神经发育行为障碍儿童的睡眠障碍

神经发育障碍(NDDs)儿童合并睡眠障碍发生率高,其病程长短不一,治疗难度及复发率各方面均明显高于正常儿童。睡眠异常对神经发育行为障碍儿童在认知、情绪、社会发展和行为表现等多领域的损害也更为显著,甚至会严重影响家人的睡眠质量和生活质量。本文介绍NDDs儿童共患睡眠障碍的病因和危险因素及其相应的临床症状、评估手段以及干预办法,以期提高临床医师其对NDDs儿童睡眠障碍的早期识别及干预水平。通过改善睡眠质量来提高NDDs儿童的日间社会功能水平和康复治疗效果,并改善其家人的睡眠质量和生活质量。     

Influenza vaccination in children with neurologic or neurodevelopmental disorders

BackgroundChildren with neurologic or neurodevelopmental disorders (NNDDs) are at increased risk of complications from influenza. Although the Advisory Committee on Immunization Practices (ACIP) has recognized NNDDs as high-risk conditions for influenza complications since 2005, little is known about influenza vaccination practices in this population.MethodsCDC collaborated with Family Voices, a national advocacy group for children with special healthcare needs, to recruit parents of children with chronic medical conditions. Parents were surveyed about their knowledge, attitudes, and practices surrounding influenza vaccination. The primary outcome of interest was parental report of vaccination, or intent to vaccinate, at the time of survey participation. CDC also collaborated with the American Academy of Pediatrics to recruit primary care and specialty physicians who provide care for high-risk children, specifically those with neurologic conditions. The primary outcome was physician recognition of ACIP high-risk influenza conditions.Results2138 surveys were completed by parents of children with high-risk conditions, including 1143 with at least one NNDD. Overall, 50% of children with an NNDD were vaccinated, or their parents planned to have them vaccinated against influenza. Among all 2138 children, in multivariable analysis, the presence of a respiratory condition and prior seasonal influenza vaccination was significantly associated with receipt or planned current season influenza vaccination, but the presence of an NNDD was not. 412 pediatricians completed the provider survey. Cerebral palsy was recognized as a high-risk influenza condition by 74% of physician respondents, but epilepsy (51%) and intellectual disability (46%) were less commonly identified.ConclusionsOur estimates of influenza vaccination in children with NNDDs are comparable to published reports of vaccination in healthy children, which continue to be suboptimal. Education of parents of children with NNDDs and healthcare providers about influenza and the benefit of annual influenza vaccination is needed.     

儿童神经发育异常的早期干预

随着早期识别神经发育异常能力的提高,医生们对早期干预的信息需求上升。本文包括了早期干预的神经发育背景、开始干预的时间、主要干预方法和治疗结果的预测因素。并强调,在临床的实践建议下将父母干预和临床干预相结合,可以最大限度地提高患儿的预后。     

324例同龄儿童心理发育障碍的对照研究

目的:了解同年龄孤独症及精神发育迟滞儿童发育水平的异同点,为临床诊疗提供参考依据。方法:162例儿童孤独症患儿及162例精神发育迟滞患儿采用发育商量表(Gesell)检测智能发育水平。结果:孤独症组男女儿童智能发育水平无统计学差异;同年龄组孤独症及精神发育迟滞患儿除语言项以外,各项发育商水平差异均有统计学意义(P<0.05)。男童、女童分别进行发育商对比分析,各功能区发育水平男童的临床表现比女童明显。结论:孤独症患儿大多数伴有精神发育迟滞,发育水平损伤程度不同,孤独症男、女儿童发育损伤表现略有不同,男性患儿临床症状更为明显。     

Parenting children with neurodevelopmental disorders and/or behaviour problems

Background Parenting behaviours influence child well‐being and development. However, much of the research on parenting behaviours and their correlates has focused on caregivers of healthy, typically developing children. Relatively less is known about the parenting behaviours of caregivers of children with chronic health conditions. Objective To examine and compare three parenting behaviours (positive interactions, consistency and ineffective parenting) among caregivers of children with neurodevelopmental disorders and/or externalizing behaviour problems, before and after accounting for child and family socio‐demographic characteristics. Methods Participants (n= 14 226) were drawn from the National Longitudinal Survey of Children and Youth, a long‐term study of Canadian children that follows their development and well‐being from birth to early adulthood. Children (and their caregivers) were divided into four groups according to the presence of a neurodevelopmental disorder (NDD; n= 815), the presence of an externalizing behaviour problem (EBP; n= 1322), the presence of both conditions (BOTH; n= 452) or neither of these conditions (NEITHER; n= 11 376). Results Caregivers of children in the NEITHER group reported significantly higher positive interaction scores and lower ineffective parenting behaviours than caregivers of children in any of the other three groups. Caregivers of children in the EBP and BOTH groups reported similar levels of consistency, but significantly lower levels than caregivers of NDD or NEITHER children. These associations largely remained after accounting for child and family socio‐demographic characteristics, with two exceptions: caregivers' reports of positive interactions were no longer significantly associated with child's NDD and BOTH conditions. Conclusions Parenting children with multiple health conditions can be associated with less positive, less consistent and more ineffective parenting behaviours. Understanding the factors that are associated with the challenges of caring for these children may require additional research attention.     

母体免疫激活与儿童神经发育障碍

孕期作为一个特殊时期,母体易遭受不良暴露进而影响子代。孕期母亲免疫失衡出现母体免疫激活（MIA）,会影响后代神经发育,流行病学研究证据支持MIA与后代神经发育障碍（NDDs）之间的关联,多种因素如遗传背景、母体营养状况、母体肠道微生物等可影响两者间的关联强度。研究表明MIA会通过多种途径影响后代大脑突触形成和修剪,胎盘也在两者关联间起作用。本文综述了近年来MIA与儿童NDDs关联的研究现状,为预防NDDs发生提供思路和方向。     

Motor difficulties in children with developmental disorders of speech and language

The motor hand function of 16 children, aged between 4 and 7 years, with developmental speech and language disorders, was compared with that of 16 control children. The children with developmental speech and language disorders were significantly slower than controls on three out of four motor tasks. They were also more likely than controls to have mixed hand preference although this results was not significant. Children with developmental speech and language disorders should be assessed to ensure that motor deficits are diagnosed and that appropriate support is given.     

Authoritative parenting and parental stress in parents of pre-school and older children with developmental disabilities

BACKGROUND: Rearing a child with a developmental disability is associated with increased parental stress. Theories of stress and adjustment and bi-directional theories of child development suggest that parenting could influence these negative outcomes. METHODS: Relationships between parenting approaches and stress in parents of children with developmental disabilities (DD) (N = 53) were examined across two age groups, 3-5 years and 9-11 years and compared with a contrast group of typically developing children (TD) (N = 60). Measures used were the Parenting Stress Index-Short Form and Rickel and Biasatti's modification of Block's Child Rearing Practices Report, classified into Baumrind's parenting styles using Reitman and Gross's method. RESULTS: Parents in the older DD group used Authoritative parenting less than parents in the younger DD group, while the opposite developmental pattern was seen in the TD group. Multivariate analysis of variance showed a significant group x parenting style interaction for Parental Distress, Parent-Child Dysfunctional Interaction and Difficult Child. Stress measures were higher for the DD group and seemed to be associated with Authoritative parenting approaches, an effect that was not observed in the TD group. CONCLUSIONS: Findings suggest that the well-established effect of group on stress may be moderated by parenting style. Authoritative parenting may be highly stressful for parents of children with DD to implement, resulting in a decrease in its use across the two age groups.     

孤独谱系障碍患儿症状及行为学表现与父母情绪障碍相关研究

目的研究孤独谱系障碍(autism spectrum disorder,ASD)患儿的症状特点、心理问题及对父母情绪障碍的影响。方法分别使用孤独症行为量表和长处与困难问卷对593名患儿进行行为学表现和心理评估,同时使用抑郁自评量表、焦虑自评量表评估患儿父母的情绪障碍表现。结果在情绪及多动注意不能和困难总分方面,高年龄组的患儿表现出了更多的困难(F=4.361,P=0.013;F=16.029,P=0.000;F=9.638,P=0.013),同时在亲社会行为方面,高年龄组则表现更好(F=11.052,P=0.000);无论在焦虑或是抑郁障碍,母亲更易患情绪障碍(χ2=15.893,P=0.000;χ2=27.592,P=0.000);父母的抑郁,焦虑情绪与ASD患儿的多个行为学表现维度相关,并直接受症状严重程度的影响。结论ASD患儿行为学表现在不同年龄段表现不同,体现在情绪、多动注意不能及亲社会行为方面;母亲往往比父亲更易患有情绪障碍,父母亲的情绪障碍受ASD患儿的多个行为表现维度影响,应引起注意。     

Variation in incidence of neurodevelopmental disorders with season of birth

BACKGROUND: The etiologies of autism spectrum disorder and many neurodevelopmental disorders are largely unknown. The detection of a seasonal variation of birth of children diagnosed with a certain disorder could suggest etiological factors that follow a seasonal pattern. We examined the seasonal variation of births of children diagnosed with any of 4 common childhood neuropsychiatric disorders: autism spectrum disorder, hyperkinetic disorder, Tourette syndrome, and obsessive-compulsive disorder. METHODS: The study cohort consisted of all children born in Denmark from 1990 through 1999 identified in the Danish Medical Birth Register (n = 669,995). Outcome data consisted of both inpatient and outpatient diagnoses reported to the Danish National Psychiatric Registry from 1995 through 2004 using the International Classification of Diseases, 10th edition, diagnostic coding system. Logistic regression combined with spline (a smoothing method) was used to estimate the variation with season of birth for each disorder. Estimates of risk of each disorder with season of birth were adjusted for differences in follow-up time and change in incidence over time. RESULTS: No convincing variations in season of birth were observed for any of the 4 disorders, or for the autism-spectrum-disorder subtypes. CONCLUSION: Although we cannot rule out the possibility of seasonal variation of birth for a range of childhood neurodevelopmental disorders, we find little evidence that seasonal environmental factors are related to these disorders.     

Development of an Internet-based real-time system for monitoring pharmacological interventions in children with neurodevelopmental and neuropsychiatric disorders

Few children have a 'pure' diagnosis of neuropsychiatric disorders such as attention deficit hyperactivity disorder or autism. Most have complex, overlapping symptoms, and it is often these associated and common comorbidities that cause as much, if not more impairments, than the core symptoms. Prescribing decisions are therefore complex and made on the basis of eliciting a range of agreed 'target symptoms'. At present, however, there are no agreed systems that allow monitoring of all areas of potential change, and few services are able to monitor symptoms, side effects, impact on family life and individual children's quality of life systematically. At best many clinics use a plethora of paper-based standardized questionnaires, based on individual diagnoses. This article describes the development of a novel biomedical informatics system that has been designed to allow parents, professionals and children to use a web-based, real-time symptom monitoring system to enable more effective treatments, better pathways of shared care, and more equitable and efficient service delivery for this group of vulnerable children.     

Occupational therapists' reported experiences using weighted vests with children with specific developmental disorders

The purpose of this study was to identify specific practice patterns of a convenience sample of paediatric occupational therapists and the behavioural changes that they observe when they use weighted vests with children with developmental disorders. Although the practice of weighted vests is accepted clinically, there is little discussion of their use nor is there empirical evidence of their efficacy in the literature. A convenience sample of 51 occupational therapists from different geographic areas of the United States participated in a telephone survey about how they used weighted vests with specific children. This study was a follow-up to a mail survey about paediatric occupational therapists' opinions and general practice patterns with weighted vests. Although the interviewees observed some different behavioural changes in children with various developmental disorders when these children used weighted vests, their practice patterns in using the vests were similar across disabilities. The most common behavioural changes noted were increased attention and staying on task. Participants' opinions and practice patterns related to weighted vests are discussed. This study is not generalizable as it utilized a self-selected group of therapists. However, the findings from the qualitative data can provide direction for future quantitative studies by providing important data about practice patterns that may serve as independent variables examining the effectiveness of weighted vests.     

关注神经发育障碍患儿心理健康?提高生活质量

神经发育障碍患儿不仅认知、沟通功能低下,且心理问题高发,给患儿家庭及社会造成巨大负担。研究介绍主要神经发育障碍(智力障碍、注意力缺陷/多动障碍、孤独症谱系障碍及发展性阅读障碍)患儿的心理健康现状,分析心理健康与神经发育的潜在关联,强调心理健康对儿童发展的重要作用,并探讨如何多维度促进神经发育障碍患儿心理健康,进而提高其生活质量。     

语言发育迟缓儿童的年龄与发育特征的相关性研究

目的 研究语言发育迟缓儿童在不同年龄阶段的发育特征, 从而了解其发育的轨迹, 为临床诊治和干预提供一定的依据。方法 以2010年8月-2011年2月在上海儿童医学中心发育行为儿科因语言发育迟缓就诊的5岁以下儿童为研究对象, 共253例, 其中男198例, 女55例。用Gesell婴幼儿发育量表进行发育评估。结果 1)随年龄增长, 以语言发育迟缓为主诉的儿童其单纯性语言问题的比例逐渐下降, 1～2岁儿童中38.46%表现为单纯性语言问题, 2～3岁降为15.97%, 3～4岁为10.96%, 4～5岁则没有单纯的语言问题。2)随年龄增长, 各能区的发育商显著下降(P＜0.001), 2岁后各能区发育商均为异常, 言语能的发育商则为各能区最低。结论 语言是不同发育问题的一个敏感指标, 2岁后的语言问题更多是其他发育障碍的表现之一, 而非单纯的语言问题。