lower than their term-born peers in general cognitive abilities as well as across a range of neuropsychological functions, indicating that these young adults do not show improvement overtime. The prevalence of intellectual impairment increased from 11 years into adulthood.

Hand Preference Develops Across Childhood and Adolescence in Extremely Preterm Children: The EPICure Study

AIM

We attempted to determine how handedness changes with age and its relation to brain injury and cognition following birth before 26 weeks of gestation.

METHODS

We used data from the EPICure study of health and development following birth in the British Isles in 1995. Handedness was determined by direct observation during standardized testing at age 2.5, six, and 11 years and by self-report using the Edinburgh Handedness Inventory at 19 years. Control data from term births were included at six, 11, and 19 years.

RESULTS

In extremely preterm children left handedness increased from 9% to 27% between 2.5 and 19 years, with a progressive reduction in mixed handedness from 59% to 13%. Although individual handedness scores varied over childhood, the between-group effects were consistent through 19 years, with greatest differences in females. In extremely preterm participants, neonatal brain injury was associated with lower right handedness scores at each age and left-handed participants had lower cognitive scores at 19 years after controlling for confounders, but not at other ages.

CONCLUSION

Increasing hand lateralization is seen over childhood in extremely preterm survivors, but consistently more individuals have non-right preferences at each age than control individuals.

Psychiatric Symptoms and Disorders in Extremely Preterm Young Adults at 19 Years of Age and Longitudinal Findings From Middle Childhood

Since the 1980s, the long-term outcomes of extremely preterm birth (before 28 weeks of gestation) have garnered considerable interest as a result of significant improvements in neonatal care and the consequent increase in survival rates. Compared with birth at full term, extremely preterm birth places infants at increased risk for neurodevelopmental disorders, intellectual impairments, and psychiatric sequelae that persist throughout childhood and adolescence.¹ There is increasing interest in the longer-term outcomes for these babies; in particular, whether adverse outcomes persist or increase in adulthood or whether survivors can outgrow earlier problems.

Intelligence and memory outcomes within 10 years of childhood convulsive status epilepticus

Long-term intelligence and memory outcomes of children post convulsive status epilepticus (CSE) have not been systematically investigated despite evidence of short-term impairments in CSE. The present study aimed to describe intelligence and memory outcomes in children within 10 years of CSE and identify potential risk factors for adverse outcomes. In this cohort study, children originally identified by the population-based North London Convulsive Status Epilepticus in Childhood Surveillance Study (NLSTEPSS) were prospectively recruited between July 2009 and February 2013 and invited for neuropsychological assessments and magnetic resonance imaging (MRI) scans. Full-scale intelligence quotients (FSIQs) were measured using the Wechsler Abbreviated Scales of Intelligence (WASI), and global memory scores (GMS) was assessed using the Children's Memory Scale (CMS). The cohort was analyzed as a whole and stratified into a prolonged febrile seizures (PFS) and non-PFS group. Their performance was compared with population norms and controls. Regression models were fitted to identify predictors of outcomes. With a mean of 8.9 years post-CSE, 28.5% of eligible participants were unable to undertake testing because of their severe neurodevelopmental deficits. Children with CSE who undertook formal testing (N = 94) were shown to have significantly lower FSIQ (p = 0.001) and GMS (p = 0.025) from controls; the PFS group (N = 34) had lower FSIQs (p = 0.022) but similar memory quotients (p = 0.88) with controls. Intracranial volume (ICV), developmental delay at baseline, and active epilepsy at follow-up were predictive of long-term outcomes in the non-PFS group. The relationship between ICV and outcomes was absent in the PFS group despite its presence in the control and non-PFS groups. Post-CSE, survivors reveal significant intelligence and memory impairments, but prognosis differs by CSE type; memory scores are uncompromised in the PFS group despite evidence of their lower FSIQ whereas both are compromised in the non-PFS group. Correlations between brain volumes and outcomes differ in the PFS, non-PFS, and control groups and require further investigation.

The EU-Emotion Voice Database

In this study, we report the validation results of the EU-Emotion Voice Database, an emotional voice database available for scientific use, containing a total of 2,159 validated emotional voice stimuli. The EU-Emotion voice stimuli consist of audio-recordings of 54 actors, each uttering sentences with the intention of conveying 20 different emotional states (plus neutral). The database is organized in three separate emotional voice stimulus sets in three different languages (British English, Swedish, and Hebrew). These three sets were independently validated by large pools of participants in the UK, Sweden, and Israel. Participants' validation of the stimuli included emotion categorization accuracy and ratings of emotional valence, intensity, and arousal. Here we report the validation results for the emotional voice stimuli from each site and provide validation data to download as a supplement, so as to make these data available to the scientific community. The EU-Emotion Voice Database is part of the EU-Emotion Stimulus Set, which in addition contains stimuli of emotions expressed in the visual modality (by facial expression, body language, and social scene) and is freely available to use for academic research purposes.

A Framework For Memory Performance Prediction From Brain Volume In Preterm-Born Adolescents

With advances in medical care, higher numbers of extremely preterm-born babies are now surviving, however the rate of neurodevelopmental and neurological complications has not improved at the same rate and the relative rate of disabilities and health problems is increasing, with associated high costs for health care systems and education. Understanding brain development after early birth is of great importance to be able to make informed decisions. Many studies have associated different areas of the preterm brain with poor cognitive performance, however it is less clear whether these associations persist into adult life. In this study, we investigate how well cortical volumes describe memory performance in 133 19 year-old adolescents, 61% of whom were born extremely preterm. We employ LASSO to identify brain regions that better explain memory performance. The brain regions identified by LASSO explained 27% and 32% of the variance in the visual working memory scores and the visual short term memory respectively. Furthermore, the correlation between the predicted scores and validation scores is statistically significant and it is 58% for the visual working memory task and 56% for the visual short term memory task.

Somatosensory function and pain in extremely preterm young adults from the UK EPICure cohort: sex-dependent differences and impact of neonatal surgery

BACKGROUND

Surgery or multiple procedural interventions in extremely preterm neonates influence neurodevelopmental outcome and may be associated with long-term changes in somatosensory function or pain response.

METHODS

This observational study recruited extremely preterm (EP, <26 weeks' gestation; n=102, 60% female) and term-born controls (TC; n=48) aged 18-20 yr from the UK EPICure cohort. Thirty EP but no TC participants had neonatal surgery. Evaluation included: quantitative sensory testing (thenar eminence, chest wall); clinical pain history; questionnaires (intelligence quotient; pain catastrophising; anxiety); and structural brain imaging.

RESULTS

Reduced thermal threshold sensitivity in EP vs TC participants persisted at age 18-20 yr. Sex-dependent effects varied with stimulus intensity and were enhanced by neonatal surgery, with reduced threshold sensitivity in EP surgery males but increased sensitivity to prolonged noxious cold in EP surgery females (P<0.01). Sex-dependent differences in thermal sensitivity correlated with smaller amygdala volume (P<0.05) but not current intelligence quotient. While generalised decreased sensitivity encompassed mechanical and thermal modalities in EP surgery males, a mixed pattern of sensory loss and sensory gain persisted adjacent to neonatal scars in males and females. More EP participants reported moderate-severe recurrent pain (22/101 vs 4/48; χ2=0.04) and increased pain intensity correlated with higher anxiety and pain catastrophising.

CONCLUSIONS

After preterm birth and neonatal surgery, different patterns of generalised and local scar-related alterations in somatosensory function persist into early adulthood. Sex-dependent changes in generalised sensitivity may reflect central modulation by affective circuits. Early life experience and sex/gender should be considered when evaluating somatosensory function, pain experience, or future chronic pain risk.

Finding the time: an audit of the acute ward mealtime processes

It has been found that many organisations still fail to meet the basic rights of those in their care, in terms of access to food, drink and support when they need it. In acknowledgment that food service in hospitals must be given a higher priority, and be recognised as an integral part of the patient's treatment and care, Irish hospitals must now have a system to evaluate the nutritional and hydrational care for patients admitted to hospital. The purpose of this audit was to examine the level of mealtime support available to patients during the main mealtime service in our hospital. As the audit highlighted the need to alter ward processes around the mealtime service, quality improvement initiatives were introduced. These initiatives had a positive impact, enabling ward staff to improve adequacy of mealtime support to patients, leading to better patient quality care at this time.

Heart rate passivity of cerebral tissue oxygenation is associated with predictors of poor outcome in preterm infants

AIM

Near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) allow non-invasive assessment of cerebral haemodynamics. We assessed cerebrovascular reactivity in preterm infants by investigating the relationship between NIRS- and TCD-derived indices and correlating them with severity of clinical illness.

METHODS

We recorded the NIRS-derived cerebral tissue oxygenation index (TOI) and TCD-derived flow velocity (Fv), along with other physiological variables. Moving correlation coefficients between measurements of cerebral perfusion (TOI, Fv) and heart rate were calculated. We presumed that positivity of these correlation coefficients - tissue oxygenation heart rate reactivity index (TOHRx) and flow velocity heart rate reactivity index (FvHRx) - would indicate a direct relationship between cerebral perfusion and cardiac output representing impaired cerebrovascular autoregulation.

RESULTS

We studied 31 preterm infants at a median age of 2 days, born at a median gestational age of 26 + 1 weeks. TOHRx was significantly correlated with gestational age (R = -0.57, p = 0.007), birth weight (R = -0.58, p = 0.006) and the Clinical Risk Index for Babies II (R = 0.55, p = 0.0014). TOHRx and FvHRx were significantly correlated (R = 0.39, p = 0.028).

CONCLUSION

Heart rate has a key influence on cerebral haemodynamics in preterm infants, and TOHRx may be of diagnostic value in identifying impaired cerebrovascular reactivity leading to adverse clinical outcome.

Cortical source analysis of high-density EEG recordings in children

EEG is traditionally described as a neuroimaging technique with high temporal and low spatial resolution. Recent advances in biophysical modelling and signal processing make it possible to exploit information from other imaging modalities like structural MRI that provide high spatial resolution to overcome this constraint. This is especially useful for investigations that require high resolution in the temporal as well as spatial domain. In addition, due to the easy application and low cost of EEG recordings, EEG is often the method of choice when working with populations, such as young children, that do not tolerate functional MRI scans well. However, in order to investigate which neural substrates are involved, anatomical information from structural MRI is still needed. Most EEG analysis packages work with standard head models that are based on adult anatomy. The accuracy of these models when used for children is limited, because the composition and spatial configuration of head tissues changes dramatically over development. In the present paper, we provide an overview of our recent work in utilizing head models based on individual structural MRI scans or age specific head models to reconstruct the cortical generators of high density EEG. This article describes how EEG recordings are acquired, processed, and analyzed with pediatric populations at the London Baby Lab, including laboratory setup, task design, EEG preprocessing, MRI processing, and EEG channel level and source analysis.

Is macrocephaly a neural marker of a local bias in autism?

Previous research has suggested that the local processing bias often reported in studies of Autism Spectrum Condition may only be typical of a subgroup of individuals with autism also presenting with macrocephaly. The current study examined a group of children with autism, with and without macrocephaly, on the Children's Embedded Figures Test (CEFT), a well-established measure of local processing bias. The results demonstrated that the children with autism and macrocephaly performed significantly better on the CEFT than children with autism without macrocephaly, indicative of a local bias. These results lend support to the proposal that both macrocephaly in autism and a local processing bias may arise from the same underlying neural processes and these characteristics represent an endophenotype in a subgroup of individuals with ASC worthy of further investigation.

Functional brain network organisation of children between 2 and 5 years derived from reconstructed activity of cortical sources of high-density EEG recordings

There is increasing interest in applying connectivity analysis to brain measures (Rubinov and Sporns, 2010), but most studies have relied on fMRI, which substantially limits the participant groups and numbers that can be studied. High-density EEG recordings offer a comparatively inexpensive easy-to-use alternative, but require channel-level connectivity analysis which currently lacks a common analytic framework and is very limited in spatial resolution. To address this problem, we have developed a new technique for studies of network development that overcomes the spatial constraint and obtains functional networks of cortical areas by using EEG source reconstruction with age-matched average MRI templates (He et al., 1999). In contrast to previously reported channel-level analysis, this approach provides information about the cortical areas most likely to be involved in the network as well as their functional relationship (Babiloni et al., 2005; De Vico Fallani et al., 2007). In this study, we applied source reconstruction with age-matched templates to task-free high-density EEG recordings in typically-developing children between 2 and 6 years of age (O'Reilly, 2012). Graph theory was then applied to the association strengths of 68 cortical regions of interest based on the Desikan-Killiany atlas. We found linear increases of mean node degree, mean clustering coefficient and maximum betweenness centrality between 2 years and 6 years of age. Characteristic path length was negatively correlated with age. The correlation of the network measures with age indicates network development towards more closely integrated networks similar to reports from other imaging modalities (Fair et al., 2008; Power et al., 2010). We also applied eigenvalue decomposition to obtain functional modules (Clayden et al., 2013). Connection strength within these modules did not change with age, and the modules resembled hub networks previously described for MRI (Hagmann et al., 2010; Power et al., 2010). The high temporal resolution of EEG additionally allowed us to distinguish between frequency bands potentially reflecting dynamic coupling between different neural oscillators. Generally, network parameters were similar for networks based on different frequency bands, but frequency band did emerge as a significant factor for clustering coefficient and characteristic path length. In conclusion, the current analysis shows that source reconstruction of high-density EEG recordings with appropriate head models offers a valuable tool for estimating network parameters in studies of brain development. The findings replicate the pattern of closer functional integration over development described for other imaging modalities (Fair et al., 2008; Power et al., 2010).

Normal neurological outcome in two infants treated with exchange transfusions born to mothers with Crigler-Najjar Type 1 disorder

Patients with Crigler-Najjar Type 1 (CN-1) disorder have an unconjugated hyperbilirubinaemia due to the complete absence in activity of uridinediphosphate glucuronosyltransferase, a bilirubin-conjugating enzyme. In pregnant women with CN-1, the foetus is at high risk of being adversely affected by the bilirubin, as unconjugated bilirubin can cross the placenta and is potentially neurotoxic. We report the long-term outcomes of two infants born to women with CN-1. These infants had exchange transfusions soon after birth and have normal neurodevelopmental outcomes at 18 months and four years of age, respectively. We propose that this intervention might have improved the neurological outcome of these infants.

Big heads, small details and autism

Autism is thought to be associated with a bias towards detail-focussed processing. While the cognitive basis remains controversial, one strong hypothesis is that there are high processing costs associated with changing from local into global processing. A possible neural mechanism underlying this processing style is abnormal neural connectivity; specifically reduced structural or functional connectivity between brain regions might lead to good exemplar-based processing but poor generalisation. Abnormal neural connectivity has also been suggested to account for the increased incidence of macrocephaly in autism (increased head/brain size). The present study therefore investigated the effect of head size on the ability to switch between global and local processing in autism. 49 high-functioning 7-12 year olds with autism (12 with macrocephaly) were compared to 25 normally developing children in their performance on a Local-Global Switching task. Those children with autism who also had macrocephaly showed a greater processing cost when switching into global processing, or 'zooming out', than both the remaining children with autism and the control children. A second experiment revealed that macrocephaly in the context of normal development is not associated with difficulty switching into global processing but rather occurs in children who are physically large. Macrocephaly in the context of autism may therefore be a biological marker of abnormal neural connectivity, and of a local processing bias.

In vitro fertilisation in a small unit in the NHS

In vitro fertilisation is one of the most effective new treatments for infertility, but financial restrictions have made it impossible for it to be widely carried out in the National Health Service. We report on the establishment of a small, largely self funded, unit that was set up with the help of the local health service management. All cycles are programmed so that most work is carried out during the working week; oocyte recoveries are performed as outpatient procedures without general anaesthesia and guided by ultrasound. Roughly a tenth of treatment cycles and roughly a fifth of embryo transfers resulted in a clinical pregnancy.

Verbal conditioning of stimulus significance in the orienting response context: an exploration demonstrating a new personality effect

The manipulation of stimulus significance, by instructions from the experimenter, may be taken as an example of verbal conditioning. Consideration of such a mechanism suggested that personality effects previously found in conditioning studies should be apparent in instructional manipulations of significance in a study of the orienting response (OR) to words. Because of recent changes in dimensioning of the personality structure, some of the items originally used to define Eysenck's extraversion (E) dimension are now used to assess the new dimension of psychoticism (P), suggesting that at least some of the established effects of E upon conditioning may be associated now with P. Hence the P scale was focused on in this study. Words differing on the evaluative dimension of the semantic differential were presented in three blocks, the first under indifferent instructions, the second under instructions to rate the words for their affective impact, and the third under indifferent instructions again. These blocks correspond to baseline, conditioning, and extinction conditions respectively. Electrodermal activity indicated enhanced conditioning, together with greater carry-over effects in the extinction phase, for low-P compared with high-P subjects. The results indicate the importance of personality effects in studies of stimulus significance and illustrate the value of the verbal conditioning mechanism in this area of the OR field. They also suggest the need to re-examine previously obtained E-effects in conditioning studies in light of changing personality tests.

Restricted feeding and circadian activity rhythms of a predatory marsupial, Dasyuroides byrnei

There is considerable disagreement as to whether food availability entrains circadian activity rhythms in omnivorous laboratory rodents. However, in carnivorous mammals a restricted feeding regime could act as a zeitgeber because the predator should hold a periodism correlated to that of the prey. Nevertheless, a restricted feeding schedule does not dominate the LD cycle for entrainment of circadian activity rhythms of the nocturnal predator Dasyuroides byrnei, nor does it entrain the free-running activity rhythms in DD. Anticipatory wheel running prior to food availability was observed in most animals. Some evidence for weak coupling between LD-entrained and meal-associated oscillators was indicated by occurrences of relative coordination. This species does not appear to have a dominance hierarchy of zeitgebern different to that reported for laboratory rodents. One would have predicted that it would have been ecologically adaptive for cycles of food availability to be more important than the LD cycle in this species.