Delayed visuomotor development in children born to adolescent mothers

The objective of the present study was to determine visuomotor development of children born to adolescent mothers and to compare it with that observed in those born to adult mothers. The sample included 59 urban Mestizo children, 7–8 years of age, who were born to adolescent mothers, and 73 urban Mestizo children of the same age, who were born to adult mothers (>20 years). Visuomotor development was assessed using the Bender test. Children born to adolescent mothers had a higher number of errors in the Bender Gestalt scores compared to those obtained by children born to adult mothers. Items of perseverance and integration in the Bender-Gestalt test were the most affected in children born to adolescent mothers. Of the children born to adolescent mothers, 13.8% repeated a school grade compared to 4.3% of children born to adult mothers (P < 0.01). Differences in sociocultural circumstances between the adolescent and adult mothers may have influenced the results. Nevertheless, children born to adolescent mothers have delayed visuomotor maturation and a low performance at school. Am. J. Hum. Biol. 9:717–723, 1997. © 1997 Wiley-Liss, Inc.     

Social information-processing skills training to promote social competence and prevent aggressive behavior in the third grades

This article describes a school-based study designed to promote social competence and reduce aggressive behavior by strengthening children's skills in processing social information and regulating emotions. Three successive cohorts of 3rd graders (N = 548) from 2 schools participated. In 2000-2001, children received a routine health curriculum; in 2001-2002, students received the Making Choices: Social Problem Solving Skills for Children (MC) program; and in 2002-2003, children received MC supplemented with teacher and parent activities. Compared with children in the routine condition, children in both MC conditions were rated lower on posttest social and overt aggression and higher on social competence. Moreover, they scored significantly higher on an information-processing skills posttest. The findings suggest that prevention programs can strengthen social- emotional skills and produce changes in aggressive behavior.     

Multisensory adaptation of spatial-to-motor transformations in children with developmental coordination disorder

Recent research has demonstrated that adaptation to a visuomotor distortion systematically influenced movements to auditory targets in adults and typically developing (TD) children, suggesting that the adaptation of spatial-to-motor transformations for reaching movements is multisensory (i.e., generalizable across sensory modalities). The multisensory characteristics of these transformations in children with developmental coordination disorder (DCD) have not been examined. Given that previous research has demonstrated that children with DCD have deficits in sensorimotor integration, these children may also have impairments in the formation of multisensory spatial-to-motor transformations for target-directed arm movements. To investigate this hypothesis, children with and without DCD executed discrete arm movements to visual and acoustic targets prior to and following exposure to an abrupt visual feedback rotation. Results demonstrated that the magnitudes of the visual aftereffects were equivalent in the TD children and the children with DCD, indicating that both groups of children adapted similarly to the visuomotor perturbation. Moreover, the influence of visuomotor adaptation on auditory-motor performance was similar in the two groups of children. This suggests that the multisensory processes underlying adaptation of spatial-to-motor transformations are similar in children with DCD and TD children.     

Brief report: effect of intravenous methotrexate dose and infusion rate on neuropsychological function one year after diagnosis of acute lymphoblastic leukemia

OBJECTIVE: To compare the effects of two intravenous (IV) methotrexate (MTX) infusion protocols on cognitive function in children newly diagnosed with acute lymphoblastic leukemia (ALL). METHODS: We compared 19 children treated with 1 g/m(2) of IV MTX over 24 hr (Group 1) to 13 children treated with 2 g/m(2) of IV MTX over 4 hr (Group 2) on measures of working memory, nonverbal, and verbal skills shortly after diagnosis (Time 1) and 1 year later (Time 2). RESULTS: A significant GroupxTime interaction was found for a composite measure of working memory with Group 2 declining from Time 1 to Time 2. Group 2 performed significantly worse than Group 1 on a composite measure of nonverbal skills at both time points. CONCLUSIONS: Findings suggest that difficulties in working memory and nonverbal skills may be evident during the first year of treatment for ALL and that severity may be dependent on IV MTX dose and/or infusion rate.     

Cognitive effects of childhood leukemia therapy: a case for four specific deficits

Prophylactic treatment of the central nervous system (CNS) with cranial irradiation and antineoplastic drugs has made childhood acute lymphoblastic leukemia (ALL) a survivable disease, but at the same time there have been many reports of iatrogenic effects, including deficits in cognitive functioning. Previous research suggests a particular effect on the Freedom from Distractibility factor of the WISC-R, memory, and attention. These particular abilities are tested in a group of 43 ALL survivors, with comparisons against solid tumor as well as sibling controls. The results indicate that four cognitive processes are affected by CNS prophylaxis for ALL: short-term memory, speed of processing, visuomotor coordination, and sequencing ability. Younger children have a more severe speed of processing deficit and children treated with a less rigorous protocol appear to be slightly less affected generally. The specific cognitive deficits found are related to neurological evidence on both theoretical and empirical grounds. Results suggest that children who have received CNS prophylaxis are able to learn, but may be slower to acquire new material and may benefit from bimodal presentation.     

Motor and perceptual timing deficits among survivors of childhood leukemia

OBJECTIVE: There is growing evidence of cerebellar-frontal system change in children treated for leukemia with chemotherapy alone (Lesnik et al., 1998). METHODS: We compared 22 long-term survivors of acute lymphoblastic leukemia (ALL), aged 8-18, to 22 age- and gender-matched controls on tasks emphasizing cerebellar-frontal functioning including judgment of time duration and motor timing. Groups were also compared on a judgment of pitch task, used as a control measure. Children with ALL were at least 5 years from diagnosis, treated with intrathecal chemotherapy (methotrexate in all, hydrocortisone and cytarabine in 20/22), but not radiation therapy, and free from recurrence of disease. RESULTS: After controlling for IQ, the ALL group had poorer performance than controls on judgment of long duration and motor timing, but not judgment of pitch. CONCLUSIONS: Treatment with intrathecal and infusional chemotherapy for childhood ALL may be associated with skill deficits comparable to those seen in individuals with cerebellar-frontal abnormalities.     

Intellectual, neuropsychological, and academic functioning in long-term survivors of leukemia

OBJECTIVE: To assess the effects of treatment for acute lymphoblastic leukemia (ALL) on children's cognitive functioning. METHOD: Participants were long-term survivors of ALL treated with cranial irradiation and central nervous system (CNS) chemotherapy (n = 20), or CNS chemotherapy only (n = 21), healthy children (n = 21), and children with chronic asthma (n = 21). The groups were compared on measures of intellectual, neuropsychological, and academic functioning. RESULTS: CNS chemotherapy, with and without cranial irradiation, was associated with significantly lower levels of intellectual and academic functioning. Children with chronic asthma obtained lower scores than healthy controls, but these differences were not significant. Tests of neuropsychological functioning did not consistently separate the groups. CONCLUSIONS: CNS chemotherapy and, to a lesser extent, chronic illness both contribute to the poorer performance of long-term survivors of ALL on measures of intellectual and academic functioning.     

Intellectual efficiency in children and adolescents with spina bifida myelomeningocele and shunted hydrocephalus

We studied the intellectual profiles of 13 Italian children diagnosed with spina bifida myelomeningocele and shunted hydrocephalus (MMC HC) against a control group of children. The results showed that MMC HC group had lower performance in all subtests, four indices, and the FSIQ of the Wechsler Intelligence Scale for Children, forth-edition. The MMC HC group showed flat cognitive profiles between subtests within each index and between four core indices. However, the cognitive abilities that were mostly impaired seemed to be related to visual selective and focused attention, to visual acuity, to visuo-perceptive organization and visuomotor integration and to visual short-term memory.     

Sex differences in cognitive processing in children treated with CNS prophylaxis for acute lymphoblastic leukemia

Evaluated cognitive processing in 51 children (27 female, 24 male) who had been treated for acute lymphoblastic leukemia (ALL) with CNS prophylaxis (cranial radiation in combination with intrathecal chemotherapy) and were continuously disease-free for 5 to 12 years. The control group comprised 15 children treated for Wilm's tumor. Functions assessed included visuoperceptual skills, generation of organizational strategies, sensitivity to organizational structure, and attention. The ALL group showed performance deficits relative to the solid tumor controls in appreciating the organization inherent in complex visuospatial material and alertness, with females more severely affected than males. Sex differences favoring males on IQ and academic achievement were related to these cognitive processes.     

Visual processing in Noonan syndrome: dorsal and ventral stream sensitivity

Global spatial and motion processing abilities were assessed in 18 patients with Noonan syndrome (NS) and in 43 matched controls using form and motion coherence testing, respectively. We observed a discrepancy between the two groups since the study group had significantly lower performances than the control group for form coherence while there was no impairment on motion coherence. All the patients were also assessed on the Movement Assessment Battery for Children (M-ABC) to evaluate visuomotor skills. Thirteen of the 18 (72%) also had global poor performances on the M-ABC. The results show that children with NS have a specific impairment in the global processing of visuospatial information and are likely to have a specific ventral stream deficit as also suggested by the frequent visuomotor perceptual difficulties. Testing form and motion coherence thresholds may be a useful diagnostic tool for this group of patients, despite their normal cognitive abilities, since aspects of global form processing and visuomotor perceptual difficulties can be identified and potentially targeted for a specific rehabilitation program.     

Analysis of microsatellite instability in children treated for acute lymphocytic leukemia with elevated HPRT mutant frequencies

Survival rates of children treated for cancer have increased dramatically over the last 25 years following the development of risk-directed multi-modality treatment protocols. As a result, there is a rapidly growing population of children and young adult cancer survivors in which the long-term genotoxic effects of chemotherapeutic intervention is unknown. We have previously observed that children treated for acute lymphocytic leukemia (ALL) have significantly increased somatic mutant frequencies (Mfs) (30- to 1300-fold higher) at the hypoxanthine-guanine phosphoribosyltransferase (HPRT) reporter gene in their non-malignant peripheral T cells compared with children at diagnosis or controls. In order to gain insight into the etiology of the observed dramatic increase in Mfs following antineoplastic therapy, we investigated the prevalence of microsatellite instability (MSI), reflective of a defect in DNA mismatch repair (MMR), in children with ALL at diagnosis, during and after chemotherapy and compared them with healthy age-matched controls. MSI analysis using five microsatellite markers was performed on 167 T cell isolates from 40 healthy children and on 842 T cell isolates from 50 patients treated for ALL. High-frequency MSI (MSI-high) was identified in 2 healthy children (5%) and in 2 of 20 ALL subjects at the time of disease recurrence (relapse) (10%). There was no statistically significant difference between the prevalence of MSI-high in patients at the time of ALL relapse and healthy children, nor between the children with ALL at other time points and healthy children. These data indicate that MMR defects, represented by MSI, are not a significant contributor to the elevated HPRT Mfs seen in children treated for ALL. However, in a small number of patients chemotherapy may play a role in the selection of cells with defects in MMR that may have long-term clinical implications.     

Neuropsychological Abilities of Children With Cardiac Disease Treated With Extracorporeal Membrane Oxygenation

We examined the effect of venoarterial extracorporeal membrane oxygenation (ECMO) on right- and left-hemisphere neuropsychological abilities in children with cardiac disease. Nine children treated with ECMO, ages 4 to 6 years, with no history of neurologic or genetic disorder, were compared to 13 controls matched for cardiac disease and age of surgery and 31 normal controls. Children treated with ECMO demonstrated significant impairment in general cognitive ability compared to normal controls. No group differences were found in impulsivity or sustained attention. On lateralized measures, children treated with ECMO demonstrated significant impairment in left-hand motor skill, visual memory, and spatial construction compared to both cardiac controls and normal controls. There were no group differences in general verbal ability, verbal memory, right-hand motor skills, or tactile perception. Results indicated mild general cognitive impairment and impairment of functions associated with right-hemisphere abilities in children treated with ECMO.     

Neuropsychological Abilities of Children With Cardiac Disease Treated With Extracorporeal Membrane Oxygenation

We examined the effect of venoarterial extracorporeal membrane oxygenation (ECMO) on right- and left-hemisphere neuropsychological abilities in children with cardiac disease. Nine children treated with ECMO, ages 4 to 6 years, with no history of neurologic or genetic disorder, were compared to 13 controls matched for cardiac disease and age of surgery and 31 normal controls. Children treated with ECMO demonstrated significant impairment in general cognitive ability compared to normal controls. No group differences were found in impulsivity or sustained attention. On lateralized measures, children treated with ECMO demonstrated significant impairment in left-hand motor skill, visual memory, and spatial construction compared to both cardiac controls and normal controls. There were no group differences in general verbal ability, verbal memory, right-hand motor skills, or tactile perception. Results indicated mild general cognitive impairment and impairment of functions associated with right-hemisphere abilities in children treated with ECMO.     

Cognitive and Academic Late Effects Among Children Previously Treated for Acute Lymphocytic Leukemia Receiving Chemotherapy as CNS Prophylaxis

Objective: Examine cognitive and academic late effects amongchildren and adolescents who had received central nervous system(CNS) prophylactic chemotherapy alone for acute lymphocyticleukemia (ALL); none had received whole brain radiation therapy(RT). Method: Subjects included 47 children and adolescents from 5to 22 years of age who were treated on the same protocol andhad been off treatment from 2 to 7 years at the time of assessment. Results: As a group the survivors displayed generally averageperformance on measures of cognitive and academic abilities,although they differed from normative means on tests of nonverbalskills. Girls performed more poorly than the normative sampleon nonverbal tasks, while no differences were found for boys.Age at diagnosis and time off treatment were not significantlyassociated with cognitive and academic functioning for survivorsof this particular chemotherapy-only protocol. Conclusions: Data were interpreted to support generally modestpotential late effects in specific areas for children and adolescentssurviving ALL. These findings suggest a need for monitoringnonverbal cognitive skills for childhood survivors of ALL, particularlyfor girls.     

Concurrent maturation of visuomotor skills and motion perception in typically-developing children and adolescents

Perceptual and visuomotor skills undergo considerable development from early childhood into adolescence; however, the concurrent maturation of these skills has not yet been examined. This study assessed visuomotor function and motion perception in a cross-section of 226 typically-developing children between 4 and 16 years of age. Participants were tested on three tasks hypothesized to engage the dorsal visual stream: threading a bead on a needle, marking dots using a pen, and discriminating form defined by motion contrast. Mature performance was reached between 8 and 12 years, with youngest maturation for kinematic measures for a reach-to-grasp task, and oldest maturation for a precision tapping task. Performance on the motion perception task shared no association with motor skills after controlling for age.     

Second neoplasms after acute lymphoblastic leukemia in childhood

BACKGROUND. Effective forms of treatment for acute lymphoblastic leukemia (ALL) in childhood now result in survival rates above 70 percent at five years, but the treatments are potentially carcinogenic. To determine the magnitude of this risk and identify possible risk factors for the development of second neoplasms, we studied a large cohort of children treated for ALL. METHODS AND RESULTS. We undertook a retrospective cohort study of 9720 children who had been given a diagnosis of ALL between June 1972 and August 1988 and had been treated according to the therapeutic protocols of the Children's Cancer Study Group. The median follow-up was 4.7 years (range, 2 months to 16 years). We found that 43 second neoplasms occurred among the children in the cohort, including 24 neoplasms of the central nervous system, 10 new leukemias and lymphomas, and 9 other neoplasms. This represented a 7-fold excess of all cancers and a 22-fold excess of neoplasms of the central nervous system. The estimated cumulative proportion of children in whom a second neoplasm developed was 2.53 percent 15 years after diagnosis (95 percent confidence limits, 1.74 percent and 3.38 percent). An even higher risk, particularly of central nervous system tumors, was evident in children five years of age or less at the time of the diagnosis of ALL (P = 0.012). All central nervous system neoplasms developed in children who had previously undergone irradiation. There was no association with exposure to cyclophosphamide or anthracyclines. CONCLUSIONS. There is a substantial excess of second neoplasms, especially of the central nervous system, among children treated for ALL. Children five years old or younger and those receiving radiation are at higher risk, especially for second tumors arising in the central nervous system.     

Behavioral treatment of childhood social phobia

Sixty-seven children (ages 8 and 12) with social phobia were randomized to either a behavioral treatment program designed to enhance social skills and decrease social anxiety (Social Effectiveness Therapy for Children, SET-C) or an active, but nonspecific intervention (Testbusters). Children treated with SET-C were significantly more improved across multiple dimensions, including enhanced social skill, reduced social fear and anxiety, decreased associated psychopathology, and increased social interaction. Furthermore, 67% of the SET-C group participants did not meet diagnostic criteria for social phobia at posttreatment compared with 5% of those in the Testbusters group. Treatment gains were maintained at 6-month follow-up. The results are discussed in terms of treatment of preadolescent children with social phobia and the durability of treatment effects.     

Executive Functioning,Motor Difficulties,and Developmental Coordination Disorder

The current study assessed a comprehensive range of executive functions (EFs) in children with poor motor skills, comparing profiles of children with a diagnosis of developmental coordination disorder (DCD) and those identified with motor difficulties (MD). Children in both groups performed more poorly than typically developing controls on nonverbal measures of working memory, inhibition, planning, and fluency, but not on tests of switching. The similar patterns of strengths and weaknesses in children with MD and DCD have important implications for parents, teachers, and clinicians, as children with MD may struggle with EF tasks even though their motor difficulties are not identified.     

Neuropsychological function in adults with von Recklinghausen's neurofibromatosis

The cognitive function of adults with von Recklinghausen's neurofibromatosis (NF-1) was examined. This study sought to replicate in an adult sample the findings of decreased visuospatial and attention abilities reported for many children with NF-1. Specifically, it was anticipated that adults with NF-1 would be classified separately from unaffected controls according to visual and attention-executive function skills. Second, this study examined whether language skills discriminated between adults with NF-1 and unaffected controls. The sample included 20 participants with NF-1 and 25 control participants. All participants were administered a battery of neuropsychological tests (Developmental Test of Visual-Motor Integration (VMI), Judgment of Line Orientation (JLO), Visual Form Discrimination, Booklet Category Test, Figure Cancellation, Peabody Picture Vocabulary Test-Revised (PPVT-R), Sentence Repetition, Controlled Oral Word Association). The results of a discriminant function analysis partially supported the hypothesis: Two of the tests of visual-spatial skill (VMI, JLO) and one of the language tests (PPVT-R) were found to be the best predictors for group membership. The discriminant function accounted for 45% of the variance between the groups and correctly classified 15 of the NF-1 participants and 21 of the control participants. Post hoc exploratory analyses revealed that the VMI was the most important test in discriminating between the groups. It is suggested that patients with NF-1 will tend to have sparing of basic cognitive functions but will have greater impairment on tests that use multiple cognitive skills.     

Early N400 development and later language acquisition

Recent developmental research on word processing has shown that mechanisms of lexical priming are already present in 12-month-olds whereas mechanisms of semantic integration indexed by the N400 mature a few months later. In a longitudinal setting we investigated whether the occurrence of an N400 at 19 months is associated with the children's language skills later on. To this end children were retrospectively grouped according to their verbal performance in a language test at 30 months. Children with later age-adequate expressive language skills already displayed an N400 at 19 months. In contrast, children with later poor expressive language skills who have an enhanced risk for the development of specific language impairment (SLI) did not show an early N400. The results imply that children who have deficits in their expressive language at the age of 30 months are already impaired in their semantic development about one year earlier.