Intellectual Functioning In Children Research Articles

The effects of motor and intellectual functions on the effectiveness of comprehensive rehabilitation in young children with cerebral palsy.

To determine the effects of motor and intellectual functions on the effectiveness of comprehensive rehabilitation (CR) in young children with cerebral palsy (CP). This longitudinal cohort study recruited paediatric patients with a confirmed diagnosis of CP. Baseline gross motor function was classified using the Gross Motor Function Classification System. Baseline intellectual level was evaluated using the Developmental Quotient (DQ) via the Gesell Development Scale. Children underwent CR for 3 months and then their motor and intellectual functions were assessed using the Gross Motor Function Measure, Fine Motor Function Measure and DQ. The changes from baseline were calculated. Forty-eight children with CP were recruited to this study. Greater improvements in motor function were associated with a lower baseline level of intellectual impairment. Motor and intellectual function in children with CP was significantly improved when treatment was started before 12 months of age. There might be a close and reciprocal relationship between the baseline levels of impairment of motor and intellectual function with regard to the effectiveness of CR. Early intervention is important to gain a good outcome in children with CP.

Evaluating the use of the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q) to estimate IQ in children with low intellectual ability.

In situations where completing a full intellectual assessment is not possible or desirable the clinician or researcher may require an alternative means of accurately estimating intellectual functioning. There has been limited research in the use of proxy IQ measures in children with an intellectual disability or low IQ. The present study aimed to provide a means of converting total scores from a screening tool (the Child and Adolescent Intellectual Disability Screening Questionnaire: CAIDS-Q) to an estimated IQ. A series of linear regression analyses were conducted on data from 428 children and young people referred to clinical services, where FSIQ was predicted from CAIDS-Q total scores. Analyses were conducted for three age groups between ages 6 and 18 years. The study presents a conversion table for converting CAIDS-Q total scores to estimates of FSIQ, with corresponding 95% prediction intervals to allow the clinician or researcher to estimate FSIQ scores from CAIDS-Q total scores. It is emphasised that, while this conversion may offer a quick means of estimating intellectual functioning in children with a below average IQ, it should be used with caution, especially in children aged between 6 and 8 years old.

WISC-IV Intellectual Profiles in Italian Children With Specific Learning Disorder and Related Impairments in Reading, Written Expression, and Mathematics

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders grouped specific learning disabilities in the single diagnostic category of specific learning disorder (SLD), with specifiers for impairments in reading, written expression, and mathematics. This study aimed at investigating the intellectual profile, assessed with the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV), of 172 children with a diagnosis of SLD, compared to 74 clinical referral controls. WISC-IV intellectual functioning in children with SLD was characterized by a significant discrepancy between general ability and cognitive proficiency (General Ability Index [GAI] > Cognitive Proficiency Index [CPI]), and worse performances on the Similarities, Digit Span, Letter–Number Sequencing, and Coding subtests, supporting models of multiple cognitive deficits at the basis of neurodevelopmental disorders as SLD. GAI was the best and more conservative measure provided by the WISC-IV to identify intellectual functioning in children with SLD, and the intellectual discrepancy between GAI and CPI could be considered a “cognitive sign” for the presence of SLD in a single diagnostic category. Cognitive deficits differed in subtypes of impairment (reading, written expression, and mathematics), supporting their distinction for empirical, educational, and rehabilitative purposes. These findings need further replication in larger samples and in comparison to typically developing children.

Depleted uranium instead of lead in munitions: the lesser evil

Uranium has many similarities to lead in its exposure mechanisms, metabolism and target organs. However, lead is more toxic, which is reflected in the threshold limit values. The main potential hazard associated with depleted uranium is inhalation of the aerosols created when a projectile hits an armoured target. A person can be exposed to lead in similar ways. Accidental dangerous exposures can result from contact with both substances. Encountering uranium fragments is of minor significance because of the low penetration depth of alpha particles emitted by uranium: they are unable to penetrate even the superficial keratin layer of human skin. An additional cancer risk attributable to the uranium exposure might be significant only in case of prolonged contact of the contaminant with susceptible tissues. Lead intoxication can be observed in the wounded, in workers manufacturing munitions etc; moreover, lead has been documented to have a negative impact on the intellectual function of children at very low blood concentrations. It is concluded on the basis of the literature overview that replacement of lead by depleted uranium in munitions would be environmentally beneficial or largely insignificant because both lead and uranium are present in the environment.

Arsenic methylation capacity and developmental delay in preschool children in Taiwan

Environmental exposure to lead or mercury can cause neurodevelopmental damage. Arsenic is another neurotoxicant that can affect intellectual function in children. This study was designed to explore the difference of arsenic methylation capacity indices between with and without developmental delay in preschool children. We also aimed to identify whether blood levels of lead or mercury modify the effect of arsenic methylation capacity indices. A cross sectional study was conducted from August 2010 to March 2012. All participants recruited from the Shin Kong Wu Ho-Su Memorial Teaching Hospital. In all, 63 children with developmental delay and 35 children without developmental delay were recruited. Urinary arsenic species, including arsenite (As(III)), arsenate (As(V)), monomethylarsonic acid (MMA(V)) and dimethylarsinic acid (DMA(V)) were measured with a high-performance liquid chromatography-linked hydride generator and atomic absorption spectrometry. Lead and mercury levels of red blood cells were measured by inductively coupled mass spectrometry. All participants underwent developmental assessments to confirm developmental delays, including evaluations of gross motor, fine motor, speech-language, cognition, social, and emotional domains. Urinary total arsenic and MMA(V) percentage were significantly positively associated and DMA(V) percentage was negatively associated with the risk of developmental delay in a dose-dependent manner after adjustment for blood lead or mercury levels and other risk factors. A multivariate regression analysis indicated that blood lead level and arsenic methylation capacity each independently contributed to the risk of developmental delay. This is the first study to show that arsenic methylation capacity is associated with developmental delay, even without obvious environmental arsenic exposure.

Subtypes of Intellectual Disability in School-Aged Children

Purpose: To explore the presence of subtypes of intellectual functioning in children with mild intellectual disability (ID) and to externally validate the subtypes on measures of academic, adaptive and psychosocial functioning. Method: Participants were 167 children age 6-16 years with a mild ID. All children completed the WISC-III, WIAT, VABS, and PIC-R. Results: Based on a two-stage cluster analysis on the four WISC-III Index scores four subtypes emerged reflecting distinct profiles: (1) language-strength subtype; (2) nonverbal strength subtype; (3) symbol-processing strength subtype; and (4) global deficits subtype. The subtypes were externally validated on tests of academic achievement, adaptive functioning, and psychosocial functioning. Conclusions: Rather than only demonstrating a global or “flat” pattern of cognitive deficits, the findings suggest that children with mild ID have certain profiles of intellectual functioning that are similar to those seen in normal children and children with learning disabilities.

Intellectual functioning in children with epilepsy: Frontal lobe epilepsy, childhood absence epilepsy and benign epilepsy with centro-temporal spikes

PurposeThe purpose of our study is to describe intellectual functioning in three common childhood epilepsy syndromes – frontal lobe epilepsy (FLE), childhood absence epilepsy (CAE) and benign epilepsy with centro-temporal spikes (BECTS). And also to determine the influence of epilepsy related variables, type of epilepsy, age at epilepsy onset, duration and frequency of epilepsy, and treatment on the scores. MethodsIntellectual functioning was examined in a group of 90 children with epilepsy (30 FLE, 30 CAE, 30 BECTS), aged 6–15 years, and compared with a control group (30). All subjects obtained a Full Scale IQ≥70 and they were receiving no more than two antiepileptic medications. Participants completed the Wechsler Intelligence Scale for Children – Third Edition. The impact of epilepsy related variables (type of epilepsy, age at epilepsy onset, duration of epilepsy, seizure frequency and anti-epileptic drugs) on intellectual functioning was examined. ResultsChildren with FLE scored significantly worse than controls on WISC-III Verbal IQ, Full Scale IQ and Processing Speed Index. There was a trend for children with FLE to have lower intelligence scores than CAE and BECTS groups. Linear regression analysis showed no effect for age at onset, frequency of seizures and treatment. Type of epilepsy and duration of epilepsy were the best indicators of intellectual functioning. ConclusionIt is crucial that children with FLE and those with a longer active duration of epilepsy are closely monitored to allow the early identification and evaluation of cognitive problems, in order to establish adequate and timely school intervention plans.

Intellectual functioning in children with MPS VI

Intellectual functioning in children with MPS VI

Comparison of the Leiter International Performance Scale—Revised and the Stanford-Binet Intelligence Scales, 5th Edition, in Children with Autism Spectrum Disorders

A review of hospital records was conducted for children evaluated for autism spectrum disorders who completed both the Leiter International Performance Scale-Revised (Leiter-R) and Stanford-Binet Intelligence Scales, 5th Edition (SB5). Participants were between 3 and 12 years of age. Diagnoses were autistic disorder (n = 26, 55%) and pervasive developmental disorder-not otherwise specified (n = 21, 45%). Analysis showed that the full sample received significantly higher scores on the Leiter-R than SB5 (mean discrepancy of 20.91 points), specific diagnosis was not a significant factor, and younger children had a larger discrepancy between tests. These analyses strongly suggest that the Leiter-R and the SB5 may not be equivalent measures of intellectual functioning in children with autism spectrum disorders, and that use of one or the other exclusively could lead to misclassification of intellectual capacity.

Is recovery from a pervasive developmental disorder possible?

‘UNLIKELY’ IS THE answer to this question until recently, as pervasive developmental disorders (PDD) have generally been regarded as severe and life-long conditions; however, this does not seem to be the case now. Three lines of research findings may support this view. The first is that several recent epidemiological studies on PDD or autism spectrum disorders (ASD) reported a higher prevalence of children with PDD/ASD and a higher rate of children with no intellectual disability or even normal intellectual functioning in children with PDD/ASD than previously reported. In 2006, Baird et al. reported that 45% of 158 children with ASD identified in a total population of 56 946 children aged 9–10 years (ASD prevalence, 1.16%) in South Thames, UK had an IQ of 70 or over.1 In 2008, Kawamura et al. reported that 66.4% of 223 IQ-measured children in 228 children with PDD in a total population of 12 589 children aged 1.1–7.2 years in Toyota, Japan had an IQ of 70 or over (PDD prevalence, 1.81%).2 In 2011, Kim et al. reported that 84% of 172 children with ASD identified in the general population of 23 234 children aged 7–12 years in Korea (ASD prevalence, 1.89%) were not intellectually disabled.3 Although these epidemiological studies did not report prevalence by PDD subtype, such a favorable prospect certainly applies to milder PDD subtypes (Asperger's disorder, pervasive developmental disorder not otherwise specified [PDD-NOS] and a part of autistic disorder) but not to severer ones (Rett's disorder and childhood disintegrative disorder). The reason for the recent surge in the prevalence of PDD/ASD, especially of its milder form, is still in dispute. However, the dominant view is the advancement in system and methods to detect children with PDD, especially those with milder impairments who had otherwise been overlooked in older days, although the true rise in the incidence of PDD is not negated. The second is that some recent studies reported children with PDD/ASD (even though a small minority) who showed satisfactory improvement over time. Turner and Stone reported that 63% of 48 children diagnosed as having ASD at age 2 did not meet ASD diagnostic criteria at age 4.4 Kleinman et al. reported that 15 (19%) of 77 children who were diagnosed as having ASD before age 3 moved off ASD between the ages of 3.5 and 6.8 years.5 Helt et al. reviewed that 3–25% of children with ASD lost ASD diagnosis and achieved a normal range of cognitive and adaptive functioning at follow up.6 And the third is that several studies reported favorable outcomes in young children with PDD/ASD who had received early intervention after early detection. Dawson et al. reported the efficacy of a comprehensive developmental behavioral intervention for improving cognitive and adaptive behavior and reducing ASD severity in 48 children with ASD aged 18–30 months in the first randomized controlled trial.7 Magiati et al. showed the similar efficacy of two early interventions (i.e., home-based early intensive behavior intervention and autism-specific nursery provision) for improving cognitive ability, language, play or autism severity in 44 children with ASD aged 23–53 months in a two-year follow-up study.8 In clinical practices these days, a clinician not infrequently meets a child who definitely meets the diagnostic criteria for some PDD subtype in infancy but does not continue to do so at follow up, even less than a few years later. In that event, the clinician would tell the parents of the child that their child is in partial remission from the PDD subtype if the child does not satisfy the diagnostic criteria for the PDD subtype but has some residual symptoms. And the clinician would tell parents that their child is in full remission from the PDD subtype if the child does not show any symptoms of the PDD subtype. However, we must be cautious about the distinction between full remission and recovery. Full remission means disappearance of clinical symptoms as defined in the diagnostic criteria but recovery requires more (i.e., at least disappearances of clinical symptoms and adaptation disturbances are essential). Although DSM-IV9 has the definitions of partial and full remissions, we need to study the definition and predictors of recovery in view of the recent trend of improving outcomes in PDD. Nonetheless, with high rates of high-functioning or normally intelligent children with PDD and advancement of early intervention for infants with PDD, clinicians will have increasing opportunities to inform parents of young children with PDD that their children would have favorable outcomes, including full remission or even recovery, which was an unlikely judgment for clinicians last century.

Relationship Between Gross Motor and Intellectual Function in Children With Cerebral Palsy: A Cross-Sectional Study

Dalvand H, Dehghan L, Hadian MR, Feizy A, Hosseini SA. Relationship between gross motor and intellectual function in children with cerebral palsy: a cross-sectional study. ObjectiveTo explore the relationship between gross motor and intellectual function in children with cerebral palsy (CP). DesignA cross-sectional study. SettingOccupational therapy clinic. ParticipantsChildren with CP (N=662; 281 girls, 381 boys; age range, 3–14y). InterventionsNot applicable. Main Outcome MeasuresIntelligence testing was carried out by means of the Wechsler Preschool and Primary Scale of Intelligence and the Wechsler Intelligence Scale for Children–Revised. Gross motor function level was determined by the Gross Motor Function Classification System Expanded and Revised (GMFCS E&R). ResultsOf the children, 10.4% were at level I of the GMFCS E&R, 38% at levels II and III, and 51.5% at levels IV and V. The lowest level of intelligence or profound intellectual disability was found in children with spastic quadriplegia (n=28, 62.2%). Children at the lowest levels (I–IV, GMFCS E&R) obtained higher ratings in terms of intelligence in comparison with children at level V. Based on the present results, the diagnosis was statistically related to the intellectual level as dependent variable (P<.01); accordingly, hypotonic, quadriplegic, and hemiplegic patients had the highest odds to assign higher ratings in abnormal intelligence, respectively. Sex and age were not statistically related to the dependent variable. ConclusionsThe study results demonstrated a significant association between GMFCS E&R and intellectual function. Therefore, we suggest that particular attention should be paid to the intellectual level in terms of evaluations of gross motor function. These results, in respect, might be interested for occupational and physical therapists who are involved in rehabilitation programs for these children.

An Assessment of Relationship Between Arsenic in Drinking Water, Health Status and Intellectual Functioning of Children in District Kasur

In this study determination of arsenic (As) contamination in the drinking water and urine of children along with its effect on their health status and intellectual functioning was assessed. The study was carried out in order to determine any correlation between intake of arsenic and intellectual functioning level of the children. Raven Standard Progressive Matrices (RPM) was administered on children of (8-15) years of age to assess their intellectual functioning and their health status was checked by measuring their height and weight. Water and urine sample were studied in both experimental and control group. In experimental area Arsenic level was above the World Health Organization (WHO) permissible value which was compared with control area having arsenic level below WHO permissible value in both water and urine. An average 45% of arsenic level in drinking water samples was above WHO permissible value (10 μg/L). Considering urinary arsenic as a biomarker of exposure to arsenic through drinking water, it was found that an average of 50% of children of the experimental group were found to have arsenic in their urine ranging from a concentration of 0.01-0.0119 μg/L. Conclusively, this study showed that the intellectual functioning level of children drinking arsenic contaminated water was significantly lower as compared to those, drinking arsenic-free water.

Relationship between working memory and intellectual functioning in children with mild intellectual disability

The research was aimed to determine the relationship between working memory and intelligence in children with mild intellectual disability (MID), ages 10 to 14. The sample encompassed 53 children with MID, 47.2% of girls and 52.8% of boys. Their IQ ranges from 50 to 70 (AS=63.17; SD=6.56). The tasks that assess the Central Executive aspect of the working memory system, namely in verbal and non-verbal modality, have been selected. The obtained results indicate that working memory ('central executor') and intelligence are the constructs that significantly correlate in the range of 0.29 to 0.41, depending upon the working memory modality. It was determined that IQ category explains about 19% of the variability of the verbal and non-verbal working memory results, grouped in the unified model (p<0.05). However, the statistically significant relation was determined by means of the individual variables analysis only between IQ and non-verbal working memory (p<0.01). The statistically significant differences have also been determined in the non-verbal working memory development in the participants belonging to lower and higher IQ categories (p<0.05).

Borderline intellectual functioning in children and adolescents – insufficiently recognized difficulties

To draw attention to groups of children and adolescents with borderline intellectual functioning, especially with respect to their school-situation. In one study, population-based, children with borderline intellectual functioning at age 10 years were followed until they finished compulsory school when their final certificates could be analysed. In a second study parents of 20 individuals in the upper secondary school for pupils with mild mental retardation were interviewed according to the Vineland adaptive scales and school health records were reviewed. In a third study pupils attending an individual programme in upper secondary school were assessed and we report one representative case. (1) Pupils with borderline intellectual functioning, assessed in grade 4, received significantly lower grades when finishing the compulsory school. (2) In the group of pupils in the upper secondary school for the mildly mentally retarded, compiled data indicated that a considerable number did not fulfil the combined IQ and adaptive criteria for mild mental retardation. (3) The subtle nature of borderline intellectual functioning may delay appropriate measures at school, which our case illustrates. Borderline intellectual functioning seldom attracts attention. Our studies indicate that school and also society at large must be prepared to adapt educational and working conditions for the large minority of individuals with borderline intellectual functioning.

The Impact of Children with High-Functioning Autism on Parental Stress, Sibling Adjustment, and Family Functioning

The article discusses a study conducted to investigate the impact of children with high-functioning autism (HFA) on parental stress, sibling adjustment, and family functioning; the study involves a sample of parents of 15 children with HFA and parents of 15 matched control children who completed questionnaires measuring the dependent variables. The results indicate parents of children with HFA experience significantly more parenting stress than parents of children with no psychological disorder, which was found to be directly related to characteristics of the children. The study further shows that the higher intellectual functioning in children with HFA does not compensate for the stress associated with parenting children with autism spectrum disorders. Because the intervention efforts directed at children with HFA will not eliminate the child's primary symptoms, treatment programs may need to address parental stress, which in turn will help optimize treatment outcome for the child and the family.

Intellectual Functioning in Children with Early Shunted Posthemorrhagic Hydrocephalus

Objectives: Early intervention for cognitive impairments seen in children with hydrocephalus is key to successful developmental outcome. Thus, the examination of the cognitive and behavioral functioning of children with hydrocephalus is important, given increasing survival rates and the potential to implement successful cognitive interventions. The current literature suggests that intellectual impairment is common in hydrocephalus patients, yet the findings vary concerning the extent and specifics of the cognitive deficits seen in these children. To better understand the pattern of cognitive impairment observed in children with shunted hydrocephalus, the present study examined a cohort of children with hydrocephalus uniformly shunted with a nonsiphoning valve in the first year of life. Methods: Forty-one children and adolescents with a history of congenital hydrocephalus, who were shunted with nonsiphoning valves in the first year of life and are currently achieving academically within 1 year of appropriate school grade for their chronological age, were compared to 16 nonaffected age- and education-level-matched controls. The subjects completed a comprehensive neuropsychological battery that included the Wechsler Intelligence Scale for Children, Third Edition, (WISC-III) as a measure of general intellectual functioning. Performances across the WISC-III were compared between the 2 groups. Results: The data were normally distributed for both groups. The children shunted for hydrocephalus scored approximately 1 standard deviation lower than the controls on the measures of general intellectual functioning (shunted group mean WISC-III full-scale intelligence quotient = 83.8 vs. control mean full-scale intelligence quotient = 102.9, p ≤ 0.001), verbal intellectual skill development [shunted group mean WISC-III verbal IQ (VIQ) = 86.6 vs. control mean VIQ = 107.1, p ≤ 0.001] and visuospatial and perceptual-organizational skill development [shunted group mean WISC-III performance IQ (PIQ) = 83.6 vs. control mean PIQ = 98.2; p ≤ 0.006]. History of shunt revisions, infections, prematurity, seizures and hemorrhage was not significantly correlated with intellectual functioning. While VIQ and PIQ have been reported as discrepant in many previous studies of cognitive functioning after shunting due to hydrocephalus, the current results revealed statistically similar VIQ/PIQ performance (Spearman’s ρ rank order r_s = 0.685, p ≤ 0.001). Conclusions: Intellectual functioning in this selected group of children with hydrocephalus is normally distributed, yet significantly below that of nonaffected peers. Previously reported discrepancies between VIQ and PIQ were not evident in our study. This finding may be accounted for by the selectivity of our study population, implying a differential effect of etiology and treatment on intellectual function outcome in hydrocephalic children.

Intellectual function in children with teacher reported language problems

We predicted that teacher reported language problems are associated with low IQ, even when gender and behavior-emotional disorders are controlled for. All subjects were participants in a population based study. In stage 1, teachers completed a questionnaire containing four items pertaining to language function. A case-control sample (n= 294) was assessed using WISC-III and Kiddie-SADS-PL. A child was defined with "language problems" (LP) if s/he obtained a score indicating severe problems on at least one item. Teacher reported LP was found in 9.9% of the population sample and 20.7% of the case-control sample, with a three-fold higher risk for boys than girls. The LP group obtained significantly lower scores on all WISC-III factors compared with the non-LP group. The differences were not accounted for by the presence of behavioral-emotional disorders. When primary school teachers report LP, further assessment of the child's cognitive function is warranted.

Manganese and Infant Mortality: Well Water May Raise Death Rates in Bangladesh

Many wells in Bangladesh exceed the WHO threshold for manganese of 0.4 mg/L—in the Araihazar region in eastern Bangladesh, 80% of the wells provide water with manganese concentrations above 0.5 mg/L. A new study now suggests that manganese exposure through drinking water may contribute to Bangladesh’s extremely high infant mortality rate of 54 per 1,000 live births [EHP 115:1107–1112; Hafeman et al.]. Well water in Bangladesh already receives close scrutiny for its naturally high levels of arsenic, a known carcinogen. Manganese is also a concern, however, due to research showing associations between exposure and subclinical neurological effects in adults and decreased intellectual function in children. Additionally, neonatal animal studies have linked reduced weight gain and decreased survival to manganese exposure. An ongoing cohort study in Araihazar, the Health Effects of Arsenic Longitudinal Study (HEALS), provided the framework for investigating whether manganese might affect human infant survival. Of the HEALS participants, 1,628 women met the criteria for the current study: they married before age 40, drank from the same well for most of their reproductive years, and reported at least one live birth. The researchers considered concentrations of manganese and other metals in the wells used by the target population, the mothers’ reproductive history and education, and the families’ socioeconomic status and other factors that can affect infant survival. Although breastfeeding rates are high in Bangladesh, newborns are often given sugar water in place of colostrum, and most young infants receive complementary foods by age 6 months. Of the 3,824 infants born to the study group, nearly 85% were exposed to water manganese levels above 0.4 mg/L, and 335 died before age 1 year, an elevated risk of death not explained by measured covariates. The finding was more pronounced when restricted to women married after 1991, who appeared to give more complete reproductive histories; among these women, the infant death rate was 82 per 1,000 live births. No dose–response relationship was seen, though, and the association was not found when analysis was restricted to water samples collected for the current study. The researchers recommend designing a study specifically to investigate the role of manganese exposure in infant mortality, with particular attention to causes of mortality and potential routes of exposure.

Health‐related quality of life and intellectual functioning in children in remission from acute lymphoblastic leukaemia

To evaluate the health-related quality of life (HRQOL) and intellectual functioning of children in remission from acute lymphoblastic leukaemia (ALL). Children and adolescents treated for ALL (n = 40; mean age 11.8 years, range 8.5-15.4) and healthy controls (n = 42; mean age 11.8, range 8.11-15.0) were assessed through a cross-sectional approach using the Pediatric Quality of Life inventory (PedsQL) 4.0 and the Wechsler Intelligent Scale for children-III (WISC-III). Children and adolescents treated for ALL reported on average significantly lower HRQOL compared to healthy controls: the mother's proxy-report showed significantly lower HRQOL for their children, as did the father's proxy-report, measured by the PedsQL 4.0 Total Scale and Psychosocial Health Scale. Intellectual functioning as measured by the WISC-III Full Scale IQ was below that of the control group, but still within the normal range. Significant differences found between children treated for ALL and their control group for the PedsQL Psychosocial Health Scale may indicate that the complex illness-treatment experience can make children more vulnerable with regard to psychosocial sequels, in spite of otherwise satisfactory physical and intellectual functioning. Follow-up programs that target the psychosocial health of children in remission from ALL should be implemented.

Propylthiouracil Versus Methimazole in Treatment of Graves' Disease During Pregnancy

To evaluate the evidence supporting the use of propylthiouracil (PTU) versus methimazole for the treatment of Graves' disease during pregnancy. An English-language literature search was conducted using MEDLINE (1966-March 2007). Identified articles were then reviewed for additional sources. Search terms included hyperthyroidism, Graves' disease, pregnancy, propylthiouracil, and methimazole. All clinical trials and case reports that were published in English and reported either subjective or objective outcomes were reviewed. Rationale supporting the use of PTU over methimazole in treatment of Graves' disease during pregnancy is limited. Theories suggesting that PTU has less placental transfer to the fetus than methimazole are not supported by current literature. Studies demonstrating a causal relationship between methimazole use during pregnancy and congenital anomalies and/or fetal hypothyroidism do not exist. The selection of PTU versus methimazole for the treatment of Graves' disease during pregnancy should not be based solely on the following assumptions: that PTU crosses the placenta less than methimazole, that PTU leads to less fetal hypothyroidism, or that exposure to methimazole during pregnancy leads to decreased intellectual function in children. However, due to a possible association between the use of methimazole during pregnancy and fetal anomalies such as aplasia cutis, esophageal atresia, and choanal atresia, methimazole may be a less desirable first-line treatment for Graves' disease in pregnancy than PTU. Therefore, in the absence of a compelling indication for the use of methimazole, PTU should still be considered as the first-line agent in the treatment of Graves' disease during pregnancy. Methimazole should be considered a viable second choice if the patient is intolerant to PTU, has an allergic reaction to PTU, or fails to become euthyroid while receiving PTU.