The reliability and diagnostic validity of the physical and neurological examination for soft signs (PANESS)

Twenty-one children, mean age of 8 years, were each examined on separate occasions by two pediatric residents, blind to diagnosis, using the neurological examination (PANESS) included in the group of instruments recommended by the National Institute of Mental Health for psychotropic drug studies in children. Half the children were hyperactive/aggressive, one quarter were normal, and one quarter had histories or signs strongly presumptive of brain damage. Many of the signs, though reliable, did not occur in the majority of children. Examiners did achieve a high level of agreement about global neurological status. It was concluded that the neurological examination probably contains a substantial number of non-contributory items and should be regarded as experimental rather than definitive.This study was supported in part by a grant to Professor Werry from the Medical Research Council of New Zealand and USPHS grant #MH 18909 from the National Institute of Health to R. L. Sprague, Ph.D. Drs. M. Hudson and M. Morris performed the examinations. We should like to pay particular tribute to Dr. Thelma Becroft, a school doctor in Auckland, who supplied the normal and neurological subjects.