Myelin basic protein in the cerebrospinal fluid of patients infected with HIV

Summary The major pathological abnormalities of HIV encephalopathy are infiltrates of macrophages, multinucleated giant cells, microglial nodules and demyelination. Elevated myelin basic protein (MBP) levels in the cerebrospinal fluid (CSF) provide a marker for central nervous system demyelination. The purpose of this study was to investigate the possible role of CSF MBP as a useful and early marker for HIV encephalopathy. The CSF of 40 consecutive patients with HIV infection of various clinical stages was investigated, including 13 patients with clinical signs of HIV encephalopathy. CSF MBP was elevated in 2 patients (5.0 and 5.3 ng/ml), both of whom had moderate to severe HIV encephalopathy. The course of the disease was rapid in both patients. In the remaining 38 patients, CSF MBP levels were marginally elevated (n=12) or normal (n=26). Our results suggest that CSF MBP is not a sensitive marker for the diagnosis and evaluation of HIV encephalopathy, but may be an indicator of prognosis for the course of the disease. There were only few findings of elevated CSF MBP levels in patients with HIV encephalopathy in the current study, and this may be because the disorder progressed slowly in most patients. It is possible that CSF MBP levels in HIV encephalopathy may only be elevated with acute clinical deterioration but are normal in slowly progressive forms of demyelination, as seen in multiple sclerosis.     

Mental health of primary family caregivers with children with intellectual disability who receive a home care programme

Background The aims of the present study were to describe the change in mental health over time in a group of family caregivers with a child with intellectual disability (ID) and to explore the effect of a home care service on the psychological well‐being of the caregiver. Methods The authors identified children with ID who received home care services in the southern part of Taiwan. A total of 46 primary family caregivers (age range = 21–65 years) were recruited for the present study. The study design was a quasi‐experimental follow‐up analysis. The children with ID and their families regularly received home‐based care. The 12‐item version of the Chinese Health Questionnaire (CHQ) was used to evaluate the subjects’ mental health at three time points: (1) baseline, (2) 3 months and (3) 9 months. The validity and reliability of the CHQ have been tested in Taiwan. The Generalized Estimating Equation was used to conduct longitudinal data analyses. Results The authors found that the family caregivers showed a significant improvement in their mental health by month 9. Conclusions The preliminary findings of this study accredit the effect of home care services and suggest that home care services are necessary for family caregivers.     

The development of a multimedia online language assessment tool for young children with autism

This study aimed to provide early childhood special education professionals with a standardized and comprehensive language assessment tool for the early identification of language learning characteristics (e.g., hyperlexia) of young children with autism. In this study, we used computer technology to develop a multi-media online language assessment tool that presents auditory or visual stimuli. This online comprehensive language assessment consists of six subtests: decoding, homographs, auditory vocabulary comprehension, visual vocabulary comprehension, auditory sentence comprehension, and visual sentence comprehension. Three hundred typically developing children and 35 children with autism from Tao-Yuan County in Taiwan aged 4–6 participated in this study. The Cronbach α values of the six subtests ranged from .64 to .97. The variance explained by the six subtests ranged from 14% to 56%, the current validity of each subtest with the Peabody Picture Vocabulary Test-Revised ranged from .21 to .45, and the predictive validity of each subtest with WISC-III ranged from .47 to .75. This assessment tool was also found to be able to accurately differentiate children with autism up to 92%. These results indicate that this assessment tool has both adequate reliability and validity. Additionally, 35 children with autism have completed the entire assessment in this study without exhibiting any extremely troubling behaviors. However, future research is needed to increase the sample size of both typically developing children and young children with autism and to overcome the technical challenges associated with internet issues.     

The development of a trial making test in young children: the TRAILS-P

Preschool children have a more limited verbal repertoire, less proficient manual skills, and more variable attention spans relative to those of school age, with comparatively few neuropsychological tasks available for use in this age range. A prototypic neuropsychological test, the Trail Making Test, was adapted for use with young children, the TRAILS-P, using a developmentally salient storybook format with colorful stimuli in differing conditions with varying executive demands. The TRAILS-P was administered to 103 normally developing preschoolers between 2 and 6 years of age; 30 of these children were retested within one month to determine test reliability. Correlations among latencies to complete each condition and condition errors generally were moderate to high, suggesting coherence in test content. There also was evidence for good test-retest reliability. Latency to complete the TRAILS-P conditions differed as a function of the interaction of condition type and age group. Although the youngest children generally took more time to complete all TRAILS-P conditions, 3-year-old children were disproportionately slow to complete the condition that required shifting between stamping stimuli of two classes, with distraction by the additional presence of irrelevant stimuli. In contrast, the number of errors differed only in the 5-year-olds relative to younger children. These findings suggest that executive abilities can be assessed adequately in young children when tasks are designed to take advantage of the developmentally unique features of the preschool period.     

The development of falling intonation in young children with cochlear implants: a 2-year longitudinal study

This article describes the development of intonation in 12 cochlear implant (CI) recipients. In a previously reported study of the first year of CI use, children who were implanted late (after 24 months) acquired intonation more rapidly than the younger participants. The older children's advantage is plausibly owing to their greater maturity. However, children who were implanted early (before 25 months) did not have an advantage over the still younger control group of infants with normal hearing (NH), suggesting that the advantage requires a critical age of about 30 months. The younger CI-users reached this age in the second year of CI use. The results confirmed our expectation that even the younger CI recipients would acquire intonation more rapidly than infants with NH who had the same amount of robust hearing experience. Clinical implications are discussed in relation to the question of early versus late implantation.     

The effect of environmental stimulation upon the stereotyped behavior of autistic children

Two groups of three autistic children, equated for chronological age but differing in IQ and performance MA, were observed for 20-minute sessions. Total duration of time subjects engaged in stereotyped behavior was recorded for each minute. During minutes 6–15, subjects were provided with either minimal or high environmental stimulation. High environmental stimulation was found to increase the mean duration of time the low-IQ group engaged in stereotyped behavior but to decrease the duration for the high-IQ group. The theoretical implications are discussed.This research was supported by MH Grant #29248 and MCH Grant #927.     

The spectrum of polyneuropathies in patients infected with HIV.

Twenty five patients with peripheral neuropathy at different stages of human immunodeficiency virus (HIV) infection are reported. Cerebrospinal fluid (CSF) findings were available in 17 cases, electrophysiology in all and a neuromuscular biopsy in 11. Of six otherwise asymptomatic HIV+ patients, five had chronic inflammatory demyelinating polyneuropathy (CIDP) and one acute inflammatory demyelinating polyneuropathy (AIDP). CSF showed pleocytosis in all cases. Infiltration of the endoneurium and/or the epineurium by mononuclear cells was seen in biopsies from three cases. These six patients recovered either spontaneously, or with corticosteroids or plasmaphereses. Of five patients with AIDS related complex (ARC), three had distal predominantly sensory peripheral neuropathy (DSPN), one CIDP and one mixed neuropathy. Of 14 patients with AIDS, one had mononeuropathy multiplex and 13 painful DSPN. Electrophysiological studies were consistent with an axonopathy. Nerve biopsies in six cases showed axonal changes but surprisingly associated with marked segmental demyelination in two cases. Cell infiltration was present in nerve samples in two cases. Five patients died within six months after the onset of the neuropathy.     

Visual and visuospatial development in young children with Williams syndrome

This study investigated the relation between sensory visual problems and the severity of visuospatial difficulties in a large group of young children with Williams' syndrome (WS). A questionnaire describing visual and associated problems was completed by the families of 108 children with WS and detailed follow-up assessments were conducted, including visual, spatial, motor, visuocognitive, and linguistic tests of 73 of these children (mean age 7 years 3 months; 40 males, 73 females). Children with WS showed a much higher incidence of common paediatric sensory vision problems (strabismus, visual acuity loss, amblyopia, reduced stereopsis) than normally developing children. It was found that delays with respect to age normative values increased with age on all tests. No significant correlation was found between the presence of a visual deficit and the severity of the visuospatial problems, suggesting that the difficulties children with WS have in understanding spatial arrangements are not simply a result of their earlier sensory visual problems. Results confirm the dissociation between visuospatial and language abilities in children with WS, and support the neurobiological model of a split between ventral and dorsal stream processing of visual information with a generalized deficit in dorsal stream processing in young children with WS.     

Developmental milestones of vertically HIV infected and seroreverters children: follow up of 83 children

The aim of the study was to detect neurological abnormalities in human immunodeficiency virus (HIV) infected children. This was achieved by a prospective evaluation, from November/1995 to April/2000, of 43 HIV infected children (group I) and 40 HIV seroreverters children (group II) through neurological exam and neurodevelopmental tests: Denver Developmental Screening Test (DDST) and Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS). A control group (III), of 67 children, were evaluated by CAT/CLAMS. Hyperactivity, irritability and hypotonia were the findings on neurological examination, without statistical differences between group I and II. On CAT/CLAMS, the group I developmental quotient (DQ) was significantly lower than the other groups. The same occurred in DDST, with group I presenting significantly more failures than group II. Nineteen HIV children of group I had brain computed tomographic scan, with abnormalities in three of them (basal ganglia calcification, white matter hypodensity and asymmetry of lateral ventricles). We conclude that in HIV infected children a neurodevelopment delay occur early in the disease, and it can be detected by screening tests.     

Dysphoric mood in young children referred to a child development unit

Seventeen parents of 100 young children referred to a child development unit reported predominantly dysphoric mood in their children. The dysphoric group exhibited a cluster of depressive symptoms and also differed from the nondysphorics on referral problems, family history items, I.Q., and other measures.     

Promoting the peer-related social development of young children with mild developmental delays: effectiveness of a comprehensive intervention

To address the unusual peer-related social competence difficulties characteristic of young children with mild developmental delays, we conducted a randomized clinical trial to evaluate the effectiveness of a comprehensive, developmentally oriented, highly individualized intervention extending over a 2-year period. Outcome measures emphasized generalization of peer interactions in unfamiliar playgroups. Results revealed modest effects of the intervention, with children who had lower cognitive levels benefiting most. Intervention effects were best conceptualized as preventative, minimizing the negative features and atypical patterns of children's social play with peers. Our discussion of future work was focused on alternative implementation models to enhance intervention intensity, inclusion of specific subgroups of children, and direct measurement of children engaging in social tasks.     

The clinical course of children treated in a short-term inpatient programme

Forty-six children admitted to short-term, usually 4–6-week child psychiatric inpatient treatment were evaluated from multiple perspectives on admission, at discharge, and at 5-month, one-year, and 3-year follow-ups. The majority of the patients showed an improvement in functioning over the course of the 3-year follow-up. However, the 3-year stability of parent, teacher and clinical ratings of the child was very high. Furthermore, the majority of children had a high level of symptoms at follow-ups. Conduct problems had the highest stability and predicted the poorest outcome. The results stress the importance of long-term follow-up of children discharged from child psychiatric tertiary sevices. In many of these cases, the problems were persistent chronic problems that require continued monitoring and evaluation over many years. Short-term hospitalization should be seen as a pathway to further assistance rather than a complete form of treatment.     

The relationship between cognitive development and conduct problems in young children with autism spectrum disorder

Individuals with ASD often demonstrate elevated rates of challenging behaviors, such as tantrums, aggression, and property destruction. The current study examined the relationship between cognitive abilities and conduct problem behaviors in 263 children aged 18 to 39 months. Cognitive development was measured utilizing the cognitive developmental quotient (DQ) on the Battelle Developmental Inventory, Second Edition (BDI-2). Participants were separated into two groups: (1) low cognitive DQ group (cognitive DQ less than or equal to 70), and (2) typical cognitive DQ group (cognitive DQ greater than 70). Conduct problems were assessed using the Tantrum/Conduct Behavior subscale of the Baby and Infant Screen for Children with aUtIsm Traits, Part 2 (BISCUIT-Part 2). Higher rates of overall conduct problem behaviors were observed in young children with ASD and typical cognitive development relative to children with low cognitive development. Comparisons of specific conduct behaviors indicated cognitive ability may be associated with particular presentations of conduct problems. Implications are discussed.     

Response to thyrotropin-releasing hormone stimulation in young psychotic children: a pilot study.

(1) To test the hypothesis that CNS dysfunction, specifically in the hypothalamus, exists in young psychotic children, synthetic thyrotropin-releasing hormone (TRH), 400 μg, was given intravenously to ten patients, ages 2$\text{1}\text{2}$ yr to 7 yr 7 months. (2) Timed venous samples were obtained for determination of the plasma triiodothyronine (T₃), thyroid stimulating hormone (TSH) and in some patients, of prolactin, by radioimmunoassay. (3) The responses were compatible with, but not diagnostic of, hypothalamic disease in most of the subjects. (4) It is suggested that a genetic vulnerability and/or associated pre- or perinatal insult to the CNS may result in a variety of abnormalities, which include behavioral and neuroendocrine parameters.     

Fears about the development of a group home

Neighbor resistance has been a major barrier to the development of group homes in the community. This study describes the effects of a group home on its neighborhood along three dimensions—criminal behavior of the residents, traffic problems and adjacent property values. A survey of key informants in the community revealed that none of the expected problems had occurred. The author describes the locational decisionmaking process within the context of open systems and exchange theories.Donald E. Maypole was the Executive Director of the Mississippi River Human Services Center from 1971–1976, which covers the beginning of the study period. He is currently coordinator of the Social Work Program at the University of Northern Iowa. Requests for reprints should be sent to Dr. Maypole, Social Work Program, University of Northern Iowa, Cedar Falls, Iowa 50614.     

The effect of vitamin administration on mental development in mentally retarded children

Vitamin administration in severely mentally retarded children in order to improve their IQ and other forms of personality development has not such a favourable effect as in children with minor cerebral dysfunction. The author administered vitamins A, B, C, D and E to 18 imbecile children. As compared with a control group not given vitamins, no marked changes were observed. This leads to the view that the favourable action of vitamins in children with minor cerebral dysfunction is sometimes assumed in severely mentally affected children where the final effect is in the optimal case nil.     

Evaluation of the nutrition counselling component of a fitness programme for children with disabilities

Objective: To describe and evaluate the nutrition counselling component of a fitness programme for children with disabilities.

Methods: Twenty-eight children with disabilities, ages 6–14 years, participated in a 16-week comprehensive fitness programme consisting of twice weekly exercise sessions, nutrition counselling and physical activity promotion education sessions. Nutrition sessions consisted of three individual and two group sessions. Individual nutrition goals were developed for each child using 3-day food intake diaries and parent interview. Body Mass Index (BMI) and progress towards nutrition goals were documented.

Results: No significant BMI changes were recorded for the entire group (n?=?28) or a sub-group with a goal to decrease BMI (n?=?8). Most of the children made improvements in individual goals indicating improvements in healthy eating habits. This included eating the daily recommended amount of servings of each food group, trying new foods and limiting foods containing saturated and trans fats, sodium and sugar.

Conclusion: Short-term changes were noted in eating habits and behaviours during the 16-week fitness programme, although the effects did not influence overall BMI during the 16-week programme. Children with disabilities are at nutritional risk, and long-term follow-up is needed to determine if initial changes in parent-reported child eating behaviours will impact long-term nutrition, BMI and overall health.

Objetivos: Describir y evaluar el componente del consejo nutricional de un programa de acondicionamiento físico para niños con discapacidad.

Métodos: 28 niños con discapacidad, con edades de 6 a 14 años, participaron en un programa de acondicionamiento físico integral con duración de 16 semanas, el cual consistía de sesiones de ejercicio dos veces por semana, de consejo nutricional y de sesiones educativas para promover la actividad física. Las sesiones nutricionales consistían de tres sesiones individuales y dos sesiones en grupo. Las metas de nutrición individual fueron desarrolladas para cada niño usando un registro diario de la ingestión de alimentos por tres días y de una entrevista a los padres. Se documentaron el índice de masa corporal (BMI) y el progreso hacia las metas de nutrición.

Resultados: No se registraron cambios significativos en el BMI para todo el grupo (n?=?28) o en un subgrupo que tenia como meta la disminución del BMI (n?=?8). La mayoría de los niños tuvieron mejoría en metas individuales, lo que indicaba mejoría hacia hábitos alimenticios más sanos. Estos incluían comer diariamente la cantidad recomendada de porciones de cada grupo alimenticio, probar nuevos alimentos, y limitar la ingesta de alimentos que contenían grasas trans y saturadas, así como sodio y azúcar.

Conclusiones: Notamos cambios a corto plazo en los hábitos de alimentación y en los compartimientos alimenticios durante el programa de acondicionamiento de 16 semanas, aunque los efectos no influyeron en forma total al BMI durante el programa de 16 semanas.

Los niños con discapacidades se encuentran bajo un riesgo nutricional y por lo tanto es necesario el seguimiento a largo plazo para determinar, si los cambios iniciales en los comportamientos alimenticios del niño reportados por los padres, tendrán un impacto en la nutrición a largo plazo en el BMI y en su salud en general.