Clumsy children: a prognostic study

Twenty-four clumsy children of whom 13 had matched controls were reappraised eight years after their original assessment. The findings indicate that developmental clumsiness generally has a favourable prognosis. Mild and moderate degrees of clumsiness improved to normality, but severe degrees of clumsiness had a less favourable outcome only in regard to motor proficiencies. Clumsiness seemed not to have bearing, either on social class or on the subsequent pursuit of sporting activities. Although there was a lower level of academic achievement in the clumsy children, who also chose careers which were less manually exacting, these observations did not reach statistical significance. Maturational lag might be the aetiology in mild developmental clumsiness, whereas structural lesions involving the cerebral cortex may be present in more severely afflicted children. These findings should be considered when counseling clumsy children, both academically and vocationally.     

Clumsy children: a prognostic study

ABSTRACT. Twenty-four clumsy children of whom 13 had matched controls were reappraised eight years after their original assessment. The findings indicate that developmental clumsiness generally has a favourable prognosis. Mild and moderate degrees of clumsiness improved to normality, but severe degrees of clumsiness had a less favourable outcome only in regard to motor proficiencies. Clumsiness seemed not to have bearing, either on social class or on the subsequent pursuit of sporting activities. Although there was a lower level of academic achievement in the clumsy children, who also chose careers which were less manually exacting, these observations did not reach statistical significance.
Maturational lag might be the aetiology in mild developmental clumsiness, whereas structural lesions involving the cerebral cortex may be present in more severely afflicted children. These findings should be considered when counselling clumsy children, both academically and vocationally.     

How sexual abuse interviews go astray: implications for prosecutors, police, and child protection services

This article argues that child sexual abuse interviews can go astray in two different ways: (a) improper interviewing has the potential to elicit false allegations from children, and (b) clumsy interviewing does not typically produce false allegations, but may have other negative consequences, particularly for child victims. The article clarifies the distinction between the two kinds of bad interviewing and suggests that clumsy interviewing is the more common of the two. The potential negative consequences of both improper and clumsy interviewing are described, along with implications for prosecutors, police, and child protection services. In the authors' opinion, improper interviewing can probably be eliminated rather easily, but clumsy interviewing may be considerably more resistant to change.     

PATTERNS OF ROTARY PURSUIT PERFORMANCE IN CLUMSY AND NORMAL CHILDREN

The present study is concerned with the development of motor programs in clumsy children. In order to investigate this, the performance of clumsy and normal children on a rotary pursuit tracking task was compared. The performance of the clumsy group was inferior to that of the control group in terms of time on target, but the pattern of performance across successive trials was broadly similar for the two groups, suggesting a progression from control by visual feedback to control by motor programs. It was concluded that the performance of clumsy children on the rotary pursuit task may be limited more by impaired visual feedback control than by an impairment in the ability to develop motor programs.     

Hyperactivity and Delay Aversion III: The Effect on Cognitive Style of Imposing Delay After Errors

The claim that impulsiveness associated with hyperactivity is the result of deficits in inhibition of responses over time was examined. The cognitive style of hyperactive children was studied under two conditions. As in previous studies hyperactive children appeared impulsive (i.e. gave shorter latencies and made more errors than controls) under conditions where this style led to shorter trials. In contrast, in a revised condition where each error led to an enforced/fixed trial length, hyperactive children waited as long as controls before responding, but still made more errors. Hyperactive children withheld responses when this offered them the best chance of avoiding extra delay. They were however, unable to use the extra time provided as effectively as controls. The link between hyperactive children's aversion to delay and their poor use of time is discussed.     

Neurologic, psychologic and logopedic follow-up of 6 to 8-year-old former premature infants with a birth weight below 1,501 g

The purpose of the present study was to find out if formerly premature babies (birth weight less than or equal to 1,501 g) show differences in their neurological, psychological and linguistic development of school-age when compared to children without perinatal problems. Discrete neurological dysfunctions (clumsy child syndromes, discrete hemi-syndromes) and left-handedness were found significantly more frequently in the premature group. The test psychological investigation of the intellectual development and the development of language did not reveal significant differences between the two groups. Also with regard to the cognitive partial functions (attention, visual differentiation, serial memory performance and visuomotor coordination) the prematures were significantly behind only in serial memory performance. On the other hand the results of the psychological investigations were significantly worse in children of lower social classes independent of birth weight.     

How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism?

BACKGROUND: The objective of this study is to identify intact and deficient cognitive processes in children with attention deficit hyperactivity disorder (ADHD) and children with high functioning autism (HFA). METHOD: Three rigorously diagnosed groups of children aged between 6 and 12 years (54 ADHD, 41 HFA, and 41 normal controls) were tested on a wide range of tasks related to five major domains of executive functioning (EF): inhibition, visual working memory, planning, cognitive flexibility, and verbal fluency. In addition, the role of comorbid oppositional defiant disorder (ODD) and comorbid conduct disorder (CD) in ADHD was investigated by directly comparing 20 children with ADHD and 34 children with comorbid ADHD + ODD/CD. RESULTS: ADHD was associated with EF deficits in inhibiting a prepotent response and verbal fluency. Children with HFA demonstrated deficits in all EF domains, except interference control and working memory. The HFA group showed more difficulties than the ADHD group with planning and cognitive flexibility. The comorbid ADHD + ODD/CD group did not show a distinctive pattern of performance on the EF tests compared to the ADHD group. CONCLUSION: The present study indicates that children with HFA exhibit more generalised and profound problems with EF tasks compared to children with ADHD.     

Parent reported sleep problems in preschool children with sickle cell anemia and controls in East London

Snoring and poor sleep may affect cognition, particularly in young children with chronic conditions. Parents of London preschoolers with sickle cell anemia (SCA; n = 22), matched controls (n = 24), and unselected typically developing (n = 142) preschoolers completed sleep questionnaires. Preschoolers with SCA had significantly more sleep problems when compared to matched controls and the larger population. Snoring occurred at least one to two nights a week for 79% of the SCA group. This is compared with 25% of matched controls and 33% of larger population. Randomized controlled trials to improve sleep in young children with SCA already at‐risk for cognitive dysfunction should be considered.     

Association between pronounced IgA response in RSV bronchiolitis and development of allergic sensitization

Forty-five children who had heen hospitalized with bronchiolitis caused by respiratory syncytial virus (RSV) at a mean age of 4 months, and 90 matched control children, were tested for occurrence of RSV antibodies at one year of age. Of the children who had suffered from bronchiolitis. forty had demonstrable IgG antibodies, whereas the remaining five only had IgA antibodies against RSV. In the control group. 42% were RSV seropositive. The anti-RSV IgA antibody titres tended to be higher in patients with bronchiolitis ihan in controls and a larger proportion of the seropositive children in the former than in the latter group had demonstrable IgG antibodies. These fmdings suggest that RSV infections causing bronchiolitis are more often associated with a strong antibody response than are mild cases of the infection.
Follow-up of the children at 3 years of age showed that allergic sensitization and development of asthma had occurred much more frequently in children with past RSV bronchiolitis than in controls. Children with past RSV bronchiolitis who later developed allergic sensitization had elevated RSV IgA antibody titres at one year of age more frequently than children with past RSV-bronchiolitis. who were not sensitized (p=0.015). No significant differences regarding IgG antibody titres were observed. Since IgA, similarly a. s IgE. antibody formation is strongly Th2 cell dependent, the results are compatible with other fmdings suggesting that RSV has an unusual propensity to activate the Th2 cell system. This may contribute to the pathological picture of bronchiolitis in small children and at the same lime render the infected child predisposed for later development of allergic sensitization. RSV bronchiolitis may thus be an important risk factor for later development of atopic disease although it cannot be excluded that the bronchiolitis simply serves as a marker that predicts later development of atopy.     

Hyperactivity and Delay Aversion—II. The Effect of Self versus Externally Imposed Stimulus Presentation Periods on Memory

The memory of hyperactive and non-hyperactive children for "attended" and "unattended" picture cards was compared under two conditions. Under Self Imposed Presentation (SI) conditions children set their own limits on presentation time while under Externally Imposed Presentation (EI) conditions children were encouraged to spend 30 seconds attending to the cards. Hyperactive children selected shorter presentation times than non-hyperactive children and recognized fewer "attended" cards under SI conditions, while the two groups performed equally well under EI conditions. These findings suggest that a major determinant of memory deficits in hyperactivity is a self imposed limitation on presentation time rather than more specific cognitive process limitations.     

Modelling the Training Effects of Kinaesthetic Acuity Measurement in Children

In previous papers (Sims, Henderson, Hulme, & Morton, 1996a; Sims, Henderson, Morton, & Hulme, 1996b) we have found that the motor skills of clumsy children are capable of significant improvement following relatively brief interventions. Most remarkably, this included a 10-minute intervention while testing the kinaesthetic acuity of the children using a staircase method (Pest). In this paper, we show that Pest testing improves the kinaesthetic acuity of normal children as well. We analyse the available data on the development and improvement of motor skills and kinaesthetic acuity and derive a causal model for the underlying skills. We show that at least three independent cognitive/biological components are required to account for the data. These three components are affected differently by the various interventions that have been tried. We deduce that improvement on a general test of motor impairment can be found as a result of training in kinaesthetic acuity or through other, independent factors.     

Is bronchodilator response in 2‐yr‐old children associated with asthma risk factors?

Factors that might influence lung function bronchodilator response by 2 yr of age is largely unknown, thus we aimed to assess this in the 'Environment and Childhood asthma' (ECA) study in Oslo. A clinical investigation at mean age 26 months was attended by 516 (84%) children included in a nested case-control study [children with recurrent bronchial obstruction (rBO)] (n = 265) and controls without a history of lower respiratory disease (n = 251). Tidal lung function measures before and after inhaled nebulized salbutamol (bronchodilator response) (when clinically without BO) were obtained in 46%. Clinical characteristics and personal and family history of allergic/respiratory diseases (asthma risk factors) were ascertained by structured interview and clinical examination. Allergic sensitization was assessed by skin prick test/specific IgE antibody analyses to common allergens. Mean (95% CI) per cent change in time to reach peak flow/total expiratory time (t(PTEF)/t(E)) from before to after salbutamol was significantly larger in children with rBO [17.3 (9.4-25.3) than controls (-2.2 (-7.7 to 3.0)]. The bronchodilator response increased significantly (p = 0.001) with increasing number of asthma risk factors, but was not significantly associated with allergic sensitization, parental 'atopy', or maternal smoking alone. Children treated with inhaled corticosteroids had greater bronchodilator response than those treated with bronchodilators alone. Bronchodilator response in asymptomatic 2-yr-old children was most closely associated with the presence of rBO, but increasing number of asthma risk factors and treatment with inhaled corticosteroids were associated with increased bronchodilator response.     

A special type of head stereotypies in children with developmental (?cerebellar) disorder: description of 8 cases and literature review.

The authors report eight children, who presented in the first year of life with isolated head stereotypies, that corresponded neither to the usual normal 'rhythmic habit patterns of infancy', nor to various types of abnormal repetitive head movements described in young children. Their head stereotypies closely resembled those described in bobble-head doll syndrome. The neurological status evidenced axial hypotonia, ataxia, oculomotor abnormalities, motor and language delay. The patients were followed for several years clinically and with video recordings. No single aetiology was found. Computed tomography (CT) or magnetic resonance imaging (MRI) show a congenital cerebellar abnormality in two children but no hydrocephalus. The outcome of these children showed in all but one patient a normal cognitive and psychosocial development, even though the head stereotypies are still present in six of eight patients and all remain significantly clumsy. The association of head stereotypies and motor delay should prompt a search for cerebellar congenital malformation. The outcome of those patients was much better than originally anticipated and these head stereotypies are not related either to mental retardation, or to psychopathology. The possible mechanisms involved are also discussed.     

Listen to the noise: noise is beneficial for cognitive performance in ADHD

Background: Noise is typically conceived of as being detrimental to cognitive performance. However, given the mechanism of stochastic resonance, a certain amount of noise can benefit performance. We investigate cognitive performance in noisy environments in relation to a neurocomputational model of attention deficit hyperactivity disorder (ADHD) and dopamine. The Moderate Brain Arousal model (MBA; Sikström & Söderlund, 2007 ) suggests that dopamine levels modulate how much noise is required for optimal cognitive performance. We experimentally examine how ADHD and control children respond to different encoding conditions, providing different levels of environmental stimulation. Methods: Participants carried out self‐performed mini tasks (SPT), as a high memory performance task, and a verbal task (VT), as a low memory task. These tasks were performed in the presence, or absence, of auditory white noise. Results: Noise exerted a positive effect on cognitive performance for the ADHD group and deteriorated performance for the control group, indicating that ADHD subjects need more noise than controls for optimal cognitive performance. Conclusions: The positive effect of white noise is explained by the phenomenon of stochastic resonance (SR), i.e., the phenomenon that moderate noise facilitates cognitive performance. The MBA model suggests that noise in the environment, introduces internal noise into the neural system through the perceptual system. This noise induces SR in the neurotransmitter systems and makes this noise beneficial for cognitive performance. In particular, the peak of the SR curve depends on the dopamine level, so that participants with low dopamine levels (ADHD) require more noise for optimal cognitive performance compared to controls.     

Information processing profiles of internalizing and externalizing behavior problems: evidence from a population-based sample of preadolescents

BACKGROUND: The present study explores the relationships between several information processing capacities and internalizing and externalizing behavior problems in a general population sample of 10- to 12-year olds (N = 2,037 51% girls). METHODS: Parent-reported behavior problems as assessed by the Child Behavior Checklist were used to form four groups of children with 1) neither internalizing nor externalizing problems (n = 1,470), 2) only internalizing problems (n = 237), 3) only externalizing problems (n = 182), and 4) both internalizing and externalizing problems (n = 148). These groups were compared on measures of speed and accuracy from the Amsterdam Neuropsychological Tasks program reflecting the efficiency of several input-, central cognitive-, and output-related information processing capacities. RESULTS: Children with both internalizing and externalizing problems demonstrated the least efficient performance, followed by children with only externalizing problems, whereas children with only internalizing problems did not differ from children without problems. More specifically, response variability and the ability to maintain and quickly compare information in working memory were found to be related to the severity of problem behavior. The ability to inhibit prepotent responses was related to the type of problem behavior, discriminating between the children with only internalizing problems and only externalizing problems. However, this latter capacity no longer differentiated when controlling for IQ. No differences were found between boys and girls. CONCLUSIONS: The results suggest that, in general, cognitive processing deficits are more strongly related to the degree than to the type of maladaptive behavior. Furthermore, response variability and working memory may serve as potential markers for identifying high-risk children and response inhibition as an indicator of the type of maladaptive behavior.     

Delay discounting of reward in ADHD: application in young children

Background: A key underlying process that may contribute to attention‐deficit/hyperactivity disorder (ADHD) involves alterations in reward evaluation, including assessing the relative value of immediate over delayed rewards. This study examines whether children with ADHD discount the value of delayed rewards to a greater degree than typically developing children using a delay discounting task. Methods: Children aged 7–9 years diagnosed with ADHD and controls completed a task in which they chose between a hypothetical $10 available after a delay (7, 30, 90 and 180 days) versus various amounts available immediately. Results: ADHD participants discounted more steeply than controls. However, this effect did not survive covarying of IQ. Conclusions: ADHD is associated with a steeper delay gradient when contemplating hypothetical later rewards, but not independently of IQ. The interplay of cognitive processing and IQ with reward evaluation in ADHD requires further exploration.     

Pediatric acquired immunodeficiency syndrome. Neurologic syndromes

Central nervous system (CNS) dysfunction was documented in 61 of 68 infants and children with symptomatic human immunodeficiency virus infection. The most frequent manifestations included acquired microcephaly, cognitive deficits, and bilateral pyramidal tract signs. Lymphoma of the CNS, cerebrovascular accidents, and CNS infection caused by conventional pathogens were documented in only ten children (15%). Neurologic deterioration in 11 children was subacute but steadily progressive; in 31 the course was more indolent and began with a plateau. Of these 31 children, 13 had further neurologic deterioration and the conditions of three improved. Seventeen children had a static course with cognitive deficits (seven children) or cognitive plus neurologic impairment (ten children). Neuroradiologic studies in the children with a subacute progressive or plateau course disclosed cerebral atrophy, white matter abnormalities, and calcification of the basal ganglia. Postmortem findings included variable degrees of inflammatory response, multinucleated cells, calcific vasculopathy, and pyramidal tract degeneration. Computed tomographic studies of the children with a static course were normal or showed mild atrophy, but poor brain growth was documented by serial head circumference measurements.     

Postural control among children with and without attention deficit hyperactivity disorder in single and dual conditions

Given the known deficits in attention in attention deficit hyperactivity disorder (ADHD) and the evidence suggesting that postural control requires attention, this study aimed to investigate the mechanisms of postural control of children with and without ADHD in single-(ST) and dual-task (DT) conditions. Postural sway and stabilogram diffusion analysis (SDA) were performed on the Center of Pressure trajectories on 24 ADHD children and 17 age-gender-matched healthy controls. The subjects were instructed to stand as stable as possible on a force platform in two task conditions: (1) single task (ST) and (2) dual task (DT)-an auditory-memory attention-demanding cognitive task. During ST and DT conditions, the ADHD children showed significantly greater ML-sway, short- and long-term effective diffusion coefficients, and critical displacement of SDA compared with controls. The effects of DT were somewhat unexpected; the control group indicated a significant decrease in ML-sway, AP-sway, sway area, and critical displacement of SDA; the ADHD group showed a significant decrease in ML-sway range and critical displacement. It is concluded that a greater sway displacement before closed-loop mechanisms is called into play in ADHD children. The DT enhanced balance control by reinforcing balance automaticity and minimizing sway in both healthy and ADHD children.     

The Effects of Reinforcement and Response–Cost on a Delayed Response Task in Children with Attention Deficit Hyperactivity Disorder: A Research Note

Children with attention deficit hyperactivity disorder are more inattentive, active, and impulsive than normal children. Some researchers have postulated that these symptoms can all be explained as a result of reduced sensitivity to reinforcement. In order to evaluate this hypothesis, we tested 20 ADD-H children and 18 matched normal controls, 4 1/2-11 years of age, on a delayed response task, a measure of impulsiveness, under conditions of positive reinforcement, and punishment in the form of response-cost. The contingencies each improved performance compared to baseline but did not differ significantly from each other. Neither contingency affected the groups differentially, thus failing to provide support for the reinforcement hypothesis.     

Cognitive function at 10 years of age in children who have required neonatal intensive care

AIM: To study cognitive function at 10y of age in a cohort of children who required neonatal intensive care within the Uppsala Neonatal Follow-up Study. METHODS: 226 children, who were born in 1986-1989 and had required neonatal intensive care (NIC) and 72 full-term, healthy control children were enrolled in the study. NIC children were grouped according to gestational age (group I, 23-31 wk; subgroup IA, 23-27 wk; IB 28-31 wk; group II, 32-36 wk; group III, > 36 wk), with infants with congenital malformation (IWCM) included and excluded from the main groups. The Kaufman Assessment Battery for Children (K-ABC) was administered and results were analysed in relation to the K-ABC global scales: sequential, simultaneous, mental processing composite and achievement. RESULTS: The great majority of children had well-developed cognitive function, reaching scores at an average level or above. When groups were compared, full-term children that required NIC (group III) showed lower scores than controls on all scales measured by the K-ABC. Preterm children from all the studied groups (groups IA, IB, II) showed poorer performance than controls in the simultaneous processing scale, and group IA scored lower than controls in the achievement scale. The incidence of major cognitive impairment (IQ < 70) was low in NIC children (< 5%), but children from group IA showed significant higher frequency of impairment in the simultaneous, mental processing composite and achievement scales. Children from group IA presented a high frequency of discrepancy between the K-ABC scales, with lower simultaneous and higher sequential scores. Analysis with IWCM excluded from the main groups revealed identical results. CONCLUSION: Most children who needed neonatal intensive care had developed well their cognitive function at 10 y of age. The long-term effect of neonatal intensive care on cognitive function was more evident in extremely preterm infants (group IA), especially in tasks involving simultaneous ways of processing information.