IQ Impairment Research Articles

Severe Congenital Lead Poisoning in Siblings.

Congenital lead toxicity is rare. Lead freely crosses the placenta, therefore, placing the developing fetus at a higher risk for lead toxicity. This can lead to adverse consequences, such as spontaneous abortion, low birth weight, low IQ, and neurodevelopmental impairment. We present a rare case of siblings born to a mother with pica behaviors. Her venous lead level was 42 μg/dL at the time of disclosure. The repeat venous level at delivery 2 weeks later was 61 μg/dL. The infant's venous level shortly after birth was 89 μg/dL. The neonate was transferred to the NICU, where he received 9 doses of intramuscular dimercaprol and 5 days of intravenous Ca2Na2EDTA. Seventy-two hours after completing chelation, the blood lead level rebounded to 46 μg/dL. A 19-day course of dimercaptosuccinic acid was then initiated. As of 12 months of age, he has not required additional chelation. Shortly after, the mother conceived another child, who was born prematurely at 29 weeks. Twelve days before delivery, the mother's lead level was 30 ug/dL. The infant's lead level was 32 ug/dL at the time of delivery. The infant's lead trended down without requiring chelation. Both children have since demonstrated developmental delays and have needed early intervention services.

Cognitive- and memory-enhancing activity of Cinnamon (Cinnamomum zeylanicum) aqueous extract in lead acetate-exposed rats

BackgroundLead (Pb) exposure has been linked to reduced academic performance, lower IQ, cognitive and memory impairments, and other psychiatric conditions such as depression and anxiety. Natural antioxidants and dietary sources of phytochemicals, including Cinnamomum zeylanicum (CZ), have been investigated to possibly replace the current adverse reacting drugs used to treat Pb poisoning. Consequently, this study evaluated the activity of CZ against Pb-mediated neurotoxicity. MethodsWistar rats were assigned into six groups (n = 8) namely: Control; Lead acetate (Pb; 100 mg kg−1 body weight [BW]); CZ-pre-treated groups (CZ1 [200 mg.kg−1 BW] + Pb and CZ2 [400 mg kg−1 BW] + Pb); and CZ-only groups (CZ1 and CZ2). After 28 days, neurobehavioral, antioxidant, lipid peroxidation, nitric oxide, and Pb concentration levels, as well as hippocampal and cerebral histology, were evaluated. ResultsFindings showed a significant reduction (p < 0.05) in final body and whole brain weights, cognition, and memory impairments, dysregulation of antioxidant enzymes, lipid peroxidation, and elevated nitric oxide as well as high Pb concentrations in the hippocampus and cerebrum of Pb-exposed rats following comparison to the control and CZ pretreated rats. Histological findings revealed morphological alterations with vacuolated tissue architecture in the hippocampus and cerebrum of Pb-exposed rats while the rats pre-treated with CZ showed similar morphology to the control rats. ConclusionAltogether, the findings showed that CZ was not toxic to the rats but protected against Pb toxicity, mediated possibly through its potent antioxidant, nitric oxide scavenging, and metal chelation activity.

Robust, wide-range, and precise transmitter IQ impairment monitoring scheme for coherent digital subcarrier multiplexing systems.

In this Letter, we present a robust, wide-range, and precise monitoring scheme for transmitter (Tx) impairments in coherent digital subcarrier multiplexing (DSCM) systems. The proposed scheme employs frequency-domain pilot tones (FPTs) to compensate for frequency offset (FO), polarization aliasing, and carrier phase noise, thus isolating Tx impairments from channel distortions. It then implements 4 × 4 real-valued MIMO to compensate for Tx impairments by equalizing symmetric subcarriers. Tx impairment monitoring is derived from the equalizer coefficients. By considering the phase shift caused by Tx impairments, a wide-range and precise monitoring of Tx impairments including IQ skew, IQ phase, and gain imbalances is achieved. We experimentally validated our approach using a 48-GBaud, four-subcarrier, dual-polarization coherent DSCM system. The results confirm the method's capability for a wide-range, robust, and precise Tx impairment monitoring in coherent DSCM systems, maintaining performance even in the presence of ultra-fast polarization variation.

The Role of Everyday Executive Function in Observed Social Symptoms of Autism Spectrum Disorder.

Recent research suggests there may be differences in the social presentations of autistic males and females. Camouflaging is believed to account for some of these differences and executive function (EF) may support compensatory social behaviors. As few studies have explored the role of sex and everyday EF when evaluating specific social difficulties among autistic youth, the present study seeks to address this. The Social Responsiveness Scale-2 (SRS-2) was used to measure types of social difficulties and the Behavioral Rating Inventory of Executive Function-2 (BRIEF-2) served as a measure of everyday EF. Four three-step hierarchical multiple regressions were conducted with SRS-2 social subscales as dependent variables. Autism symptom severity, BRIEF-2 EF Indices (i.e., behavioral, emotional, and cognitive regulation), and sex served as independent variables. Types of EF impairment significantly predicted social symptoms of autism. Behavioral dysregulation predicted all social symptoms assessed, cognitive dysregulation predicted social awareness and communication challenges, and emotion dysregulation predicted social motivation and communication difficulties. Sex significantly predicted social communication and cognition challenges, beyond the contributions of age, IQ, autism severity, and EF impairment. Findings from this study provide evidence for the contribution of EF to observed social symptoms of autism. Results suggest there may be sex-based differences in the relationship between EF and social problems for autistic youth. Implications and future directions are discussed.

Digital Coherent Receiver Enabling Nyquist Wavelength Demultiplexing Under Frequency Offset and Receiver-Side IQ Impairments

Digital Coherent Receiver Enabling Nyquist Wavelength Demultiplexing Under Frequency Offset and Receiver-Side IQ Impairments

Cognitive Support Technology for People with Intellectual Disabilities: Factors for Successful Implementation

In Europe, large numbers of people with disabilities are willing to work but have problems finding a job. One of the barriers to this is job complexity, particularly for those with low education, low IQ, or cognitive impairments. Digital technologies might help. Specifically, cognitive support technology (CST) has the potential to make jobs less complex and thus more accessible. CST may concern step-by-step digital instructions presented with monitors, tablets, smart phones, beamer projections, or near-eye displays. Based on cross-case evaluations, we aimed to define the success factors in the process of technology selection, development, and implementation. Four cases, situated at public social firms which offer jobs to people with disabilities, were selected. In each case, the optimal form of CST was selected. A qualitative analysis of subjective experiences of work accessibility, performance, usability, and acceptance was applied. The results were positive for most participants in most cases. Once installed, the CST was successful in simplifying jobs. A proportion of the workforce for which a specific job had been considered too complex was able to perform that job when supported by CST. Moreover, a majority of people judged the usability of the technology positively. For the consecutive steps of selection, development, and implementation, we ended up with eleven factors of success; these included, among others, shared and transparent decision making (in technology selection), the iterative and active involvement of workers to optimally adjust work instructions (in technology development), and explicit attention for psychosocial barriers (in technology implementation).

Re-appraisal of callosotomy: rates and predictors of short-term seizure outcome in pediatric epileptic encephalopathy

BackgroundEpilepsy is a chronic debilitating disease especially in pediatric population. Most of reported studies for corpus callosotomy as a palliative surgery in drug-resistant cases are on limited number of cases and there is scarcity in literature for outcomes reported from developing countries. Here, we present our study on a large series of cases with analysis of potential predicators outcomes in the era of more expensive devices like vagal nerve stimulation to give a litany on a universal epilepsy surgery procedure which had been missed in the literature through the last decade.ResultsAn observational retrospective study was done reviewing 129 patients with PEE underwent open microscopic corpus callosotomy. Total and drop attack seizure outcomes were studied after surgery. Potential outcomes predictors studied are: preoperative EEG and MRI. Preoperative IQ impairment epilepsy duration, age at diagnosis, MRI finding, IQ score, EEG findings, history of infantile spasm and extent of callosotomy done. All the recorded outcomes were substantially improved after callosotomy in our study population of 129 pediatric patients. The median (IQR) preoperative drop attack frequency was 70 (21–140) which decreased to 3 (0–14) postoperatively. Similarly, the number of anti-epileptics used by patients had a median of 3 (2–4) which decreased to 2 (2–3) after the surgery. All patients were experiencing status epilepticus which disappeared in 72% of the patients after callosotomy. Preoperative normal MRI was a predictor for drop attack favorable outcome and mild preoperative impairment of IQ was a predictor of favorable total seizure and drop attack outcome.ConclusionsCorpus callosotomy is a well-tolerated palliative procedure for drug-resistant generalized epilepsy notably, drop attacks which had its notorious effect on quality of life of pediatric patients and their families, no appreciable prognostic factors for favorable outcome were clearly observed except for normal preoperative MRI, mild preoperative IQ affection, and complete callosotomy.

Digital Four-Dimensional Transceiver IQ Characterization

Signal impairments caused by the relative characteristic differences and crosstalk between electrical in-phase (I) lanes and quadrature (Q) lanes are some of the main obstacles to the development of 100-Gbaud-class high-symbol-rate transceivers. To address such IQ impairments, we propose a method for enabling fully frequency-resolved four-dimensional (4D) characterization of IQ impairments even in the presence of arbitrary crosstalk across four IQ lanes of polarization-multiplexed transceivers. We formulated a 4D signal-propagation model that takes into account inter-polarization IQ crosstalk and found how to separate the 4D IQ characteristics of the transmitter and receiver from the coefficients of a single-layer complex 8×2 multiple-input multiple-output adaptive equalizer on the basis of the model. We also introduce an application of the method for characterizing typical IQ impairments (e.g., IQ skew, IQ amplitude imbalance, phase deviation) from the filter coefficients. We numerically and experimentally tested our method with 96-Gbaud 16QAM signals and demonstrated its feasibility.

Low-complexity two-stage equalizer for receiver IQ imbalance compensation and polarization demultiplexing for real-time System

Reducing the complexity of adaptive equalizer is significant for realizing real-time hardware systems. In this paper, we propose a low-complexity two-stage equalizer that can be used in real-time systems. The performance of the proposed equalizer was verified through a 112 Gbit/s polarization multiplexing quadrature phase shift keying (PM-QPSK) back-to-back experiment with a receiver IQ impairment emulation module. The results revealed that, as for FIR module, compared with the conventional 2 × 2 MIMO, the number of multipliers in the proposed equalizer can be reduced by approximately 70% by use of 21 taps, while this equalizer is less sensitive to IQ impairment.

Compensation and monitoring of transmitter and receiver impairments in 10,000-km single-mode fiber transmission by adaptive multi-layer filters with augmented inputs.

We propose an adaptive multi-layer (ML) filter architecture to compensate for linear impairments that occur in transmitter (Tx) and receiver (Rx) components in ultra-long-haul optical fiber transmission systems, in which large chromatic dispersion (CD) accumulates in the received signal. The architecture consists of strictly linear (SL) and widely linear (WL) filter layers, and the coefficients of the ML filters are adaptively controlled by gradient calculation with back propagation and stochastic gradient descent. Static CD compensation is performed on the received signal and its complex conjugate before the adaptive ML filters. These augmented signals are then the inputs of the first 2×1 SL filter layer of the ML filters, for compensation of in-phase (I) and quadrature (Q) impairments on the Rx side. Tx IQ impairments and polarization effects as well as Rx IQ impairments are adaptively compensated in the ML filters. By sweeping CD compensation filters before the ML filters, this architecture mitigates the computational complexity for back propagation of the ML filters especially for ultra-long-haul transmission, while mutual non-commutativity between the WL filter for IQ impairment compensation and the CD compensation filter is appropriately solved. We evaluated the proposed adaptive ML filter architecture with augmented inputs through both simulation and wavelength-division multiplexed transmission experiments of 32-Gbaud polarization-division-multiplexed 64-quadrature amplitude modulation-based probabilistic constellation shaped signals over 10,000 km of single-mode fiber (SMF). The results demonstrated that the proposed adaptive ML filter architecture effectively compensates for Tx and Rx IQ skews in ultra-long-haul SMF transmission, and that impairments can be monitored individually from the converged filter coefficients of the corresponding layers.

Effects of Pediatric Traumatic Brain Injury on Verbal IQ: A Systematic Review and Meta-Analysis.

To examine the effects of pediatric traumatic brain injury (TBI) on verbal IQ by severity and over time. A systematic review and subsequent meta-analysis of verbal IQ by TBI severity were conducted using a random effects model. Subgroup analysis included two epochs of time (e.g., <12 months postinjury and ≥12 months postinjury). Nineteen articles met inclusion criteria after an extensive literature search in MEDLINE, PsycInfo, Embase, and CINAHL. Meta-analysis revealed negative effects of injury across severities for verbal IQ and at both time epochs except for mild TBI < 12 months postinjury. Statistical heterogeneity (i.e., between-study variability) stemmed from studies with inconsistent classification of mild TBI, small sample sizes, and in studies of mixed TBI severities, although not significant. Risk of bias on estimated effects was generally low (k = 15) except for studies with confounding bias (e.g., lack of group matching by socio-demographics; k = 2) and measurement bias (e.g., outdated measure at time of original study, translated measure; k = 2). Children with TBI demonstrate long-term impairment in verbal IQ, regardless of severity. Future studies are encouraged to include scores from subtests within verbal IQ (e.g., vocabulary, similarities, comprehension) in addition to functional language measures (e.g., narrative discourse, reading comprehension, verbal reasoning) to elucidate higher-level language difficulties experienced in this population.

光收发机IQ损伤宽范围联合估计新型DSP方案

光收发机IQ损伤宽范围联合估计新型DSP方案

Neurocognitive Functioning among Children with Sickle Cell Anemia Attending SCA Clinic at MNH, Dar es Salaam, Tanzania

Background Children with sickle cell anemia are at a higher risk of developing neurological sequelae like abnormal intellectual functioning, poor academic performance, abnormal fine motor functioning, and attentional deficits. There is a paucity of data about neurocognitive impairment among children with sickle cell anemia in Tanzania. Recognition of the magnitude of neurocognitive impairment will help to provide insight in the causative as well as preventive aspects of the same. Therefore, this study was carried out to determine the prevalence and factors associated with neurocognitive impairment in children with sickle cell anemia. Methods This is a cross-sectional comparative study between children with SCA and a control group of the hemoglobin AA sibling. It was carried out in Muhimbili National Hospital during a five-month period. The Rey–Osterrieth Complex Figure test (ROCF) which is used to test memory and visual special functions and KOH block design tools that have been previously validated through another study locally were used. Additional information on demographic characteristics was also collected using a predetermined questionnaire. Proportions and comparisons of means were used to examine associations between neurocognitive impairment and independent variables for associated factors. Results A total of 313 children were included in the final analysis. Among all the participants, the majority of the participants in the sickle cell group were of the age group 14-15 years (45.9%). In the comparison group, the majority were of the age group 9-10 years (43.8%). The neurocognitive scores in children with sickle cell anemia were significantly different from the normal siblings. In the copy ROCF, the neurocognitive function in SCA participants was 68.2% below the mean as compared to 45% of their counterparts, p ≤ 0.001. Additionally, there was no difference in memory in children with SCA compared to normal siblings (14.8% vs. 12.5%, respectively, p=0.606). Children with SCA had a higher proportion of impaired IQ (85.4%) as compared to children without SCA (72.5%), and the difference was statistically significant, p=0.009. Factors associated with neurocognitive impairment were age above 13 years, BMI, and absenteeism from school. Conclusion and Recommendation. Children with SCA had more impairment in terms of copying and IQ. We recommend assessment at the younger age group, increased sample size in future studies, and long-term cohort follow-up.

Clinical Lessons From Studies of Children With Specific Language Impairment

PurposeThis clinical focus article addresses a current debate contrasting the long-standing label of “specific language impairment” (SLI) with a recent alternative, “developmental language disorders” (DLDs); the criteria for SLI yields a subset of children defined as DLD. Recent social media advocacy for DLD asserts that the two categories of children are clinically equivalent, and therefore, DLD can be used as a label for which SLI criteria would hold. Coupled with DLD advocacy is the assumption that research on SLI has not yielded clinically relevant outcomes. This clinical focus article challenges those assumptions. The clinical focus article is framed as parallels between precision medicine and evidence-based practice. The purposes of this clinical focus article are as follows: (a) revisit the legacy of research on SLI; (b) describe language development in children with SLI into adulthood; (c) address widespread but erroneous assumptions about relationships between speech impairments and language impairments, and relationships between nonverbal IQ and language impairments; (d) briefly review evidence for causal pathways; and (e) present clinical lessons from research on children with SLI.MethodNarrative review is the method used in the study.ConclusionsThe purposes of the clinical focus article were met by reviews, commentary, and supporting arguments in each section. The conclusions are that the research and clinical category of SLI is needed for accurate and precise clinical practice, including diagnosis, prognosis, clinical goals, sequencing of tasks for success, and consideration of language disorders in the context of a broad thicket of related consequences.

Visuospatial Attention and Saccadic Inhibitory Control in Children With Cerebral Palsy.

Cerebral palsy (CP) is a non-progressive syndrome due to a pre-, peri- or post-natal brain injury, which frequently involves an impairment of non-motor abilities. The aim of this article was to examine visuospatial attention and inhibitory control of prepotent motor responses in children with CP showing a normal IQ or mild cognitive impairment, measuring their performance in oculomotor tasks. Ten children (9–16-year-old) with spastic CP and 13 age-matched, typically developing children (TDC) participated in the study. Subjects performed a simple visually-guided saccade task and a cue-target task, in which they performed a saccade towards a peripheral target, after a non-informative visual cue was flashed 150 ms before the imperative target, either at the same (valid) or at a different (invalid) spatial position. Children with CP showed severe executive deficits in maintaining sustained attention and complying with task instructions. Furthermore, saccadic inhibitory control appeared to be significantly impaired in the presence of both stimulus-driven and goal-directed captures of attention. In fact, patients showed great difficulties in suppressing saccades not only to the cue stimuli but also to the always-present target placeholders, which represented powerful attentional attractors that had to be covertly attended throughout the task execution. Moreover, impairment did not affect in equal manner the whole visual field but showed a marked spatial selectivity in each individual subject. Saccade latencies in the cue-target task were faster in the valid than in the invalid condition in both child groups, indicating the preservation of low-level visuospatial attentive capabilities. Finally, this study provides evidence that these impairments of executive skills and in inhibitory control, following early brain injuries, manifest in childhood but recover to virtually normal level during adolescence.

Teasing Apart the Impact of Illness and IQ on Functional Neuroimaging Findings in Schizophrenia

Schizophrenia is a major psychiatric disorder associated with cognitive impairment. Functional brain imaging (fMRI) studies of schizophrenia patients reveal a complex pattern of brain differences in the prefrontal cortex. Both decreased (hypofrontality) and increased (hyperfrontality) activity have been reported in patients – inconsistencies that this paper argues could be explained by differences in IQ between patients and healthy controls. This study demonstrates a novel method to tease apart IQ and schizophrenia effects on brain activity. Twelve schizophrenia patients were matched to twelve healthy controls matched to patients’ estimated (premorbid) IQ before their illness, and twelve healthy controls matched to patients’ measured current IQ. All participants performed an executive function event-related fMRI task. Schizophrenia patients’ mean behavioral scores fell numerically between those of both control groups, and did not differ significantly from either group. Two distinct patterns of brain activity were found that were consistent with an effect due to either IQ impairment or schizophrenia diagnosis. Schizophrenia patients’ relatively reduced activity in middle/superior frontal (BA6/BA8) regions was related to their schizophrenia diagnosis, whereas their relatively increased activity in inferior frontal (BA44/45) and left middle frontal (BA8/9) regionsrelated instead to their current IQ impairment. These findings indicate that some fMRI differences reported in schizophrenia patients are artefacts of IQ matching. After removing the IQ confounds, schizophrenia was associated with lateral frontal hypoactivations and medial frontal failure of deactivation. This paper proposes a method to address IQ matching-related issues when studying populations where their illness involves cognitive deterioration.

Using kinematic analyses to explore sensorimotor control impairments in children with 22q11.2 deletion syndrome

BackgroundThe 22q11.2 deletion is associated with psychiatric and behavioural disorders, intellectual disability and multiple physical abnormalities. Recent research also indicates impaired coordination skills may be part of the clinical phenotype. This study aimed to characterise sensorimotor control abilities in children with 22q11.2 deletion syndrome (22q11.2DS) and investigate their relationships with co-occurring IQ impairments and psychopathology.MethodsFifty-four children with 22q11.2DS and 24 unaffected sibling controls, comparable in age and gender, underwent kinematic analysis of their hand movements, whilst performing a battery of three visuo-manual coordination tasks that measured their tracking, aiming and steering abilities. Additionally, standardised assessments of full-scale IQ (FSIQ), attention deficit hyperactivity disorder, indicative autism spectrum disorder (ASD) and anxiety disorder symptomatology were conducted.ResultsChildren with 22q11.2DS showed deficits on seven of eight kinematic descriptors of movement quality across the three coordination tasks, compared to controls. Within 22q11.2DS cases, the extent of impairment on only three kinematic descriptors was significantly related to FSIQ after correction for multiple testing. Moreover, only error whilst visuo-manually tracking was nominally associated with ADHD symptom counts.ConclusionsImpairments in sensorimotor control are seen on a range of visuo-manual tasks in children with 22q11.2DS but the extent of these impairments are largely unrelated to the severity of other psychopathological and intellectual impairments commonly found in children with 22q11.2DS.

Modeling the Risk of Neurocognitive Effects from Radiation Therapy in Childhood Cancer Survivors: Initial Results From the Pediatric Normal Tissue Effects in the Clinic (PENTEC) CNS Task Force

Brain injury from radiation therapy (RT) includes necrosis and neurocognitive (NC) impairment that can affect childhood cancer survivors’ quality-of-life. PENTEC seeks to quantitate RT dose-dependence of adverse effects and the risk modification by age and other factors. The PENTEC CNS task force reports preliminary results of RT related NC outcomes. A literature search for studies reporting incidence of RT associated NC sequelae (impaired IQ, NC function, or need for special education) was performed. Prescribed doses were converted to equivalent 2 Gy/fraction (EQD2). The Lyman-Kutcher-Burman formalism with generalized equivalent uniform dose (gEUD) was used for modeling normal tissue complication probability (NTCP) of NC effects. For whole brain (WB)/craniospinal or partial brain (PB) RT it was assumed that the prescribed dose uniformly irradiated the entire brain or 1/8 of the brain, respectively. In this analysis, a simple composite variable reflecting various NC endpoints was used. The model was fitted using a weighted least squares method and corrected for the patient number in each study. Best-fit parameter confidence intervals were determined using a bootstrap resampling technique. The search identified 1173 abstracts; each was evaluated by 2 reviewers. Two hundred nineteen studies with useful information were short-listed. The 62 highest scored articles were abstracted and the 19 studies (21 data sets, 1498 patients) with objective NC testing and RT data were analyzed (Table). Preliminary results show a sigmoidal dose-response for NC impairments: D50 corresponding to 50% risk of complication of 26.6 Gy (68% CI 25.5-27.9 Gy); slope of dose response 0.35 (0.31-0.40) and volume parameter 0.46 (0.40-0.59). The model indicates a 5% NC risk associated with 11.3 Gy WB and 29.8 Gy PB RT.Abstract 1032; TableStudyYearPtsWB/CS Dose (Gy)Focal Dose (Gy)Neurocognitive Function DeclineIncidence of Endpoint %Fouladi200331-52.2IQ0Fouladi Focal200538-54IQ < 7023.6Fouladi CSI20051418-3051.9IQ71.4Waber19952718-IQ0Krull201310224-IQ52Vern-Gross201434-59.4IQ0Agbahiwe2017483656IQ54.1Merchant2000823.4-3250.4IQ12.5Merchant200488-23.4-32IQ0Merchant200978-54IQ100Merchant201477-52.13IQ0Merchant20145823.4-39.655.8NC100Edelstein20112418-General50Waber200412518-General0Christopherson20143928.854General49Krull 18 Gy201316718-General12.3Krull 24 Gy201318624-General27Jakacki200461854Status50Cheng20162223.440Process Speed33.3Van Dijk201228521-24.849.3-51.3Disorder14.4Yeom20134118-39.654Special Ed70 Open table in a new tab The initial results of this meta-analysis confirm a RT dose and volume relationship to NC injury risk. Further model refinement will include the effect of age, chemotherapy and include a formal evaluation of heterogeneity across studies.

Risk Factors for Mental Health Problems in Children with Cerebral Palsy and Spina Bifida

Children with cerebral palsy (CP) and spina bifida (SB) are at an increased risk for mental health problems. Aim of this study was to correlate disease specific and psychosocial risk factors with characteristic mental health problems. 271 children with CP and 84 with SB aged 3-17 years were included in a cross sectional study of 15 centers. Parents answered the Strengths and Difficulties Questionnaire (SDQ) for mental health problems, rated social participation of their children and gave data to their own educational and professional level. IQ and motor impairment were tested or rated by the caring pediatricians. Abnormal Total-Difficulties Scores were found in CP (30,2%) and SB (18,1%) as compared to the norm (10,0%). Increased prevalences persisted after controlling for IQ as covariate. In both groups, moderate correlations between externalizing problems and levels of cognitive and motor impairment were found. Emotional problems correlated with participation irrespective of level of impairment. Weak correlations were found with age and gender in both groups. After controlling for IQ as covariate mental health problems showed no systematic difference between both groups. Mental health problems in children and youth with CP and SB are frequent. They correlated with various risk factors (IQ, motor impairment, age, gender, participation). Early recognition, participation and psychotherapeutic facilities should be strengthened.

Attainment of Functional and Social Independence in Adult Survivors of Pediatric CNS Tumors: A Report From the St Jude Lifetime Cohort Study.

Purpose Beyond survival, achieving independence is a primary goal for adult survivors of pediatric CNS tumors. However, the prevalence of and risk factors for failure to achieve independence, assessed with multiple concurrent indicators, have not been examined. Patients and Methods Functional and social independence was assessed in 306 survivors (astrocytoma [n = 130], medulloblastoma [n = 77], ependymoma [n = 36], and other [n = 63]; median current age, 25.3 years [range, 18.9 to 53.1 years]; time since diagnosis, 16.8 years [range, 10.6 to 41.8 years]). Six observed indicators were used to identify latent classes of independence, which included employment, living independently, assistance with personal care, assistance with routine needs, obtaining a driver's license, and marital status. Physical performance impairments were defined as scores < 10th percentile on measures of aerobic capacity, strength, flexibility, balance, mobility, and adaptive function. Multinomial logistic regression estimated odds ratios (ORs) and 95% CIs were calculated for associations of disease/treatment exposures and impairments in physical performance with nonindependence. Results Three classes of independence were identified as independent (40%), moderately independent (34%), and nonindependent (26%). In multivariable models, craniospinal irradiation (OR, 4.20; 95% CI, 1.69 to 10.44) and younger age at diagnosis (OR, 1.24; 95% CI, 1.14 to 1.35) were associated with risk of nonindependence versus independence. Beyond impaired IQ, limitations in aerobic capacity (OR, 5.47; 95% CI, 1.78 to 16.76), flexibility (OR, 3.66; 95% CI, 1.11 to 12.03), and adaptive physical function (OR, 11.54; 95% CI, 3.57 to 37.27) were associated with nonindependence versus independence. Nonindependent survivors reported reduced physical but not mental health-related quality of life compared with independent survivors. Conclusion Sixty percent of survivors of pediatric CNS tumors do not achieve complete independence as adults. Reduction in intensity of primary therapies and interventions that target physical performance and adaptive deficits may help survivors to achieve greater independence.