Examining the link between working memory behaviour and academic attainment in children with ADHD

Aim The aim of the present study was to investigate whether behaviours typical of working memory problems are associated with poor academic attainment in those with attention‐deficit–hyperactivity disorder (ADHD), as well as a non‐clinical group identified on the basis of working memory difficulties. Method Children clinically diagnosed with ADHD‐combined (n=31; mean age 9y 7mo, SD 12mo; 27 males) were matched with 44 low working memory children (mean age 9y 4mo, SD 15mo; 32 males) and 10 healthy controls (mean age 10y, SD 12mo; 5 males). Working memory behaviour was measured using the Working Memory Rating Scale (WMRS) and academic attainment was assessed with standardized tests of literacy and numeracy. Results The majority of children considered by their teachers to have problematic behaviours performed poorly in literacy and numeracy. When the whole sample were split into two groups on the basis of their working memory behaviour (on the WMRS), the ‘At Risk’ group performed significantly worse in academic attainment. Interpretation As children with ADHD and a non‐clinical group exhibit classroom behaviour typical of working memory problems, early screening to prevent subsequent learning difficulties is important. The use of the WMRS allows educators to draw on their expertise in the classroom for early detection of children with working memory failures.     

Social communication difficulties and autism spectrum disorder in young children with optic nerve hypoplasia and/or septo‐optic dysplasia

Aim The aim of this study was to study systematically social, communication, and repetitive/restrictive (SCRR) behavioural difficulties and clinical autism spectrum disorder (ASD) in children with optic nerve hypoplasia (ONH) and/or septo‐optic dysplasia (SOD), and to investigate the relationship between visual impairment, SCRR difficulties, ASD, and cognition. Method A case‐note study of clinic records from a specialist developmental vision service was completed. Standardized assessments of vision and development and clinician judgements about SCRR difficulties and clinical ASD were made by a multidisciplinary team. Results A total of 45 females and 38 males (mean age 3y 5mo; range 10mo–6y 10mo) with ONH or SOD and profound visual impairment (PVI) or severe visual impairment (SVI) were assessed. A total of 58% of children had at least one SCRR difficulty, and 31% had a clinical diagnosis of ASD. The prevalence of ASD was slightly higher in children with SOD than in children with ONH (36% vs 26%) also slightly more frequent in children with PVI than in children with SVI (36% vs 27%). The prevalence of SCRR difficulties was statistically higher in children with PVI than in children with SVI (p=0.003). Clinical ASD was most likely to be diagnosed between 2 years 4 months and 4 years 6 months. Development was significantly delayed in children with ASD compared with children without social communication difficulties (p=0.001). Interpretation Children with SVI or PVI are at risk of SCRR difficulties and clinical ASD. Children with ONH and/or SOD and visual impairment have a similar risk of developing clinical ASD as other visual impairment groups. However, ASD prevalence data from this study are a minimum estimate, as some young children may have developed ASD behaviours in later childhood. Developmental surveillance for children with ONH and/or SOD should continue until at least the age of 4 years 6 months.     

Developmental delay of finger torque control in children with developmental coordination disorder

Aim We examined whether the behavioral impairments in finger torque control evident in children with developmental coordination disorder (DCD) follow a delayed or different developmental trajectory compared with their typically developing peers. Method Children with DCD (n=36; 18 males, 18 females; mean age 9y 7mo, SD 1y 8mo) and 36 typically developing children (15 males, 21 females; mean age 9y 7mo, SD 2y), between 6 years 10 months and 12 years 7 months of age were recruited from schools in Porto Alegre, Brazil. Particpants completed finger torque control and maximum finger torque production tasks. The inclusion criterion for children with DCD was a Movement Assessment Battery for Children score below the fifth centile. Group means and cross‐sectional age‐related landscapes of the two groups were compared. Results Children with DCD were more variable (p<0.001), less accurate (p=0.007), and less irregular (p<0.001), on average, in their finger torque control than their typically developing peers, despite producing nearly equivalent levels of maximum torque (p=0.49). Despite these mean differences, the cross‐sectional age‐related changes in torque control were similar in the two groups (all p>0.05). Interpretation The developmental trajectory of finger torque control in children with DCD, compared with typically developing children, is delayed. This suggests the behavioral deficits in finger torque control in children with DCD persist as a function of age, rather than progressing or resolving.     

Differentiating attention deficits in children with fetal alcohol spectrum disorder or attention‐deficit–hyperactivity disorder

Aim The attention and inhibition problems found in children with attention‐deficit–hyperactivity disorder (ADHD) are also common in children with fetal alcohol spectrum disorders (FASDs). Attempts to distinguish ADHD from FASDs in terms of these deficits are rare and were pursued in this study. Method A total of 116 children (47 with ADHD, 31 males, 16 females; 30 with FASDs, 17 males, 13 females; and 39 comparison children, 20 males, 19 females) participated. The mean age was 9 years 4 months (SD 1y 8mo) in the ADHD groups, 8 years 10 months (SD 1y 2mo) in the FASD group, and 9 years 1 month (SD 1y 1mo) in the comparison group. Sustained attention was tested with a slow event rate continuous performance task (CPT). Inhibitory control was tested with both a slow and fast event rate Go/No‐Go task. Results On the CPT task, children with ADHD, combined type (ADHD‐C), ADHD, primarily inattentive type (ADHD‐PI), and FASDs showed greater declines in task performance as a function of time than comparison children, suggesting sustained attention problems in all clinical groups. Children’s Go/No‐Go performance was event‐rate dependent, with the ADHD‐C group being affected in the slow condition and the ADHD‐PI and FASD groups having problems with the fast condition. Interpretation Children with ADHD‐C are typically impaired in handling understimulation, while children with FASDs may have problems with overstimulation. The dissociation in responsivity to event rate between groups may have significant differential diagnostic value.     

No association between the 2D:4D fetal testosterone marker and multidimensional attentional abilities in children with ADHD

Aim It has been suggested that high levels of prenatal testosterone exposure are implied in the aetiology of attention‐deficit–hyperactivity disorder (ADHD). This study examined the association between the ratio of the length of the second and fourth digits (2D:4D ratio), a marker of fetal testosterone exposure, and the presence of ADHD‐related cognitive and behavioural problems in children with ADHD and in typically developing comparison individuals. Method A clinically referred group of 64 children who fulfilled DSM‐IV‐TR criteria for ADHD (47 males, 17 females; mean age 8y 8mo, SD 1y 8mo, range 7–12y) and 46 comparison children (25 males, 21 females; mean age 9y 2mo; SD 1y 10mo, range 7–12y) were included in the study. The length of the second and fourth digits was measured by two independent raters. The Child Behaviour Checklist (CBCL) and the Test of Everyday Attention for Children (TEA‐Ch) were used to assess behavioural problems and different aspects of attention. Results No group differences in 2D:4D ratio were observed between children with (combined, inattentive, or hyperactive‐impulsive subtype of) ADHD and comparison children. The ratio did not show the postulated relation with cognitive and behavioural aspects of ADHD. Interpretation These findings challenge the hypothesis that fetal testosterone exposure plays a prominent role in the aetiology of ADHD.     

Stereotypic movement disorder: easily missed

Aim To expand the understanding of stereotypic movement disorder (SMD) and its differentiation from tics and autistic stereotypies. Method Forty‐two children (31 males, mean age 6y 3mo, SD 2y 8mo; 11 females, mean age 6y 7mo, SD 1y 9mo) consecutively diagnosed with SMD, without‐self‐injurious behavior, intellectual disability, sensory impairment, or an autistic spectrum disorder (ASD), were assessed in a neuropsychiatry clinic. A list of probe questions on the nature of the stereotypy was administered to parents (and to children if developmentally ready). Questionnaires administered included the Stereotypy Severity Scale, Short Sensory Profile, Strengths and Difficulties Questionnaire, Repetitive Behavior Scale – Revised, and the Developmental Coordination Disorder Questionnaire. The stereotyped movement patterns were directly observed and in some cases further documented by video recordings made by parents. The probe questions were used again on follow‐up at a mean age of 10 years 7 months (SD 4y 4mo). Results Mean age at onset was 17 months. Males exceeded females by 3:1. Family history of a pattern of SMD was reported in 13 and neuropsychiatric comorbidity in 30 (attention‐deficit–hyperactivity disorder in 16, tics in 18, and developmental coordination disorder in 16). Obsessive–compulsive disorder occurred in only two. The Short Sensory Profile correlated with comorbidity (p<0.001), the Stereotypy Severity Scale (p=0.009), and the Repetitive Behavior Scale (p<0.001); the last correlated with the Stereotypy Severity Scale (p=0.001). Children (but not their parents) liked their movements, which were usually associated with excitement or imaginative play. Mean length of follow‐up was 4 years 8 months (SD 2y 10mo). Of the 39 children followed for longer than 6 months, the behavior stopped or was gradually shaped so as to occur primarily privately in 25. Misdiagnosis was common: 26 were initially referred as tics, 10 as ASD, five as compulsions, and one as epilepsy. Co‐occurring facial grimacing in 15 children and vocalization in 22 contributed to diagnostic confusion. Interpretation SMD occurs in children without ASD or intellectual disability. The generally favorable clinical course is largely due to a gradual increase in private expression of the movements. Severity of the stereotypy is associated with sensory differences and psychopathology. Differentiation of SMD from tics and ASD is important to avoid misdiagnosis and unnecessary treatment.     

Autism and other psychiatric comorbidity in neurofibromatosis type 1: evidence from a population‐based study

Aim To investigate psychopathology in children with neurofibromatosis type 1 (NF1), particularly the prevalence of autism spectrum disorder (ASD) and attention‐deficit–hyperactivity disorder (ADHD) symptomatology, using a population‐based sampling approach. Method Standard questionnaire screen reports were analysed for ASD (Social Responsiveness Scale, SRS), ADHD (Conners’ Parent Rating Scale‐ Revised, CPRS‐R), and other psychiatric morbidity (Strengths and Difficulties Questionnaire, SDQ) from parents and teachers of children aged from 4 to 16 years (112 females, 95 males) on the UK North West Regional Genetic Service register for NF1. Results Parental response rate was 52.7% (109/207 children; 59 females, 50 males, mean age 9y 11mo, SD 3y 3mo). The SRS showed that in 29.4% (32/109) of children, autism was in the severe, clinical range (T‐score>75) and in 26.6% (29/109) in the mild to moderate range (T‐score 60–75). CPRS‐R scores showed that in 53.8% (57/106) of children autism was in the clinical ADHD range (ADHD index T‐score>65). Based on their scores on the SDQ total difficulties scale, 41.5% (44/106) of children were in the abnormal range and 14.2% (15/106) were in the borderline range. Twenty‐five per cent (26/104) of children met criteria for both clinical autism and ADHD. Interpretation This representative population‐based sample of children with NF1 indicates a high prevalence of ASD symptoms associated with NF1 as well as substantial co‐occurrence with ADHD symptoms. The findings clarify the psychopathology of NF1 and show the disorder as a potentially important single‐gene cause for autism symptoms.     

Effect of a social skills training group on everyday activities of children with attention-deficit-hyperactivity disorder

This preliminary study compared the daily living skills of children with and without attention-deficit-hyperactivity disorder (ADHD), and the influence of a social skills training group on these skills. Twenty-seven children with ADHD (2 females, 25 males; age range 5 to 8y, mean 6y 6mo, SD 10mo), and 24 children without ADHD (8 females, 16 males; age range 5 to 8y, mean 6y 11mo, SD 10mo) performed the Assessment of Motor and Process Skills (AMPS). Fourteen of the children with ADHD used medication daily. Nine of the total group with ADHD were randomly selected to attend group treatment which focused on social skills training, through meaningful occupations (e.g. art, games, cooking). Children were evaluated at the beginning of group treatment and after 10 sessions. Ten children without ADHD were evaluated at similar intervals. Children with ADHD initially achieved significantly lower scores on the AMPS in all process skills (p<0.001) and in the coordination motor subtest (p<0.005) than children without ADHD. Children with ADHD significantly improved from the first to the second evaluation and no longer differed from the children without ADHD after treatment (p<0.008). The results emphasize the need for a focus upon occupation in assessment and treatment of children with ADHD.     

Symptomatology of autism spectrum disorder in a population with neurofibromatosis type 1

Aim Difficulties in neurocognition and social interaction are the most prominent causes of morbidity and long‐term disability in children with neurofibromatosis type 1 (NF1). Symptoms of attention‐deficit–hyperactivity disorder (ADHD) have also been extensively recognized in NF1. However, systematic evaluation of symptoms of autism spectrum disorder (ASD) in children with NF1 has been limited. Method We present a retrospective, cross‐sectional study of the prevalence of symptoms of ASD and ADHD and their relationship in a consecutive series of 66 patients from our NF1 clinic. The Social Responsiveness Scale and the Vanderbilt ADHD Diagnostic Parent Rating Scale were used to assess symptoms of ASD and ADHD. Results Sixty‐six participants (42 males, 24 females) were included in this study. Mean age at assessment was 10 years 11 months (SD 5y 4mo). Forty percent of our NF1 sample had raised symptom levels reaching clinical significance on the Social Responsiveness Scale (T ≥ 60), and 14% reached levels consistent with those seen in children with ASDs (T ≥ 75). These raised levels were not explained by NF1 disease severity or externalizing/internalizing behavioral disorders. There was a statistically significant relationship between symptoms of ADHD and ASD (χ²=9.11, df=1, p=0.003, φ=0.56). Particularly salient were the relationships between attention and hyperactivity deficits, with impairments in social awareness and social motivation. Interpretation We found that symptoms of ASD in our NF1 population were raised, consistent with previous reports. Further characterization of the specific ASD symptoms and their impact on daily function is fundamental to the development and implementation of effective interventions in this population, which will probably include a combination of medical and behavioral approaches.     

Is the presence of urinary indolyl‐3‐acryloylglycine associated with autism spectrum disorder?

To test whether the presence of indolyl-3-acryloylglycine (IAG) is associated with autism, we analyzed urine from population-based, blinded cohorts. All children in York, UK with autism spectrum disorders (ASDs), diagnosed using ICD-10 research diagnostic criteria, were invited to participate. Fifty-six children on the autism spectrum (mean age 9y 8mo, SD 3y 8mo; 79% male) agreed to participate, as did 155 children without ASDs (mean age 10y, SD 3y 2mo; 54% male) in mainstream and special schools (56 of whom were age-, sex-, and school-matched to children with ASDs). IAG was found at similar levels in the urine of all children, whether IAG concentrations or IAG:creatinine ratios were compared. There was no significant difference between the ASD and the comparison group, and no difference between children at mainstream schools and those at special schools. There is no association between presence of IAG in urine and autism; therefore, it is unlikely to be of help either diagnostically or as a basis for recommending therapeutic intervention with dietary manipulation. The significance of the presence of IAG in urine has yet to be determined.     

Sex differences in tactile defensiveness in children with ADHD and their siblings

Tactile defensiveness (TD) is a disturbance in sensory processing and is observed in some children with attention-deficit-hyperactivity disorder (ADHD). TD has been examined in male children with ADHD and in children with ADHD without differentiating by sex. As males and females with ADHD may differ in the clinical expression of the disorder and associated deficits, the aim of this study was to examine sex differences in TD in males and females with ADHD. Non-affected siblings were also examined to investigate familiality of TD. The Touch Inventory for Elementary-School-Aged Children was administered to 47 children with ADHD (35 males, 12 females; mean age 9y 8mo [SD 1y 11mo]), 36 non-affected siblings (21 males, 15 females; mean age 8y 10mo [SD 2y 4mo]), and 35 control children (16 males, 19 females; mean age 9y 5mo [SD 6mo]). Results indicated that females with ADHD displayed higher levels of TD than males with ADHD (who did not differ from control males). This suggests that TD is sex specific and may contribute to the identification of ADHD in females, thus improving diagnostic and therapeutic strength in this under-referred group. Non-affected siblings were unimpaired, regardless of sex, which suggests that TD is specific to the disorder and not part of a familial risk for ADHD.     

Verbal and academic skills in children with early‐onset type 1 diabetes

Aim Basic verbal and academic skills can be adversely affected by early‐onset diabetes, although these skills have been studied less than other cognitive functions. This study aimed to explore the mechanism of learning deficits in children with diabetes by assessing basic verbal and academic skills in children with early‐onset diabetes and in comparison children. In addition, the incidence of dyslexia (≤10th centile in reading speed or reading–spelling accuracy) was studied. Method The performance of 51 children with early‐onset diabetes (25 females, 26 males; mean age 9y 11mo, SD 4mo; range 9–10y) was compared with that of 92 children without diabetes (40 females, 52 males; mean age 9y 10mo, SD 3mo; range 9–10y) in the tasks of phonological processing, short‐term memory, rapid automatized naming, reading, spelling, and mathematics. Results The performance of children with diabetes was poorer than that of the comparison children in phonological processing (p=0.001), spelling accuracy (p<0.001), and mathematics (p=0.024). They learned to read later (p=0.013), but reading performance and the incidence of dyslexia in the third grade (aged 9–10y) were similar in the two groups. Interpretation Children with early‐onset diabetes are prone to minor learning difficulties in their early school years as a result of deficits in phonological processing.     

Does attention‐deficit–hyperactivity disorder exacerbate executive dysfunction in children with neurofibromatosis type 1?

Aim Although approximately 40% of children with neurofibromatosis type 1 (NF1) meet diagnostic criteria for attention‐deficit–hyperactivity disorder (ADHD), the impact of ADHD on the executive functioning of children with NF1 is not understood. We investigated whether spatial working memory and response inhibition are impaired in children with NF1 without a diagnosis of ADHD and whether executive deficits are exacerbated in children with a comorbid diagnosis. Method Forty‐nine children aged 7 to 15 years with NF1 only (31 males, 18 females; mean age 11y, SD 2y 4mo) or 35 with NF1 and ADHD (18 males, 17 females; mean age 10y 8mo, SD 2y 4mo) and 30 typically developing comparison children (16 males, 14 females; mean age 10y, SD 2y 8mo) were compared on measures of spatial working memory and response inhibition. Group differences in IQ and visuospatial ability were controlled for as required. Results Compared with typically developing children, children with NF1 with or without comorbid ADHD demonstrated significant impairment of both spatial working memory (both p<0.004) and inhibitory control (both p<0.010). There were, however, no differences between the two NF1 groups in spatial working memory (p=0.91) or response inhibition (p=0.78). Interpretation Executive dysfunction occurs with the same severity in children with NF1, whether or not they have a comorbid diagnosis of ADHD, suggesting that executive impairments are not unique contributors to ADHD symptomatology in NF1. The findings are discussed within the context of recent evidence in Nf1 optic glioma (OPG) mice, in which a mechanistic connection between NF1 gene expression, executive system failure, and dopaminergic pathway integrity has been established.     

Children at risk for developmental coordination disorder: judgement of changes in action capabilities

In three separate manipulations, a group of children at risk for developmental coordination disorder (DCD; five males, seven females; mean age 11y 6mo [SD 6.8mo]who were at or below the 15^th centile on the Movement ABC) and a group of typically developing children (TDC; seven males, five females; mean age 11y 3mo [SD 6.8mo]) judged the limit of their standing horizontal reach (HR_max) under two conditions in which actual HR_max differed. The manipulations were: (1) one-hand versus two-hand reach; and (2) standard versus short effective foot-length; and (3) rigid versus compliant support surface. For the foot-length and support surface manipulations (but not for the hand manipulation), children correctly judged that their actual HR_max differed in the two conditions ( p <.05). On all three manipulations, TDC made significantly larger adjustments in their judgements than did children at risk for DCD ( p <0.05). The TDC group adjusted their judgements in the appropriate direction on all three manipulations, whereas the DCD group adjusted in the appropriate direction for the foot-length manipulation only. The results suggest that children at risk for DCD are less adept at detecting changes in the limits of their action capabilities.     

Evidence of impaired neurocognitive functioning in school‐age children awaiting cardiac surgery

Aim Children with congenital heart disease (CHD) are at risk of developing neurocognitive problems. However, as these problems are usually identified after cardiac surgery, it is unclear whether they resulted from the surgery or whether they pre‐existed and hence might be explained by complications and events associated with the heart disease itself. The purpose of this study was to examine whether neurocognitive deficits commonly reported after cardiac surgery are present before surgery. Method Forty‐five children (22 males, 23 females; mean age 11y 6mo, SD 3y 0mo) with cyanotic and acyanotic heart diseases scheduled for elective cardiac surgery were compared with 41 healthy peers (17 males, 24 females; mean age 11y 10mo, SD 2y 10mo) for attention and processing speed, construction, motor speed, motor planning and fluency, and visual memory. Twenty‐three children in the patient group were awaiting their first cardiac surgery and 22 were awaiting follow‐up surgery. Results The patients showed manifest neurocognitive difficulties. Their performance was inferior to that of the healthy comparison group for motor planning (p=0.02) and visual memory (p=0.01). The same neurocognitive profile was found in the group of patients awaiting their first cardiac operation. Interpretation School‐age children with various forms of CHD are at risk of neurocognitive impairments before cardiac surgery.     

Effect of osmotic-release oral system methylphenidate on different domains of attention and executive functioning in children with attention-deficit-hyperactivity disorder

Aim This study investigated whether components of attention and executive functioning improve when children with attention‐deficit–hyperactivity disorder (ADHD) are treated with osmotic‐release oral system (OROS) methylphenidate. Method Thirty children (24 males, six females; mean age 8y 6mo, SD 1y 11mo; range 6y 5mo –12y 6mo) with ADHD combined type participated in a double‐blind, placebo‐controlled crossover trial with the child’s clinically most effective dose as identified with a systematic open‐label titration procedure. After 1 week on each treatment (placebo and OROS methylphenidate), a neuropsychological battery that assessed sustained attention, selective attention, attentional control, response inhibition, and working memory was administered. This battery included the Gordon Diagnostic System, seven subtests of the Test of Everyday Attention for Children, and two tests of working memory. Results Performance on two of three tests of response inhibition improved on OROS methylphenidate compared with placebo (p<0.01). Performance on one of two tasks assessing attentional control and one of five measures assessing sustained attention demonstrated clear improvement. There was no improvement on the two tasks assessing selective attention or the two tasks assessing working memory. Interpretation When OROS methylphenidate was used to treat children with ADHD at the clinically most effective dose, general improvement was noted on tasks requiring response inhibition; response to treatment in other domains was either variable or not demonstrated.     

Neuromotor task training for children with developmental coordination disorder: a controlled trial

The aim of this study was to evaluate neuromotor task training (NTT), a recently developed child-centred and task-oriented treatment programme for children with developmental coordination disorder (DCD). A treatment and a non-treatment control group of children with DCD were included. Children were selected if they scored below the 15th centile on the Movement Assessment Battery for Children (MABC). The children in the treatment group were recently referred for physiotherapy (n=26; 20 males, 6 females; mean age 7y 2mo [SD 1y 3mo]). The parents of the non-treated children were concerned about their children's motor performance and responded to advertisements for free testing (n=13; 10 males, 3 females; mean age 7y 2mo [SD 2y 1mo]). Before and after nine weekly 30-minute sessions of NTT or at least 9 weeks of no intervention, the MABC and the Test of Gross Motor Development - 2 (TGMD-2) were administered. Therapists reported per session on treatment goals and tasks trained. The results indicate that motor performance does not improve spontaneously and that NTT is effective. During the intervention period, only the treated group improved on the MABC and the TGMD-2. Children improved most on tasks similar to those trained. In older children with poorer motor patterns, NTT's treatment success was higher. The Child Behavior Checklist subscales withdrawn, thought problems, anxious/depressed, and delinquency were determinants of effects on motor patterns.     

The effect of early confirmation of hearing loss on the behaviour in middle childhood of children with bilateral hearing impairment

Aim To determine if the benefit of early confirmation of permanent childhood hearing impairment (PCHI) on children’s receptive language development is associated with fewer behavioural problems. Method Follow‐up of a total population cohort of 120 children with PCHI of moderate or greater severity (≥40 decibels relative to hearing threshold level) (67 males, 53 females; mean age 7y 11mo, range 5y 5mo–11y 8mo) and 63 hearing children (37 males, 26 females; mean age 8y 1mo, range 6y 4mo–9y 10mo). The main outcome measures were the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents and the Vineland Adaptive Behaviour Scales (VABS) which are completed on the basis of a parental interview. Results Children with PCHI had lower standard scores than hearing children on the Daily Living Skills (p=0.001) and the Socialisation (p=0.001) scales of the VABS. They had significantly higher Total Behaviour Problem scores on the parent‐rated (p=0.002) and teacher‐rated SDQ (p=0.03). Children for whom PCHI was confirmed by 9 months did not have significantly fewer problems on the behavioural measures than those confirmed after that age (p=0.635 and p=0.196). Interpretation Early confirmation has a beneficial effect on receptive language development but no significant impact in reducing behavioural problems in children with PCHI.     

Motor skill deficits in children with partial hearing

Aim We examined the effect of partial hearing, including cochlear implantation, on the development of motor skills in children (aged 6–12y). Method Three independent groups of children were selected: a partial hearing group (n=25 [14 males, 11 females]; mean age 8y 8mo, SD 1y 10mo), a nonverbal IQ‐matched group (n=27 [15 males, 12 females]; mean age 9y, SD 1y 6mo), and an age‐matched group (n=26 [8 males, 18 females]; mean age 8y 8mo, SD 1y 7mo) from three schools with special units for children with partial hearing. All children with partial hearing had a bilateral hearing loss >60 decibels. Motor and balance skills were assessed using the Movement Assessment Battery for Children (MABC) and two protocols from the NeuroCom Balance Master clinical procedures. Results The mean standardized total MABC score of the children with partial hearing (95% confidence interval [CI] 71.8–88.7) was significantly lower than both the age‐matched (95% CI 95.8–111.4; p<0.01) and the IQ‐matched (95% CI 87.6–103.0; p=0.03) comparison groups. The children with partial hearing had particular difficulties with balance, most notably during tests of intersensory demand. However, subgroup analyses revealed that the effect of cochlear implantation was clearly dependent on the nature of the task. Interpretation Children with partial hearing are at high risk of clinical levels of motor deficit, with balance difficulties providing support for conventional vestibular deficit theory. However, the effect of cochlear implantation suggests that other sensory systems may be involved. A broader ecological perspective, which takes into account factors external to the child, may prove a useful framework for future research.     

Developmental coordination disorder in children with attention-deficit-hyperactivity disorder and physical therapy intervention

Although physical therapy (PT) is effective in improving motor function in children with developmental coordination disorder (DCD), insufficient data are available on the impact of this intervention in children with combined attention-deficit-hyperactivity disorder (ADHD) and DCD. This prospective study aimed to establish the prevalence of DCD among a cohort of patients with ADHD, characterize the motor impairment, identify additional comorbidities, and determine the role of PT intervention on these patients. DCD was detected in 55.2% of 96 consecutive children with ADHD (81 males, 15 females), mostly among patients with the inattentive type (64.3% compared with 11% of those with the hyperactive/impulsive type, p<0.05). Mean age was 8 years 4 months (SD 2 y). Individuals with both ADHD and DCD more often had specific learning disabilities (p=0.05) and expressive language deficits (p=0.03) than children with ADHD only. Twenty-eight patients with ADHD and DCD randomly received either intensive group PT (group A, mean age 9 y 3 mo, SD 2 y 3 mo) or no intervention (group B, mean age 9 y 3 mo, SD 2 y 2 mo). PT significantly improved motor performance (assessed by the Movement Assessment Battery for Children; p=0.001). In conclusion, DCD is common in children with ADHD, particularly of the inattentive type. Patients with both ADHD and DCD are more likely to exhibit specific learning disabilities and phonological (pronunciation) deficits. Intensive PT intervention has a marked impact on the motor performance of these children.