Executive function deficits in preschool children with ADHD and DBD

Background: Impairments in executive functions (EF) are consistently associated with attention deficit hyperactivity disorder (ADHD) and to a lesser extent, with disruptive behavior disorder (DBD), that is, oppositional defiant disorder or conduct disorder, in school‐aged children. Recently, larger numbers of children with these disorders are diagnosed earlier in development, yet knowledge about impairments in clinically diagnosed preschool children and the role of comorbidity is limited. Therefore, the aim of the current study was to examine EF in clinically referred preschool children with a clinical diagnosis of ADHD, DBD and ADHD + DBD. Method: Participants were 202 children aged 3.5–5.5 years, 61 with ADHD only, 33 with DBD only, 52 with comorbid ADHD + DBD and 56 typically developing children. Five EF tasks were administered. Results: Confirmatory factor analysis showed that the two‐factor model (inhibition and working memory) fit the data better than a one‐factor model in this clinical sample. Preschoolers with ADHD displayed inhibition deficits, also after controlling for IQ. Likewise, preschoolers with DBD displayed impaired inhibition, but when IQ was controlled differences were carried mostly by the effect on the task where motivational demands were high (i.e. when tangible rewards were used). This pattern was also found in the interaction between ADHD and DBD; impaired inhibition in the comorbid group, however, was more severe than in the DBD group. Regarding working memory, few group differences were found. Conclusions: Clinically diagnosed preschool children with ADHD showed robust inhibition deficits, whereas preschool children with DBD showed impaired inhibition especially where motivational incentives were prominent. Severity of inhibition impairment in the comorbid group was similar to the ADHD group.     

Executive functioning in children: a comparison of hospitalised ODD and ODD/ADHD children and normal controls

BACKGROUND: Deficits in executive functioning are supposed to have a predisposing influence on impulsive or aggressive behaviour. We tested the hypothesis that oppositional-defiant disorder (ODD) children with or without attention deficit hyperactivity disorder (ADHD) have problems in executive functioning. METHOD: Seventy-seven 7- to 12-year-old children (15 ODD, 26 ODD/ADHD, and 36 normal controls), all with normal IQ, completed 7 neuropsychological measures of executive functioning, assessing the abilities of set shifting, planning, working memory, inhibition/attention, and impulsivity. Some of these tasks involved the possibility of monetary rewards with a view to testing the prediction of a specific motivational inhibitory deficit. RESULTS: We found no evidence of deficits in working memory, planning, inhibition, or impulsivity. However, the ODD/ADHD group was worse than the normal control (NC) group in set shifting, and both the ODD and ODD/ADHD groups performed worse on a response perseveration task. Moreover, on the basis of one variable derived from a motivational inhibition task, 77% of the children could be correctly classified as ODD or NC. CONCLUSIONS: The findings do not support the hypothesis that ODD and ODD/ADHD children have a deficit in executive inhibitory control; rather, they emphasise that they have problems in regulating their behaviour under motivational inhibitory conditions.     

儿童结核病短程化疗中的药物毒性观察

为探讨儿童结核病短程化疗中药物的毒副作用及儿童的耐受性,对61例结核病患儿采用治疗前后检查肝,肾功能,尿常规,脑干测听或听力测定,观察（6－9）个月,结果显示年龄在7个月以上小儿毒副作用发生率小于2％,治疗期间无产重毒副作用发生,7个月以下患儿7例儿童中5例出现ALT,AST改变,提示严格掌握多药联用剂量的情况下,一般患儿对短程化疗能很好耐受,年龄在7个月以下婴儿加用保肝治疗仍然能接受短程化疗。     

A comparison of executive function in very preterm and term infants at 8 months corrected age

Background

Executive function (EF) emerges in infancy and continues to develop throughout childhood. Executive dysfunction is believed to contribute to learning and attention problems in children at school age. Children born very preterm are more prone to these problems than their full-term peers.

Aim

To compare EF in very preterm and full-term infants at 8 months after expected date of delivery.

Subjects

37 very preterm infants without identified disabilities, and 74 gender and age matched healthy full-term infants. The very preterm infants were all ≤ 32 weeks gestation and < 1250 g birthweight.

Outcome measures

EF tasks which measured working memory, inhibition of distraction, and planning at 8 months after expected date of delivery.

Results

The very preterm infants performed significantly more poorly than the full-term infants on all measures of executive function. No significant differences were found between very preterm and full-term infants on any of potentially confounding variables of, infant temperament, maternal education, family income and maternal psychological wellbeing. Very preterm infants had significantly lower scores on the Mental Development Index (MDI) and Psychomotor Development Index (PDI) on the Bayley Scales of Infant Development (BSID II), however when this was partialled out the differences in EF scores remained. Medical complications, lower birthweight and lower gestation age were all found to adversely affect the performance of very preterm infants on executive function tasks.

Conclusion

Very preterm infants performed more poorly than full-term infants on measures of EF. Further follow up studies are required to investigate whether EF measures in infancy can predict learning and attention outcome at school age.     

孤独症谱系障碍共患注意力缺陷多动障碍的研究进展

研究发现,很多孤独症谱系障碍(autism spectrum disorders,ASD)儿童伴有不同程度的注意力缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的症状.与单纯ASD儿童相比,共患病儿童的ASD症状更明显,认知功能也受损更严重,其生活也会受到影响.该文对目前共患ADHD的ASD儿童临床表现以及执行功能的相关研究做出综述.     

Everyday memory deficits in children and adolescents with PTSD: performance on the Rivermead Behavioural Memory Test

Adult post-traumatic stress disorder (PTSD) patients often report a wide range of cognitive problems in memory, concentration, attention, planning, and judgement. Evaluation of these cognitive aspects of PTSD in adults has helped to define the nature of the disorder. However, there is a paucity of such work in younger subjects. This study has employed the Rivermead Behavioural Memory Test (RBMT) to examine cognitive factors in children and adolescents with PTSD. Eighteen child and adolescent patients with PTSD and 22 control subjects completed the test. PTSD subjects showed poorer overall memory performance compared with controls. Specifically, they were worse on the prospective and orientation items of the RBMT. The results are discussed in the light of research on everyday memory in adults with PTSD.     

Phimosis of infants and young children in Japan

The prepuce and glans was examined in 4521 healthy infants and young children with a birthweight over 2600 g. There were 3238 infants aged 1–12 months and 1283 children aged 3 years. There is no custom of circumcision in Japan. The term phimosis implies the adhesion of the prepuce and glans, which cannot be separated by manipulation. Phimosis was found in 88.5% of infants aged 1–3 months, and the corresponding figures at the ages of 4–6 months, 7–9 months, 10–12 months and 3 years were: 74.4, 63.9, 58.0 and 35.0%, respectively. However, cases where the prepuce could be retracted by gentle manipulation were found in 3.0% of infants aged 1–3 months, 19.9% of those aged 10–12 months and increased to 38.4% of children aged 3 years, which exceeded the rate of phimosis. The complete adhesion of prepuce and glans was found in many infants, and a small space between the prepuce and glans was observed in some cases of 3-year-old boys. The smegma was notable in only 16 cases (0.5%) of infants and in 5 cases (0.4%) of the 3-year-olds. Balanopothitis was found in only one case of the 3-year-olds. It is not recommended to separate the foreskin by manipulation, which sometimes leads to bleeding or paraphimosis. And it is not necessary to surgically correct phimosis in infancy and early childhood except in the case of accompanying urological disturbance.     

Involving children and young people in research

Attitudes to the participation and involvement of infants, children and young people in research have evolved over the years and will undoubtedly continue to change. Today we recognize that they have the right to benefit from research and have their care ‘assured by research’, as well as the right to protection from any dangers from research participation as well as protection against the dangers of receiving non-evidenced treatments. We also recognize that they can be involved in many ways, including prioritising research questions and the outcomes that are measured, helping design studies so that they are acceptable and successful, ensuring information is comprehensible, and participating in disseminating outcomes and discussing emerging issues. Here, I provide a summary of the changes that have occurred. I explain why involvement is important, discuss how to do this, and provide tips and perspectives from children and young people themselves. I provide pointers to other sources of information and advice. Finally, I consider ways in which involvement might evolve in the future.     

Daily physical activity in young children and their parents: A descriptive study

BACKGROUND:

Little is known about physical activity (PA) in young children and about the relationship between their PA and that of their parents.

OBJECTIVE:

The main purpose of the present study (Y-Be-Active) was to examine the daily PA levels of young children and their parents, and to explore the relationship between children’s and parents’ PA.

METHOD:

Fifty-four children (mean age 4.3 years) and their parents (54 mothers, mean age 35.8 years; 50 fathers, mean age 38.2 years) wore accelerometers for three weekdays and two weekend days. Parents also completed questionnaires on family sociodemographics and PA habits.

RESULTS:

Children spent most of their time in light PA. Almost all children attained 30 min of daily moderate-to-vigorous PA (MVPA), and most boys and girls attained 60 min of daily MVPA on weekdays. Only 60% of fathers and approximately one-half of mothers attained 30 min of daily MVPA on weekdays and weekend days. Children’s and fathers’ PA were correlated on weekends. Few parents (20% to 30%) participated regularly in organised PA with their child. Fathers’ involvement in PA with their children was associated with higher MVPA in children.

CONCLUSIONS:

Many young children and parents did not meet current Canadian recommendations for daily PA. Parental involvement in PA with their young children, particularly the involvement of fathers, appeared to promote higher levels of MVPA in young children.     

A pilot study evaluating the use of sirolimus in children and young adults with desmoid-type fibromatosis

Deregulation of the mTOR pathway may play an important role in tumor biology when the APC/β-catenin pathway is disrupted in desmoid-type fibromatosis (DT). A pilot study was conducted to determine whether sirolimus can block the mTOR pathway (primary aim) as well as determine whether it can safely be given in the preoperative setting, decrease tumor size/recurrence, and decrease tumor-associated pain in children and young adults (secondary aims) with DT. Nine subjects ages 5–28 years were enrolled from 2014 to 2017 across four centers. Sirolimus was feasible and was associated with a nonstatistically significant decrease in pS706K activation.     

幼儿期支气管哮喘的临床特点及诊断策略

年长儿与成人期的支气管哮喘(哮喘)的诊断并不难,但幼儿期哮喘由于其特殊的生理解剖和免疫特点,并且致喘因素复杂,容易导致诊断不足或过度诊断.目前关于幼儿期哮喘的诊断在全球范围内仍然没有统一的标准,一直是儿科医学界的难点和热点问题.文章总结了幼儿期哮喘诊断的历程及概念,分析幼儿气道生理解剖免疫及临床特点,综合近年来GINA及各国指南对幼儿喘息的诊断观点,探讨幼儿期哮喘的临床特点及诊断策略,以期引起更广泛的关注.     

A comparison of developmental versus functional assessment in the rehabilitation of young children

BACKGROUND: The purpose of this study was to explore the differences in and potential uses of information derived from developmental vs. functional assessment during the acute rehabilitation of very young children with acquired brain injury. Both methods of assessment are typically used during hospitalization in order to assist in developing individualized goals and outcome measures. With the trend of shortened hospital stays, effective assessment for determining optimal treatment goals and outcomes becomes increasingly important. The results from a developmental and a functional assessment obtained on 23 inpatient children below 6 years of age who had experienced either an acquired brain injury or encephalitis were compared. The data was collected through a retrospective chart review spanning 4 years. METHODS AND OUTCOME MEASURES: Each child received a cognitive and a language test using either the Early Learning Accomplishment Profile (E-LAP) or the Learning Accomplishment Profile Diagnostic (LAP-D) for the developmental assessment measure. The Functional Independence Measure for Children (WeeFIM) was used as a functional assessment. Summary statistics and frequencies were calculated for variables including age and diagnosis. Partial Pearson correlations and 95% confidence intervals were calculated between the functional and developmental assessments, adjusting for the amount of time between administrations of the two exams. Pearson correlations were computed between length of hospital stay and performance on the developmental and functional quotients. RESULTS: Moderate, statistically significant Pearson partial correlations were found between the E-LAP/LAP-D cognitive quotient and the WeeFIM cognitive quotient (r = 0.42, 95% CI (0, 0.72)), the E-LAP/LAP-D language quotient and the WeeFIM cognitive quotient (r = 0.55, 95% CI (0.17, 0.79)) and the E-LAP/LAP-D cognitive quotient and the WeeFIM total quotient (r = 0.50, 95% CI (0.10, 0.76)). An inverse correlation was found between the length of stay and the E-LAP/ LAP-D cognitive quotient (r = -0.68, 95% CI (-0.86, -0.34)) as well as the E-LAP/LAP-D language quotient (r = -0.61, 95% CI (-0.83, -0.23)). CONCLUSIONS: The moderate but limited correlations between developmental and functional assessments may be attributed to differences in the two forms of assessment including the test items, their administration and scoring. While both forms of assessment were thought to be useful for developing individualized treatment goals and measuring outcomes, there were advantages and disadvantages to each.     

Patterns of development in young children with autism

Objective: To determine the extent to which the developmental profile of children less than 4 years can help in distinguishing children with autism from children with developmental delay.Methods: Subjects were 32 children with autism as per the DSM IV criteria and 32 children with developmental delay matched on chronological and academic age. The Developmental Profile II was used to assess the developmental functioning in five domains including physical, social, self help, academic, and communication.Results: The two groups showed significantly different developmental profiles and these differences were accounted for mainly by significantly lower social skills and superior motor skills in the autistic group as compared to the developmentally delayed group.Conclusion: Developmental Profile II may help in distinguishing young children with autistic disorder from non-autistic children with comparable developmental delays     

吸入丙酸倍氯米松治疗婴幼儿哮喘的疗效观察

目的进一步了解吸入皮质激素对婴幼儿哮喘的治疗作用、副作用等问题.方法对170例1～3岁的轻中重度婴幼儿哮喘患儿,随机分成两组.治疗组根据病情的严重程度用面罩型筒式储雾罐吸入丙酸倍氯米松250～750μg/d;对照组不用吸入激素,只给予酮替芬等预防性治疗.结果治疗组患儿发作次数、咳嗽、喘息天数均较未经吸入治疗患儿少,并未发现明显副作用.结论各种严重程度的婴幼儿哮喘,借助面罩型储雾罐吸入皮质激素每日250～750μg均能收到较好疗效,而且安全.     

兰州地区婴幼儿轮状病毒和杯状病毒腹泻的研究

目的 研究兰州地区婴幼儿轮状病毒和杯状病毒腹泻的分子流行病学特点。方法 2001年12月～2002年11月在兰州医学院第一附属医院儿科收集婴幼儿病毒性腹泻粪便标本244份,用酶联免疫吸附试验(ELISA)检测轮状病毒抗原,阳性标本用逆转录聚合酶链反应(RT-PCR)、巢式PCR及琼脂糖凝胶电泳方法进行基因分型;阴性标本用ELISA和RT-PCR进行杯状病毒病原检测。结果 224份标本轮状病毒检出率为45．5％(111／244份),G分型中G3为58．6％,G1为18．0％,G2为4．5％,G9为2．7％,混合型为6、3％,11例未能分型。P分型中P[8]为61．0％,P[4]为7．3％,混合型为2．4％,14例未能分型。133份轮状病毒阴性标本杯状病毒检出率为15．8％,其中ELISA检测阳性率为11．3％,RT-PCR检测阳性率为9．0％。结论 轮状病毒是兰州地区婴幼儿病毒性腹泻的主要病原,2002年流行株为G3型,发现了G9型轮状病毒感染;杯状病毒也是引起兰州地区婴幼儿病毒性腹泻的病原之一,应引起重视。     

Characteristics of young foster children in the urban slums of Bangladesh

Aim: To identify the reasons for the fostering of children, and to describe their feeding practices and assess their health and nutritional status. Methods: Forty-six pairs of mothers and their young foster children (up to 24 mo of age) were interviewed in a cross-sectional study in the urban slums of Dhaka, Bangladesh. Another 82 pairs of mothers and their biological children of a similar age group were interviewed for comparison. Results: Sixty-five percent of the children were fostered because of the death of their biological mothers. Eighty-three percent of the biological mothers died because of complications during delivery or the immediate postpartum period and the remainder died after the postpartum period of diseases unrelated to their pregnancies. More than half (52%) of the foster mothers were childless and a quarter (24%) fostered children for reasons of gender preference. Almost a quarter (24%) of the children were placed in foster homes because of extreme parental poverty. Divorce or separation of the biological parents accounted for only 7% of children fostered. Approximately 90% of the foster children were given animal and/or formula milk in their first month of life while all children in the comparison group were given breast milk. Among the foster children, 58% were given semisolid or solid food before completion of 4 mo compared with 14% in the comparison group. Significantly more children in the foster group suffered from diarrhoea and acute respiratory infection than in the comparison group.

Conclusion: Maternal death, poverty and childlessness and child gender preference of foster mothers were important factors in fostering of children in the study group. Inappropriate feeding practices compounded by diseases may have contributed to the poor nutritional status of the foster children.