A retrospective case series of skeletal surveys in children with suspected non-accidental injury

INTRODUCTION: The skeletal survey is widely used as the principal radiological investigation in suspected physical abuse of infants and young children. However, the evidence on which current guidelines are based is limited, especially for siblings of index cases. We conducted a retrospective study to describe the characteristics of children who underwent skeletal surveys for suspected non-accidental injury (NAI) in the Edinburgh area; to evaluate the diagnostic efficacy of skeletal surveys; and to identify any predictive factors that might guide clinical practice. METHODS: All skeletal surveys performed at the Royal Hospital for Sick Children in Edinburgh for suspected non-accidental injury between 1/1/99 and 31/12/03 were reviewed. RESULTS: Seventy-seven children underwent skeletal surveys for suspected NAI. Data were available for 76 (70 index cases and 6 siblings). Of the index cases, 17 (24%) skeletal surveys were positive, with a mean of 2.5 fractures per child (range 0-9). The age of positive cases ranged from 2 weeks to 36 months with the majority (14, 82%) being under 12 months of age. Nine (53%) were boys. In index children with positive results, indications for skeletal survey were head injury (skull fracture in 2, 12%; intracranial injury in 4,24%); skeletal fracture (excluding skull fracture) in 6 (35%) and bruising in 4 (24%). chi(2) analysis revealed no significant differences in age, sex or primary reason for skeletal survey between those with a negative and positive skeletal survey. Six skeletal surveys were performed on siblings of children with known or suspected NAI. The siblings' ages ranged from 1 to 36 months although 3 (50%) were under 12 months of age. One (17%) of the siblings' surveys (a twin) was positive. CONCLUSION: The age of a child (<12 months) and type of presenting injury (overt fracture or head injury) are factors which can help the clinician to decide whether or not to obtain a skeletal survey. There remains a lack of evidence for the effectiveness of skeletal survey in the siblings of index children. Guidelines for the process of repeating uncertain skeletal surveys are needed.     

Speed,Variability, and Timing of Motor Output in ADHD: Which Measures are Useful for Endophenotypic Research?

Attention-Deficit/Hyperactivity Disorder (ADHD) shares a genetic basis with motor coordination problems and probably motor timing problems. In line with this, comparable problems in motor timing should be observed in first degree relatives and might, therefore, form a suitable endophenotypic candidate. This hypothesis was investigated in 238 ADHD-families (545 children) and 147 control-families (271 children). A motor timing task was administered, in which children had to produce a 1,000 ms interval. In addition to this task, two basic motor tasks were administered to examine speed and variability of motor output, when no timing component was required. Results indicated that variability in motor timing is a useful endophenotypic candidate: It was clearly associated with ADHD, it was also present in non-affected siblings, and it correlated within families. Accuracy (under- versus over-production) in motor timing appeared less useful: Even though accuracy was associated with ADHD (probands and affected siblings had a tendency to under-produce the 1,000 ms interval compared to controls), non-affected siblings did not differ from controls and sibling correlations were only marginally significant. Slow and variable motor output without timing component also appears present in ADHD, but not in non-affected siblings, suggesting these deficits not to be related to a familial vulnerability for ADHD. Deficits in motor timing could not be explained by deficits already present in basic motor output without a timing component. This suggests abnormalities in motor timing were predominantly related to deficient motor timing processes and not to general deficient motor functioning. The finding that deficits in motor timing run in ADHD-families suggests this to be a fruitful domain for further exploration in relation to the genetic underpinnings of ADHD. Edited by Irwin Waldman.     

Brief report: Physical health of adolescent perpetrators of sibling aggression

We describe adolescents' perpetration of sibling aggression and its link to physical health two years later. In-school surveys at Time 1 (N = 331) and Time 2 (two-years later, N = 283) were administered to adolescents (at Time 1, M_age = 15.71 years, SD = .63; 52% female) living in the United States querying about perpetration of aggression toward a sibling closest in age and perceived physical health. The majority of adolescents perpetrated aggression towards their sibling (74%). Adolescents who were part of brother–brother pairs reported the most aggression. Hierarchical regression analysis showed that perpetrating sibling aggression more often at Time 1 was predictive of lower physical health at Time 2 controlling for Time 1 physical health and demographic characteristics. Perpetration of aggression toward a sibling is common and has negative health consequences in late adolescence suggesting this issue should be targeted to improve adolescents' sibling dynamics and physical health.     

Family circumstance and adolescent dietary behaviours

The available information on the contribution of family circumstance to adolescent dietary behaviours is inconsistent. Indicators of family circumstance may impact adolescent behaviours by influencing their daily home environment. This study examined cross-sectional and longitudinal relationships between indicators of family circumstance and (i) breakfast skipping and (ii) consumption of snack food, fast food, fruits and vegetables among adolescents. Dietary behaviour was assessed using a web-based survey completed by 1884 adolescents from years 7 and 9 of secondary schools in Victoria, Australia, at baseline and 2 years later. Five indicators of family circumstance (parental marital status, maternal education, maternal employment status, number of brothers and number of sisters) were assessed with a questionnaire completed by parents at baseline only. Logistic regression was used to examine cross-sectional associations between indicators of family circumstance and dietary behaviours. Multinomial logistic regression was used to examine associations between indicators of family circumstance and 2-year change in dietary behaviours. Individual indicators of family circumstance were differentially associated with adolescent dietary behaviours. Cross-sectional and longitudinal associations differed for adolescent boys and girls highlighting the importance of assessing specific dietary behaviours and food types individually by gender. This study highlights the complexity of the relationships between family circumstance and adolescent dietary behaviours. Future research needs to assess the efficacy of strategies promoting maternal nutritional knowledge on the dietary behaviours of adolescents.     

Measured environmental contributions to cannabis abuse/dependence in an offspring of twins design

Genetic and environmental factors are known to contribute to cannabis abuse/dependence (CAD). We sought to determine the magnitude of the contribution from measured environmental variables to offspring cannabis dependence in a design that controls for familial vulnerability. Data come from a study of 725 twin members of the Vietnam Era Twin Registry, 720 of their biological offspring (age 18-32 years) and 427 mothers. Data were obtained on offspring perception of family and peer support and substance use behaviors and offspring CAD. After adjusting for familial risk, and environmental covariates, CAD was significantly more likely among male offspring (OR=2.73; 95% CI: 1.69-4.41). Offspring CAD was associated with reporting: siblings used illicit drugs (OR=3.40; 95% CI: 1.81-6.38), a few friends used drugs (OR=2.72; 95% CI: 1.04-7.09), a quarter or more friends used drugs (OR=8.30; 95% CI: 3.09-22.33) and one-half or more 12th grade peers used drugs (OR=3.17; 95% CI: 1.42-7.08). Perceived sibling, friend and school peer substance use are strongly associated with CAD in young adults even after accounting for latent familial risk and for multiple measured intra-family and extra-family environmental influences.     

Determination of the sensitivity and specificity of sibship calculations using AmpF lSTR Profiler Plus

In circumstances where a known DNA reference sample from the deceased’s belongings or biological parents is not available, more complex kinship analyses are possible. The purpose of the work reported here is to determine the sensitivity and specificity of the sibship analysis utilising multiple STR loci. Using all nine Profiler Plus loci, likelihood ratios for biologically-related siblings ranged from slightly less than 1 to over 45,000. When allelic dropout was mimicked, likelihood ratios ranged from less than 1 to over 1,000. Thus, the results of this study have a direct application to forensic laboratories faced with identifications involving sibling comparisons. Received: 26 April 2001 / Accepted: 9 October 2001     

Brief report: Behavioral adjustment of siblings of children with autism

Existing research studies have shown mixed results relating to the impact upon children of having a sibling with a disability. However, siblings of children with autism may be more at risk than siblings of children with other disabilities. In the present study, data were gathered on 22 siblings of children with autism. These children were rated by their mothers as having more behavior problems and fewer prosocial behaviors than a normative sample. Analysis of variables predicting sibling behavioral adjustment revealed that boys with siblings who have autism, and also those younger than their sibling with autism, engaged in fewer prosocial behaviors. Psychological adjustment of mothers (stress) and the child with autism (behavior problems) were not predictive of sibling behavioral adjustment.     

Cry features in siblings of SIDS

AIM: To examine the acoustic features of crying demonstrated by infants whose older sibling died of sudden infant death syndrome (SIDS) and compare these features to a nonrisk group of infants. METHODS: Pain-induced crying episodes were collected from a group of healthy term (HT) infants and siblings of SIDS infants. One complete crying episode was obtained from each infant and analyzed acoustically with regard to durational and spectral features. RESULTS: The cries of SIDS siblings were found to be significantly higher in pitch and reflected hyperadductory vocal fold vibratory behaviour compared to the HT group. There were no group differences with regard to durational features of crying. CONCLUSIONS: The laryngeal behaviour of infant crying, as inferred via acoustic analyses, differs between HT infants and siblings of SIDS infants. Accordingly, acoustic features of infant crying may serve as an additional diagnostic marker in the identification of children who may be at risk for SIDS.     

Familial occurrence of osteoid osteoma

Familial occurrence of osteoid osteoma is an exceedingly rare event. This paper describes the second report of this event, where two siblings presented with this lesion in the same location, the proximal left femur. They both presented at 6 years of age, but 3 years apart.