Computerized fetal heart rate monitoring after vibroacoustic stimulation in the anencephalic fetus

Background

To quantify changes in fetal heart rate (FHR) parameters after vibroacoustic stimulation (VAS) and to evaluate the usefulness of VAS testing (VAST) in anencephalic fetuses. Our findings may also help to clarify the route(s) of vibration and sound transmission during VAST.

Study design and subjects

We obtained the antepartum FHR tracings of 16 anencephalic fetuses, including both the nonstress test (NST) and VAST. Using a computerized monitoring system, HYFM, we determined all FHR parameters from data collected for 10 min before and 10 min after VAS, at successive gestational stages.

Results

We observed three false reactive responses at term. The false reactive rate for VAST (3/16) was higher than that for NST (1/16). No FHR parameters increased significantly after VAS except for the number of fetal movements (FM), which increased significantly in all gestational groups (25th-32nd and 33rd-40th weeks).

Conclusions

These findings call attention to an increased probability of a false reactive response in VAST analysis, when the fetus is affected by a CNS disorder. Increased numbers of FM after VAS suggest that the vibratory pathway is more likely to elicit fetal response than the auditory pathway in this setting, and that the vibratory stimulation travels by subcortical rather than by cortical pathways.     

Discrimination of attention deficit hyperactivity disorder by the continuous performance test

Objective: To investigate the Continuous Performance Test in discriminating a group of 56 attention deficit hyperactivity disorder (ADHD) children from 56 school children individually matched for age, sex and social class.
Methodology: The children all completed the Continuous Performance Task (CPT). The mothers and teachers completed a Conners' Parent-Teacher Rating Scale for the clinic children.
Results: The ADHD sample was selected so that the average IQ was 99.8 to match the school sample. A non-parametric discriminant function showed that the subtests of the CPT that best discriminated ADHD were age-normalized errors of commission (NCPTC) and age-normalized mean reaction time (NMNRT).
Conclusion: Optimal use of the CPT for discrimination of ADHD should include age normalization and mean reaction time to targets. Further evoked potential studies may show brief cortical events involved in reaction time over the course of the CPT, and the processes involved in behavioural control.     

Deficient attention is hard to find: applying the perceptual load model of selective attention to attention deficit hyperactivity disorder subtypes

BACKGROUND: Whether selective attention is a primary deficit in childhood Attention Deficit Hyperactivity Disorder (ADHD) remains in active debate. METHODS: We used the perceptual load paradigm to examine both early and late selective attention in children with the Primarily Inattentive (ADHD-I) and Combined subtypes (ADHD-C) of ADHD. RESULTS: No evidence emerged for selective attention deficits in either of the subtypes, but sluggish cognitive tempo was associated with abnormal early selection. CONCLUSIONS: At least some, and possibly most, children with DSM-IV ADHD have normal selective attention. Results support the move away from theories of attention dysfunction as primary in ADHD-C. In ADHD-I, this was one of the first formal tests of posterior attention network dysfunction, and results did not support that theory. However, ADHD children with sluggish cognitive tempo (SCT) warrant more study for possible early selective attention deficits.     

Training anxious children to disengage attention from threat: a randomized controlled trial

Background: Threat‐related attention biases have been implicated in the etiology and maintenance of anxiety disorders. As a result, attention bias modification (ABM) protocols have been employed as treatments for anxious adults. However, they have yet to emerge for children. A randomized, double‐blind placebo‐controlled trial was conducted to examine the efficacy of an ABM protocol designed to facilitate attention disengagement from threats, thereby reducing anxiety and stress vulnerability in children. Methods: Participants were 34 chronically high‐anxious 10‐year‐olds. An emotional attention spatial cueing task was used. In the ABM condition (n = 18), threat faces never cued the targets’ locations, such that the valid–invalid ratio was 0%/100%, respectively. The valid–invalid ratio on neutral cue trials was 25%/75%, respectively. In the control condition, the valid–invalid ratio was 25%/75% for both neutral and threat faces. Anxiety and depression were measured pre‐ and post‐training and pre‐ and post‐stress induction. Results: ABM facilitated attention disengagement from threat. In response to the stressor task, children in the ABM condition reported less state anxiety relative to controls. Conclusion: Computerized attention training procedures may be beneficial for reducing stress vulnerability in anxious children.     

Autism and a deficit in broadening the spread of visual attention

BACKGROUND: This study examines if visual attention in autism is spatially overfocused (Townsend & Courchesne, 1994) and if there is an associated deficit in broadening the spatial spread of attention. METHOD: Two crosshairs were presented on each trial separated by a brief (500 ms) interval. There was a modest difference in the lengths of the two hairs in each crosshair and participants had to decide which one was longest. Previous research (Mack & Rock, 1998) has revealed that in making this judgement people spread their visual attention to embrace the whole crosshair. Varying the overall size of each crosshair was intended to control participants' spread of attention. The impact of the size of the first crosshair gave an indication of participants' default setting for the spread of attention. The impact of the size transition between the first and second crosshair gave an indication of the fluency with which participants could change the spatial spread of visual attention. RESULTS: Based on the first proposal it was predicted that individuals with autism (N = 13), relative to ability-matched moderately learning disabled (N = 15) and typically developing individuals (N = 15), would be more accurate and quicker to respond when the first crosshair was small rather than large. However, the results revealed no effects of the size of the first crosshair and no group differences. Based on the second proposal it was predicted that individuals with autism, relative to both control groups, would be less accurate and slower to respond to the second crosshair when the size transition from the first crosshair involved a change from small to large (in comparison with large to large), but would not differ when the change was from large to small (in comparison with small to small). This prediction was confirmed. CONCLUSION: Autism is associated with a deficit in broadening the spatial spread of visual attention. The implications of this for other visual and attentional anomalies observed in autism are discussed.     

Management of attention deficit hyperactivity disorder: a parental perspective

OBJECTIVES: There are few studies exploring parental perceptions of the diagnosis and overall treatment of their children with attention deficit hyperactivity disorder (ADHD). This community-based study was conducted to consider this important aspect of care. METHODS: A total of 7 226 (65%) parents responded to a community survey of 11 184 children aged 10-12 years living in northern Sydney in 2000, out of which 278 children with ADHD were identified. Their parents completed an anonymous questionnaire covering their perceptions relating to diagnosis, treatment and overall management. RESULTS: Only 66% of parents recalled the use of questionnaires or rating scales. There were 82% of children who had trialed medication and 66% of these were still taking it. Behavioural intervention had occurred in 42% of the children. Non-conventional treatments, most commonly elimination diet and/or fatty acid supplementation, had been used in 71% of the children. These were considered helpful in one-third of cases. A total of 55% of parents reported being either satisfied or very satisfied with their child's care. Parents were more likely to report satisfaction when their children were on medication and when reviews were held at least 6 monthly. Lack of educational support and teachers' understanding of ADHD were identified as ongoing issues. CONCLUSION: Parental responses suggested that adherence to recommended diagnostic guidelines was inadequate. Behavioural intervention was underutilized despite its documented positive role. Non-conventional therapies were widely used and considered helpful in one-third of the children who used them. Use of stimulant medication and frequent reviews were more likely to be associated with overall management satisfaction.     

Heritability of attention problems in children: longitudinal results from a study of twins, age 3 to 12

BACKGROUND: Twin studies of childhood behavior problems support the conclusion that individual differences in impulsivity, hyperactivity, and inattention are largely due to genetic influences. Non-genetic variation is due to environmental influences that are unique to the individual, and possibly to rater contrast effects. In the present longitudinal twin study, we report on the size of genetic and environmental effects on individual differences in attention problems at ages 3, 7, 10 and 12 years. METHODS: Mothers were asked to complete the CBCL for their twin offspring when the children were 3 (n = 11,938), 7 (n = 10,657), 10 (n = 6,192), and 12 years old (n = 3,124). We focus on the Overactivity (OA) scale in the Child Behavior Checklist (CBCL/2-3), and on the Attention Problem (AP) scale of the CBCL/4-18. The data were analyzed using longitudinal structural equation modeling. RESULTS: Broad heritability of OA and AP is estimated at nearly 75%, at each age. A contrast effect was observed at age 3 only. The results revealed less stability of OA at age 3 to AP at age 7 (r = .40), compared to the stability from AP at age 7 and beyond (r = .70). Genetic effects explained between 76% and 92% of the covariance between OA and AP. CONCLUSIONS: OA and AP are highly heritable at all ages in both genders. The same set of genes appears to be expressed in boys and girls. The size of genetic and environmental contributions remains the same across the ages studied. Stability in OA and AP is accounted for by genetic influences. Children who do not display OA or AP at a given age are unlikely to develop these problems at a subsequent age.     

Visual attention in deaf and hearing infants: the role of auditory cues

BACKGROUND: Successful communication with profoundly deaf children is heavily dependent on visual attention. Previous research has shown that mothers of deaf children--notably those who are deaf themselves--use a variety of strategies to gain their children's attention. This study compares patterns of visual attention in deaf and hearing children to determine how they are affected by the absence of auditory cues, especially when looking to the mother's face. METHOD: The visual attention of 18-month-old infants to their mothers was examined in two groups of deaf children (6 with deaf mothers and 6 with hearing mothers) and two of hearing children (6 with deaf mothers and 8 with hearing mothers). Dyads were observed in free play and 10 minutes of videorecorded interaction was analysed. All looks to the mother were classified as Spontaneous, Responsive (Child turns in response to something done by mother) or Elicited (Mother actively seeks to gain child's attention by, e.g., tapping or waving). The kind of event that attracted the child's attention in Responsive and Elicited episodes was also determined (e.g., object movement, speech, physical contact), as was the focus of the child's attention (e.g., mother's face, mother's body). RESULTS: Responsive looks to the mother were the most frequent for all groups but on only about 25% of occasions were they directed to her face. Elicited and spontaneous looks occurred less often but were frequently directed to the mother's face. Spontaneous looking occurred in all groups but elicited looking very seldom occurred in Hearing-Hearing dyads. Overall, there were fewer looks to the mother in the two groups where mother and child had congruent hearing status, although the proportion of the looks to the mother's face was similar. CONCLUSIONS: Both spontaneous and elicited looks are likely to involve attention to the mother's face. However, while active elicitation of attention is an important part of successful communication with young deaf children, this does not appear necessary for typically developing hearing children who turn to look at their mother's face on hearing her voice. The implications of these findings for differences in the dynamics of communication with young deaf and hearing children are discussed.     

生物反馈联合神经电刺激疗法治疗儿童便失禁的研究进展

近年来生物反馈联合神经电刺激疗法作为一项新兴的治疗方法在小儿内外科、消化科、肛肠及康复外科中得以广泛应用.该文就此方法治疗儿童便失禁方丽的研究进展作一综述,包括生物反馈联合神经电刺激疗法的原理、临床应用疗效及在国内外应用的前景.     

Latex agglutination test: An adjunct to the laboratory diagnosis of pyogenic bacterial meningitis

Gram stain, culture and latex agglutination test (LAT) of cerebrospinal flud were performed in 50 patients clinically diagnosed as suffering from pyogenic bacterial meningitus. Using all the three techniques, an aetiological diagnosis was made in 27 (54%).Neisseria meningitidis, Streptococcus pneumoniae and H. influenzae were the infecting organisms in 21 cases (44%). There were 12 additional cases in which LAT was the only clue to the diagnosis as compared to conventional techniques.Propionibacterium acnes was isolated from one case of anaerobic meningitis. It is concluded that LAT is an adjunct to conventional techniques in the diagnosis of pyogenic bacterial meningitis, where the latter tests fail.     

Optimal parameters for effective electrical stimulation of the anal sphincters in a child with fecal incontinence: preliminary report

The purpose of the present study was to examine the optimal parameters for electrical stimulation of the anal sphincters to improve fecal incontinence in a child after abdominoperineal anorectoplasty for imperforate anus. A pair of coiled-wire electrodes was implanted bilaterally into the deep external sphincter, and alternating bidirectional, biphasic pulses of regulated current were applied. Anal pressure increased in response to an increase in pulse amplitude, width, or frequency, but fell again rapidly when the pulse frequency was higher than 10 Hz. Assuming that an anal pressure of 30 mmHg was necessary to improve anal continence and that tissue damage caused by electrical stimulation and muscle fatigue should be minimized, pulse frequency of 5 Hz and pulse width of 0.1–0.3 ms were determined to be desirable parameters for effective electrical anal sphincter stimulation.     

The Effect of Delay on Hyperactive and Non-hyperactive Children''s Response Times: a Research Note

Twenty-four hyperactive and 55 non-hyperactive children made a button press after the disappearance of a stimulus presented for either 1, 15 or 30 sec. Hyperactive children's responses were generally slower than those of non-hyperactive children and increased with length of pre-response delay, while non-hyperactive children's response time remained the same across all presentation levels. The results are interpreted as giving support to accounts that stress the role of pre-response delay, rather than time on task per se, as an important determinant of hyperactive children's attentional performance.     

Isolated ACTH Deficiency with Absent Response to Corticotrophin-Releasing Factor—41: Evidence for a Primary Pituitary Defect

ABSTRACT. An 8-year-old girl presenting in hypoglycaemic coma was shown to have isolated deficiency of adrenocorticotrophic hormone (ACTH) secretion. Failure to secrete ACTH in response to intravenous administration of synthetic ovine corticotrophin-releasing factor (CRF-41) suggests that this disorder was due to a primary pituitary defect, rather than of hypothalamic origin.     

经皮电神经刺激对痉挛型脑性瘫痪患儿运动功能影响的对照研究

目的观察经皮电神经刺激（TENS）结合功能训练对痉挛型脑性瘫痪（脑瘫）患儿运动功能的影响。方法78例脑瘫患儿,年龄36—58个月[（45．6±8．5）个月],通过计算机分层（性别、年龄）后随机分为TENS组（加例）和对照组（38例）。2组患儿均接受功能训练。TENS组使用2台TENS治疗仪（每台2个输出通道）,8个表面电极放在下肢痉挛肌群的两端肌腱和拮抗肌肌腹给予电刺激,每次20min。以上治疗每日1次,每周5次,共治疗30次。之后指导家长实施家庭康复治疗。治疗前,治疗后的6、12、24周随访时进行以下评定：①综合痉挛量表（CSS）,②粗大运动功能量表（GMFM）中的D和E两项,③步行速度。结果两组患儿的CSS评分、GMFM评分及步行速度治疗前差异无统计学意义（P〉0．05）,治疗后6、12、24周组内差异均有统计学意义（P均〈0．05）。2组患儿的CSS评分、GMFM评分及步行速度在治疗后6、12、24周组间差异均有统计学意义（治疗后24周：t值分别为8．96、3．14、2．35,P均〈0．05）。结论与对照组比较,在痉挛型脑瘫患儿的患侧肢体上给予TENS治疗6周,能明显降低息儿下肢痉挛,提高其站立、步行功能和步行速度。