A Video-Based Classification System for Assessing Locomotor Skills in Children

The Test of Gross Motor Development 2 (TGMD-2) is currently the standard approach for assessing fundamental movement skills (FMS), including locomotor and object control skills. However, its extensive application is restricted by its low efficiency and requirement of expert training for large-scale evaluations. This study evaluated the accuracy of a newly-developed video-based classification system (VCS) with a marker-less sensor to assess children's locomotor skills. A total of 203 typically-developing children aged three to eight years executed six locomotor skills, following the TGMD-2 guidelines. A Kinect v2 sensor was used to capture their activities, and videos were recorded for further evaluation by a trained rater. A series of computational-kinematic-based algorithms was developed for instant performance rating. The VCS exhibited moderate-to-very good levels of agreement with the rater, ranging from 66.1% to 87.5%, for each skill, and 72.4% for descriptive ratings. Paired t-test revealed that there were no significant differences, but significant positive correlation, between the standard scores determined by the two approaches. Tukey mean difference plot suggested there was no bias, with a mean difference (SD) of -0.16 (1.8) and respective 95% confidence interval of 3.5. The kappa agreement for the descriptive ratings between the two approaches was found to be moderate (k = 0.54, p < 0.01). Overall, the results suggest the VCS could potentially be an alternative to the conventional TGMD-2 assessment approach for assessing children's locomotor skills without the necessity of the presence of an experienced rater for the administration.

Developmental Trajectories of Anxiety and Depression Symptoms from Early to Middle Childhood: a Population-Based Cohort Study in the Netherlands

Developmental patterns of anxiety and depression symptoms in early childhood have previously been related to anxiety and mood disorders in middle childhood. In the current study, trajectories of anxiety and depression symptoms (1.5-10 years) were related to children's broader psychosocial and school-related functioning at 10 years. We included a population-based sample of 7499 children, for whom primary caregivers reported anxiety and depression symptoms on the Child Behavior Checklist, at children's ages of 1.5, 3, 6, and 10. Growth Mixture Modeling identified four distinct, gender-invariant, trajectories of anxiety and depression symptoms: low (82.4%), increasing (7.4%), decreasing (6.0%), and increasing symptoms up to age 6 followed by a decrease to age 10 (preschool-limited, 4.2%). Children with a non-Dutch ethnicity had lower odds to be in the increasing trajectory and higher odds to be in the decreasing and pre-school limited trajectory. Also, low maternal education predicted the decreasing and pre-school limited trajectory. Higher levels of psychopathology during pregnancy for both mothers and fathers predicted the increasing, decreasing, and preschool-limited trajectory, compared to the low trajectory. At age 10, children in the increasing and preschool-limited trajectory had diminished psychosocial outcomes (friendship-quality and self-esteem) and worse school-related outcomes (school performance and school problems). This study adds to current knowledge by demonstrating that developmental patterns of anxiety and depression symptoms in early childhood are related to broader negative outcomes in middle childhood. Child and family factors could guide monitoring of anxiety and depression symptoms in the general population and provide targets for prevention programs.

Development of Aggression Subtypes from Childhood to Adolescence: a Group-Based Multi-Trajectory Modelling Perspective

The persistence of elevated subtypes of aggression beginning in childhood have been associated with long-term maladaptive outcomes. Yet it remains unclear to what extent there are clusters of individuals following similar developmental trajectories across forms (i.e., physical and indirect) and functions (i.e., proactive and reactive) of aggression. We aimed to identify groups of children with distinct profiles of the joint development of forms and functions of aggression and to identify risk factors for group membership. A sample of 787 children was followed from birth to adolescence. Parent and teacher reports, and standardised assessments were used to measure two forms and two functions of aggressive behaviour, between six and 13 years of age along with preceding child, maternal, and family-level risk-factors. Analyses were conducted using a group-based multi-trajectory modelling approach. Five trajectory groups emerged: non-aggressors, low-stable, moderate-engagers, high-desisting, and high-chronic. Coercive parenting increased membership risk in the moderate-engagers and high-chronic groups. Lower maternal IQ increased membership risk in both high-desisting and high-chronic groups, whereas maternal depression increased membership risk in the high-desisting group only. Never being breastfed increased membership risk in the moderate-engagers group. Boys were at greater risk for belonging to groups displaying elevated aggression. Individuals with chronic aggression problems use all subtypes of aggression. Risk factors suggest that prevention programs should start early in life and target mothers with lower IQ. Strategies to deal with maternal depression and enhance positive parenting while replacing coercive parenting tactics should be highlighted in programming efforts.

Language profiles and literacy outcomes of children with resolving, emerging, or persisting language impairments

BACKGROUND

Children with language impairment (LI) show heterogeneity in development. We tracked children from pre-school to middle childhood to characterize three developmental trajectories: resolving, persisting and emerging LI.

METHODS

We analyzed data from children identified as having preschool LI, or being at family risk of dyslexia, together with typically developing controls at three time points: t1 (age 3;09), t3 (5;08) and t5 (8;01). Language measures are reported at t1, t3 and t5, and literacy abilities at t3 and t5. A research diagnosis of LI (irrespective of recruitment group) was validated at t1 by a composite language score derived from measures of receptive and expressive grammar and vocabulary; a score falling 1SD below the mean of the typical language group on comparable measures at t3 and t5 was used to determine whether a child had LI at later time points and then to classify LIs as resolving, persisting or emerging.

RESULTS

Persisting preschool LIs were more severe and pervasive than resolving LIs. Language and literacy outcomes were relatively poor for those with persisting LI, and relatively good for those with resolving LI. A significant proportion of children with average language abilities in preschool had LIs that emerged in middle childhood - a high proportion of these children were at family risk of dyslexia. There were more boys in the persisting and resolving LI groups. Children with early LIs which resolved by the start of formal literacy instruction tended to have good literacy outcomes; children with late-emerging difficulties that persisted developed reading difficulties.

CONCLUSIONS

Children with late-emerging LI are relatively common and are hard to detect in the preschool years. Our findings show that children whose LIs persist to the point of formal literacy instruction frequently experience reading difficulties.

Language Evaluation Scale Trivandrum (LEST 3-6 years) Development and Validation

Language Evaluation Scale Trivandrum (LEST:3-6 years) with 31-items, was validated against extended REELS with a community sample-606 children (3-6yrs). One item and two item delay as LEST delay showed a sensitivity of (81%, 47%); specificity (68%, 94%), PPV (12%, 31%); NPV (98%, 97%) and accuracy (68.5%, 92%), respectively. LEST (3-6years) is a simple, valid, community screening tool.

Validating a developmental scale for young children using the Rasch model: applicability of the teaching strategies GOLD assessment system

This article reports the results of an application of the Rasch rating scale model to the Teaching Strategies GOLD assessment system in a norm sample of children aged birth to 71 months. The analyses focused on the examination of dimensionality, rating scale effectiveness, the hierarchy of item difficulties, and the relationship of developmental scale scores to child age. Results show that each subscale satisfies the Rasch model for unidimensionality. Ratings were found to be less reliable at the lowest and highest ends of the scale and less distinct at 'In-between' levels. Items appear to form theoretically expected hierarchies, supporting evidence for construct validity for the measures. Moderately high correlations of developmental scale scores with child age suggest that teachers are able to make valid ratings of the developmental progress of children across the intended age range.

RAN and double-deficit theory

Lervag and Hulme's neuro-developmental theory and Wolf and Bowers's double-deficit hypothesis were examined in this longitudinal study. A total of 130 children were tested in preschool and followed through fifth grade, when 84 remained in the study. During preschool and kindergarten the participants were given tests of end-sound discrimination (phonological awareness; PA) and the rapid naming of objects (rapid automatic naming; RAN) and were placed into the four groupings of the double-deficit hypothesis. The growth curves for the four groups with the subtests of word reading, pseudoword reading, and comprehension supported the double-deficit hypothesis. The RAN objects scores of preschool and kindergarten predicted reading at every age level and offered support for Lervag and Hulme's neuro-developmental theory. It was concluded that both RAN and PA predicted reading in the English language throughout the elementary school years and that the early assessments of these variables were more diagnostic than measures at later ages.

Childhood trajectories of anxiousness and disruptiveness explain the association between early-life adversity and attempted suicide

BACKGROUND

Suicidal behavior is frequently associated with a history of childhood abuse yet it remains unclear precisely how early life adversity may increase suicide risk later in life. As such, our aim was to examine whether lifetime trajectories of disruptiveness and anxiousness trait dysregulation explain the association between childhood adversity and suicidal behavior; and moreover, to test the potential modifying effects of mental disorders on these associations.

METHOD

A sample of 1776 individuals from a prospective school-based cohort followed longitudinally for over 22 years was investigated. We tested the influence of disruptiveness and anxiousness trajectories from age 6 to 12 years on the association between childhood adversity (i.e. sexual and physical abuse) and history of suicide attempts (SA) using logistic regression models. Both adolescent externalizing and internalizing Axis I disorders and gender were tested as potential modifiers of these associations.

RESULTS

Four distinct longitudinal trajectories were identified for both disruptiveness and anxiousness. The high disruptiveness trajectory accounted for the association between childhood adversity and SA, but only for females. The high anxiousness trajectory also explained the association between adversity and SA; however, in this case it was not sex but mental disorders that influenced the potency of the mediating effect. More specifically, anxiousness fully explained the effect of adversity on SA in the presence of externalizing disorders, whereas in the absence of these disorders, this effect was significantly attenuated.

CONCLUSIONS

This study provides evidence that both disruptiveness and anxiousness play an important role in explaining the relationship between childhood adversity and SA.

A description of adaptive and maladaptive behaviour in children and adolescents with Cri-du-chat syndrome

BACKGROUND

Psychological tests can be useful to record adaptive and maladaptive behaviours of children with intellectual disability. The objective of this study was to describe the adaptive and maladaptive behaviour of children and adolescents with Cri-du-chat syndrome.

METHODS

The sample consisted of 10 children and adolescents with Cri-du-chat syndrome (mean chronological age=11.3 years, mean mental age=18 months). The developmental quotient was calculated through the Psychoeducational Profile - Revised. An observational protocol was used to record adaptive and maladaptive behaviours.

RESULTS

The number of maladaptive behaviours observed was different among participants. However, all of them had high rates of adaptive behaviours, such as rule-following.

CONCLUSIONS

These results, though preliminary, justify that we continue to think about the need for psychoeducational interventions aimed at stimulating the repertoire of adaptive behaviours, in people with Cri-du-chat syndrome.

The temporal relation between regression and transition periods in early infancy

According to the literature about developmental changes, periods of instability and disorganization in the social and emotional behavior in both human and non-human primate, infancy precedes major developmental achievements or transitions (Heimann, 2003; Sparrow & Brazelton, 2006). Developmental investigators have observed a more frequent and prolonged crying, clinging and bids for physical contact with mother during these periods of instability and disorganization. Some authors, according to Horwich (1974), called these periods regression periods. Rijt-Plooij and Plooij (1992) claimed that 10 regression periods could be identified during the first 20 months of human life. In an early study, Sadurní and Rostan (2002) confirmed the presence of 8 such regression periods during the first year of life of 18 Catalan babies. Their 8 regression periods were comparable to the first 8 of the 10 regression periods found by Van de Rijt Plooij and Plooij. The aim of the present study is to see whether the regression periods that we found are temporally related to some transition. We define a transition as the occurrence of a new developmental change in a child. In the present study we have used non-analyzed data from the same 18 Catalan babies (10 boys and 8 girls) as mentioned in our earlier published study on regression periods. The age of these babies was between 3 weeks and 14 months. Using a microgenetic methodology we have found 8 transitions periods in the first year of life. We have also observed a temporal relation between the regressions periods found earlier and the transition periods reported here.

Use of the motor performance checklist to study motor outcomes in 5-year-olds

AIM

To report findings about the Motor Performance Checklist (MPC) for 5-year-olds, a simple 12-item instrument for assessing gross and fine motor skills, in a research study of neurodevelopmental outcomes after neonatal events.

METHODS

We trained 10 examiners to use the MPC in a study of the outcomes of neonatal jaundice and dehydration in 339 5-year-old children. We compared MPC scores with those on the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), the Beery-Buktenica Developmental Test of Visual-Motor Integration-Fourth Edition (VMI-4), and a standard neurological examination, and compared failure rates on each MPC item across examiners. Parent concerns about their child's development were addressed using the Parent Evaluation of Developmental Status (PEDS).

RESULTS

Children who 'failed' the MPC had 7-10 points lower mean scores on the WPPSI-R subscales (P = 0.001), 9-10 points lower mean scores on the VMI-4 subscales (P = 0.001), and were almost twice as likely to have a 'questionable' neurological examination score (adjusted OR 1.86, 95% CI 1.00-3.53, P = 0.005). On the PEDS, only the concern about the use of arms and hands was significantly associated with MPC failure. We found significant sex differences on four of the 12 MPC items. We also found differences in failure rates by different examiners.

CONCLUSIONS

MPC scores correlated with other measures of neurodevelopment. Because of different failure rates across examiners, examiner terms need to be included if it is used in research studies.

Effects of fully-established Sure Start Local Programmes on 3-year-old children and their families living in England: a quasi-experimental observational study

BACKGROUND

Sure Start Local Programmes (SSLPs) are area-based interventions to improve services for young children and their families in deprived communities, promote health and development, and reduce inequalities. We therefore investigated whether SSLPs affect the wellbeing of 3-year-old children and their families.

METHODS

In a quasi-experimental observational study, we compared 5883 3-year-old children and their families from 93 disadvantaged SSLP areas with 1879 3-year-old children and their families from 72 similarly deprived areas in England who took part in the Millennium Cohort Study. We studied 14 outcomes-children's immunisations, accidents, language development, positive and negative social behaviours, and independence; parenting risk; home-learning environment; father's involvement; maternal smoking, body-mass index, and life satisfaction; family's service use; and mother's rating of area.

FINDINGS

After we controlled for background factors, we noted beneficial effects associated with the programmes for five of 14 outcomes. Children in the SSLP areas showed better social development than those in the non-SSLP areas, with more positive social behaviour (mean difference 0.45, 95% CI 0.09 to 0.80, p=0.01) and greater independence (0.32, 0.18 to 0.47, p<0.0001). Families in SSLP areas showed less negative parenting (-0.90, -1.11 to -0.69, p<0.0001) and provided a better home-learning environment (1.30, 0.75 to 1.86, p<0.0001). These families used more services for supporting child and family development than those not living in SSLP areas (0.98, 0.86 to 1.09, p<0.0001). Effects of SSLPs seemed to apply to all subpopulations and SSLP areas.

INTERPRETATION

Children and their families benefited from living in SSLP areas. The contrast between these and previous findings on the effect of SSLPs might indicate increased exposure to programmes that have become more effective. Early interventions can improve the life chances of young children living in deprived areas.

Preterm infants of educated mothers have better outcome

AIM

To determine the developmental trajectories of very-low-birthweight (VLBW) infants during the first 2 years of life, and investigate the most contributory predictors of diverse trajectories.

METHODS

This prospective cohort study enrolled 887 VLBW infants from January 1999 to December 2002 with regular follow-up at corrected age of 6, 12, 18 and 24 months. Sociodemographic and medical data were collected, and the outcome measures consisted of neurological assessment and the Bayley Scales of Infant Development-II.

RESULTS

Five trajectories of cognitive development based on the mental developmental indices from the age of 6 to 24 months were determined, including average-stable (group A, 20.1%), average-decline to borderline delay (group B, 34%), borderline delay-catch-up to average (group C, 20.2%), borderline delay-decline to significant delay (group D, 17.2%) and significant delay-stable (group E, 8.5%). Using group A as the reference category, we determined 6-month neurological status and maternal education as the most significant predictors for various trajectories (p < 0.01). Infants with transient or definite neurological abnormality and/or low maternal education had higher odds of displaying the disadvantageous trajectories (group B, D and E; odds ratios, 1.79-46.4).

CONCLUSION

VLBW infants with neurological abnormalities and/or low maternal education had high risk of developmental decline and might benefit from early intervention.

[Theory of resilience. Key conceptual constructs and chosen issues]

The aim of this article is to familiarize readers with key conceptual constructs related to resilience theory. This theory explains the phenomenon of children's and adolescents' positive adaptation despite various adverse life conditions and traumatic events. The resilience theory emphasizes the importance (relevance) of positive factors and mechanisms for child and adolescent development. Thus, it could be very useful for developing primary prevention and mental health promotion programmes among children and youth. This article is based on a review of publications written by significant resiliency researchers: M Rutter, N. Garmezy, E. Werner, S. Luthar, A. Sameroff, K. Kumpfer, A. Masten, M. Zimmerman, D. Cicchetti. More than 20 articles and book chapters published during the past 25 years were taken into consideration. They were chosen from the electronic database available at the University of Michigan and SAMSHA, and publications available in Poland. Several resilience definitions are mentioned, indicating the interactive and dynamic process of positive adaptation. These definitions encompass the impact of both risk and positive factors (and their interaction) on the individual's behavior, competence and health. The key conceptual constructs such as risk, risk factors, positive factors, resilience models and mechanisms are described in this article. The differences between the risk and protective mechanism are also presented. The difficulties related to operationalization of the key resilience constructs in empirical research are discussed. Common difficulties are related for example to clear criteria for risk and positive adaptation, and for risk group selection.

Outcome of extremely low birth weight survivors at school age: the influence of perinatal parameters on neurodevelopment

Extremely low birth weight (ELBW) is associated with impaired neurodevelopmental outcome in infancy. Information on the long-term cognitive and neurological consequences of ELBW is scarce. We aimed to identify the perinatal and neonatal factors of ELBW infants associated with adverse cognitive and neurological outcome at school age. A regional cohort of 135 ELBW infants born between 1993 and 1998 was prospectively evaluated at 3, 6, 12, and 18 months postmenstrual age and at yearly intervals up to age 10 years. The comprehensive follow-up programme for high-risk infants included neurological examinations and psychometric evaluations. According to the overall results of these tests, children were classified as either being normal or having minor or major impairment. At a mean age of 8.4 (SD: 1.6) years, 43% of children had survived without any impairment. Minor impairment was diagnosed in 39% and major impairment in 18% of assessed children. The proportion of disabled school children rose with decreasing gestational age. The following neonatal complications were significant risk factors for developing major or minor impairment at school age: an increase in head circumference < 6 mm per week (OR 4.0, 95% CI: 1.1-14.8), parenteral nutrition > or = 6 weeks (OR 2.5, 95% CI: 1.1-6.0), and mechanical ventilation > 14 days (OR 2.3, 95% CI: 1.0-5.1). High-grade intraventricular haemorrhage (IVH) and/or PVL (OR 13.3, 95% CI: 4.0-44.9), neonatal seizures (OR 5.2, 95% CI: 1.2-22.4) and bowel perforation, and/or necrotizing enterocolitis (OR 4.4, 95% CI: 1.1-17.0) were significant risk factors for developing major impairment. In spite of the relatively large proportion of normal children, ELBW remains an important risk factor for neurodevelopmental impairment at school age. Thus, measures to prevent complications such as necrotizing enterocolitis, cerebral haemorrhage, and undernutrition remain important goals for neonatal intensive care.

Child factors associated with parent involvement in usual clinical care of children and adolescents: a national register study

The study examined the role of child level characteristics of age, gender, disorder and experience of family breakdown on parent involvement in the treatment of children and adolescents in a usual clinical care setting. Data from the national register of 20,856 children and adolescents treated in psychiatric hospitals and clinics in Norway in 2002 were analyzed using a three-level hierarchical model. Consultations attended by the child, mother and father were constructed as level 1, child characteristics as level 2 and clinics as level 3. Results indicated that 42% of the variance was explained by within-family differences of consultations and 56% by child characteristics. Only 2% of the variance was explained by clinic-to-clinic differences. In the total model, child factors of gender, disorder and family breakdown (but not age) were significant predictors of consultation with children and parents. Therapists should take into account the role of the gender, disorder and family breakdown in promoting parent involvement and hindering premature termination.

[Secondary dentition eruption terms as criterion of biological maturity of child organism]

Secondary dentition eruption terms were studied in children of the age groups from 6 to 18 years in 1980-2002. Tendencies of biological maturity were determined and necessity of existing norms changing was founded. New age related norms of permanent teeth number for boys and girls of different biological age were created.

Screening for developmental delay in the setting of a community pediatric clinic: a prospective assessment of parent-report questionnaires

OBJECTIVES

Our goal for this study was to prospectively test whether parent-completed questionnaires can be effectively used in the setting of a busy ambulatory pediatric clinic to accurately screen for developmental impairments. Specific objectives included (1) assessing the feasibility of using parent-report instruments in the setting of a community pediatric clinic, (2) evaluating the accuracy of 2 available screening tests (the Ages and Stages Questionnaire and Child Development Inventory), and (3) ascertaining if the pediatrician's clinical judgment could be used as a potential modifier.

METHODS

Subjects were recruited from the patient population of a community clinic providing primary ambulatory pediatric care. Subjects without previous developmental delay or concerns noted were contacted at the time of their routine 18-month-old visit. Those subjects who agreed to participate were randomly assigned to 1 of 2 groups and completed either the Ages and Stages Questionnaire or Child Development Inventory. The child's pediatrician also completed a brief questionnaire regarding his or her opinion of the child's development. Those children for whom concerns were identified by either questionnaire underwent additional detailed testing by the Battelle Development Inventory, the "gold standard" for the purposes of this study. An equal number of children scoring within the norms of the screening measures also underwent testing with the Battelle Development Inventory.

RESULTS

Of the 356 parents contacted, 317 parents (90%) agreed to participate. Most parents correctly completed the Ages and Stages Questionnaire (81%) and the Child Development Inventory (75%). Predictive values were calculated for the Ages and Stages Questionnaire and the Child Development Inventory (sensitivity: 0.67 and 0.50; specificity: 0.39 and 0.86; positive predictive value: 34% and 50%; negative predictive value: 71% and 86%, respectively). Incorporating the physician's opinion regarding the developmental status of the child did not improve the accuracy of the screening questionnaires.

CONCLUSIONS

Three important conclusions were reached: (1) parent-completed questionnaires can be feasibly used in the setting of a pediatric clinic; (2) the pediatrician's opinion had little effect in ameliorating the accuracy of either questionnaire; and (3) single-point accuracy of these screening instruments in a community setting did not meet the requisite standard for development screening tests as set by current recommendations. This study raises important questions about how developmental screening can be performed, and we recommend additional research to elucidate a successful screening procedure.

Using developmental assessments in the NICU to empower families

NICU nurses and developmental specialists have a unique opportunity to facilitate the beginning of a meaningful parent/infant relationship in the NICU setting. The Brazelton Neonatal Behavioral Assessment Scale (BNBAS) is one tool that can be utilized to support this process. When parents observe this assessment, they learn to recognize and understand infant cues and gain confidence for everyday routines such as diapering, feeding, general caregiving, and even taking that first trip with the baby to the grocery store. Parents become empowered when they discover not only their baby's amazing competencies, but also their own. In addition, the BNBAS provides a framework through which parents can effectively communicate and advocate for their baby.

Using the Ages and Stages Questionnaire to teach medical students developmental assessment: a descriptive analysis

BACKGROUND

After a survey of medical graduates' skills found a lack of confidence in developmental assessment, a program was introduced with the broad aims of increasing medical student confidence and respect for the parents' role in childhood developmental assessment. Research has shown that parents' concerns are as accurate as quality screening tests in assessing development, so the program utilised the Ages and Stages Questionnaire, a parent completed, child development assessment tool.

METHOD

To evaluate the program, an interpretative analysis was completed on the students' reports written during the program and a questionnaire was administered to the parents to gain their perception of the experience. As well, student confidence levels in assessing growth and development were measured at the end of the paediatric term.

RESULTS

Although there was an increase in student confidence in developmental assessment at the end of the term, it was not statistically significant. However the findings indicated that students gained increased understanding of the process and enhanced recognition of the parental role, and the study suggested there was increased confidence in some students. Parents indicated that they thought they should be involved in the teaching of students.

CONCLUSION

The ASQ was shown to have been useful in an education program at the level of advanced beginners in developmental assessment.

Does a detailed assessment of poor repertoire general movements help to identify those infants who will develop normally?

BACKGROUND

The assessment of the quality of general movements (GMs) in young infants is a reliable and valid diagnostic tool for detecting brain dysfunction early in life. Poor repertoire GMs are the most frequently observed abnormal GMs during the preterm, term and early postterm period. However, their predictive value for the neurological outcome is low.

AIM

To find out whether a detailed scoring of poor repertoire GMs might lead to a better prediction of the neurological outcome.

SUBJECTS

We studied 18 preterm infants who were repeatedly videoed from birth to 22 weeks postterm age, including several recordings assessed as poor repertoire GMs. At 8 to 10 years, six children were neurologically normal, six had mild neurological abnormalities, and the remaining six were classified as cerebral palsy.

STUDY DESIGN

Each GM globally assessed as poor repertoire was scored in details according to several aspects of neck and trunk, arm and leg movements applying Prechtl's optimality concept.

RESULTS

By and large, the detailed score of poor repertoire GMs was not related to the neurological outcome.

CONCLUSION

For the clinical application of the GM assessment, it remains important to assess the fidgety movements of those infants with poor repertoire GM trajectories in order to predict their outcome.

Stability of the Bayley II Scales of Infant Development in a sample of low-risk and high-risk infants

The aim of this study was to examine the stability of the second edition of the Bayley Scales of Infant Development (Bayley II) by correlating Bayley II scores during the first year of life with Bayley II scores at approximately 18 months of age. Bayley II Mental and Motor Scales were administered to 119 infants (69 males, 50 females) during their first year of life; mean age for low-risk group 7 months (SD 3.01) and mean age for high-risk group 7.8 months (SD 2.46). A second set of Bayley II scores was collected on 104 of the infants at 17 to 22 months of age; mean age for low-risk group 18.5 months (SD 1.07) and mean age for high-risk group 18.9 months (SD 1.11). Mean time interval between the two assessments was 11.5 months for the low-risk group and 11.15 months for the high-risk group. Stability of the scores over time was assessed. Correlations for the Bayley II Mental Developmental Index and Psychomotor Developmental Index between administrations during the first and second years of life were r=0.49 (p<0.001) and r=0.48 (p<0.001) respectively. We conclude that approximately 23 to 24% of the variance in the infants' later Bayley II scores could be explained by the earlier scores. This is one of only two studies to examine the stability of Bayley II over time. Replication studies are needed to evaluate the consistency of these findings across other samples of infants.

Infant developmental milestones: a 31-year follow-up

This study examined the association between infant developmental milestones and educational level at 31 years of age in the Northern Finland 1966 Birth Cohort (n = 12 058). Developmental data (age at standing, walking, speaking, and measures of bowel and bladder control) were gathered from children's welfare centres. Information on type of schooling at 14 years of age was reported by children and parents. School achievement at 16 years of age and educational level at 31 years were obtained from national registers. Those who reached infant developmental milestones sooner in their first year of life had significantly better (p < 0.05) mean scores in teacher ratings at 16 years, and at 31 years they were more likely to have achieved a better educational level than slower developers. The adjusted odds ratios for individuals who developed more slowly to remain at a basic educational level (7 to 16y) ranged significantly from 1.1 to 1.3. The possibility of advancing from secondary to tertiary level was 1.4 times greater in faster developers than in slow developers. In conclusion, those who develop faster during their first year of life tend to attain higher levels of education in adolescence and adulthood.

Instability of the DSM-IV Subtypes of ADHD from preschool through elementary school

CONTEXT

The DSM-IV definition of attention-deficit/hyperactivity disorder (ADHD) distinguished 3 subtypes that had not been extensively studied.

OBJECTIVE

To determine whether the ADHD subtypes are stable enough over time to be valid.

DESIGN

Longitudinal study with a greater-than 89% retention rate in 7 assessments over 8 years.

SETTING

Outpatient clinics.

PARTICIPANTS

Volunteer sample of 118 4- to 6-year-olds who met DSM-IV criteria for ADHD, including impairment in 2 settings in at least 1 assessment.

MAIN OUTCOME MEASURE

Meeting DSM-IV criteria for the subtypes of ADHD during years 2 through 8.

RESULTS

The number of children who met criteria for ADHD declined over time, but most persisted. Children who met criteria for the combined subtype (CT, n = 83) met criteria for ADHD in more subsequent assessments than children in the predominantly hyperactive-impulsive subtype (HT, n = 23). Thirty-one (37%) of 83 CT children and 6 (50%) of 12 children in the predominantly inattentive subtype (IT) met criteria for a different subtype at least twice in the next 6 assessments. Children of the HT subtype were even more likely to shift to a different subtype over time, with HT children who persisted in ADHD mostly shifting to CT in later assessments. The subtypes exhibited consistently different mean levels of hyperactive-impulsive symptoms during years 2 through 8 that corresponded with their initial subtype classifications, but initial subtype differences in inattention symptoms diminished in later years.

CONCLUSIONS

In younger children, the CT and IT may be stable enough to segregate groups for research, but they seem too unstable for use in the clinical assessment of individual children. Children rarely remain in the HT classification over time; rather, they sometimes desist from ADHD but mostly shift to CT in later years. Using continuous ratings of hyperactivity-impulsivity symptoms as a diagnostic qualifier should be considered as an alternative to classifying nominal subtypes of ADHD in DSM-V.

Epidemiology of child pedestrian casualty rates: can we assume spatial independence?

Child pedestrian injuries are often investigated by means of ecological studies, yet are clearly part of a complex spatial phenomena. Spatial dependence within such ecological analyses have rarely been assessed, yet the validity of basic statistical techniques rely on a number of independence assumptions. Recent work from Canada has highlighted the potential for modelling spatial dependence within data that was aggregated in terms of the number of road casualties who were resident in a given geographical area. Other jurisdictions aggregate data in terms of the number of casualties in the geographical area in which the collision took place. This paper contrasts child pedestrian casualty data from Devon County UK, which has been aggregated by both methods. A simple ecological model, with minimally useful covaraties relating to measures of child deprivation, provides evidence that data aggregated in terms of the casualty's home location cannot be assumed to be spatially independent and that for analysis of these data to be valid there must be some accounting for spatial auto-correlation within the model structure. Conversely, data aggregated in terms of the collision location (as is usual in the UK) was found to be spatially independent. Whilst the spatial model is clearly more complex it provided a superior fit to that seen with either collision aggregated or non-spatial models. Of more importance, the ecological level association between deprivation and casualty rate is much lower once the spatial structure is accounted for, highlighting the importance using appropriately structured models.

The developmental test of visual perception-2 normative study on the visual-perceptual function for children in Hong Kong

This research study intended to investigate the visualperceptual performance of children in Hong Kong by comparing them to the accepted norms on the Developmental Test of Visual Perception-2nd edition. The research examined whether there was significant difference in child's gender, age, and grade. The normative study recruited two hundred and eight-nine children between the ages of 6 and 7 in normal primary schools in Hong Kong. Results indicated that there was a ceiling effect in eye-hand coordination, position in space and spatial relations subtests. Grade differences were found to be significant in all subtests except eye-hand coordination and visual-motor speed. On the other hand, there were no statistical difference in the test scores between boys and girls except on copying and figure-ground subtests. It is concluded that there is a strong need to ensure that norms for visual-perceptual tests are appropriate for the specific cultural groups being assessed.

Follow up of children after antenatal treatment for alloimmune thrombocytopenia

OBJECTIVE

To evaluate the long-term follow-up of surviving offspring after antenatal treatment for fetal or neonatal alloimmune thrombocytopenia (FNAIT).

PATIENTS

Fifty children at risk of FNAIT were antenatally treated with maternal intravenous immunoglobulins (IVIG) (n=11), IVIG with intrauterine platelet transfusions (IUPT) (n=26) or IUPT alone (n=9). In four cases (n=4), only fetal blood sampling (FBS) was performed. One child died in the neonatal period and one was lost to follow up.

METHODS

The remaining 48 children, aged 1.3-11.6 years (median 5.1 years), were given both general and neurological examinations and assessed on their development and susceptibility for infections or atopic constitution. In addition, immunoglobulin levels were measured in 17 infants, aged 5 years and older.

RESULTS

Intracranial hemorrhage (ICH) was not observed. The general health and neurodevelopmental outcome in the children was comparable to a normal Dutch population. Children not exposed to maternal IVIG treatment had significantly more infections and hearing problems than children exposed to IVIG treatment or the normal population. Immunoglobulin G, A and M levels were within the normal range, independent of treatment and severity of FNAIT. A high IgE level was more frequently seen in children exposed to IVIG, but did not result in clinical consequences such as allergy or atopy.

CONCLUSIONS

Antenatal treatment of children for FNAIT did not affect general health or neurodevelopmental outcome. In particular, exposure to IVIG in utero showed no adverse effect on the clinical outcome of these children.

The General Movements in children with Down syndrome

OBJECTIVE

Aim of our study was to describe the character of General Movements (GMs) in children with Down Syndrome (DS).

MATERIAL AND METHODS

GMs of 23 children with DS and of 30 healthy full-term infants were assessed from birth to 6th month corrected age. A qualitative and a semi-quantitative evaluation of GMs were achieved for each child. Data were graphically displayed to obtain growth curves of motor optimality scores.

RESULTS

GMs in children with DS are characterised by low-low/moderate speed, large-large/moderate amplitude, partially creating impression of fluency, smoothness and complexity, abrupt beginning and end, few other concurrent gross movements. During the 6 months, all children showed an improvement of qualitative and semi-quantitative evaluation, but it was possible to observe great heterogeneity among children in the evolutionary course. GMs evaluation of children with no known motor problems was normal, showing only slight and transient abnormalities at first months.

CONCLUSION

GMs character of children with DS could be related to central nervous system and peripheral abnormalities characterizing this syndrome. The evaluation of GMs in children with DS could be an early marker of motor impairment and help in early management decisions making.

Body build classes as a method for systematization of age-related anthropometric changes in girls aged 7-8 and 17-18 years

A total of 462 schoolgirls aged 7-8 and 17-18 years were examined anthropometrically (45 body measurements and 10 skinfolds) in a cross-sectional study. The data were processed in two age groups: 7-8-year-olds (n = 205) and 17-18-year-olds (n = 257). Relying on average height and weight in the groups, both groups were divided into five body build classes: small, medium, large, pyknomorphous and leptomorphous. In these classes, the differences in all other body measurements were compared, and in both age groups, analogous systematic differences were found in length, width and depth measurements and circumferences. This enabled us to compare proportional changes in body measurements during ten years, using for this ratios of averages of basic measurements and measurement groups in the same body build classes. Statistical analysis by the sign test revealed statistically significant differences between various body build classes in the growth of averages. Girls belonging to the small class differed from the girls of the large class by an essentially greater increase in their measurements. Our results suggest that the growth rate of body measurements of girls with different body build can be studied by the help of body build classification.

Modeling the impacts of child care quality on children's preschool cognitive development

The National Institute of Child Health and Human Development (NICHD) Study of Early Child Care compared 3 statistical methods that adjust for family selection bias to test whether child care type and quality relate to cognitive and academic skills. The methods included: multiple regression models of 54-month outcomes, change models of differences in 24- and 54-month outcomes, and residualized change models of 54-month outcomes adjusting for the 24-month outcome. The study was unable to establish empirically which model best adjusted for selection and omitted-variable bias. Nevertheless, results suggested that child care quality predicted cognitive outcomes at 54 months, with effect sizes of .04 to .08 for both infant and preschool ages. Center care during preschool years also predicted outcomes across all models.

Modeling the impacts of child care quality on children's preschool cognitive development

The National Institute of Child Health and Human Development (NICHD) Study of Early Child Care compared 3 statistical methods that adjust for family selection bias to test whether child care type and quality relate to cognitive and academic skills. The methods included: multiple regression models of 54-month outcomes, change models of differences in 24- and 54-month outcomes, and residualized change models of 54-month outcomes adjusting for the 24-month outcome. The study was unable to establish empirically which model best adjusted for selection and omitted-variable bias. Nevertheless, results suggested that child care quality predicted cognitive outcomes at 54 months, with effect sizes of .04 to .08 for both infant and preschool ages. Center care during preschool years also predicted outcomes across all models.

Modeling the impacts of child care quality on children's preschool cognitive development

The National Institute of Child Health and Human Development (NICHD) Study of Early Child Care compared 3 statistical methods that adjust for family selection bias to test whether child care type and quality relate to cognitive and academic skills. The methods included: multiple regression models of 54-month outcomes, change models of differences in 24- and 54-month outcomes, and residualized change models of 54-month outcomes adjusting for the 24-month outcome. The study was unable to establish empirically which model best adjusted for selection and omitted-variable bias. Nevertheless, results suggested that child care quality predicted cognitive outcomes at 54 months, with effect sizes of .04 to .08 for both infant and preschool ages. Center care during preschool years also predicted outcomes across all models.

Dimensional statistics for estimation of lung volumes

The theory of dimension has been widely used in physics to check the validity of formulae. This theory has not been used more frequently in statistics as compared to physics for development of various prediction formulae/equations in applied physiology. An attempt has, therefore, been made in the present investigation to evolve formulae for estimation of lung volumes from cubic function of height based on dimensional considerations in boys and girls 8-13 and 16-21 years of age.

The biological age of prepubescent and pubescent children with low and high motor efficiency

The aim of the study was to analyze the relations between some criteria of the biological age (growth age, biological proportional age) and motor efficiency in school-aged boys and girls (8-9 and 12-13 years old) with considerably above-average and considerably below-average total score of the test battery UNIFITTEST (6-60). The growth age results of 8 chosen groups (17-25 individuals in one group) showed that classifying the selected individuals into the normative height bands was in no relation to their age, sex or level of motor efficiency. As for the height-weight proportionality, the older the individuals were, the more of them belonged to the bands with relatively bigger weight. Analyzing the results of the biological proportional age, we did not find any significant differences between the groups of identical sex, age and different motor efficiency. Boys and girls with either low or high motor efficiency were mostly biologically average and biologically accelerated in the growth and development.

Pathways of self-reported problem behaviors from adolescence into adulthood

OBJECTIVE

The authors determined the impact of different pathways of psychopathological development on adult outcome in subjects followed from ages 11-18 to ages 21-28.

METHOD

Problem behaviors of subjects from a general population sample were assessed through the Youth Self-Report and the Young Adult Self-Report given at four time points (1987, 1989, 1991, and 1997). In addition, DSM-IV diagnoses, information pertaining to signs of maladjustment, and measures of social functioning were obtained at the last assessment. On the basis of the self-report ratings, four contrasting developmental pathways of psychopathology were determined: persistent, decreasing, increasing, and consistently normal.

RESULTS

Subjects whose overall level of psychopathology was persistent over time had a higher lifetime prevalence of DSM-IV diagnoses and a poorer general outcome in adulthood than did subjects whose level of psychopathology increased. Subjects whose level of psychopathology returned to normal after high levels of problems in adolescence were only slightly different in terms of outcome from subjects with consistently normal ratings.

CONCLUSIONS

1) People who showed high levels of problems in early adolescence but whose level of psychopathology diminished by adulthood seemed to be as healthy as people who never attained a serious level of psychopathology. 2) An ongoing devious pathway into adulthood had negative effects on many domains of functioning. These two findings are both powerful arguments for early intervention in adolescence.

Functional Independence Measure (WeeFIM) for Chinese children: Hong Kong Cohort

BACKGROUND

The Functional Independence Measure (WeeFIM) for children is a simple-to-administer scale for assessing independence across 3 domains in American children. WeeFIM was based on a conceptual framework by the World Health Organization (1980) of pathology, impairment, disability and handicap, and the "burden of care." WeeFIM is useful in assessing functional independence in children aged 6 months to 7 years. It can be used for children with developmental disabilities aged 6 months to 21 years. Normative WeeFIM data had been validated for American children. Because of cultural and environmental differences among countries, normative data for the Chinese population are needed. With a normative database, the progression of independence at home and in the community can be evaluated. WeeFIM is an 18-item, 7-level ordinal scale instrument that measures a child's consistent performance in essential daily functional skills. Three main domains (self-care, mobility, and cognition) are assessed by interviewing or by observing a child's performance of a task to criterion standards. WeeFIM is categorized into 2 main functional streams: "Dependent" (ie, requires helper: scores 1-5) and "Independent" (ie, requires no helper: scores 6-7). Scores 1 (total assistance) and 2 (maximal assistance) belonged to the "Complete Dependence" category. Scores 3 (moderate assistance), 4 (minimal contact assistance), and 5 (supervision or set-up) belonged to the "Modified Dependence" category. Scores 6 (modified independence) and 7 (complete independence) belonged to the "Independent" category. The WeeFIM is a 7-level criterion-specific ordinal scale. Level 7 requires no assistance for the child and the child completes the task independently without requiring a device. During the task, there is no concern about safety or taking an inordinate amount of time. Level 6 reflects modified independence and includes use of an assistive device or not completing the task in a timely or safe manner.

OBJECTIVE

To examine the utility of the WeeFIM in Chinese children and to create a normative WeeFIM profile suitable for Chinese children.

METHOD

Direct interviews were conducted for 445 normal Chinese children, aged 6 months to 7 years, in the community.

RESULTS

1. WeeFIM total score and 3 domains subscores versus age. The total WeeFIM scores increased progressively with age, reaching a plateau at 72 months. There was a progressive increase in subscores of self-care, mobility, and cognition independence between 6 to 62 months, especially between 6 to 45 months. Similarly, the WeeFIM self-care subscores increased progressively with age, reaching a plateau at around 72 months. The WeeFIM mobility subscores increased progressively with age, reaching a plateau at around 54 months. The WeeFIM cognition subscores increased progressively with age, reaching a later plateau at around 80 months. 2. WeeFIM subtotal scores versus age. The total WeeFIM score and 3 domain subscores correlated significantly with age. We further classified the 18 items into 3 groups according to the degree of correlation with age. Most items had high correlation with Spearman's correlation coefficient of rho >0.8. Only 1 item (chair transfer) showed moderate correlation with rho = 0.7-0.8. The item "walk" had the lowest correlation with rho = 0.6-0.7. 3. Chronological order for achieving different items. The 50th percentile of age in months for achieving level 6 (modified independence) of the 18 items were compared and ranked according to the age of achieving level 6. In creating a developmental scale of achievement of level 6 (modified independence) for all 18 items, the developmental sequence clustered in the following order: chair transfer (order 1) and walk (order 2) were achieved much earlier (at 18 and 24 months, respectively). Thereafter, there was a clustering of 4 items achieved at around 45 months: toilet transfer (order 3), stair (order 4), expression (order 5), and social interaction (order 6). Then, 9 items were achieved at around 54 to 56 months: tub or shower transfer (order 7), eating (order 8), bathing (order 9), bowel management (order 10), dressing of lower body (order 11), comprehension (order 12), dressing of upper body (order 13), bladder management (order 14), and grooming (order 15). At 60 months, the following ranked in order: memory (order 16), problem-solving (order 17), and toileting (order 18). 4. Impact of sex factor. Girls aged 22 to 45 months had higher scores in self-care subscores and cognition subscores. From 63 months onwards, boys had statistically significant higher scores in mobility subscores. Otherwise, there was no statistically significant difference in WeeFIM scores for different age groups. 5. Impact of domestic helpers. There was also significant difference for self-care subscore with the presence of a maid at home. Those children with a maid at home obtained lower self-care subscores. However, the mobility and cognition subscores were not affected.

CONCLUSION

We have created a normative functional independence profile for Chinese children by adapting the American-based WeeFIM. There were cultural differences when compared with American children. Interestingly, Chinese children in Hong Kong scored better than their American counterparts in domain 1 (self-care) in all ages. This might be attributable to early attendance in preschool settings where children are taught to tend to their needs. Even for domain 2 (mobility), the higher scores in younger Chinese children in Hong King (<3 years) might be explained by earlier attendance in preschool settings. The American children did catch up after 3 years. As for domain 3 (cognition), the local educational system emphasized reading, writing, memorizing materials, and social interaction. Thus, Chinese children in Hong Kong had better cognition scores until 42 months, when their American counterparts caught up by attending preschool. There are definitely environmental and cultural practices affecting functional independence in both ethnic groups, especially in the upper age range (>4 years) both in America and Hong Kong. Thus, a locally validated WeeFIM instrument should be adopted for Chinese children. Our study demonstrated that WeeFIM could be used as a functional independence measure for Chinese children. Hong Kong has a different cultural background compared with America; thus, usage of WeeFIM with different age criteria for achieving independence should be adopted.

Developmental screenings in rural settings: a comparison of the child development review and the Denver II Developmental Screening Test

Screening results for the Child Development Review (CDR) and the Denver II Developmental Screening Test (Denver II) were compared in two locations: the Cheyenne River Reservation in South Dakota and Sioux Falls, S.D. Seventy-three white, Native American and other minority children, half originating from the reservation and half from Sioux Falls, were randomly assigned to take one developmental screening test. A chi-square analysis indicated a significant difference in results across tests. Specifically, more CDR than Denver II subjects passed the screening and more Denver II than CDR subjects failed the screening. This pattern held for subjects living on, but not off, the reservation. Thus, for Native American, white and other minority children living on the Cheyenne River Reservation, the CDR may be undersensitive and/or the Denver II oversensitive to suspect presentations. Medical practitioners are advised to use these instruments with caution in rural settings.

Neurodevelopmental status at 1 year predicts neuropsychiatric outcome at 14-15 years of age in very preterm infants

BACKGROUND

Neurodevelopmental and behavioural problems have been repeatedly reported in very preterm survivors, often showing themselves later in childhood as poor school performance. Early identification of problems would mean that appropriate remedial therapy can be implemented. We have previously shown that neurodevelopmental status at 1 year was predictive of outcome at 8 years in a cohort of preterm infants. The aim of this paper was to see if neurodevelopmental outcome in adolescence could be predicted by assessment by 1 year in the same cohort of preterm infants.

STUDY DESIGN

Prospective cohort study.

SUBJECTS

150 adolescents, born before 33 weeks gestation.

OUTCOME MEASURES

Neurological examination, developmental quotient, vision and hearing by 1 year. At 14-15 years, neurological examination, school performance questionnaire, Schonnell test of reading age, a premorbid adjustment score, Rutter behavioural score and for those born from 1981, cognitive tests (WISC-R).

RESULTS

A highly significant relationship existed between neurological status by 1 year and the need for extra educational provision, overall neurodevelopmental status, cognitive function in those that had their IQs measured and premorbid adjustment score of prepsychotic symptoms in adolescence. However, status at 1 year was not predictive of adolescent reading age or behavioural score.

CONCLUSIONS

Neurodevelopmental assessment at 1 year is predictive of school performance and outcome in the adolescent period.

Development of a global motor rating scale for young children (0-4 years) including eye-hand grip coordination

A comparative study of the eight motor rating scales available in Western countries demonstrated methodological differences in the choice of items and standardization. We have developed a global motor rating scale that includes items which measure postural-motor, locomotor (PML) and eye-hand grip coordination (EHGC), and which allows the assessment of an average of motor function level (MFL), PML and EHGC development. Scores obtained were used to define the acquisition of motor age based on the skills completed. The items were selected on the basis of the average age at which the function developed in two populations of healthy full-term French infants, followed from birth to 4 months (n = 60) and from 4 months to 4 years (n = 63). Recent French developmental standards (mean age and standard deviation) of acquisition allow the identification of neuro-psychomotor deviations from normal motor behaviour. This includes both static and dynamic motor coordination sequences. Inter-examiner correlations (n = 3) for 15 randomly selected children indicated a coefficient of 0.90. The scale revealed a sequence in the organization of learned postural-motor, locomotor and eye-hand gripping skills which can contribute to the understanding of brain areas implicated in this maturation process.

Estimating the cost of developmental and behavioral screening of preschool children in general pediatric practice

OBJECTIVE

Despite increased recognition of the importance of development and growth of young children, formal developmental and behavioral screening often is not included in general pediatric practice. Barriers to the provision of developmental and behavioral screening are considerable; among them are the need for specialized training and uncertain reimbursement. This article develops a model for estimating the cost of providing pediatric developmental and behavioral screening that can be scaled to reflect a pediatric practice's patient population and choice of screening offered.

METHODS

The framework for our scaleable cost model was drawn from work done in estimating the Resource-Based Relative Value Scale (RBRVS). RBRVS provides estimates of the work effort involved in the provision of health care services for individual Current Procedural Terminology codes. The American Academy of Pediatrics has assigned descriptions of pediatric services, including developmental and behavioral screening, to the Current Procedural Terminology codes originally created for adult health care services. The cost of conducting a screen was calculated as a function of the time and staff required and was loaded for practice costs using the RBRVS valuation. The cost of the follow-up consultation was calculated as a function of the time and staff required and the number of relative value units assigned in the RBRVS scale.

RESULTS

The practice cost of providing developmental and behavioral screening is driven primarily by the time and staff required to conduct and evaluate the screens. Administration costs are lowest for parent-administered developmental screens ($0 if no assistance is required) and highest ($67) for lengthy, pediatric provider-administered screens, such as the Neonatal Behavioral Assessment Scale. The costs of 3 different groups of developmental and behavioral screening are estimated. The estimated per-member per-month cost per 0- to 3-year-old child ranges from $4 to >$7 in our 3 examples.

CONCLUSIONS

Cost remains a significant barrier to greater provision of formal developmental and behavioral screening. Our scaleable cost model may be adjusted for a given practice to account for the overall level of developmental risk. The model also provides an estimate of the time and cost of providing new screening services. This model allows pediatric practices to select the mix of developmental screens most appropriate for their particular patient population at an acceptable cost.

Issues in Islamic biomedical ethics: a primer for the pediatrician

The United States is becoming increasingly pluralistic. Pediatricians must become familiar with the factors that affect the emotional, physical, and spiritual health of their patients that are outside the kin of the traditionally dominant value system. Although many articles have addressed the cultural and ethnic factors, very few have considered the impact of religion. Islam, as the largest and fastest-growing religion in the world, has adherent throughout the world, including the United States, with 50% of US Muslims being indigenous converts. Islam presents a complete moral, ethical, and medical framework that, while it sometimes concurs, at times diverges or even conflicts with the US secular ethical framework. This article introduces the pediatrician to the Islamic principles of ethics within the field of pediatric care and child-rearing. It demonstrates how these principles may impact outpatient and inpatient care. Special attention is also given to adolescent and end-of-life issues.

[Somatic development indices in children and youth of Warsaw]

During the period 1996-99 in the Laboratory of Anthropology of the Department of Growth and Development of Children and Youth of the National Research Institute of Mother and Child in Warsaw, cross sectional anthropometric study in 6366 Warsaw children and youth (3152 hoys and 3214 girls) aged 1 month to 18 years was carried out. The aim of the research was to elaborate new, up to date reference data and to make a description of the biological status and the course and character of changes occurring in this population during the last 20 years. Children aged up to 3 years were selected by random choice from the Outpatient Paediatric Department registry, children aged 4-18 years were drawn by a two-step procedure: in the first step, nursery schools and primary and secondary schools were drawn and in the second step classes were drawn. Unified anthropometric methods and instruments were used. This paper contains 64 tables of means, standard deviations and percentile values and 64 percentile charts of 15 anthropometric traits and 17 calculated indexes, useful for growth evaluation and monitoring, nutritional status assessment and also for scientific research.

Children followed with difficulty: how do they differ?

OBJECTIVE

To determine if very low birthweight children followed with ease differ in any perinatal or sociodemographic characteristics, or outcomes, compared with children followed with more difficulty.

METHODOLOGY

Consecutive children of birthweight < 1000 g or with gestational ages < 28 weeks born in 1991 (n = 51) or of birthweight < 1500 g born in 1992 (n = 166) at the Royal Women's Hospital, Melbourne, surviving to 5 years of age, were assessed at 5 years of age, corrected for prematurity. Those who attended on the first mutually agreed appointment without substantial reluctance were considered to have been followed with ease. The remainder were considered to have been followed with difficulty. Outcomes included impairments such as cerebral palsy, blindness, deafness, and low IQ. Children had a disability if they had any of cerebral palsy, blindness, deafness requiring amplification, or an IQ more than 1 SD below the mean.

RESULTS

Of the 217 survivors, 204 (94%) were assessed fully at 5 years of age. Of the 204 children assessed, 153 (75%) were followed with ease, and 51 (25%) with difficulty. Of data available in the perinatal period, significantly fewer children followed with more difficulty came from intact families, and more of their mothers had fewer than 12 years of schooling. More children followed with difficulty had a disability (41% compared with 19%), as they predominantly had lower IQ scores (mean difference in IQ - 12.7, 95% confidence interval - 18.0, - 7.4). The association between difficulty of assessment and both higher rates of disability and lower IQ scores remained after adjustment for significant perinatal and sociodemographic variables.

CONCLUSIONS

Children followed with difficulty can partly be recognized on several sociodemographic characteristics in the perinatal period, and have substantially worse sensorineural outcomes than those followed with ease. In any longitudinal study, the more incomplete the follow up, the lower will be the rate of adverse sensorineural outcome.

Parental and professional agreement in developmental assessment of very-low-birthweight and term infants

The aim of this prospective follow-up study was to evaluate the accuracy of a parent-completed questionnaire compared with professionally detected developmental delay. Parents of 108 very-low-birthweight (VLBW) infants and parents of 279 term control infants completed the German version of the Revised Prescreening Developmental Questionnaire (R-PDQ) at the corrected age of 12 months. Simultaneously, infants underwent developmental examination using the Griffiths Developmental Scale. Sixty-nine VLBW infants were classified as not delayed, 16 as delayed by both methods (conegativity 76% and copositivity 94%), as compared to 240 and six term control infants (conegativity 88%, copositivity 94%). The questionnaire suggested delay in 22 VLBW infants and 32 control infants, which was not substantiated by professional examination (P=0.006). In contrast, examination-diagnosed delay was missed by the questionnaire in one infant in each group. The R-PDQ is a reliable monitoring instrument for both VLBW and term infants at the age of 12 months. Parents of VLBW infants tend to underestimate their infants' development.

Predictive utility of the Bayley Infant Neurodevelopmental Screener (BINS) risk status classifications: clinical interpretation and application

Predictive validity and clinical implications of the increasingly popular Bayley Infant Neurodevelopmental Screener (BINS) risk status classifications have not been previously reported. In this longitudinal follow-up study, the BINS was administered to high-risk infants at 6, 12, and 24 months of age, and the McCarthy Scales at 3 years of age. Ninety-two children were evaluated at 6 and 36 months, 105 at 12 and 36 months, and 118 at 24 and 36 months; 190, 125, and 140 infants were included in the comparisons at 6 to 12, 6 to 24, and 12 to 24 months. BINS risk status was classified as low, moderate, or high; or as a binary variable, LOWRISK/HIGHRISK. The three BINS items groups were moderately correlated. Consistency was most variable in the moderate-risk group. BINS risk was predictive of 36-month function in 18 out of 18 comparisons. Odds ratios, ranging from 2.76 to 54.70, were significant in 15 out of 18 logistic models. An early high-risk classification was associated with increased probability of later developmental morbidity. The BINS offers an alternative to detailed assessment in high-volume clinical applications and has good concurrent and predictive validity.

The infant index: a new outcome measure for pre-school children's services

BACKGROUND

The evaluation of community services for preschool children is hampered by the lack of valid and routinely available outcome measures. This study examines the use of data collected by teachers in response to educational legislation to determine whether a routine measure of attainments in primary school is sensitive to factors known to affect mental development.

METHOD

A community child health dataset for the cohort of children born in Sheffield in 1990-1991 was matched with a dataset provided by schools in 1995-1996. The educational data consisted of the Infant Index scores which measure education attainments in reception class pupils.

RESULTS

We matched 4487 children from both datasets, which represented 75 per cent of all children born in the 1990-1991 cohort. Factors which predicted a poor Infant Index included male gender (odds ratio (OR) = 2.1, 95 per cent confidence interval (CI)= 1.8-2.6), low birthweight (OR = 1.4, 95 per cent CI = 1.1-1.9) and lack of breast feeding either by intention to feed (OR = 1.3, 95 per cent CI = 1.1-1.7) or actual feeding practice at one month (OR = 1.5, 95 per cent CI = 1.1-2.0). Other factors associated with a poor outcome for the child were postnatal depression, number of pregnancies, ethnicity, pre-school educational experiences and poor housing.

CONCLUSIONS

Although the results are interesting in themselves, the main significance of our project is in establishing a link between routinely collected health data and routine education data. This could facilitate research in the future thus leading to a considerable saving in the cost of long-term intervention studies.

Infant screening: the usefulness of the Bayley Infant Neurodevelopmental Screener and the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale

We assessed the usefulness of the Bayley Infant Neurodevelopmental Screener (BINS) and the Clinical Adaptive Test/Clinical Linguistic Auditory Milestone Scale (CAT/CLAMS) for screening high-risk infant populations in a sample of 78 infants followed after premature birth and/or perinatal insults. Both measures were highly correlated with the Bayley Scales of Infant Development-II, but sensitivity and specificity analyses revealed disparities related to the tests administered and the cutoffs used. The BINS had optimal sensitivity (true positives) of 90% when referral was made for a BINS score of high or moderate. The CAT/CLAMS had excellent specificity (true negatives) of 95% to 98% but poor sensitivity (5%-36%). Until the cutoff issue can be clarified, clinicians should be cautious in using the CAT/CLAMS as the primary screening instrument in settings in which early identification of infants with developmental problems is the main goal.