Swedish Test of Intelligibility for Children (STI-CH) – Validity and reliability of a computer-mediated single word intelligibility test for children

The aim of this study was twofold: first, to describe a new Swedish intelligibility test (Swedish Test of Intelligibility for Children, STI-CH) and second to evaluate its validity and reliability. STI-CH is based on the repetition of single words. Ten children with a speech-sound disorder (4:6–8:3 years of age, mean?=?6.0 years) and 10 children with typical speech and language development (4:8–7:4 years of age, mean?=?5.9 years) were included. Twenty speech-language pathology students served as listeners. Intra-judge reliability was high (r?>?0.92), as was the intra-class correlation of inter-judge reliability (0.97). In terms of validity, there was a significant difference in STI-CH scores between the two groups, and the scores correlated statistically significantly with the Percentage of Consonants Correct (r?=?0.94) and with intelligibility in spontaneous speech (r?=?0.85). To sum up, the results indicate that STI-CH could be an option for the assessment of intelligibility in Swedish-speaking children, and that the principles used in the development of the test could be of use in the design of intelligibility tests in languages other than Swedish.     

First-ever population-based study on status epilepticus in French Island of La Reunion (France) – Incidence and fatality

PurposeWe aimed to determine the incidence and case-fatality of first-ever status epilepticus (SE) among the general population living in La Reunion Island, a French overseas territory in the Indian Ocean near Madagascar.MethodsWe recruited cases (1st July 2004–30th June 2005) in a population-based manner using neurology, neurosurgery, electroencephalogram, emergency, paediatric and neuroradiology services; emergency medical aid service; emergency and admission service of private and public clinics; neurologists (public and private); private paediatricians and practitioners of various rural hospitals. All cases had an electroencephalogram (EEG) and were assessed by an epileptologist. Standard definition and classification schemes were used. Those with known epilepsy were not part of this analysis.ResultsSixty-five cases (males: n = 41, 63.1%) had epileptologist-confirmed SE, with 38.5% (n = 25) being >60 years of age. Global incidence rate was 8.52/100 000 (95% confidence interval 6.5–10.5). A bimodal age distribution with high frequency and incidence among young (<10 years age) (frequency: 12.3%; incidence 6.6/100,000) and aged (>60 years) (frequency: 40.0%; incidence 35.0/100,000) was observed. We found that 60%, 32.3%, 6.7% had convulsive, partial and non-convulsive SE respectively (1% remained unclassified). Of the cases identified, 44.6%, 38.5%, 16.9% had unprovoked, provoked or cryptogenic seizures respectively. The most important aetiological factors identified included: stroke (27.7%), alcoholism/toxicity (18.5%), cryptogenic (16.9%), infections (10.8%). Mortality was 18.5%.ConclusionThe incidence of SE incidence in La Reunion Island was lower than that described elsewhere. The status type was found to be dependent on aetiology and age. The study confirms that SE is more frequent in men and in older adults and is associated with significant short-term case mortality.     

Are cholinergic enhancers beneficial for memory in schizophrenia? An event-related potentials (ERPs) study of rivastigmine add-on therapy in a crossover trial

Studies have reported beneficial effects of cholinergic enhancers, e.g., rivastigmine, on memory in schizophrenia but others have not. Possibly, these discrepancies are related to the lack of specificity of the tests used. This study investigated the effect of rivastigmine on memory in schizophrenia using event-related potentials (ERPs). Eighteen patients treated with atypical antipsychotic received rivastigmine adjuvant therapy in a randomized, crossover design. They were assessed at baseline (T1) and on two subsequent occasions (T2 and T3), where one half of the subjects were taken rivastigmine and the other half not. ERPs were recorded during a recognition memory task on each session. Behavioral and ERP data were analyzed using mixed ANOVA models first at T1 to detect potential group differences and for the trial (T1-T2) to determine the influence of rivastigmine, i.e., sessionxgroup interactions. The results showed no group difference at T1 except a trend for one group to be less efficient than the other on RT measures. When controlling for this difference the results on the trial data showed a trend for a benefit of rivastigmine on the RT memory effect. ERP analysis revealed that rivastigmine affects the amplitudes of two components elicited within 150-300 ms over posterior (reduced N2b) and frontal sites (enhanced P2a). It also enhances the magnitude of the memory (old/new) effect on two later components over posterior (N400) and frontal sites (F-N400). These results suggest that rivastigmine improves selective attention by enhancing interference inhibition processes (P2a) and lowering the reactivity to incoming stimulus (N2b). It also improves the integration of information with knowledge (N400) and with its context (F-N400). Generally, this study showed that the beneficial effect of rivastigmine on memory is not unitary but rather comes from its action at different time points within information processing cascade.     

Commentary: Worshipping the internet – the perils of serving an unpredictable master – a commentary on Aboujaoude and Gega (2021)

Numerous links have been established between cybertechnology and mental health problems. Although the direction of causality in the relationship between internet misuse and mental disturbance remains unclear, the cyberworld may contribute to the shaping of psychopathology in various ways. These include internet-enhanced impulsivity, disinhibition and aggression, attentional problems, difficulties in coping with online information and selective and constraining online interactions with likeminded individuals. One of the imperatives of public health is to help internet users, especially those who are vulnerable such as children and adolescents, to be aware of the risks involved in interactions with the digital technologies and educate them about circumventing the dangers and seeking help.     

Accurate determination of blood–brain barrier permeability using dynamic contrast-enhanced T1-weighted MRI: a simulation and in vivo study on healthy subjects and multiple sclerosis patients

Dynamic contrast-enhanced magnetic resonance imaging (DCE–MRI) is increasingly used to estimate permeability in situations with subtle blood–brain barrier (BBB) leakage. However, the method''s ability to differentiate such low values from zero is unknown, and no consensus exists on optimal selection of total measurement duration, temporal resolution, and modeling approach under varying physiologic circumstances. To estimate accuracy and precision of the DCE–MRI method we generated simulated data using a two-compartment model and progressively down-sampled and truncated the data to mimic low temporal resolution and short total measurement duration. Model fit was performed with the Patlak, the extended Tofts, and the Tikhonov two-compartment (Tik-2CM) models. Overall, 17 healthy controls were scanned to obtain in vivo data. Long total measurement duration (15 minutes) and high temporal resolution (1.25 seconds) greatly improved accuracy and precision for all three models, enabling us to differentiate values of permeability as low as 0.1 ml/100 g/min from zero. The Patlak model yielded highest accuracy and precision for permeability values <0.3 ml/100 g/min, but for higher values the Tik-2CM performed best. Our results emphasize the importance of optimal parameter setup and model selection when characterizing low BBB permeability.     

A study on the usefulness and reliability of the “Scheme of Appraisal of Emotional Development” (SAED) for persons with ID using direct observation in a group-based assessment procedure

IntroductionWhereas instruments for the assessment of intellectual and social abilities are widely available, instruments for the evaluation of emotional development of persons with intellectual disabilities (ID) are rare. The Scheme of Appraisal of Emotional Development (SAED), an internationally used tool developed by Dosen (2005a. Journal of Intellectual Disability Research, 49, 1, 2005b. Journal of Intellectual Disability Research, 49, 9), is one of the latter and is based on interviews with caregivers. The present study aims to investigate the internal consistency and interrater-reliability by changing the interview procedure into a direct observation and evaluation approach by a whole team instead of by one expert.MethodThe level of emotional development of 175 patients admitted to a psychiatric inpatient unit specialized in the treatment of adults with ID was evaluated with the SAED by the treatment team after an observation period of up to two weeks. The inter- and intra-rater-reliability was assessed by direct observation of the behaviour of an additional 50 patients by two pairs of raters.ResultsThe internal consistency of the SAED dimensions, once rated by team approach, is excellent, and the reliability measures show also good statistical results.Conclusion and implicationsThe evaluation of the level of emotional development using the SAED by a group-led and/or direct observational procedure show to be a reliable and useful approach. The group-based procedure yields equal results compared with the usual interview guidelines and might lead to an additional training effect within the respective teams. The rater-reliability measures align with those reported in other studies.     

A shift of treatment approach in speech language pathology services for children with speech sound disorders – a single case study of an intense intervention based on non-linear phonology and motor-learning principles

Even though there are documented benefits of direct intensive intervention for children with speech sound disorders (SSDs), the intensity given at Swedish Speech Language Pathology services rarely exceeds once a week. Also, indirect therapy approaches are commonly employed.

The purpose of the present case study was to investigate the effects of an intensive specialist therapy, based on non-linear phonological analysis and motor learning principles. The participant was a boy aged 4:10 years with severe SSD, who previously had received indirect therapy from age 3 with, very limited results.

A single subject ABA design was used. At baseline, whole word match was 0%, Word shape CV match was 39% and PCC was 22, 7%. He had no multisyllabic words, no consonant clusters and no established coronals.

Intervention was given 4 days weekly for 3 weeks in two periods with a 7-week intervening break and a post therapy assessments. Therapy was focused on establishing multisyllabic words, iambic stress pattern, clusters and coronals with the principle of using already established elements for targeting new elements.

At post therapy assessment, whole word match was 39%, word shape CV match was 71% and PCC 69.1%. Multisyllabic words (86%), coronals (82%) and word initial clusters (80%) were established. Without being targeted, back vowels were also present and segment timing improved.

The strong treatment effects of this study demonstrate that at least severe cases of SSD require the clinical knowledge and skills that only a SLP can provide and that frequent direct therapy is both beneficial and needed.     

Neuropathological changes in ten cases of neuronal intermediate filament inclusion disease (NIFID): a study using α-internexin immunohistochemistry and principal components analysis (PCA)

Summary. Ten cases of neuronal intermediate filament inclusion disease (NIFID) were studied quantitatively. The α-internexin positive neurofilament inclusions (NI) were most abundant in the motor cortex and CA sectors of the hippocampus. The densities of the NI and the swollen achromatic neurons (SN) were similar in laminae II/III and V/VI but glial cell density was greater in V/VI. The density of the NI was positively correlated with the SN and the glial cells. Principal components analysis (PCA) suggested that PC1 was associated with variation in neuronal loss in the frontal/temporal lobes and PC2 with neuronal loss in the frontal lobe and NI density in the parahippocampal gyrus. The data suggest: 1) frontal and temporal lobe degeneration in NIFID is associated with the widespread formation of NI and SN, 2) NI and SN affect cortical laminae II/III and V/VI, 3) the NI and SN affect closely related neuronal populations, and 4) variations in neuronal loss and in the density of NI were the most important sources of pathological heterogeneity.     

Commentary: Sports participation at 4 years old? Thoughts on mental health-risk trajectories in the longitudinal study of Australian children – a commentary on Vella et al. (2018)

Vella and colleagues (this issue) report on children in the kindergarten cohort of the Longitudinal Study of Australian Children (LSAC) study, using predictors from age 4 years to identify six trajectories of mental health risk from ages 4–12. Somewhat surprisingly, they find that among some predictable candidates for risk, such as sex and family income, that sports participation at age four emerges as a novel predictor of low difficulty with respect to mental health trajectories across the next 8 years. Is this a case of mens sana in corpore sano? Or is sports participation, that is, swimming, dancing, gymnastics, and team sports, a proxy for other factors? What can the various predictors and the trajectories of mental health risk from this longitudinal study tell us about interventions to reduce risk?     

Commentary: The diagnostic label of Asperger's in historical perspective – a commentary on Kehinde et al. (2021)

Eponyms and diagnoses that originate from the era of National Socialism have been re-evaluated as a result of historical research which reveal the unethical research and treatment behind the diagnosis. This article presents the case of Asperger's as a distinct diagnostic category and reflects on historical research which has provided further nuance behind the origins of this diagnosis.     

Commentary: Autism spectrum disorder and intellectual disability – an evolving landscape of clinical terminology – a commentary on Kehinde et al. (2021)

Diagnoses and words used are important. Terminology in autism spectrum disorders and intellectual disabilities is constantly changing in either diagnostic systems or everyday language. There are different pressures for terminological change from clinical, academic and societal perspectives. Clinically, the words are aligning in the 2 major diagnostic systems. This poses dilemmas for those with lived experience as well as professionals as to what words to use and when. An agreed set of words to use for diagnoses will improve understanding, respect and ensure needs are met appropriately.     

Commentary: Considering nomenclature for autism – aligning with the language preferences of the autistic community – a commentary on Kehinde et al. (2021)

Since the implementation of ‘autism’ as a diagnosable condition in the 1980s, the medical model has continued to dominate how we understand autism. More recently, there has been a rise in understanding autism through the neurodiversity model and the lived experiences of autistic people themselves. However, there is often misalignment between the medical model and the preferences of the autistic community. In particular, there are misalignments around the language we use in society to discuss autism and autistic people. Language misalignments are particularly important, with language playing an important role in conveying understandings of a group within society. This article highlights these nomenclature misalignments, focussing on (1) Asperger syndrome, (2) functioning labels, (3) severity assumptions, (4) the language of disorder and (5) identity-first compared to person-first language. The article discusses the difficulties that might present in healthcare settings as a result of these misalignments.     

Debate: Facing uncertainty with(out) a sense of control – cultural influence on adolescents’ response to the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has brought about healthcare, economic, and psychological crises around the world. The psychological impact on adolescents is likely going to be uneven across different societies, as cultures vary in terms of their dominant learning style that may influence how people cope with uncertainty and perceive their sense of control. We postulate that for adolescents in individualistic cultures where individual learning prevails, their sense of control might be undermined by societal disease-control regulations that restrict personal freedoms, while adolescents’ sense of control might increase via participating in societal preventive efforts in collectivistic cultures where social learning is more prevalent. Individual differences regarding one’s sense of control would, in turn, have implications for adolescents’ short-term adjustments to COVID-19-related challenges and their future development.     

Efficacy and safety of nabiximols (Sativex<Superscript>®</Superscript>) on multiple sclerosis spasticity in a real-life Italian monocentric study

Multiple sclerosis (MS) patients frequently suffer from limb spasticity and pain despite antispastic treatments. To investigate nabiximols efficacy and safety in a real-world monocentric Italian cohort, the following data were collected at baseline, week 4, 14 and 48: Ambulation Index (AI), 10-min walking test (10MWT), combined Modified Ashworth scale (cMAS), scores at numerical rating scale for spasticity (sNRS) and pain (pNRS). Responder status was defined as a ≥20 % reduction in sNRS after 4 weeks of treatment. 144 MS patients (123 progressive and 21 relapsing-remitting) complaining of moderate-to-severe spasticity (mean sNRS: 7.5) were included: 138 (95.8 %) completed the first month of therapy and were classified as follows—23.2 % were non-responders, 5.1 % were responders but discontinued treatment due to side effects, 71.7 % were responders with a mean 32 % reduction in sNRS (p < 0.001). In responders sNRS further decreased between 4 and 14 weeks (p = 0.03). Similarly, pNRS improvement was seen during the first month and between 4 and 14 weeks (p < 0.001 and p = 0.004, respectively). Moreover, at 4 weeks responders showed a significant (p < 0.05) improvement in cMAS, AI and 10MWT, which was maintained at 14 weeks. At 1-year follow-up, a benefit was still evident on spasticity and painful symptoms with a low drop-out rate. Confusion/ideomotor slowing, fatigue and dizziness were the most frequent side effects; no major adverse events were reported. Shorter disease duration at treatment start was associated with better response. This real-world study confirms nabiximols efficacy and safety in the treatment of MS-related spasticity and pain, which is maintained up to 48 weeks.