Childhood Neuropsychiatric Disorders Research Articles

Oral Health Status of Autistic Children in India

Autism is one of the most severe childhood neuropsychiatric disorders. Autistic individuals are characterized by impairment in social interaction with a restricted range of interests and often, stereotyped repetitive behaviors. Studies on oral health conditions in children with autism are sparse. The complicated disability itself makes clinical research difficult. The need for baseline information regarding the oral health status of children with autism is essential. The present study assessed the oral health status of 106 autistic children aged 4 to 15 years in Bangalore city, India. The dental caries was recorded according to the WHO criteria; oral hygiene was assessed using the oral hygiene index-simplified (OHI-S) and its modification for deciduous dentition. The behavior of children towards dental treatment was also assessed using the Frankel's behavior rating scale. Data obtained was subjected to statistical analysis. showed that caries experience among autistic children was lower; however they were found to have more debris and calculus deposits. Negative behavior towards dental treatment was seen in autistic children.

Terapia de inducción miofascial en el trastorno por déficit de atención e hiperactividad: a propósito de un caso

Attention deficit hyperactivity disorder is a childhood neuropsychiatric disorder onset that clinically impairs social, academic and personal functioning, with childhood onset. In a high proportion of cases, it persists beyond adolescence. Even though the variability of its clinical signs, symptoms and comorbidities requires a multidisciplinary therapeutic approach, there are few publications existing on the contribution of physiotherapy intervention for the treatment of this condition. Results obtained on a patient treated with two myofascial release techniques (ligamentum nuchae and suboccipital inhibition release) are presented, that point out some improvement on the patient's clinical manifestations. Controlled large scale studies would be desirable to elucidate the true role of such therapy in patients with this disorder.

Pre-existing neurodevelopmental and neuropsychiatric difficulties in children with brain tumours: implications for future outcome studies

SIR–In recent months there has been renewed interest in promoting the early detection of brain tumours in children. Delay in the diagnosis of brain tumours causes distress to the patient, their family, and the clinician. Studies into the presenting features of children with newly diagnosed brain tumours have tended to concentrate on identifying discriminatory signs or symptoms in the child which would prompt earlier referral for further investigation. We would like to highlight our own observations about the importance of careful screening in these newly diagnosed patients for neurodevelopmental problems. Outcome studies in children with brain tumours have tended to concentrate on survival rates and on cognitive and developmental measures post treatment. There is currently a relative paucity of information regarding neurodevelopmental and neuropsychiatric disorders in children presenting with brain tumours prior to the commencement of treatment. Our paediatric Neuro-oncology Multidisciplinary Team thinks that there is a high prevalence of pre-existing neurodevelopmental and neuropsychiatric problems in children with brain tumours before treatment is started. We would suggest that the early identification of these problems has important implications both for the management of the individual child and for future outcome studies. We reviewed the clinical notes and neurodevelopmental histories of all children with newly diagnosed brain tumours presenting to our service between July 2006 and November 2009. During this period 131 children with newly diagnosed brain tumours were identified. In 13 out of 131 (9.9%) of these patients a pre-existing neurodevelopmental problem was documented (Table SI published online only). In all cases children had been under follow up by local Paediatric and Community Paediatric services. Diagnoses of speech and developmental delay had been made following assessment by these services, including use of the Griffiths Mental Development Scales. Particularly striking was the 6 out of 131 (4.6%) children with documented autistic spectrum disorders (ASDs), well above the 1% prevalence expected in the general population. These diagnoses were made following comprehensive patient multidisciplinary assessment, including either the 3Di computer assessment, the Autism Diagnostic Interview or the Diagnostic Interview for Social and Communication Disorders. In a number of children longstanding psychiatric comorbidity was also documented. As might be expected, a number of these children had confirmed diagnosis of tuberous sclerosis (n=4) or neurofibromatosis (n=2), conditions pre-disposing to both tumour development and neurodevelopmental problems. In a number of children no such predisposition could be found. It is uncertain to what extents direct tumour effects contributed to the neurodevelopmental problems for each individual child. There may be an as yet unrecognised genetic predisposition to both tumour and developmental problem. We believe that our case series demonstrates a high prevalence of neurodevelopmental problems, particularly ASDs, in children presenting with newly diagnosed brain tumours. We welcome ongoing work to promote the early identification of children with brain tumours and would like to take the opportunity to encourage clinicians involved in the management of these patients to consider routine screening for neurodevelopmental problems and psychiatric comorbidity in order to help determine the true prevalence of these problems in this important patient group.

The Genetics of Autism Spectrum Disorders and Related Neuropsychiatric Disorders in Childhood

Autism spectrum disorders are considered to be among the most heritable mental disorders, a notion based on surprisingly sparse data from small clinical studies. Population-based studies of the heritability of other neuropsychiatric disorders and comorbidities among them have also been sparse. The authors sought to address both of these issues. Parents of all Swedish 9- and 12-year-old twin pairs born between 1992 and 2000 (N=10,895) were interviewed regarding autism spectrum disorders and associated conditions (response rate, 80%). Concordance rates and structural equation modeling were used for evaluating causes for familial aggregation and overlap between conditions. Monozygotic twins had higher concordance rates than dizygotic twins for autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), developmental coordination disorder, and tic disorder. Genetic effects accounted for 80% (95% CI=29-91) of the variation in liability for autism spectrum disorders, 79% (95% CI=61-88) for ADHD, 70% (95% CI=35-83) for developmental coordination disorder, and 56% (95% CI=37-68) for tic disorder. Among monozygotic co-twins of children with autism spectrum disorders, the probability of having a diagnosis of ADHD was 44%, compared with 15% for dizygotic co-twins. Differences in cross-disorder effects between monozygotic and dizygotic twins were observed for most other comorbidities, and substantial proportions of the genetic variance for autism spectrum disorders was shared with each of the other disorders. Different neuropsychiatric disorders seem to have a common genetic etiology, suggesting caution in the use of diagnostic entities and proband status in efforts to uncover genes predisposing to autism spectrum disorders.

Striatal volume changes in a rat model of childhood attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood neuropsychiatric disorders. Based on neuroimaging studies, the striatum is reported to be abnormal in size, but it is still not clear how they change during developmental stages. Spontaneously hypertensive rats (SHRs) are the commonly used animal model for ADHD. We investigated volume differences of the striatum at various ages before puberty in SHRs versus a control strain, Wistar–Kyoto rats (WKYs). Volumes of the bilateral striatum were measured using micrographs of Nissl-stained serial sections in both strains of rats at the ages of 4, 5, 6, 7, 8, 9, and 10 weeks ( n = 4, each strain at each age). The results demonstrated that the age of a significant striatal volume difference between SHRs and WKYs was 5 weeks; however, there was no significant difference for the corresponding total brain volume at each matched age. It suggested that the timing for striatal abnormalities in ADHD occurs during an early stage of childhood.

Increased resting energy expenditure in children with attention-deficit-hyperactivity disorder.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most frequently reported neuropsychiatric disorders in childhood. However, there is limited data on the biological basis for this disorder. Disturbances in neurotransmitters have been suggested to play a pathophysiologic role. Phenotypically an increased prevalence of obesity has been reported. To investigate resting energy expenditure (REE) and diet-induced thermogenesis in stimulant medication-naïve children with ADHD. Case control study of 12 pre-pubertal boys with ADHD of the hyperactive-impulsive type and 12 control boys without ADHD. Anthropometric testing and indirect calorimetry were performed before and after a standardized meal. REE and thermogenesis were measured in each subject at 2 time points. In an independent group of 60 boys with ADHD, BMI standard deviation scores (BMI-SDS) were compared to age-adapted reference values. REE was on average 6.5 kcal/kg fat free mass/day higher in the ADHD compared to the control group (p<0.01). In contrast, the thermogenic effect of food was not different between the two groups (average increase by 16%, p=n.s.). The repeat measurements, an average of 5±1 months apart, were highly reproducible in all subjects. Age and restlessness did not explain the differences in REE. Boys with ADHD had similar BMI-SDS values (mean BMI-SDS -0.10±0.98) as reference groups. REE, in contrast to diet-induced thermogenesis, is higher in medication-naïve boys with ADHD. The normal BMI levels suggest increased energy intake in these children.

Evidence appears limited for group-based social skills training for school-age children with Autism Spectrum Disorders, but this review may not tell the whole story

ed from: White, S. W., Keonig, K., & Scahill, L. (2007). Social skills development in children with autism spectrum disorders: A review of the intervention research. Journal of Autism and Developmental Disorders, 37, 1858–1868. Source of funding: National Institutes of Mental Health Childhood Neuropsychiatric Disorders Training Grant; Organization for Autism Research.

Association between polymorphisms of the DBH and DAT1 genes and attention deficit hyperactivity disorder in children from Jordan

Attention deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders in children. In this study, the association between 10-repeats in the DAT1 gene and the (GT)n repeat in the DBH gene and ADHD was examined in children from Jordan. In addition, the levels of dopamine-β-hydroxylase enzyme activity in the plasma of ADHD children were evaluated. Fifty children with ADHD and 50 age- and gender-matched control subjects were recruited. The results showed significant differences between the ADHD group and controls with respect to the plasma levels of dopamine-β-hydroxylase enzyme activity (25.4±2.3 vs. 84.7±5.0 μmol/min; p<0.01). Moreover, the 10-repeat DAT1 gene and (GT)n DBH gene polymorphisms were significantly associated with ADHD development (p<0.05). In conclusion, the DBH and DAT1 genes appear to play a role in the development of ADHD in the Jordanian population.

Streptococcal infection, Tourette syndrome, and OCD

A causal relationship of common streptococcal infections and childhood neuropsychiatric disorders has been postulated. To test the hypothesis of an increased rate of streptococcal infections preceding the onset of neuropsychiatric disorders. Case-control study of a large primary care database comparing the rate of possible streptococcal infections in patients aged 2-25 years with obsessive-compulsive disorder (OCD), Tourette syndrome (TS), and tics with that in controls matched for age, gender, and practice (20 per case). We also examined the influence of sociodemographic factors. There was no overall increased risk of prior possible streptococcal infection in patients with a diagnosis of OCD, TS, or tics. Subgroup analysis showed that patients with OCD had a slightly higher risk than controls of having had possible streptococcal infections without prescription of antibiotics in the 2 years prior to the onset of OCD (odds ratio 2.59, 95% confidence interval 1.18, 5.69; p = 0.02). Cases with TS or tics were not more likely to come from more affluent or urban areas, but more cases lived in areas with a greater proportion of white population (p value for trend = 0.05). The present study does not support a strong relationship between streptococcal infections and neuropsychiatric syndromes such as obsessive-compulsive disorder and Tourette syndrome. However, it is possible that a weak association (or a stronger association in a small susceptible subpopulation) was not detected due to nondifferential misclassification of exposure and limited statistical power. The data are consistent with previous reports of greater rates of diagnosis of Tourette syndrome or tics in white populations.

Aufmerksamkeitsdefizit-/Hyperaktivitätssyndrom in der Lebensspanne

Attention deficit hyperactivity disorder (ADHD) is one of the most common neuropsychiatric disorders in children. ADHD is often chronic persisting into adulthood in about 60% of patients. The disorder is frequently associated with co-occurring disruptive, anxiety, mood and personality disorders as well as substance abuse. The diagnosis of ADHD has to be based on careful assessment of symptoms and impairments in the different phases of life. Recent neuroimaging and genetic data support the neurobiological basis of the disorder. Multimodal treatment options including stimulants, antidepressants and behavioral therapy play a fundamental role in the management of ADHD across the life span.

PANDAS (Pediatric Autoimmune Neuropsychiatric Disease Associated with Streptococcus) in Autism?: A Case History

Pediatric Autoimmune Neuropsychiatric Disease Associated with Streptococcus is a recently described neuropsychiatric disorder in children, characterised by the onset of psychiatric symptoms accompanied by abnormal streptococcal serology in prepubertal children. A case of a young boy diagnosed with autism, with symptoms and serology previously described as consistent with this disorder but no apparent history of streptococcal illness, is discussed. In this case, colonic dysbiosis with overgrowth of streptococcal and enterococcal species is identified and the child is treated with probiotics and supplemental nutrients with good clinical response. Keyword s: PANDAS, Autism, Colonic Dysbiosis, Streptococcus, Enterococcus, Probiotics.

Actualización en el tratamiento del trastorno por déficit de atención/hiperactividad

Attention-deficit/hyperactive disorder (ADHD) is one of the most common and investigated childhood neuropsychiatric disorder witch has an important repercussion in patient's every day life. AIM. To make an update on psychopharmacological and psychological treatment for ADHD and to asses his efficacy as a single drug treatment as well as a combined treatment. As a chronic disorder ADHD needs a carefully designed and complete treatment plan. That takes into account psychoeducation and the most recent medical evidences as well as preferences and worries of their families and patients. Psychostimulants are the most studied drugs and the gold-standard in the ADHD treatment with responses as high as 65 to 85%. Atomoxetine is another alternative for treating this patients with Food and Drug Administration and European Medicines Agency approval seal. The treatment plan for these patients must be chosen, not only by their treating doctor but should include patients and patient's family preferences and should be suited to each patient. Comorbidities are an important issue in the ADHD treatment planning, mainly in non responders' patients.

Neuropsychiatric Disorders Appear in Some Kids After Strep Infection

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessNeuropsychiatric Disorders Appear in Some Kids After Strep InfectionJun YanJun YanSearch for more papers by this authorPublished Online:7 Nov 2008https://doi.org/10.1176/pn.43.21.0018aScientists have found new evidence to support a connection between streptococcus infection and neuropsychiatric disorders in children, a study in the October Journal of the American Academy of Child and Adolescent Psychiatry reported.A connection between streptococcal infection and obsessive-compulsive disorder (OCD), Tourette syndrome (TS), and tic disorder was originally proposed by Susan Swedo, M.D., a senior investigator at the National Institute of Mental Health, and colleagues. They systematically collected a series of 50 pediatric cases and published their observations in the February 1998 American Journal of Psychiatry.Swedo and colleagues believe that there is a unique group of young patients (aged 6 to 7, on average) who develop acute, episodic neuropsychiatric symptoms following an infection with group A β-hemolytic streptococcus, possibly mediated by autoimmune response that attacks neurons in the basal ganglia. These authors termed it “pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).”Several previous studies have generated evidence to support this phenomenon, but controversies remain over the validity and pathogenesis of the PANDAS diagnosis. In the new study, Douglas Leslie, Ph.D., of the Department of Health Administration and Policy at the Medical University of South Carolina, and colleagues conducted a retrospective case-control study and found a significant association between streptococcal infection and subsequent emergence of several neuropsychiatric disorders including not only OCD, TS, and tic disorder, but also attention deficit/hyperactivity disorder (ADHD) and major depression.The authors extracted 742 cases of newly diagnosed OCD, TS, and tic disorder in children aged 4 to 13 from a national database of aggregate health care claims from 60 private insurance companies from January 1998 through December 2004.They also constructed two additional, separate cohorts of children in the same age range: those who were newly diagnosed with ADHD (n=3,650) and those newly diagnosed with major depressive disorder (n=342). Each of the three cohorts was compared with a random sample of controls matched for date of insurance enrollment, birth year, sex, and ZIP code. The size of each control group was at least five times that of the case cohort.Because ADHD is a common comorbidity for OCD, TS, and tic disorder, the cohort for ADHD and the combined cohort for OCD, TS, and tic disorder were designed to be mutually exclusive, meaning that children with diagnoses of ADHD and OCD, TS, or tic disorder were not included in either cohort.Children with newly diagnosed OCD, TS, or tic disorder were 50 percent more likely than their matched controls to have had a diagnosis of streptococcal infection in the previous year, which was statistically significant (odds ratio 1.54, 95 percent confidence interval 1.29 to 2.15). In addition, children with ADHD or depression were also significantly more likely than their controls to have had streptococcal infection in the previous year (odds ratios 1.20 and 1.63, respectively).“I was very surprised to see the significant [association] with depression,” said Leslie in an interview with Psychiatric News. He explained that the reason for extracting data on depression had originally been to get a sense of the specificity of the connection between streptococcal infection and neuropsychiatric symptoms. They had not expected to see a significant association in all three case cohorts.The pathophysiology of this possible link between pediatric neuropsychiatric disorders and streptococcal infection, which seems to affect only a subset of patients, is far from being understood. There are also no evidence-based guidelines for treatment, such as using antibiotics or immunotherapy, for children with neuropsychiatric symptoms who are suspected of having PANDAS.The study was supported in part by grants from the National Institutes of Health.An abstract of “Neuropsychiatric Disorders Associated With Streptococcal Infection: A Case Control Study Among Privately Insured Children” is posted at<www.jaacap.com/pt/re/jaacap/abstract.00004583-200810000-00011.htm>.▪ ISSUES NewArchived

Primary care treatment for child and adolescent neuropsychiatric conditions in remote rural Punjab, Pakistan – a cross‐sectional survey

Pakistan is one of the most populous regions of the world. Previous work has demonstrated that there is reliance on traditional healthcare systems when seeking psychiatric care; however, there is a lack of information on help seeking for child and adolescent population. The aim of this study was to describe types of treatments and families' perceptions of the effectiveness of those treatments for childhood neuropsychiatric disorders in remote rural Punjab. Cross-sectional survey of consecutive attendees at an advertised mental health consultation day in a remote rural area. The effectiveness of these treatments, as rated by patients and their families, was variable, with highest reported effectiveness for general practitioner treatments. In families with a past history of care from a general practitioner, those who had epilepsy reported treatments to be more effective than those with mental retardation. Carers and users described consulting five different types of primary healthcare practitioners that used both physical and psychotherapeutic treatments. There is considerable variation in treatments available for child and adolescent neuropsychiatric disorders in remote rural areas of Punjab, a large proportion of which are considered ineffective by the users and carers. This highlights the need to develop effective interventions for child and adolescent neuropsychiatric conditions that can be administered by primary health workers. Our data suggest that the need for this is greatest for mental retardation.

Holly's Story: Illustration of an Attention Deficit Hyperactivity Disorder Case

During the last 10 years a significant increase of childhood neuropsychiatric disorders, such as attention deficit hyperactivity disorder (ADHD), has been reported. ADHD is believed to have a multifactorial etiology including multiple genetic and prenatal environmental factors. For this reason, there has been a recent revival regarding the role of autoimmunity in this pathology. An ADHD combined-type patient born from a drug-addicted mother was studied. Neuropsychological tests according to the criteria of the 4th edition of the Diagnostic and Statistical Manual (DSM4) permitted us to make the ADHD-diagnosis. The HLA-A, -B, and -DRB1 alleles of the child were determined by sequence-based typing (SBT) after DNA extraction. Although no autistic behavioral features were observed in the patient, a double genetic association between ADHD and autism was reported. In fact, HLA class I alleles (A*02 and B*44) associated to autism and the HLA class II allele (DRB1*04) associated both to autism and ADHD were identified.

Magnetic resonance of the brain in diagnosing neuropsychiatric disorders in children

Magnetic resonance of the brain in diagnosing neuropsychiatric disorders in children

A Common Genetic Variant in the Neurexin Superfamily Member CNTNAP2 Increases Familial Risk of Autism

Autism is a childhood neuropsychiatric disorder that, despite exhibiting high heritability, has largely eluded efforts to identify specific genetic variants underlying its etiology. We performed a two-stage genetic study in which genome-wide linkage and family-based association mapping was followed up by association and replication studies in an independent sample. We identified a common polymorphism in contactin-associated protein-like 2 (CNTNAP2), a member of the neurexin superfamily, that is significantly associated with autism susceptibility. Importantly, the genetic variant displays a parent-of-origin and gender effect recapitulating the inheritance of autism.

Neural and behavioral correlates of expectancy violations in attention‐deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a prevalent neuropsychiatric disorder in childhood with established problems in cognitive control and associated fronto-striatal circuitry. More recently, fronto-cerebellar circuits have been implicated in this disorder. Both of these circuits are important in predicting the occurrence and timing of behaviorally relevant events and in detecting violations of these predictions. Therefore, we hypothesized that the ability to predict the occurrence of frequent events would be compromised in ADHD, as well as the ability to adapt behavior when expectancy was violated. We used rapid, mixed-trial, event-related functional magnetic resonance imaging (fMRI) to examine cognitive and neural processes in two independent samples of children and adolescents with ADHD and matched controls. Subjects performed a variation of a go-no/go task where the predictability of stimulus identity (what) and timing (when) was manipulated. Behaviorally, children and adolescents with ADHD had increased variability in reaction times, and decreased benefit in reaction time when events were predictable. Differences in accuracy between groups were most reliable for temporally unpredictable trials. Functional imaging results from both samples showed that relative to the control children and adolescents, individuals with ADHD had diminished cerebellar activity to violations of stimulus timing and diminished ventral prefrontal and anterior cingulate activity to violations in stimulus timing and identity. These findings are consistent with the view that disruptive behaviors in inappropriate contexts, a major criterion in diagnosing ADHD, may be related to an impaired ability to predict temporal and contextual cues in the environment, thus hindering the ability to alter behavior when they change. This ability requires intact fronto-cerebellar, as well as fronto-striatal circuitry.

Variation in Incidence of Neurodevelopmental Disorders With Season of Birth

The etiologies of autism spectrum disorder and many neurodevelopmental disorders are largely unknown. The detection of a seasonal variation of birth of children diagnosed with a certain disorder could suggest etiological factors that follow a seasonal pattern. We examined the seasonal variation of births of children diagnosed with any of 4 common childhood neuropsychiatric disorders: autism spectrum disorder, hyperkinetic disorder, Tourette syndrome, and obsessive-compulsive disorder. The study cohort consisted of all children born in Denmark from 1990 through 1999 identified in the Danish Medical Birth Register (n = 669,995). Outcome data consisted of both inpatient and outpatient diagnoses reported to the Danish National Psychiatric Registry from 1995 through 2004 using the International Classification of Diseases, 10th edition, diagnostic coding system. Logistic regression combined with spline (a smoothing method) was used to estimate the variation with season of birth for each disorder. Estimates of risk of each disorder with season of birth were adjusted for differences in follow-up time and change in incidence over time. No convincing variations in season of birth were observed for any of the 4 disorders, or for the autism-spectrum-disorder subtypes. Although we cannot rule out the possibility of seasonal variation of birth for a range of childhood neurodevelopmental disorders, we find little evidence that seasonal environmental factors are related to these disorders.

Time Trends in Reported Diagnoses of Childhood Neuropsychiatric Disorders

To examine trends in autism (autism spectrum disorder and childhood autism) in the context of 3 additional childhood neuropsychiatric disorders: hyperkinetic disorder, Tourette syndrome, and obsessive-compulsive disorder. Population-based cohort study. Children were identified in the Danish Medical Birth Registry. Relevant outcomes were obtained via linkage with the Danish National Psychiatric Register, which included reported diagnoses through 2004 by psychiatrists using diagnostic criteria from the International Statistical Classification of Diseases, 10th Revision. All children born in Denmark from 1990 through 1999, a total of 669 995 children. Cumulative incidence proportion by age, stratified by year of birth, for each disorder. Statistically significant increases were found in cumulative incidence across specific birth years for autism spectrum disorder, childhood autism, hyperkinetic disorder, and Tourette syndrome. No significant change in cumulative incidence was observed for obsessive-compulsive disorder. Recent increases in reported autism diagnoses might not be unique among childhood neuropsychiatric disorders and might be part of a more widespread epidemiologic phenomenon. The reasons for the observed common pattern of change in reported cumulative incidence could not be determined in this study, but the data underscore the growing awareness of and demand for services for children with neurodevelopmental disorders in general.