Whole-body mineral measurements in Swedish adolescents at 17 years compared to 15 years of age

Aim: To provide reference data for bone mineral variables in 15- and 17-y-old adolescents and to analyse the relationships between these variables and measures of bone and body size, gender, puberty, growth, various lifestyle and environmental factors and socioeconomic background.

Methods: In the same 321 randomly selected adolescents (147 boys and 174 girls) living in two different regions of Sweden, the total bone mineral content (TBMC), bone area (BA) and total bone mineral density (TBMD) were assessed by dual-energy X-ray absorptiometry at ages 15 and 17 y. The effects of bone and body size, gender, growth, sexual maturity, physical activity, region of domicile, social conditions, food habits, smoking and alcohol intake on TBMC and TBMD were examined in multivariate analyses.

Results: In the 15-y-old adolescents, BA, height, gender, physical activity, maturity and weight explained 91% and 48%, of the variance in TBMC and TBMD, respectively. In similar analyses in the 17-y-olds, the corresponding figures were 92% and 62%, respectively, when BA, height, growth, physical activity, gender and region emerged as significant in the model. In all these analyses, BA explained most of the variance in TBMC and TBMD. No significant reduction of variance was found when different measures of social conditions, smoking, food habits, alcohol or dietary intakes of energy, calcium or vitamin D were included in the models. The reason why region of domicile had a significant impact on TBMC in the 17-y-olds is not known. The fact that the normal fluoride concentration in drinking water (1.1 mg/L) is 10 times higher in the region where TBMC was higher than in the other region is an interesting observation.

Conclusion: Almost 90% of the variance in TBMC and 50% of that in TBMD was explained by measures of bone and body size and only a few percent by gender, physical activity, Tanner stage, growth and region of domicile.     

Contraception, and pregnancy in adolescents with type 1 diabetes: a review

Adolescence is a critical period for girls with type 1 diabetes mellitus (T1D). Reproductive issues, such as menstrual abnormalities, risk of an unplanned pregnancy, and contraception, should be addressed during this phase of life. This paper reviews several reproductive issues that are important in the care of adolescents, including pubertal development, menstrual abnormalities, ovulatory function, reproductive problems, the effects of hyperglycemia, contraception, and treatment of an unplanned pregnancy. A review of the literature was conducted. A MEDLINE search January 1966 to March 2011 was performed using the following MESH terms: puberty, menarche, ovary, polycystic ovary syndrome, menstruation, contraception, contraception-barrier, contraceptives-oral-hormonal, sex education, family planning services, and pregnancy in adolescence. This literature search was cross-referenced with an additional search on diabetes mellitus-type 1, diabetes complications, and pregnancy in diabetes. All published studies were searched regardless of the language of origin. Bibliographies were reviewed to extract additional relevant sources.     

Breastfeeding and childhood obesity: A 12‐country study

This study aimed to examine the association between breastfeeding and childhood obesity. A multinational cross‐sectional study of 4,740 children aged 9–11 years was conducted from 12 countries. Infant breastfeeding was recalled by parents or legal guardians. Height, weight, waist circumference, and body fat were obtained using standardized methods. The overall prevalence of obesity, central obesity, and high body fat were 12.3%, 9.9%, and 8.1%, respectively. After adjustment for maternal age at delivery, body mass index (BMI), highest maternal education, history of gestational diabetes, gestational age, and child's age, sex, birth weight, unhealthy diet pattern scores, moderate‐to‐vigorous physical activity, sleeping, and sedentary time, exclusive breastfeeding was associated with lower odds of obesity (odds ratio [OR] 0.76, 95% confidence interval, CI [0.57, 1.00]) and high body fat (OR 0.60, 95% CI [0.43, 0.84]) compared with exclusive formula feeding. The multivariable‐adjusted ORs based on different breastfeeding durations (none, 1–6, 6–12, and > 12 months) were 1.00, 0.74, 0.70, and 0.60 for obesity (P_trend = .020) and 1.00, 0.64, 047, and 0.64 for high body fat (P_trend = .012), respectively. These associations were no longer significant after adjustment for maternal BMI. Breastfeeding may be a protective factor for obesity and high body fat in 9‐ to 11‐year‐old children from 12 countries.     

ENZYME STUDIES AND NEONATAL BRAIN DAMAGE

ABSTRACT. Dalens, B, Viallard, JL, Raynaud, EJ, Dastugue, B. (Département d'Anesthésie-Réanimation, Laboratoire de Biochimie Médicale et Enzymologie, Clinique Médicale Infantile, Hotel-Dieu, Clermont-Ferrand, France). Enzyme studies and neonatal brain damage. Acta Paediatr Scand, 70:743,.–The authors report a double-blind study of 57 full-term newborn infants prospectively subjected to clinical, electroencephalographical, blood and cerebrospinal fluid, and developmental examinations. Four enzymatic activities were measured in blood and CSF: aminotransferase (ASAT), creatine kinase (CK), lactate dehydrogenase (LD) and hydroxybutyrate dehydrogenase (HBD). Close relationships of enzymatic levels with psychomotor outcome are reported. In blood, ASAT and CK seemed to be the most important determinations, allowing threshold-values to be suggested. In CSF, LD and HBD were the determinations the most closely related to psychomotor events at age one. This method seems to be of theoretical as well as practical importance in evaluating neonatal brain injury.     

Pulmonary thromboembolism in children

Pulmonary thromboembolism (PTE) is uncommonly diagnosed in the pediatric patient, and indeed often only discovered on autopsy. The incidence of pediatric PTE depends upon the associated underlying disease, diagnostic tests used, and index of suspicion. Multiple risk factors can be found including: peripartum asphyxia, dyspnea, haemoptysis, chest pain, dehydration, septicemia, central venous lines (CVLs), trauma, surgery, ongoing hemolysis, vascular lesions, malignancy, renal disease, foreign bodies or, uncommonly, intracranial venous sinus thrombosis, burns, or nonbacterial thrombotic endocarditis. Other types of embolism can occur uncommonly in childhood and need to be recognized, as the required treatment will vary. These include pulmonary cytolytic thrombi, foreign bodies, tumor and septic emboli, and post-traumatic fat emboli. No single noninvasive test for pulmonary embolism is both sensitive and specific. A combination of diagnostic procedures must be used to identify suspect or confirmed cases of PTE. This article reviews the risk factors, clinical presentation and treatment of pulmonary embolism in children. It also highlights the current diagnostic tools and protocols used to evaluate pulmonary embolism in pediatric patients.     

VARICELLA ZOSTER VIRUS INFECTIONS IN THE PEDIATRIC STEM CELL TRANSPLANT PATIENT

Varicella zoster virus (VZV), a member of the human herpesvirus family, causes the clinical syndromes of chickenpox during primary infection and shingles on later reactivation. In immunocompromised patients, including those undergoing hematopoietic stem cell transplantation, VZV can produce life-threatening infections. The most serious forms of VZV infection involve hematogenous dissemination of the virus to vital organs, such as the lung, brain, and liver. Advances in immunoprophylaxis, antiviral chemotherapy, and vaccine development have provided effective tools to limit the morbidity and mortality previously associated with VZV infection in hematopoietic stem cell transplant patients. In this review, we discuss virologic aspects of VZV, pathogenesis of VZV infection, methods of viral diagnosis, clinical manifestations of infection in both normal and immunocompromised patients, and available preventative and therapeutic measures.     

Anomalies of Cartilaginous and Ossified Axial Skeleton in Rat Fetuses Treated with Cyclophosphamide: Type, Frequency, and Stage Specificity

The purpose of the present study was to assess the type, frequency and stage specificity of axial skeletal anomalies induced by cyclophosphamide (CP). Female Crj: Wistar rats were mated with male rats (vaginal sperm = gestation day 0, GDO). They were then injected intravenously with 5 mg/kg of CP in a saline solution on GD7, 8, 9, 10, 11, 12, 13, or 14, or with saline on GD8 for controls. Dams were sacrificed on GD20. Fetuses were stained with alcian blue and alizarin red S. Eighteen types of axial skeletal anomaly were detected, e. g., shifted ventral lamina, cervical rib, cleft arch of the atlas, axis fused to atlas, sternebral misalignment, bipartite sternum, fused ribs, change in pre-sacral vertebral number, supernumerary rib, misdirected transverse process, anteriorly-shifted spinous process, short spinous process, fused vertebral bodies, cartilaginous short rib at Th.7, short or absent rib at Th.12 or 13, dumbbell-shaped vertebral body, wavy rib, and rib cartilage not attached to the sternal cartilage. The present experimental study indicates that: 1) observations of cartilaginous skeletons can provide more information than observations of ossified skeletons; 2) the pattern of CP-induced anomalies along the anterior–posterior axis may depend on the sequence of development progression among structures, spinous process, vertebral arch, vertebral body, rib/transverse process; and 3) in more cranial vertebrae, anteriorly-shifted anomalies, such as anteriorly-shifted ventral lamina and anteriorly-shifted spinous processes, rather than posteriorly-shifted anomalies, may be the primary indicators for detecting developmental toxicity, since CP injection increased the frequencies of these anomalies.     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Early androgen influences on human neural and behavioural development

Gonadal hormones, particularly androgens, influence sexual differentiation of the body, as well as the brain and behaviour. Antenatal exposure to atypical hormone environments leads to alterations in human behaviours that show sex differences. These include childhood play, sexual orientation, gender identity, and personality characteristics, such as empathy and aggression. Individual variability among healthy children in antenatal hormone exposure show similar relationships to individual variability in postnatal behaviour. As in studies of atypical exposure, higher levels of androgen predict more male-typical, and less female-typical, behaviour. Hormone-induced alterations in brain development are thought to underlie these behavioural outcomes, although there is little information on specific neural differences associated with early hormone differences. Notable, however, is evidence relating early androgen exposure to activation of the medial amygdaloid nucleus in women. Other emerging research areas include the role of neonatal hormones in infant development and interactions between hormone-induced predispositions and postnatal experience in producing behavioural outcomes.     

Untersuchungen über Enzymaktivitäten im Liquor cerebrospinalis bei Kindern mit Encephalitis,seröser Meningitis und Hydrocephalus

Zusammenfassung Im Liquor cerebrospinalis von 293 Kindern mit cerebro-meningealen Erkrankungen wurden elf Enzyme untersucht (LDH, MDH, HBDH, GOT, GPT, IDH, CPK, Ald, SDH, LAP, GlDH) mit der Frage, ob besonders bei der Encephalitis Enzymaktivitätsänderungen auftreten, durch die man die Diagnose erhärten kann. Ein Vergleichskollektiv mit 32 Liquores gesunder Kinder wurde dem ersten gegenübergestellt. Signifikante Erhöhungen bei Encephalitis (und beim rasch wachsenden Hydrocephalus) wurden für LDH, MDH, HBDH, GOT, CPK, Ald, LAP und SDH gemessen, nicht dagegen für die anderen Enzyme, deren Aktivität aber ebenfalls angestiegen war. Die möglichen, bis heute noch nicht geklärten Ursachen des Enzymanstieges im Liquor werden ausführlich diskutiert.Mit dankenswerter Unterstützung durch die Deutsche Forschungsgemeinschaft (Si 98/5).Auszugsweise vorgetragen auf der 6. Tagung der österreichischen Gesellschaft für Kinderheilkunde in Wien 11.–13. 10. 1968.     

EFFECT OF SOMATOSTATIN INFUSION ON INTERMEDIARY METABOLISM AND ENTERO-INSULAR HORMONE RELEASE IN INFANTS WITH HYPERINSULINAEMIC HYPOGLYCAEMIA

Abstract. Aynsley-Green, A., Barnes, N. D., Adrian, T. E., Kingston, J., Boyes, S., and Bloom, S. R. (University Department of Paediatrics, John Radcliffe Hospital, Oxford, Department of Paediatrics, New Addenbrookes Hospital, Cambridge, and Department of Medicine, Hammersmith Hospital, London, England). Effect of somatostatin infusion on intermediary metabolism and enteroinsular hormone release in infants with hyperinsulinaemic hypoglycaemia. Acta Paediatr Scand, 70: 889, 1981.-The hypoglycaemia of infantile hyper-insulinism is often exceedingly difficult to control. The use of somatostatin has been advocated recently in such infants because of its effect on inhibiting insulin release, but nothing is known of the wider effects of this potent hormone in the young child. Two infants presenting at 9 weeks and 5 days of age with severe hyperinsulinaemic hypoglycaemia were studied during an infusion of somatostatin. In both infants normoglycaemia was restored with suppression of insulin secretion. An increase in blood ketone bodies occurred, but no change was seen in blood pyruvate, lactate or alanine concentrations. The plasma concentrations of glucagon, Cortisol, growth hormone, motilin.-pancreatic polypeptide, gastric inhibitory polypeptide, neurotensin, gastrin and vasoactive intestinal peptide decreased markedly during the somatostatin infusion. No consistent change occurred in plasma enteroglucagon or secretin values. We conclude that somatostatin effectively suppresses abnormal insulin secretion in infants, but it has profound effects on the release of nine other hormones. Further studies are needed to define the consequences of suppressing the release of these hormones before somatostatin can be used routinely in the management of infantile hyperinsulinism.     

高频彩色多普勒超声对3个月以内婴儿胆道闭锁的诊断价值

目的 探讨经腹高频彩色多普勒超声对3个月以内的婴儿胆道闭锁的诊断价值. 方法 回顾经手术确诊为胆道闭锁患儿的超声特征,总结各声像特征对胆道闭锁诊断的敏感性、特异性、阳性预测值（positive predictive va1ue,PPV）及阴性预测值（negative predictive value,NPV）. 结果 “三角索带征”对胆道闭锁诊断的敏感性、特异性、PPV及NPV分别为48.8％、99.6％、95.2％、91.8％.胆囊形态学异常的敏感性、特异性、PPV及NPV分别为85.4％、88.6％、56.4％、97.2％.胆囊收缩功能不良的敏感性、特异性、PPV及NPV分别为87.8％、89.4％、59％、97.7％.肝包膜下血流阳性对胆道闭锁诊断的敏感性、特异性、PPV及NPV分别为73.2％、92.4％、62.5％、95.2％. 结论 经腹高频彩色多普勒超声可较准确地从胆汁淤积性肝病患儿中筛查出胆道闭锁患儿.     

Autism medical comorbidities

Medical comorbidities are more common in children with autism spectrum disorders (ASD) than in the general population. Some genetic disorders are more common in children with ASD such as Fragile X syndrome, Down syndrome, Duchenne muscular dystrophy, neurofibromatosis type I, and tuberous sclerosis complex. Children with autism are also more prone to a variety of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headaches, and congenital abnormalities of the nervous system. Besides, sleep disorders are a significant problem in individuals with autism, occurring in about 80% of them. Gastrointestinal (GI) disorders are significantly more common in children with ASD; they occur in 46% to 84% of them. The most common GI problems observed in children with ASD are chronic constipation, chronic diarrhoea, gastroesophageal reflux and/or disease, nausea and/or vomiting, flatulence, chronic bloating, abdominal discomfort, ulcers, colitis, inflammatory bowel disease, food intolerance, and/or failure to thrive. Several categories of inborn-errors of metabolism have been observed in some patients with autism including mitochondrial disorders, disorders of creatine metabolism, selected amino acid disorders, disorders of folate or B12 metabolism, and selected lysosomal storage disorders. A significant proportion of children with ASD have evidence of persistent neuroinflammation, altered inflammatory responses, and immune abnormalities. Anti-brain antibodies may play an important pathoplastic mechanism in autism. Allergic disorders are significantly more common in individuals with ASD from all age groups. They influence the development and severity of symptoms. They could cause problematic behaviours in at least a significant subset of affected children. Therefore, it is important to consider the child with autism as a whole and not overlook possible symptoms as part of autism. The physician should rule out the presence of a medical condition before moving on to other interventions or therapies. Children who enjoy good health have a better chance of learning. This can apply to all children including those with autism.     

1 163例3～6岁城市儿童忽视调查分析

目的 建立中国3—6岁城市儿童忽视常模,并对其信度和效度进行检验。方法 复习文献,自行设计调查问卷;采用多阶段分层整群随机抽样方法,在全国25个城市采样1465例;对样本中的66例间隔2周重复测查——评价重测信度。调查问卷均由家长或看护人(和被测查儿童在一起生活1年以上)填写;采用项目分析、因素分析和信度分析等统计学方法重新建构量表并检验其信度和效度。结果 用统计学方法删除了不适宜题项,去除了社会忽视层面,排除了2岁组研究对象,最终确定了由91个题项组成的正式量表,它包括身体、情感、教育、安全和医疗等5个忽视层面,分别包含17、40、17,10、7个题项。采用身体、情感、教育、安全和医疗等各忽视层面及总量表得分的第90百分位数的分值作为划界分,分别为35、80、40、20、15、190分。总量表的内在信度是0．94,分半信度为0．88,重测信度为0．92。对于身体、情感、教育、安全和医疗等5个忽视层面,内部一致性α系数为0．60—0．88,分半信度为0．54—0．80,重测信度为0．77—0．94,P值均小于0．01;其结构效度、表面效度和外部效度也较为满意;结论 本常模符合中国国情,适用于在3—6岁城市儿童忽视状况的研究中作为一个评价标准,而且也可以作为一个测查工具用来衡量家长及与儿童有关的人员在养育和看护孩子时的行为和态度,值得推广和应用。     

Common environmental allergens causing respiratory allergy in India

Respiratory allergy affects all age groups but the children are the worst affected by the respiratory allergy. Bioparticles from different biological sources are the main cause of allergy. Pollen grains, fungal spores, insect and other materials of biological origin form the most important allergen load in the air. For the efficient diagnosis of the allergy and its effective treatment it is very important to know about the prevalence, seasonal and annual variations of aeroallergens of the area. India being the climatically diversed country, there is diversity in the flora and fauna of different parts of the country. Atmospheric surveys carried out in different parts of India reveal that,Alanus nitida, Amarantus spinosus, Argemone mexicana Cocos nucifera, Betula utilis, Borasus flabellifer, Caraica papaya, Cedrus deodara, Cassia fistula, Parthenium, Chenopodium album,Dodonaea viscosa, Malotus phillipensis, Plantago ovata, Prosopis juliflora, Ricinus communis, Holoptelea intergifolia are the allergenically important pollens of the country. Among the fungal aeroallergens,Altemaria, Candida aibieans, Aspergillus versicolor, Aspergillus terreus, Aspergillus japonicus, Cladosporium cladosporoides, Fusarium roseum, Ganoderma lucidum,Neurospora sitophila Helminthosporium, Ustilago trtici, Uromyses are important allergens. Dust mitesD. farinae,D.pteronyssinus are also important source of inhalant allergens particularly in the coastal areas of the country. Cockroaches, beetles, weevils, mosquitoes, house flies also contribute towards the aeroallergen load and are allergenically implicated. Avoidance of the indoor and outdoor aeroallergens is recommended for better management of respiratory allergy.     

Book Reviews

Books Reviewed:
W. Damon, N. Eisenberg, Handbook of Child Psychology: Fifth Edition, Vol. Three: Social, Emotional and Personality Development
W. Damon, I. E. Sigel and K. A. Renninger, Handbook of Child Psychology, Fifth Edition, Vol. Four: Child Psychology in Practice
M. Eminson and R. J. Postlethwaite, Munchausen Syndrome by Proxy Abuse: A Practical Approach
E. Dowling and G. G. Barnes, Working with Children and Parents through Separation and Divorce. The Changing Lives of Children
Clare Sainsbury, Martian in the Playground: Understanding the Schoolchild with Asperger's Syndrome
R. Dallos and R. Draper, Introduction to Family Therapy
T. E. Brown, Attention-deficit Disorders and Comorbidities in Children, Adolescents and Adults     

儿童先天性主动脉瓣畸形32例病理组织学特征

目的 探讨儿童先天性主动脉瓣畸形的病理组织学特征，为诊断提供依据。方法 对2003年1月至2005年12月因先天性主动脉瓣畸形、主动脉瓣功能障碍行外科手术切除的32例儿童主动脉瓣标本进行大体观察和组织学检查，复习病史并摘录相关资料，分析其病理组织学特征。诊断依据临床表现、术前超声心动图、术中所见及术后病理组织学检查，除外风湿性或退行性主动脉瓣病变、感染性心内膜炎及原发性结缔组织病变如Marfan综合征。结果 32例儿童先天性主动脉瓣畸形中，男性27例，女性5例，男：女=5.4：1，年龄6~18岁，平均年龄14.9岁。二叶型占37.5％（12例），三叶型59.4％（19例），四叶型3.1％（1例）。主动脉瓣狭窄（aortic stenosis，AS）5例（15.62%），主动脉瓣关闭不全（aortic insufficiency，AI）25例（78.13%），AS-AI 2例（6.25%），均不伴其他心脏瓣膜病变。20例伴其他先天性心脏病：室间隔缺损19例，动脉导管未闭2例，右室双腔心1例，主动脉右冠窦瘤3例。病理组织学改变为瓣叶增厚、大小不等、不规则（卷曲或脱垂）及坚度增加，部分伴钙化，光镜下示纤维组织增生，粘液样变性，胶原纤维溶解、断裂，弹性纤维破坏，偶见胶原纤维玻璃样变性、灶性钙化，无小血管增生及炎性细胞浸润。少数可见心内膜面局部破溃，内皮下毛细血管增生，纤维素性渗出，炎性细胞浸润，继发性钙质、脂质沉着和纤维化。结论 儿童先天性主动脉瓣畸形以男性为多见，二叶型、三叶型主动脉瓣常见，常伴有其他先天性心脏病，瓣膜功能障碍以AI为主，病理组织学改变主要为为瓣叶增厚、大小不等、不规则（卷曲或脱垂），光镜下示纤维组织增生，粘液样变性，胶原纤维溶解、断裂，弹性纤维破坏，无小血管增生及炎性细胞浸润，而纤维化、钙化少见。     

Incentive-related modulation of cognitive control in healthy, anxious, and depressed adolescents: development and psychopathology related differences

BACKGROUND: Developmental changes in cognitive and affective processes contribute to adolescent risk-taking behavior, emotional intensification, and psychopathology. The current study examined adolescent development of cognitive control processes and their modulation by incentive, in health and psychopathology. Predictions include 1) better cognitive control in adults than adolescents, and in healthy adolescents than anxious and depressed adolescents, and 2) a stronger influence of incentives in adolescents than adults, and in healthy adolescents than their depressed and anxious counterparts. METHODS: Antisaccadic eye movement parameters, which provide a measure of cognitive control, were collected during a reward antisaccade task that included parameterized incentive levels. Participants were 20 healthy adults, 30 healthy adolescents, 16 adolescents with an anxiety disorder, and 11 adolescents with major depression. Performance accuracy and saccade latency were analyzed to test both developmental and psychopathology hypotheses. RESULTS: Development and psychopathology group differences in cognitive control were found. Specifically, adults performed better than healthy adolescents, and healthy adolescents than anxious and depressed adolescents. Incentive improved accuracy for all groups; however, incremental increases were not sufficiently large to further modulate performance. Incentives also affected saccade latencies, pushing healthy adolescent latencies to adult levels, while being less effective in adolescents with depression or anxiety. This latter effect was partially mediated by anxiety symptom severity. CONCLUSIONS: Current findings evidence the modulation of cognitive control processes by incentives. While seen in both healthy adults and healthy adolescents, this modulatory effect was stronger in youth. While anxious and depressed adolescents exhibited improved cognitive control under incentives, this effect was smaller than that in healthy adolescents. These findings suggest differential incentive and/or cognitive control processing in anxiety and depression, and across development. Differences could result from disorder specific, or combined developmental and pathological mechanisms.     

Imitation performance in toddlers with autism and those with other developmental disorders

BACKGROUND: The present study sought to examine the specificity, developmental correlates, nature and pervasiveness of imitation deficits very early in the development of autism. METHODS: Subjects were 24 children with autism (mean age 34 months), 18 children with fragile X syndrome, 20 children with other developmental disorders, and 15 typically-developing children. Tasks included manual, oral-facial, and object oriented imitations, developmental measures, joint attention ability, and motor abilities. RESULTS: Children with autism were found to be significantly more impaired in overall imitation abilities, oral-facial imitation, and imitations of actions on objects than children in all of the other groups. Imitation skills of young children with fragile X syndrome were strongly influenced by the absence or presence of symptoms of autism. For children with autism, imitation skills were strongly correlated with autistic symptoms and joint attention, even when controlling for developmental level. For comparison groups, imitation was related to other developmental abilities including play, language, and visual spatial skills. Neither motor functioning nor social responsivity accounted for a significant amount of variance in imitation scores, when controlling for overall developmental level, which accounted for much of the variation in imitation ability. CONCLUSIONS: Simple imitation skills were differentially impaired in young children with autism, and lack of social cooperation did not account for their poor performance. In autism, imitation skills clustered with dyadic and triadic social interactions and overall developmental level, but were not related to play or language development. For comparison children, all these areas were inter-related. Hypotheses about a specific dyspraxic deficit underlying the imitation performance in autism were not supported.     

Determinants of Participation in Leisure Activities in Children and Youth with Cerebral Palsy: Systematic Review

Children and youth with cerebral palsy (CP) experience difficulties in their ability to move, problem solve, socialize, and communicate, associated with limitations in activities in all environments. They are at risk for lower participation in social and leisure activities critical in fostering friendships, developing interests, and promoting well-being. Little is known about involvement in leisure activities and their determinants. This systematic review aims to describe participation in leisure activities by children with CP and identify personal and environmental factors that influence participation. The following databases were reviewed—CINAHL, Medline, Cochrane, Web of Science, OTseeker, and REHABDATA—using the keywords participation, cerebral palsy, leisure, and recreation. The literature to date suggests that children with physical disabilities are less involved in leisure activities than their peers; activities are more passive, home based, and lack variety. Several factors influence participation in leisure activities, including age, gender, activity limitations, family preferences and coping, motivation, and environmental resources and supports.