Using the five to fifteen-collateral informant questionnaire for retrospective assessment of childhood symptoms in adults with and without autism or ADHD

European Child & Adolescent Psychiatry - Due to lack of previous studies, we aimed at evaluating the use of the Five to Fifteen (FTF) questionnaire in adults with neurodevelopmental disorders...     

Pancreaticoduodenectomy for periampullary cancer in patients more than 70 years of age

BACKGROUND/AIMS: To assess the indications for and results of pancreaticoduodenectomy in patients more than 70 years old with periampullary cancer. METHODOLOGY: Thirty-four consecutive patients older than 70 years with periampullary cancer. The surgical procedure was pancreaticoduodectomy (Whipple's operation) with an extensive dissection of lymph nodes and the connective tissue in the peripancreatic region. Main outcome measures were postoperative morbidity and mortality, median and 5-year survival rates. RESULTS: Postoperative medical complications occurred in 24% and surgical complications in 53% of the patients. Four patients (12%) died in the postoperative period (within 30 days), and 3 patients (9%) died later in the postoperative course. The cumulative and age corrected 5-year survival rate for the remaining patients was 26%. Fifteen patients died of recurrence, and 7 patients of other causes. Five patients are still alive more than 5 years after surgery. In patients with noncurative operation the median survival time was 1 1/2 years, which is longer than would be expected from other palliative procedures. Apart from a moderately increased postoperative mortality the results were similar to those reported for younger patients. CONCLUSIONS: Pancreaticoduodenectomy should be considered in patients older than 70 years with resectable periampullary cancer. A 5-year survival rate of 20-35% can be obtained. Palliative resection may be indicated in patients in good general condition, as resection gives the best palliation and longer survival than other palliative methods.     

A neuropsychological study of children with elevated dentine lead level: assessment of the effect of lead in different socio-economic groups

The study was carried out in the municipality of Aarhus, a city of 250,000 inhabitants. The study was designed as a cross-sectional cohort study of school children in first grade in 1982-83. A total of 2,412 children were contacted and asked to submit their shed teeth to the teacher, and 1,291 children delivered at least one usable tooth (response rate, 54 percent). The lead level in circumpulpal dentin showed an average of 10.7 micrograms/g. Eight percent of the children (N = 110) had a lead level above 18.7 micrograms/g and were selected as a "high" lead exposure group. This group was matched by sex and socio-economic status of the parents with control children with a dentin lead level below 5 micrograms/g. Following a detailed interview with the parents, children were excluded from the study if medical risk factors were present. A clinical psychologist, blind to the lead data, administered selected psychometric tests to 162 of the children selected. The high-lead children scored lower on the WISC when compared to low-lead children, especially on the Verbal IQ (p less than 0.001) and Full Scale IQ (p less than 0.01). No significant difference was seen between the high- and low-exposure groups on the Performance IQ and on several experimental tests. Impaired function associated with lead exposure was also found on the Bender Visual Motor Gestalt Test (p less than 0.001) and on a behavioral rating scale (p less than 0.01). These results remained statistically significant even after controlling for socio-economic status and other confounding variables.     

The role of the microcirculation in delayed cerebral ischemia and chronic degenerative changes after subarachnoid hemorrhage

The mortality after aneurysmal subarachnoid hemorrhage (SAH) is 50%, and most survivors suffer severe functional and cognitive deficits. Half of SAH patients deteriorate 5 to 14 days after the initial bleeding, so-called delayed cerebral ischemia (DCI). Although often attributed to vasospasms, DCI may develop in the absence of angiographic vasospasms, and therapeutic reversal of angiographic vasospasms fails to improve patient outcome. The etiology of chronic neurodegenerative changes after SAH remains poorly understood. Brain oxygenation depends on both cerebral blood flow (CBF) and its microscopic distribution, the so-called capillary transit time heterogeneity (CTH). In theory, increased CTH can therefore lead to tissue hypoxia in the absence of severe CBF reductions, whereas reductions in CBF, paradoxically, improve brain oxygenation if CTH is critically elevated. We review potential sources of elevated CTH after SAH. Pericyte constrictions in relation to the initial ischemic episode and subsequent oxidative stress, nitric oxide depletion during the pericapillary clearance of oxyhemoglobin, vasogenic edema, leukocytosis, and astrocytic endfeet swelling are identified as potential sources of elevated CTH, and hence of metabolic derangement, after SAH. Irreversible changes in capillary morphology and function are predicted to contribute to long-term relative tissue hypoxia, inflammation, and neurodegeneration. We discuss diagnostic and therapeutic implications of these predictions.     

What distinguishes autism spectrum disorders from other developmental disorders before the age of four years?

Abstract The increasing recognition of the benefits of early intervention for children with autism spectrum disorder (ASD) stresses the importance of early identification of children who might benefit from those programs. However, in the early years of life it may be difficult to distinguish children with ASD from children with other developmental disorders. The aim of the present study was to identify behavioural patterns that could facilitate this differentiation. Prior to diagnostic assessment, 2- and 3-year-old children (n=30), all referred to a clinic for possible autism, were observed in a semi-structured play interaction, and their parents were interviewed about the childrens early development from 0 to 24 months. Following diagnostic assessment, the 17 children fulfilling the ICD-10 criteria for ASD were compared to the 13 children diagnosed with other developmental disorders (outside the autism spectrum). On the basis of parent reports only a few distinguishing signs of ASD were found before 24 months of age. On the basis of professional observations in a semi-structured play interaction several distinguishing signs were found for the 2- and 3-year-olds; smiles in response, responds to name, follows pointing, looks to read faces, initiates requesting verbal and nonverbal behaviours, and functional play.     

Validating neuropsychological subtypes of ADHD: how do children with and without an executive function deficit differ?

Objective: The study investigates behavioural, academic, cognitive, and motivational aspects of functioning in school‐age children with attention‐deficit/hyperactivity disorder (ADHD) with and without an executive function deficit (EFD). Method: Children with ADHD – EFD (n = 22) and children with ADHD + EFD (n = 26) were compared on aspects of ADHD behaviour, school functioning, general cognitive ability, intra‐individual response variability, affective decision‐making, and delay aversion. Results: Children with ADHD – EFD and children with ADHD + EFD were comparable in terms of ADHD symptomatology and school functioning. However, children with ADHD + EFD had significantly lower IQ and more intra‐individual response variability than no EFD counterparts. Children with ADHD alone appeared more delay averse on the C‐DT task than children with ADHD + EFD. Conclusions: Some children with ADHD were primarily characterised by problems with executive functions and variability others by problems with delay aversion supporting multiple pathway models of ADHD. Given the exploratory nature of the study, results are in need of replication.     

Predictors of Change in Relationship Satisfaction during the Transition to Parenthood

Couple‐focused interventions have shown limited success at preventing relationship satisfaction decline in couples during transition to parenthood. More knowledge on what constitutes relationship risk may inform future practice. This study investigated the role of underexplored individual and contextual risk factors through interactive and additive models. Participating couples (N = 228) completed questionnaires during pregnancy and at 6 and 30 months postpartum. The authors used bootstrapped Bayesian information criterion analyses to select significant and reliable predictors of change in relationship satisfaction within three predefined sets of factors representing components of the vulnerability‐stress‐adaptation model. Anxiety and depression symptoms during pregnancy, shorter length of the relationship, and lower levels of constructive communication predicted declines in relationship satisfaction from pregnancy to 30‐months postpartum. When these risk factors were combined, additive rather than interactive risk models were supported. Practical implications of additive risk factors are discussed     

Theory of Mind in Non-Retarded Children with Autism and Asperger's Syndrome. A Research Note

In the present study, 20 non-retarded children with autism and 20 non-retarded children with Asperger's syndrome, individually matched to the group of children with autism, participated. No statistically significant differences between the groups were found in the theory of mind tasks. In fact, the two groups performed almost as well as a group of normal children. These findings suggest that the theory of mind model has its limitations in explaining autism and that children with Asperger's syndrome are not more competent in theory of mind tasks than children with autism within the normal range of intelligence.     

Developmental profiles on the basis of the FTF (Five to Fifteen) questionnaire-clinical validity and utility of the FTF in a child psychiatric sample

The Five to Fifteen parent questionnaire (FTF) was developed to offer a neuropsychological dimension to the assessment of children with Attention Deficit/Hyperactivity Disorder and other child psychiatric disorders. The domains included in the FTF were motor skills, executive functions, perception, memory, language, social skills and learning, in addition to a domain for emotional and behavioural problems. The aim of the present study was to test the clinical validity and utility of the FTF with a main focus on discriminant and criterion validity. The clinical sample consisted of 155 clinically diagnosed children (ICD-10 criteria), 102 were tested with WISC-III. The parents rated their children independent of the diagnostic evaluation. The results were presented as profiles. These clinical profiles were compared to those of a Swedish norm sample consisting of 854 children from the age of five to fifteen. Results demonstrated that the profiles for the clinical groups were similar in forms and levels to those of the upper 10 percent of the norm sample (those with most difficulties). Five out of eight FTF domains discriminated significantly between diagnostic groups in the clinical sample. Influence of IQ, gender and age on the results were low. Three out of four relevant FTF domains correlated significantly with corresponding WISC-III indexes/measures. The clinical utility of individual children's profiles were demonstrated. On the whole, the findings supported the clinical validity and utility of the FTF.