Intellectually Disabled Children Research Articles

Comparison of stool antigen immunoassay and serology for screening for Helicobacter pylori infection in intellectually disabled children

Diagnosis of active Helicobacter pylori infection in intellectually disabled (ID) children is problematic because they are unable to cooperate with performance of invasive tests. In this study, the non-invasive methods of measuring serum IgG antibody concentrations and performing stool antigen tests were used to screen for H. pylori infection in ID children. Eighty-seven children with intellectual disabilities were studied. The amount of serum IgG antibody against H. pylori was measured by the ELISA method. Stool samples were examined using an amplified IDEIA HpStAR kit. To assess categorical variables, X(2) , Fisher's exact and Kappa tests were used. The stool antigen tests showed that 93.1% of the children had H. pylori antigen and the serology test that 85.1% of children were positive for H. pylori IgG antibodies. Agreement between results of H. pylori stool antigen (HpSA) testing and IgG antibody serology was 82.8%; however, according to the kappa measure of agreement this agreement is not statistically significant (value, 0.128; P = 0.19). Discordant results were observed for 15 children (17.2%): 11 (12.6%) who were positive on HpSA test but negative by serology and 4 (4.6%) who were IgG seropositive but had negative HpSA tests. This study showed a notably higher rate of H. pylori infection in ID children than has been reported by others for non-ID children from the same geographical area. The HpSA test is a valid method for primary screening for H. pylori infection in ID children; it detects the specific antigens shed during active infections and has less cross-reactivity than serological tests that detect antibodies. HpSA is a sensitive non-invasive method for detecting infection in ID children and may serve as an accurate alternative to serology.

The Coexistence of Psychiatric Disorders and Intellectual Disability in Children Aged 3–18 Years in the Barwani District, India

Background. The coexistence of psychiatric disorders in people with intellectual disability (ID) is common. This study determined the prevalence of psychiatric disorders in children with ID in Barwani, India. Method. A total of 262 children with ID were evaluated for psychiatric disorders using the diagnostic criteria outlined in the International Classification of Diseases (ICD-10). Results. Psychiatric disorders appeared in study participants at the following rates: attention deficit hyperactivity disorder (ADHD), 6.5%; autism, 4.2%; anxiety, 2.7%; bipolar disorder, 1.1%; delusional disorder, 0.8%; depression, 2.3%; obsessive-compulsive disorder, 0.8%; schizophrenia, 1.9%; enuresis, 10.3%; epilepsy, 23.7%; and behavioral problems, 80.9%. The prevalence of psychiatric disorders was statistically higher in severely intellectually disabled children (IQ ≤ 49) than mildly intellectually disabled children (IQ ≥ 50). Conclusions. There is a higher prevalence of psychiatric disorders in children with ID when their IQ ≤ 49 compared with ID children whose IQ ≥ 50.

Obesity and overweight in intellectual and non‐intellectually disabled children

Few studies have compared overweight and obesity in intellectually disabled (ID) and non-intellectually disabled (N-ID) children. This research compared the prevalence of overweight and obesity between a sample of 218 ID and 229 N-ID school pupils in Northern Ireland (NI). Comparison of the physical activity and dietary behaviour of the two groups of school pupils were also undertaken. Each pupil completed (assisted if required) a food intake and physical activity questionnaire. Following this body mass index (BMI) and waist circumference were measured and recorded. Significantly more ID pupils (72, 33%) were overweight/obese compared with 55 (24%) of the N-ID pupils in accordance with their BMI. ID pupils also had significantly higher waist circumferences. Over a quarter of foods consumed by the pupils were fatty and sugary foods and close to 30% of these foods were eaten by the ID children. Pupils spent most of their time engaging in low levels of activity such as reading, watching TV, on games consoles and listening to music. Pupils with an ID spent fewer hours on moderate and high levels of activities compared with those children with N-ID. Results of this study found higher levels of overweight and obesity in this sample than in international published research. Additionally significantly higher numbers of ID pupils were overweight and obese indicating the need for future research and public health to focus on this issue.

Altered serum pro-inflammatory cytokines in children with Down's syndrome

There are reports showing that pro-inflammatory cytokines are dysregulated in patients with Down's syndrome (DS). However, most of these reports concern adults. We analyzed cytokine levels in serum samples from children with DS, and compared them with samples from intellectually disabled (ID), and healthy, control children. Blood samples were collected from 24 DS, 24 age-/sex-matched ID, and 24 age-/sex-matched healthy, control children. Serum levels of the cytokines IL-5, IL-10, IL-13, IFN-γ, and TNF-α were measured using a sandwich ELISA method, . The age range of the children was 1-15 years, with a mean ± SD of 5.75 ± 4.36 years. TNF-α levels were significantly higher in the DS and ID groups compared with those found in healthy, control children (P<0.05). The DS and ID groups had significantly higher IFN-γ levels compared with healthy, control children (P = 0.0002 and P<0.01, respectively), with significant higher levels in the DS than the ID group (P<0.05). Serum from the ID group showed significantly higher IL-10 levels compared with those from the DS group (P<0.05), but not the healthy, control group. Significant correlations were found between the differences in TNF-α and IFN-γ levels, in both ID (rs = 0.558; P = 0.005) and DS children (rs = 0.405; P<0.05). There were no significant differences found in serum levels of IL-13 between the groups, and IL-5 was not detectable in any of the serum samples. Levels of TNF-α and IFN-γ were increased, and IL-10 decreased in serum from children with DS. It may be that these differences contribute to the clinical symptoms seen in DS: consequently, these pro-inflammatory cytokines might be useful as early biomarkers of the disorders associated with DS.

Superior Mesenteric Artery Syndrome in Intellectually Disabled Children

Superior mesenteric artery syndrome (SMAS) is a rare cause of small intestinal obstruction in pediatric patients. Children with intellectual disabilities are a challenging patient population in which to make this diagnosis. The goal of this study was to determine the frequency, presenting symptoms, and outcomes of SMAS in intellectually disabled and non-intellectually disabled children. Retrospective chart review of pediatric patients with SMAS admitted to Penn State Hershey Children's Hospital between January 1999 and July 2010. Sixteen children with SMAS were identified. The majority were male (n = 9) and more than two thirds had an intellectual disability (n = 11). Presenting symptoms were similar between groups, but 78% (7/9) of intellectually disabled patients who had a gastrostomy tube presented with feeding intolerance. Although intellectually disabled patients had a higher number of comorbidities and the number of health care visits before diagnosis was higher, this did not reach statistical significance. There were also no significant differences in length of symptoms before diagnosis and amount of weight loss. However, the weight-for-age percentiles in intellectual disabled children were significantly lower in those without an intellectual disability (9.09 [20.31] vs 48 [20.19], respectively, P ≤ 0.001). Seventy-five percent of patients responded favorably to conservative treatment, but 36% (4/11) of intellectually disabled patients required multiple treatments before there was an improvement in their condition. Superior mesenteric artery syndrome was found more often in children with an intellectual disability. These data highlight the need to consider SMAS if there is difficulty tolerating gastrostomy tube feedings in patients with weight-for-age percentiles less than 5%.

Helicobacter pylori Seropositivity in Institutionalized Children With Down Syndrome

To the Editors: Helicobacter pylori is usually acquired in early infancy and probably persists throughout the life.1 Host genetic background, environment, and bacterial determinants contribute to the development of H. pylori-associated diseases.2 Poor living and socioeconomic conditions as well as overcrowding are among the main risk factors for infection during childhood.3 Children with Down syndrome (DS) have multiple immunologic defects.4 It remains controversial whether abnormality of immune responses in such children increases the propensity to infections. We undertook a study to find H. pylori seropositivity among children with DS compared with age- and gender-matched children having other intellectual disabilities with similar nutritional regimen and living and hygienic environment. Peripheral blood samples were collected from 24 children with DS and 24 children with other intellectual disabilities who were residents of 3 institutes for intellectually disabled children in Tehran. The paired match of each DS case was selected from other intellectual disabilities cases of the same institute, so the matched cases had similar living conditions. Serum H. pylori-specific immunoglobulin G (IgG) antibody was measured using ELISA (enzyme-linked immunosorbent assay) method, according to manufacturer's instructions (IMMUNOLAB GmbH, Germany). The results were considered positive if H. pylori IgG titer were >0.1 U/mL. For statistical analysis, χ2 test and nonparametric tests (Mann-Whitney and Kruskal–Wallis tests) were used. A P value of ≤0.05 was considered statistically significant. The DS and other intellectual disabilities groups each consisted of 13 females and 11 males, ranging in age from 1 to 15 years, and the mean age ± SD was 5.75 ± 4.35. H. pylori-specific IgG was detected in 17 of 24 (70.8%) DS children with a median titer of 30.09 U/mL. Among other intellectual disabilities children, 15 of 24 (62.5%) were seropositive with a median IgG of 34.34 U/mL. The seroprevalence of H. pylori infection in children with DS did not significantly differ from that in children suffering from other intellectual disabilities (odds ratio: 1.45; 95% confidence interval: 0.43–4.87). In the current small groups, seropositivity rates were similar in DS and other intellectual disabilities children in relation to age. More than half of seropositive children in DS (52.9%) and other intellectual disabilities (60%) groups were younger than 6 years, and this difference was not statistically significant. The median duration of institutionalization was 30 months (range, 6–96 months) for DS group and 24 months (range, 7–96 months) for other intellectual disabilities group. The antibody response against H. pylori was not associated with gender and duration of institutionalization. The current study demonstrated high seropositivity for H. pylori in DS children. The high seropositivity may be attributed to the fact that overcrowding, sanitary conditions, and dietary regimen in childhood affect the route of H. pylori transmission and infection.3 No significant difference was found in the risk of H. pylori seropositivity between children with DS and those with other intellectual disabilities. Two studies have reported H. pylori seropositivity in children with DS with lower rates. Jaber5 assessed 24 children with DS in Saudi Arabia and found a 29.2% seropositivity rate. A study of 46 children with DS by Failla et al6 showed that 19.5% of cases were seropositive. Both studies were of noninstitutionalized children with DS, whereas we examined children reside permanently in the institutes. Hence, the higher seropositivity of H. pylori infection might be explained by institutionalization and sanitary conditions as major risk factors. On the other hand, children with DS did not show a significantly higher susceptibility to H. pylori infection than children with other intellectual disabilities. It seems that host response against H. pylori infection is similarly influenced by environmental conditions in DS versus other intellectually disabled cases. Masoumeh Douraghi, PhD Department of Microbiology Shahid Beheshti University of Medical Sciences Division of Microbiology Department of Pathobiology School of Public Health Tehran University of Medical Sciences Tehran, Iran Hossein Goudarzi, MD, PhD Department of Microbiology Shahid Beheshti University of Medical Sciences [email protected] Mahmoud Nateghi Rostami, PhD Department of Public Health Qom University of Medical Sciences Qom, Iran Elnaz Sadat Mirsamadi, MSc Department of Microbiology Shahid Beheshti University of Medical Sciences Tehran, Iran

Prevalence of overweight in adolescents with intellectual deficiency. Differences in socio-educative context, physical activity and dietary habits

The study investigates the prevalence of overweight and obesity in a population of intellectually disabled (ID) adolescents. An observational study was conducted on a group of 410 ID children, living in France. Overweight and obesity, defined according to international standards, were analyzed and related to demographic and sociological parameters, educational care, physical activity and dietary habits. The study highlighted a high prevalence of overweight and obesity (19.0%) in ID adolescents and 22.5% in oldest teenagers, age 15–20 y. This observation was more likely in medico-educative institutes (25.1%) than in general schools (12.3%). Average time spent in physical activity was 4.5 h/week, compared with 3.5 h/week in obese subjects. Time spent in sedentary behavior was 26.6 h/week for the whole population, compared with 18.6 h/week in obese adolescents. Meals were ingested regularly, and adherence to eating breakfast was good. However, snacks and soft drinks were consumed between and during meals by 66.5% of subjects. Overweight in young ID appeared to be related to parental overweight. Even though ID adolescents receive a balanced diet and practice sport regularly, they exhibit a high prevalence for overweight and obesity. In subjects more than 15 years of age, enrollment in medico-educative institutes and parental overweight were contributory factors to poor weight status.

Social Workers' Intervention Preferences in Cases of Parental Violence Toward Intellectually Disabled Children

ABSTRACT Children with intellectual disabilities are at risk of being abused by family members. This study sought to identify factors influencing the intervention decisions of social workers. Fifty-nine social workers employed at welfare services participated in the study. The study used a factorial survey design describing a violent interaction between a child with intellectual disability and a parent. Professional characteristics of the workers as well as personal attitudinal characteristics had no significant effect on the preference of intervention mode. However, levels of child and parental aggression presented in the vignettes did influence the preferred intervention. Child's challenging behavior plays an important and increasing role in preferences for more intrusive and authoritative interventions, even after controlling for parental aggression.

Theory of Mind and socio-affective abilities in disabled children and adolescents

Relations between theory of mind (ToM) and socioaffective abilities perceived by adults in intellectually disabled (ID) children and typically developing (TD) children matched on their developmental age were investigated. Seven tasks assessed ToM abilities; two measures of understanding of emotions and five tasks concerning the perception of self and others’ beliefs. Results showed that developmental patterns of ToM were partially similar (emotions) and partially different (beliefs) in ID group in comparison with TD group. Parents’ and teachers’ perceptions of socioaffective abilities were assessed by a questionnaire. TD children were perceived by their parents and teachers as presenting more socioaffective competences than ID children and adolescents. Differences observed between the two groups in family and school characteristics did not predict participants’ abilities in ToM. In addition, teachers’ perceptions in specialized schools were the most linked with the understanding of emotions and beliefs displayed by their ID pupils. Methodological aspects of this study and perspectives for psychoeducative intervention are discussed.

Diseño de Juegos Basados en el Paradigma de Gramáticas Artificiales Para Favorecer el Aprendizaje Implícito en Niños

Two computer-based games were developed based on Reber’s Artificial Grammar Paradigm, in order to facilitate implicit learning ocurrence in normal (N), ADHD, and intellectually disabled (ID) children. Results show that N and ADHD children perform above chance level, as opposed to ID children whose performance is equivalent to random response. These findings show that ADHD children learn through implicit paths as well as children without attention problems, independently of the game used.

Omeprazole: Therapy of choice in institutionalized intellectually-disabled children

We examined 157 patients aged from 1 day to 17 years (92 males and 65 females). Main indications were: caustic (73 pts) or foreign body (FB) ingestion (42 pts) and gastrointestinal bleeding (GIB) (40 pts). 2 patients were examined for severe and intractable hemesis. 73.8% of examinations were performed under general anaesthesia, 6.2 % with conscious sedation and 20 % with no sedation nor anaesthesia. 27.3% of patients had an endoscopic treatment. All caustic ingestions but four were accidental. 56.1% of these patients showed different degree lesions, evaluated on the basis of Niguarda '90 classification (Acta Endoscopica, 22 (4)~ 413-418, 1992). We retrieved as soon as possible any object lodged in the oesophagus. Those located in the stomach were removed in emergencY only if they could be dangerous because of their size, sharpness or possible toxicity; otherwise they were removed after 48-72 hours if they didn't cross the pylorus. Since we observed one case of mucosal lesion due to corrosive leakage from a disk-battery which Stayed in the stomach for almost 48 hours, we planned to retrieve them from the gastric cavity within 24 hours. 35 (87.5%) of all FB were successfully removed. In 5 patients (11.9%) FB had already reached the jejunum at the moment of endoscopy and couldn't be retrieved. In 2 patients FB couldn't be endoscopically localized because of the presence of food. Emergency gastrointestinal endoscopy led to a correct diagnosis of the source of bleeding in 33/40 patients (82.5%). Perinatal acute esophagitis (9 pts) and hemorrage from esophageal varices (8 pts), were, in our series, the most common cause of acute GIB. Other sources of bleeding were: acute hemorragic gastritis (5 pts), duodenal ulcer (6 pts) gastric ulcer (2 pts), esophageal ulcer (1 pt) and rectal polyps (2 pts). In 7 patients emergency endoscopy couldn't demonstrate any relevant lesion. Emergency sclerotherapy of esophageal varices as well as hemostasis of bleeding lesions were successful in all cases. We recorded 1 case (0.6%) of"ab ingestis" pneumonia. Our experience outlines that not only pediatrician or surgeon, but also endoscopist has a crucial role in the management of paediatric gastrointestinal emergencies, in fact 68.7% of our procedures showed some pathological feature, while only 31.2% were normal. Moreover in patients with gastrointestinal bleeding or foreign body ingestion, therapeutic endoscopy proved to be highly effective and safe.