Validation of the Preverbal Visual Assessment (PreViAs) questionnaire

Background

Visual cognitive integrative functions need to be evaluated by a behavioral assessment, which requires an experienced evaluator. The Preverbal Visual Assessment (PreViAs) questionnaire was designed to evaluate these functions, both in general pediatric population or in children with high risk of visual cognitive problems, through primary caregivers' answers.

Aim

We aimed to validate the PreViAs questionnaire by comparing caregiver reports with results from a comprehensive clinical protocol.

Study design

A total of 220 infants (< 2 years old) were divided into two groups according to visual development, as determined by the clinical protocol. Their primary caregivers completed the PreViAs questionnaire, which consists of 30 questions related to one or more visual domains: visual attention, visual communication, visual–motor coordination, and visual processing. Questionnaire answers were compared with results of behavioral assessments performed by three pediatric ophthalmologists.

Results

Results of the clinical protocol classified 128 infants as having normal visual maturation, and 92 as having abnormal visual maturation. The specificity of PreViAs questionnaire was > 80%, and sensitivity was 64%–79%. More than 80% of the infants were correctly classified, and test–retest reliability exceeded 0.9 for all domains.

Conclusions

The PreViAs questionnaire is useful to detect abnormal visual maturation in infants from birth to 24 months of age. It improves the anamnesis process in infants at risk of visual dysfunctions.     

Development of an Age Band on the ManuVis for 3-Year-Old Children with Visual Impairments

Aim: To compare fine motor performance of 3-year-old children with visual impairment with peers having normal vision, to provide reference scores for 3-year-old children with visual impairment on the ManuVis, and to assess inter-rater reliability. Method: 26 children with visual impairment (mean age: 3 years 7 months (SD 3 months); 17 boys) and 28 children with normal vision (mean age: 3 years 7 months (SD 4 months); 14 boys) participated in the study. The ManuVis age band for 3-year-old children comprised two one-handed tasks, two two-handed tasks, and a pre-writing task. Results: Children with visual impairment needed more time on all tasks (p < .01) and performed the pre-writing task less accurately than children with normal vision (p < .001). Children aged 42–47 months performed significantly faster on two tasks and had better total scores than children aged 36–41 months (p < .05). Inter-rater reliability was excellent (Intra-class Correlation Coefficient = 0.96–0.99). Conclusions: The ManuVis age band for 3-year-old children is appropriate to assess fine motor skills, and is sensitive to differences between children with visual impairment and normal vision and between half-year age groups. Reference scores are provided for 3-year-old children with visual impairment to identify delayed fine motor development.     

Visual outcomes and perinatal adversity

Preterm birth per se, the neonatal environment, retinopathy of prematurity (ROP) and neurological damage are all causes of visual impairment and the impact of these factors is discussed in relation to the resultant ophthalmic deficits. Visual acuity impairments range from blindness, due to ROP or cortical visual impairment, which can be identified at an early age, to subtle deficits related to preterm birth only identified at a later age. Visual function deficits are not limited to visual acuity but can affect contrast sensitivity, field of vision and colour vision. Strabismus and refractive errors are also very common in children following perinatal adversity. Although more is now known about the types of deficits affecting these children, there is still a poor understanding of how these deficits impact on a child's functional ability. The impact of these ophthalmic deficits on the long term ophthalmic care required, and the role of perinatal factors, is discussed.     

Effects of very low birth weight (VLBW) on visual development during the first year after term

Behavioural visual functions were assessed in 155 very low birth weight (VLBW) infants during the first 12 months after expected term. Visual development was examined (mainly cross-sectionally) at 6 weeks, 3, 6, 9, and 12 months of corrected age by assessment of visual acuity, visual fields, optokinetic nystagmus and visual threat response. Many VLBW infants showed visual impairments (54.2%). No single visual function appeared to be specifically susceptible to impairments, deficits were often apparent across a range of functions. Visual impairments were observed at all test ages, and could already be assessed at 6 weeks of corrected age. The highest incidence of visual impairments was scored at 6 months corrected age. Beyond 6 months, less deficits were observed, suggesting in many infants a delayed rather than a permanently impaired visual development. In some infants deficits became evident at a later stage, after an apparently normal initial development. The results suggest that VLBW infants are at risk for impaired visual development.     

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??Visual impairment in children is considered to be an area of priority because of its long term of disability and its influence on development. Early diagnosis of visual impairment in children is very important??visual defects should be discovered as soon as possible and timely treatment should be given in order to obtain maximum vision. It is difficult for children??especially infants??to cooperate in the complicated vision examinations. Therefore??the diagnosis and examination of children’s visual impairment should be based on the age and development phase. The diagnosis and examination of children’s visual impairment can be made by objective methods. The population of visually impaired children includes a substantial proportion of children with additional systemic disorders or damage. Paediatricians and other paediatric professionals play a key role in early detection and multidisciplinary management.     

年龄与发育进程问卷（中文版）评估上海市3~66月龄儿童神经精神发育春夏秋季的差异

目的 应用“年龄与发育进程问卷：父母完成的儿童发育监测系统”的标准化翻译中文版（ASQ-C）,研究上海市3～66月龄儿童在春、夏和秋季神经精神发育的差异。方法 于春、夏和秋季,在上海市3～66月龄儿童中分层随机整群抽样。共有8 472名儿童的父母和（或）养育人完成了儿童月龄相应的ASQ-C测试。儿童ASQ-C的量表总分及沟通（CM）、大运动（GM）、精细运动（FM）、解决问题（CG）和个人-社会（PS）能区得分以±s表示;多组样本均数的比较采用完全随机设计的单因素方差分析;两两比较采用SNK法。采用多元线性回归分析以排除混杂因素。结果 ①不同季节测试儿童的ASQ-C量表总分间差异有统计学意义（P＜0.01）,从高至低的排序是秋、夏和春季,秋季显著高于夏和春季（P＜0.05）,夏季与春季间差异无统计学意义;②不同季节测试儿童的ASQ-C 5个能区得分间差异均有统计学意义（P＜0.01或＜0.05）,均以秋季最高;其中CM能区得分从高至低的排序为秋、春和夏季,其他4个能区得分从高至低的排序均为秋、夏和春季。两两比较结果显示,CM能区得分秋季显著高于夏季（P＜0.05）,秋季与春季、春季与夏季间差异无统计学意义;其他4个能区得分均表现为秋季显著高于夏和春季（P＜0.05）。结论 季节对3～66月龄儿童的神经精神发育有影响;进一步研究季节或气候与儿童发育的关系很有必要;在儿童发育评估量表的研究中,建议考虑季节因素的影响。     

Clinical features of cerebral palsy in children with symptomatic congenital cytomegalovirus infection

BackgroundHuman cytomegalovirus is the most common cause of vertically transmitted viral infection, affecting around 1% of liveborns. Infection is symptomatic in nearly 10% of infected children who are at higher risk of development of severe neurological disorders, including cerebral palsy.AimsTo study the clinical profile of children with cerebral palsy caused by symptomatic congenital cytomegalovirus infection in a multicenter study involving six countries from the Surveillance of Cerebral Palsy in Europe (SCPE) Network.MethodsData on 35 children (13 males, 22 females; mean age at last assessment 12y 6mo, age range 14y 6mo, min 4y, max 18y 6mo) on pre/peri/neonatal history and last clinical assessment were collected. Classification of cerebral palsy and associated impairments was performed according to SCPE criteria.ResultsThe majority of children had bilateral spastic cerebral palsy, 85.7%, with a confidence interval (CI) [69.7–95.2], and 71.4% [CI 53.7–85.4] were unable to walk (GMFCS levels IV–V) while fine motor function was severely affected in 62.8% [CI 44.9–78.5] (BFMF levels IV and V). Most of the children with severe CP had severe associated impairments. 11.4% of children had severe visual and 42.8% severe hearing impairment, 77.1% [CI 59.9–89.6] suffered from epilepsy, also 77.1% had severe intellectual impairment, and speech was undeveloped in 71.4%. Female:male ratio was 1.69:1 and 80% of children were term born.ConclusionsCerebral palsy following symptomatic congenital cytomegalovirus infection seems to be in most cases a severe condition and associated impairments are overrepresented.     

Pediatric asthma quality of life questionnaire (PAQLQ): Validation among asthmatic children in Thailand

Quality of life (QoL) is an important consideration among asthma sufferers. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) is one of the most widely used instruments for measuring health-related QoL in children with asthma. The standardized version of PAQLQ contains 23 questions in three domains, i.e., activity limitation, symptoms and emotional function. The objective of this study was to validate the Thai-translated version of the PAQLQ. The study design consisted of a five-week single cohort study. Patients recorded symptoms, and peak expiratory flow rate (PEFR) each morning and evening during the first and fifth week of the study in asthma diary. At each clinic visit, a trained-interviewer administered the PAQLQ and performed spirometric measurements. Fifty-one children, ages between 7 and 17 yr participated in the study. Scores from the asthma diary were used to classify patients into stable vs. unstable groups. The construct validity of the questionnaire was confirmed in both cross-sectional and longitudinal studies by demonstrating correlations between various PAQLQ domains with clinical asthma parameters (asthma diary, beta-agonist use and PEFR). There was high internal consistency for scores of the three domains (Cronbach's alpha-coefficient = 0.83-0.95). For those with stable asthma, the reliability of PAQLQ was good for the rating scale (intra-class correlation coefficient--ICC = 0.84) and for total score (alpha = 0.97) indicating high reproducibility of the PAQLQ. The significant difference of changes QoL scores between stable and unstable groups was observed in all domains. We conclude that the Thai version of PAQLQ is valid and reliable for implementing in Thai children with asthma.     

Visual acuity and stereopsis between the ages of 5 and 10 years

The development of visual acuity and stereopsis was studied in 321 boys and 340 girls aged between 5 and 10 years. Visual acuity was assessed by the E test and a modified version of the STYCAR test, stereo acuity by the Lang-Stereo test [17]. Both vision tests showed an increase in the median visual acuity between the ages of 5 and 10 years. The E test indicated an increase from 1.2 between 5 and 6 years to 1.5–1.7 between 7 and 10 years. The values obtained with the STYCAR test were 0.6–1.3 higher, depending on the test rating used. Visual acuity norms between 5 and 10 years are presented as empirical centile curves. No significant differences were observed in visual acuity between the left and right eyes, nor between the sexes. The right eye was found to be the leading eye in 54.8% of the boys and 54.5% of the girls (P<0.001). The Lang-Stereo test was passed by 87.9%–94.3% of all children, and there were no significant differences with respect to age and sex. Children who failed the test had a significantly lower visual acuity than those who passed it. In the former group a significant interocular difference in visual acuity was present (P<0.01). This work was supported by the Swiss National Science Foundation No. 3988.-1.84     

Development of the Affordances in the Home Environment for Motor Development–Infant Scale

Background: The present study reports the development and application of the Affordances in the Home Environment for Motor Development–Infant Scale (AHEMD‐IS), a parental self‐report designed to assess the quantity and quality of affordances in the home environment that are conducive to motor development for infants aged 3–18 months. Methods: Steps in its development included use of expert feedback, establishment of construct validity, interrater and intrarater reliability, and predictive validity. With all phases of the project, 113 homes were involved. Results: Intraclass correlation coefficients for interrater and intrarater reliability for the total score were 1 and 0.94, respectively. In addition, results indicate that the test has the characteristic of differentiating a wide range of scores. Regression analysis for the AHEMD‐IS and motor development using the Alberta Infant Motor Scale supports preliminary evidence for predictive validity. Conclusion: Our findings suggest that the AHEMD‐IS has sufficient reliability and validity as an instrument for assessing affordances in the home environment, with clinical and research applications.     

Development of the Children's Eating Behaviour Questionnaire

Individual differences in several aspects of eating style have been implicated in the development of weight problems in children and adults, but there are presently no reliable and valid scales that assess a range of dimensions of eating style. This paper describes the development and preliminary validation of a parent-rated instrument to assess eight dimensions of eating style in children; the Children's Eating Behaviour Questionnaire (CEBQ). Constructs for inclusion were derived both from the existing literature on eating behaviour in children and adults, and from interviews with parents. They included responsiveness to food, enjoyment of food, satiety responsiveness, slowness in eating. fussiness, emotional overeating, emotional undereating. and desire for drinks. A large pool of items covering each of these constructs was developed. The number of items was then successively culled through analysis of responses from three samples of families of young children (N = 131; N = 187; N = 218), to produce a 35-item instrument with eight scales which were internally valid and had good test-retest reliability. Investigation of variations by gender and age revealed only minimal gender differences in any aspect of eating style. Satiety responsiveness and slowness in eating diminished from age 3 to 8. Enjoyment of food and food responsiveness increased over this age range. The CEBQ should provide a useful measure of eating style for research into the early precursors of obesity or eating disorders. This is especially important in relation to the growing evidence for the heritability of obesity, where good measurement of the associated behavioural phenotype will be crucial in investigating the contribution of inherited variations in eating behaviour to the process of weight gain.     

非线性混合效应模型评估脑瘫患儿粗大运动功能发育进程

目的 采用非线性混合效应模型对不同级别脑瘫患儿粗大运动功能发育进程进行分析,以期为脑瘫患儿康复管理提供依据。方法 以2000年8月至2009年12月在上海7家康复机构和特殊学校接受康复诊治的脑瘫患儿为研究对象。采用中文译本的粗大运动功能测试量表（GMFM）进行粗大运动功能评估、中文版脑瘫粗大运动功能分级系统（GMFCS）进行粗大运动功能分级,分别将各GMFCS级别患儿的GMFM-66分值使用stable limit模型分析,获得各GMFCS级别患儿达到其GMFM-66的最大值以及达到最大值的速率（该值被转化为年龄-90,表示达到GMFM-66最大值90%时的年龄）。同时与加拿大相关研究（OMG）进行比较,分析不同干预背景下脑瘫患儿的粗大运动功能发育进程差异。结果 228例脑瘫患儿进入分析,其中男性152例（66.7%）,女性76例（33.3%）,痉挛型双瘫87例（38.2%）,痉挛型四肢瘫63例（27.6%）,痉挛型偏瘫48例（21.1%）,痉挛型三瘫4例（1.8%）,肌张力障碍型4例（1.8%）,徐动型11例（4.8%）,共济失调型11例（4.8%）。共有986次符合条件的GMFM-66测试结果,平均每例患儿有4.32次测试结果。首次评估时总体研究对象的平均年龄为2.95岁。GMFCS Ⅰ～Ⅴ级的GMFM-66最大值分别为81.2、62.4、52.9、40.8和24.4分,呈显著降低趋势;年龄-90分别为3.8、2.7、2.1、2.0和1.5岁,GMFCS Ⅲ和Ⅳ级间差别不大,在其余各级间表现出明显差别。本研究的GMFCSⅠ和Ⅱ级的GMFM-66最大值低于OMG,而GMFCS Ⅲ～Ⅴ级的GMFM-66最大值与之较为接近;各GMFCS级别的年龄-90均明显低于OMG。结论 本研究GMFCS Ⅰ级和Ⅱ级脑瘫患儿尽管粗大运动功能发育更早地进入了GMFM-66最大值区域,但运动功能发育的峰值水平低于OMG,应充分重视在4岁后轻度脑瘫患儿中积极实施具有针对性的多种康复干预手段。     

Psychogenic Disorders of Vision in Childhood ("Visual Conversion Reactions"): Perspectives from Adolescence: A Research Note

Fifteen adolescents who had exhibited psychogenic disorders of vision in childhood were compared with a control group of adolescents who had experienced childhood visual dysfunction of organic origin. The principal modes of assessment were clinical interviews, the Parental Bonding Instrument (PBI). and self-report measures concerning specific personality trails. Adolescents who had previously presented with psychogenic disorder were more likely to (1) report having experienced school difficulties and the loss of a significant figure at the time of presentation. (2) rate their mothers as over-invoked on the PBI and (3) report adjustment difficulties and obsessional personality trails in adolescence.     

Feasibility of Using the General Movements Assessment of Infants in the United States

Aims: To pilot the practicality of administering the Prechtl General Movements Assessment of infants (GMA) in the Neonatal Intensive Care Unit (NICU) setting and at home to infants at risk for developing cerebral palsy (CP). Additional aims included assessing inter-rater reliability and comparing GMA predictions to AIMS motor assessment at 12 months. Methods: 12 “at risk” infants were recruited by convenience sample. Video recordings were obtained in the NICU and provided by parents after discharge. These recordings were analyzed by two trained examiners to assess infants in the writhing and fidgety movement periods (birth to 16 weeks). Infants were assessed at 12 months corrected age using the Alberta Infant Motor Scale (AIMS) with scores lower than 5th centile considered a motor delay. Results: 33 of 42 videos (79%) were of sufficient quality to permit interpretation and there was 97% inter-examiner subcategory agreement and 100% overall developmental trajectory (abnormal/normal) agreement. The GMA demonstrated a sensitivity of 60% and a specificity of 100% in predicting AIMS score (age appropriate or delayed). Conclusions: Clinical feasibility of GMA obtained in the NICU was demonstrated however feasibility of parents providing video samples after discharge was not demonstrated, indicating a need for a parent-friendly method.     

Activation of the right fronto-temporal cortex during maternal facial recognition in young infants

BACKGROUND/AIM: Within the first days of life infants can already recognize their mother. This ability is based on several sensory mechanisms and increases during the first year of life, having its most crucial phase between 6 and 9 months when cortical circuits develop. The underlying cortical structures that are involved in this process are still unknown. Herein we report how the prefrontal cortices of healthy 6- to 9-month-old infants react to the sight of their mother's faces compared to that of an unknown female face. METHODS: Concentrations of oxygenated haemoglobin [HbO2] and deoxygenated haemoglobin [HHb] were measured using near infrared spectroscopy (NIRS) in both fronto-temporal and occipital areas on the right side during the exposure to maternal and unfamiliar faces. RESULTS: The infants exhibited a distinct and significantly higher activation-related haemodynamic response in the right fronto-temporal cortex following exposure to the image of their mother's face, [HbO2] (0.75 micromol/L, p < 0.001), as compared to that of an unknown face (0.25 micromol/L, p < 0.001). CONCLUSION: Event-related haemodynamic changes, suggesting cortical activation, in response to the sight of human faces were detected in 6- to 9-month old children. The right fronto-temporal cortex appears to be involved in face recognition processes at this age.     

Visual Signals and the Communication Abilities of Children

The communication abilities of children of differing ages (4- 6-, and 11 years) were compared. The children performed two communication tasks and were interviewed in both face-to-face and audio-only contexts. While older children adapted to the loss of visual signals the younger age groups did not and their communication suffered. It appears that a significant amount of information which young children transmit occurs in a nonverbal format, and that visual signals are less demanding for young listeners. Such findings have implications for professionals working with young children since they show the importance of addressing both the child's visual signals and one's own.