A follow-up pilot study of objective measures in children with attention deficit hyperactivity disorder

OBJECTIVES: Attention deficit hyperactivity disorder (ADHD) is a common childhood problem requiring stimulant medications in a significant proportion of cases. The aim of this pilot study was to assess the effects of prolonged stimulant medication therapy on a continuous performance test, the Test of Variables of Attention (TOVA), which measures objectively features of ADHD. METHODS: Eighteen children aged 8 to 16 years who were diagnosed with ADHD, based on the Diagnostic and Statistical Manual of Mental Disorders 4th edn criteria, were included in the study. Assessment on a continuous performance test (TOVA) was performed initially and the children were administered stimulant medications for at least 12 months. The medications were stopped for 1 week, followed by a repeat TOVA assessment which was compared to the initial TOVA assessment. RESULTS: Follow up TOVA scores showed a significant improvement in mean commission errors (impulsivity) after the stimulant medication therapy. No significant improvement was found in omission errors (inattention), response time and variability. There was a significant positive correlation between commission and omission scores (P value 0.0001). CONCLUSIONS: The results of this pilot study indicate that there is objective improvement in impulsivity in children with ADHD after a prolonged period of stimulant medication therapy. The study suggests that it would be useful to perform formal studies to investigate this further and also to assess the role of continuous performance test (TOVA) as a method for monitoring the need for ongoing therapy.     

Amount and Focus of Physical Therapy and Occupational Therapy for Young Children with Cerebral Palsy

ABSTRACT

The aims of this study were to describe physical therapy (PT) and occupational therapy (OT) services for a cohort of 399 children with cerebral palsy (CP), 2–6 years old, residing in the United States and Canada. Parents completed a services questionnaire by telephone interview. Therapists classified children's Gross Motor Function Classification System (GMFCS) level. Mean minutes per month of PT and OT were greater for children receiving services in both an educational and clinic setting. Mean minutes per month of PT and OT were greater for children in levels IV–V than children in level I and greater for children in the United States than children in Canada. Parents reported that interventions focused a moderate to great extent on primary impairments, secondary impairments, activity, and structured play activities, a moderate extent on environmental modifications and equipment; and a moderate to small extent on self-care routines. The results support the importance of coordination of PT and OT services.     

Developmental dysplasia of the hip. A population-based comparison of ultrasound and clinical findings

Clinical and ultrasound findings were compared in 3613 newborns examined for developmental dysplasia of the hip (DDH) within 48 hours of delivery. Clinical and sonographic hip stability was described as stable, borderline unstable, dislocatable or dislocated, and the morphology on ultrasound as normal, immature or dysplastic. Persistent clinical or sonographic dislocatability or dislocation. major dysplasia or minor dysplasia combined with an unstable femoral head were indications for early treatment. A total of 123 (3.4%) infants were subjected to early treatment. of which 55 (45%) fulfilled the criteria for treatment on both clinical and ultrasound examinations, 52 (42%) were treated on the basis of ultrasound findings alone, and 16 (13%) on the basis of clinical findings alone. Thirty percent of the infants with clinically dislocated or dislocatable hips were judged to have stable or just borderline unstable hips on the first clinical examination. Of 486 (13.5%) infants with sonographically immature or minor dysplastic but stable hips, 472 (97%) normalized spontaneously, while treatment was initiated in 14 (3%) of them at 1-3 months of age because of lack of sonographic improvement. Only one infant presented with late DDH during an observation period of 3 years. Accepting sonographic dysplasia as a criterion for early splinting may result in a treatment rate which is almost twice the rate based on clinical criteria, but late dislocation may be virtually eliminated.     

THE MECHANISM OF DIARRHOEA IN CONGENITAL DISACCHARIDE MALABSORPTION

Intestinal malabsorption of lactose and sucrose, and the effect of these disaccharides on the movements of water and electrolytes were studied in two siblings with congenital lactose malabsorption (CLM) and one infant with congenital sucroseisomaltose malabsorption (CSIM), using the intestinal intubation technique. Sucrose in the CLM-patients and lactose in the CSIM-patient were absorbed already in the proximal part of the small intestine, whereas hardly any lactose in CLM and sucrose in CSIM disappeared from the small intestinal lumen. The unabsorbed disaccharides caused considerable movement of water and electrolytes into the intestinal lumen test fluid being diluted to 1 1/2–2 1/2 times in the duodenum and proximal jejunum. The contents of the small intestine were throughout isoosmotic with extracellular fluid and the unabsorbed disaccharides represented 25–30% of the osmotic activity. In the colon, the unabsorbed disaccharides disappeared in varying degree, they were split into monosaccharides and converted to lactate. Water, Na⁺ and Cl^- were absorbed in the colon even in relative excess to the disappearance of the disaccharide and its splitting products, and in all cases the faecal volume was smaller than the volume of the test fluid. In a CLM-patient a 3-week period on lactose-containing diet had no effect on the phenomena demonstrated in the small intestine, but disappearance of lactose and formation of lactate was greater in the colon, and amount of water less in the stools than before. It is suggested that the retention of water in the intestinal lumen through the osmotic activity of the unabsorbed disaccharide, together with the organism's tendency to Na⁺-equilibrium between the luminal and extracellular fluid is the most important mechanism of diarrhoea in disaccharide malabsorption.     

Classification,identification, and assessment of surgical treatment of anorectal anomalies

In order to keep pace with new work in the field of anorectal anomalies, pediatric surgeons who had contributed recent publications on new aspects were invited to a workshop meeting, the objects of which included reviews of: (1) current classifications of anorectal anomalies; (2) criteria for assessment of results of treatment; and (3) methods of recording clinical features, diagnosis, and surgical procedures. The overall objective was standardization of terms and diagnostic features in order to facilitate intercommunication and comparison between surgeons engaged in the reconstruction of anorectogenital anomalies.     

Predicting and Explaining Behavior: A Comparison of Autistic, Mentally Retarded and Normal Children

Abstract— The relationship between performance on a false belief task and a new task designed to elicit explanations of human action was examined in two experiments. In the first study normal preschoolers' performance on both tasks was significantly correlated. The second experiment included matched groups of autistic, mentally retarded, and older normal children. The autistic subjects were significantly worse than controls at offering mentalistic explanations. Performance on the false belief and the explanation of action tasks was highly correlated for the autistic subjects. These findings are discussed in terms of the relationships between language and theory of mind.     

Measles vaccination after exposure to natural measles

When an extensive measles epidemic broke out in Turku in late 1975, the availability of a previous study on measles vaccination reactions in 442 children permitted a comparative evaluation to be made on reactions to and the efficacy of measles vaccine (Schwartz strain) administered after exposure to natural measles. In a preliminary study, nine children were vaccinated one to 14 days after exposure to natural measles but before prodromal symptoms appeared. Only one of these nine children developed symptoms and signs comparable to those of the natural disease. In five day-care centers the children were vaccinated when five or more children out of 30 to 40 at each center had measles. In only five of 74 exposed children were the signs and symptoms comparable to those of natural measles. No marked differences in signs and symptoms after the vaccinations were observed between the exposed and nonexposed children. It is concluded that vaccination is safe, can usually prevent measles, even when administered after a prolonged interval following exposure to natural disease, and can usually control an epidemic in progress.     

Executive Function Deficits in High-Functioning Autistic Individuals: Relationship to Theory of Mind

A group of high-functioning autistic individuals was compared to a clinical control group matched on VIQ, age, sex and SES. Significant group differences were found on executive function, theory of mind, emotion perception and verbal memory tests, but not on spatial or other control measures. Second-order theory of mind and executive function deficits were widespread among the autistic group, while first-order theory of mind deficits were found in only a subset of the sample. The relationship of executive function and theory of mind deficits to each other, and their primacy to autism, are discussed.     

Early breastfeeding cessation: validation of a prognostic breastfeeding score

Aim: To validate a simple breastfeeding score to identify mothers who stop breastfeeding within 4 months after birth.
Methods: Two independent cohorts of Danish mothers in 1999 and 2004 with 4 months of follow-up on breastfeeding duration were used. The breastfeeding score was developed from 471 mothers' responses to a questionnaire in 1999 and based on duration of schooling, previous breastfeeding experience, self-efficacy, and mother's confidence in ability to produce milk. The 2004 cohort consisting of 723 mothers was used to validate the score.
Results: A breastfeeding score of 7 or higher classified 45% of the mothers in the 2004 cohort as being at risk of breastfeeding cessation. With this cut-point the sensitivity was 70% and the specificity 71%. Among primipara the cut-point gave a sensitivity of 76% and a specificity of 54% and classified 60% to be in the risk group. Among multipara the corresponding figures were 66%, 81% and 34%, respectively. The area under the ROC curve was 0.78.
Conclusion: The breastfeeding score based on a simple scoring system derived from four risk factors was capable of predicting the breastfeeding duration in an independent sample. It may help health professionals to identify mothers at risk of breastfeeding cessation before 4 months.     

Imaginary companions and young children's responses to ambiguous auditory stimuli: implications for typical and atypical development

BACKGROUND: Previous research has reported a link between imaginary companions (ICs) in middle childhood and the perception of verbal material in ambiguous auditory stimuli. These findings have been interpreted in terms of commonalities in the cognitive processes underlying children's engagement with ICs and adults' reporting of imaginary verbal experiences such as auditory verbal hallucinations. The aim of the present study was to examine these relations using improved methodology and a younger sample of children for whom engagement with ICs would be expected to be particularly salient. METHOD: Data on young children's (age range: 4-8 years) reporting of ICs were gathered in two studies (total N = 80). Responses to ambiguous auditory stimuli were investigated using the new Jumbled Speech task, which measures participants' likelihood of perceiving words in meaningless but speech-like auditory stimuli. RESULTS: Reporting hearing words in the Jumbled Speech task was associated with having a parentally corroborated IC. Hearing words on the task and having an IC were unrelated to age, gender, verbal ability, and understanding of the stream of consciousness. CONCLUSIONS: Findings are consistent with the hypothesis that engaging with ICs is one aspect of a general susceptibility to imaginary verbal experiences. We consider the implications for the assumption of continuity in psychopathological experiences between childhood and adulthood.     

Expressing ethical principles of treatment and care in a charter: What value?

More than ever before, public institutions are expected to have accessible guidelines on what they do, both for their staff and for those served by them. With this in mind, some principles of treatment and care of sick children were drafted for the Children's Hospital at Westmead. These were centred on ethics, primarily of what was best for the child. They were neither all-inclusive nor specific. They were labelled as a charter. They were rejected by a parent committee and met with unenthusiastic responses at meetings of hospital and ethics professionals. Reasons for this are unclear, but it is speculated that fear of the unknown and distrust of institutions may be factors. To date, the charter has not proved useful, except in provoking further discussion on how general guidelines are written, used and valued and on end-of-life decision-making more generally.     

Health-related quality of life and coping strategies of children after treatment of a malignant bone tumor: a 5-year follow-up study

PURPOSE: This study was designed to evaluate the development of health-related quality of life (HRQoL) and coping strategies of children and young adults, who have undergone surgery for a malignant bone tumor in childhood. PATIENTS AND INSTRUMENTS: In this single center follow-up study 20 patients were included. The patients were tested 3 and 8 years after treatment. At the 3-year mark the parents participated as well. To measure the HRQoL and coping strategies the TACQOL and the TAAQOL questionnaires and the Utrecht Coping List for Adolescents (UCLA) were used. All measurements were compared to a control group of healthy peers (n = 1,122 and n = 272, respectively). RESULTS: At the first measurement (3 years after treatment) both the study patients and their parents reported significantly lower HRQoL scores on two domains: motor functioning and autonomy (P < 0.05). In addition parents reported their children to have significantly lower HRQoL scores on cognitive functioning and experiencing positive emotions. Five years later (8 years after treatment) the young adults reported comparable HRQoL on motor functioning and autonomy, and significantly higher HRQoL scores on cognitive functioning, social contacts and negative emotions (less depressive moods). With regard to coping strategies no significant differences between the two measurements in the study population and the reference group were found. CONCLUSIONS: Three years after surgery for a malignant bone tumor, patients and their parents reported lower HRQoL scores on different domains compared with a reference group. Eight years after surgery the young adults surprisingly reported comparable or higher HRQoL scores. These patients treated for bone cancer were able to adapt well after treatment and showed no long-term emotional or social problems.     

不同孕期大鼠铅暴露胎盘一氧化氮/一氧化氮合酶系统与其超微结构改变的相关性

目的探讨不同孕期大鼠血铅水平与胎盘一氧化氮(NO)及一氧化氮合酶(NOS)与胎盘绒毛超微结构的关系。方法用硝酸还原酶法、NOS测定试剂盒测定46例(分为A、B、C组)不同孕期铅暴露和17例对照组孕鼠胎盘匀浆NO、NOS水平,并对受试胎盘组织切片进行电镜检查。结果A、B组NO及NOS高于正常对照组(P均<0.01);C组NO及NOS与正常对照组比较差异无显著性(P>0.05)。阶段铅暴露组,电镜显示胎盘结构代偿增生或轻度损伤表现。全程铅暴露组血铅水平最高,胎盘结构呈现失代偿改变。结论孕期铅暴露血铅水平、胎盘局部NO/NOS水平变化与胎盘发生病理改变间关系密切,可能在围生期铅毒性发生发展中起重要作用。     

New reference for the age at childhood onset of growth and secular trend in the timing of puberty in Swedish

The objectives of the present work were to present a new reference for the age at childhood onset of growth and to investigate the secular trend in the timing of puberty in a community‐based normal population in Sweden. A total of 2432 children with longitudinal length/height data from birth to adulthood were used to determine the two measures by visual inspection of the measured attained length/height and the change in growth velocity displayed on a computer‐generated infancy‐childhood‐puberty (ICP) based growth chart. The series represents a sample of normal full‐term children born around 1974 in Göteborg, Sweden. We found about 10% of children were delayed (>12 mo of age) in the childhood onset of growth based on the previous reported normal range, i.e. 14% in boys and 8% in girls. Distribution of the age at childhood onset of growth was skewed. The medians were 10 and 9 mo for boys and girls, respectively. After natural logarithmic transformation, the mean and standard deviation (SD) were 2.29 (anti‐log 9.9 mo) and 0.226 for boys, 2.23 (anti‐log 9.3 mo) and 0.220 for girls, respectively. The 95% normal ranges were 6.3‐15.4 and 6.0‐14.3 for boys and girls, respectively. The distribution of the timing of PHV was close to the normal distribution. The mean values were 13.5 y for boys and 11.6 y for girls with 1 y SD for both sexes. Conclusion: A downward secular trend in the onset of puberty was clearly shown in the population. The age at childhood onset of growth did not correlate with the timing of puberty (r=?0.01 and 0.05, p > 0.7 and 0.1 in boys and girls, respectively). Normal ranges of the age at childhood onset of growth are in need of revise, as this study indicates. The new reference presented here could be a reliable indicator in further studies.     

The Validity of Mixed Disorders of Conduct and Emotions in Children and Adolescents: A Research Note

In a study of differential validity, three diagnostic groups based on ICD-10 criteria were compared, namely children with emotional disorders, children with conduct disorders, and children with mixed disorders of conduct and emotions. The patients were taken from a consecutive series of child and adolescent psychiatric service attenders from 1988 to 1992 and represented the total entire subgroups of patients with the respective diagnoses. Based on standardized item sheets that were filled out by the clinicians who were responsible for the respective cases, the groups were compared with regard to age, sex ratio, family background, premorbid behavioral abnormalities, abnormal psychosocial situations, and treatment. It was found that children with mixed disorders of conduct and emotions share many characteristics with pure conduct disordered children. It is concluded that the former group is a subgroup of the latter, and there is little evidence in this study supporting the validity of a separate category of mixed disorders of conduct and emotions.     

Circumstances of dying in hospitalized children

Conditions of dying in a tertiary children's hospital were assessed in a retrospective cohort study. Non-survivors, excluding newborns and emergency room patients, were allocated to four groups: brain death (BD), failed cardiopulmonary resuscitation (failed CPR), death following a do-not-resuscitate (DNR) order and death following withholding or withdrawal of therapy (W/W). In a 4-year period 190 (1.3%) of 14,903 admitted patients died. Of these 134 (71%) died on the paediatric intensive care unit, 42 (22%) on the ward and 14 (7%) in the operating room. W/W was found in 75 (39%), failed CPR in 57 (30%), BD in 32 (17%), and death following a DNR order in 26 (14%). Justifications for restrictions of treatment (W/W or DNR) were imminent death in 41 (41%), lack of future relational potential in 13 (13%) and excessive burden of disease in 47 (47%). In non-survivors analgesics and sedatives were frequently used to relieve suffering in the terminal phase. General principles for the approach of terminally ill children in whom death may become an option instead of a fate are discussed. Conclusion In the majority of children dying in hospital, death occurred following restrictions of life-sustaining treatment, comprising do-not-resuscitate or other forms of withholding or withdrawal of therapy. Received: 24 December 1997 / Accepted in revised form: 30 May 1998     

Findings in Child Deaths Registered as Sudden Infant Death Syndrome (SIDS) in Madison, Wisconsin

A review of a sequential series has been carried out on 0 Madison infants whose deaths had been registered as SIDS. In 18% it was possible to identify lesions that could have given a diagnosis other than SIDS on these same infants. When the cases were assessed on a multifactorial basis, 67% of the infants had a variety of lesions present, which in combination would probably have made their deaths explicable. It was only in children dying before the age of 18 weeks that more than half of the deaths were not explicable. The generally accepted concept of SIDS as a completely unexplained death would appear to apply only if the term is confined to a single aspect of pathology—the terminal anatomic state. If the total pathologic situation of the child is taken into consideration, the diagnosis of a completely unexplained death applies to only about a third of the cases examined in Madison. The current autopsy approach to sudden and unexpected deaths from a causal viewpoint requires critical reappraisal.     

A study on working educated mothers and its impact on child health

The impact of work by mother on child health was assessed by comparing 200 working educated mothers and their 408 children with 200 non-working mothers and their 440 children. Children’s health status was determined by anthropometry, immunization status and morbidity pattern. Significantly more children were malnourished in the study group. Malnutrition showed a significant co-relation with mother’s length of service, type of substitute child care and type of mother’s profession. Significant number of children in study group were reported to have psychological problem as perceived by the mothers. Working of the mothers produced a significant nutritional and psychological impact on the children.     

Relation between age at surgery and regression of right ventricular hypertrophy in tetralogy of Fallot

Pre- and postoperative echocardiographic right ventricular wall thickness (RVW), transverse dimension (RVD), and their ratio (W/D) were measured from subcostal views in 29 patients with Tetralogy of Fallot (TOF) in order to assess whether primary reparative surgery without prior palliative shunts in early infancy results in significantly faster regression of RV hypertrophy than repair later in life.Fourteen patients who were repaired before 6 months of age were compared with 15 patients who were repaired after 6 months of age. In the group of patients who were repaired before 6 months of age both RVW and W/D ratio decreased significantly whereas RVD did not change from pre- to postoperative status. The group of patients who were repaired after 6 months of age showed no significant changes in RVW, RVD, or W/D ratio.These findings suggest that early primary reparative surgery of TOF may have a positive effect on faster regression of RVH during the first postoperative year which may reduce the detrimental effect of longstanding hypertrophy on myocardial function and the potential for arrhythmia.     

Reverse tri-iodothyronine to tri-iodothyronine ratio and gestational age.

The biologic significance of reverse tri-iodothyronine is not yet identified. Cord blood values reflect the fetal thyroid state, with rT3 excess and tri-iodothyronine deficiency. In an attempt to correlate thyroid function and gestational age, T3 and rT3 concentrations were measured by radioimmunoassay on 64 cord blood samples. Infant gestational ages ranged from 29 to 42 weeks; birth weights from 650 to 3,870 gm. The results show a significant positive correlation between gestational age and T3 and a significant negative correlation between gestational age and rT3. The rT3/T3 offers the best correlation.