Preverbal Children Research Articles

ABSTRACT

ABSTRACT

Recognition acuity in preverbal children with fixation preference but equal sweep visual-evoked potentials acuity

Recognition acuity in preverbal children with fixation preference but equal sweep visual-evoked potentials acuity

Amblyopic children identified by photoscreening respond well to treatment

Introduction: Photoscreening programs have been shown to identify children with amblyopia or amblyogenic risk factors. This study serves to evaluate the effect of therapy on amblyopic children identified through a community outreach photoscreening program. Methods: Retrospective chart review of 510 children referred to one academic pediatric ophthalmology group from a photoscreening program. Children diagnosed with amblyopia were treated with standard therapy, including spectacles, patching, and/or atropine penalization. Successful treatment of amblyopia was defined as two lines or greater of improvement in visual acuity, equal visual acuity among both eyes, or equal fixation preference in preverbal children. Results: Of the 510 photoscreen-positive children, 110 were diagnosed with amblyopia, 288 had AAPOS-defined risk factors without amblyopia, 82 were false-positives without amblyopia or amblyogenic risk, and 30 were excluded. Of the 110 with amblyopia, 84 (76%) were successfully treated, with a mean follow-up time of 34 ± 23 months. Of the remaining 26 patients, 75% are still being actively treated. Additional follow-up will be updated prior to presentation. Discussion: The treatment of amblyopia in children identified through photoscreening is successful in a majority of cases. Conclusions: Photoscreening programs are not only capable of identifying at-risk children; in addition, those children with amblyopia can be successfully treated. Implementation of such vision screening programs can be a useful adjunct in the prevention of amblyopia-related vision loss.

The narrative matrix and wordless narrations: A research note

Preverbal and non-speaking children are able to share an experience, recount an event, and tell a story in collaboration with an intimate adult who provides the words. These children's narrative expressions take the form of gestures, sounds not recognizable as standard language, the combination of sounds and gestures, and sequenced actions. These narrative forms are understood by the parent or intimate adult because child and adult dwell within a shared narrative matrix, defined by personal, social, temporal, and spatial aspects of life together. In this article, narrative inquiry is presented as a research methodology that may be of interest to the augmentative and alternative communication (AAC) community. In addition, examples are presented.

A comparison of between- and within-subjects imitation designs

Two experimental methods, which have dominated the study of declarative memory in preverbal children with imitation tasks, namely the deferred imitation and elicited imitation paradigm, differ in the amount of physical contact with test stimuli afforded infants prior to a test for long-term recall. The current study assessed effects of pre- and post-demonstration contact with test stimuli on deferred imitation of novel, single-step unrelated actions with multiple objects by 8½- and 10½-month-old infants ( N = 50). The rate of target action completion after a delay remained consistent at both ages across different conditions of prior contact with test stimuli. This study shows that a within-subjects baseline appraisal is valid within certain experimental parameters and offers a more economical alternative. The results show furthermore that different experimental designs utilized to assess deferred imitation are highly comparable for the first year despite differences in determining baseline.

A New 3D Monitor–Based Random-Dot Stereotest for Children

Objective testing for random-dot stereovision in preverbal children requires some type of dissociating glasses. Drawbacks of such methods are the alteration of natural visual conditions and sometimes nonacceptance of the glasses. For this reason, a new, natural method for random-dot stereopsis measurement was developed and tested. Random-dot circles (diameter 10 cm, crossed disparity of 0.34 degrees ) were generated on an autostereoscopic display and presented to 18 normal children (mean age, 5.1 +/- 1.1 years), 8 with anisometropic amblyopia (mean age, 4.9 +/- 1.3 years), 14 with infantile essential esotropia (mean age, 5.3 +/- 0.7 years), and 16 with primary microstrabismus (mean age, 5.2 +/- 1.4 years). While the position of the stimulus randomly changed among four possible locations, eye positions were recorded by infrared photo-oculography. If two or more consecutive saccades ends corresponded to the stimulus coordinates, a positive response was assumed. The results with the new test were compared with the ability to recognize the Lang I random-dot stereotest. Twenty-four of 26 Lang I-positive children had positive responses (sensitivity of 92.3%), 29 of 30 Lang I-negative children had negative three-dimensional (3D) stimulus responses (specificity, 96.7%). The positive predictive value of the new test was 0.96 (95% CI, 0.79-0.99); the negative predictive value, 0.94 (95% CI, 0.78-0.99); and the overall accuracy, 0.95 (95% CI, 0.85-0.99). This new 3D monitor-based test allows objective assessment of random-dot stereopsis in children older than 3 years.

Assessing the Early Characteristics of Autistic Disorder using Video Analysis

The behaviours of infants were observed using home videos, in an attempt to identify social difficulties characteristic of infants with autistic disorder. Three groups of infants were analysed: 15 infants who had later been diagnosed with autism, 15 infants who had a developmental or language delay, and 15 typically developing infants. Social behaviours were coded using both quantitative and qualitative measures. The principal discriminating items between the groups were found to be 'peer interest', 'gaze aversion', 'anticipatory postures', and 'proto-declarative showing'. The results suggest that these children later diagnosed with autism are clinically distinct from their peers before the age of two years, and that there are clearly observable behaviours which are important predictors of autistic disorder in pre-verbal children.

Health and quality of life of ventilator‐dependent children

This paper reports a qualitative study with ventilator-dependent children and their parents, describing their experiences and meanings concerning the children's health and quality of life. Recent medical advances have enabled children to survive premature birth, congenital anomalies, critical illness and accidents with long-term use of mechanical ventilation to support breathing. In economically developed countries, the number of ventilator-dependent children is increasing and many require nurse-led home healthcare services. Debate has been polarized as to whether life on a ventilator is in the best interests of all children. The perspectives of ventilator-dependent children are largely absent in the literature. Principles derived from Heideggerian phenomenology were used to describe how children and their parents interpreted and rationalized the quality of the child's 'ventilator-dependent' life and their health. The study had two phases with data collection commencing in 1998 and completed in 2004. The participants were 35 ventilator-dependent children, and 50 mothers and 17 fathers of 53 children. Emergent themes revealed some common features across this heterogeneous group. Ventilation made the children feel better and if they had sufficient breath, they experienced better quality of life. It was not possible to delineate the magnitude of health gain or benefit, especially amongst preverbal children and those with profound sensory impairments. Quality of life equated to quality of life experiences, but some children experienced negative social impacts and low self-esteem. Home healthcare services were not designed to bring about the desired social outcomes that children identified. Parent's accounts showed subtle more negative differences. The acceptance of children's dependence on machines to live has brought about the need for nursing, medical, social and biological boundaries to be redefined, especially around children's meanings of their health, what they understand to be good quality of life, and what they need to achieve it. Flexible, high quality child-focused homecare is likely to improve children's outcomes.

Dental Discomfort Questionnaire for young children following full mouth rehabilitation under general anaesthesia: a Follow-up report

The aim of the present study was firstly to assess the persistence of pain related behaviours of the Dental Discomfort Questionnaire (DDQ) and secondly to complete a follow-up study to assess the effect of dental treatment on pain related behaviours in preschool children. The 9-question DDQ instrument was used to assess dental pain related behaviours in a group of preverbal children. The test-retest analysis questionnaire was filled out twice by 44 parents on behalf of their referred child. For the follow-up study the questionnaire was filled out by 71 parents before and after all dental disease was completed. A strong correlation for the test-retest was found over a 2 month period before treatment. When the behaviour items were compared independently before and after treatment it appeared that after treatment all but one behaviour (i.e. bite with molar instead of teeth) was displayed less often. Overall, after treatment all children had a lower mean DDQ score. Dental treatment of children leads to reduced toothache related behaviours and subsequently to a better quality of life. The DDQ is a sensitive instrument to measure dental discomfort before and after restorative treatment if and when the follow-up period is short. The DDQ can possibly support healthcare providers, teachers and parents in their assessment of toothache in young children.

Prevalence and causes of visual impairment in craniosynostotic syndromes

To assess the prevalence and causes of visual impairment in patients with craniosynostotic syndromes of Apert, Crouzon, Pfeiffer, Saethre-Chotzen and craniofrontonasal dysplasia. The medical records of patients who attended the Craniofacial Clinic at two large paediatric hospitals in Sydney, Australia between 1983 and 2004 were retrospectively reviewed. Presenting visual acuity (VA) was assessed using tests appropriate to age and cognition: 'fix and follow' in infants (<18 months old), Teller card acuity in preverbal children (18 months to less than 3 years old), Kay picture test or Sheridan-Gardiner test in children aged between 3 and less than 6 years and Snellen chart in those aged 6 years or older. Visual impairment was defined as the inability to fix and follow or presenting VA < 6/12 in the better eye. Amblyopia was defined as a two-line difference in VA between both eyes in the absence of an organic eye disease. Sixty-three patients with craniosynostotic syndromes were identified, of whom 55 had VA assessed at the first visit. Of these 55, 19 (35.5%) had bilateral visual impairment and 5 (9.1%) had unilateral visual impairment. Causes of visual impairment include amblyopia (16.7%), ametropia (25%), optic atrophy (16.7%) and exposure keratopathy (4.2%). Risk factors for amblyopia include strabismus (43.3%), astigmatism (> or =1.5 dioptres) (39.5%), hypermetropia (18.4%) and anisometropia (> or =1.5 dioptre difference between both eyes) (15.8%). Six of the 63 patients (9.5%) had papilloedema; those who were followed up showed gradual resolution of papilloedema following timely decompressive surgery. A high prevalence of visual impairment in patients with craniosynostotic syndromes was found, almost half of them due to potentially correctable causes, including amblyopia and ametropia. Optic atrophy remains an important cause of visual impairment. Further studies are needed to assess the timing and efficacy of intervention for modifiable causes of visual loss in craniosynostotic syndromes.

Auditory speech sounds evaluation (A§E®): a new test to assess detection, discrimination and identification in hearing impairment

This paper describes a set of suprathreshold tests, available as a software package (A§E®), for the auditory evaluation of the hearing impaired. It uses isolated speech sounds as test material for a discrimination, identification and detection test, and is specifically suited to test preverbal children. All tests allow strict analytical interpretation. The test material and procedures are described. Their clinical use is illustrated. The authors claim that suprathreshold tests are feasible in the preverbal child, allowing analytical evaluation of the auditory capacities. These tests are complementary to the routinely used detection tests and add significantly to the hearing evaluation in preverbal children. The authors recommend the phoneme discrimination test for selection of cochlear implant candidates and for the evaluation and fitting of cochlear implants. Copyright © 2006 John Wiley & Sons, Ltd.

Normative data of the A§E® discrimination and identification tests in preverbal children

The A§E® is a set of suprathreshold tests for the auditory evaluation of the hearing impaired. A particular population of interest is the hearing-impaired preverbal child. This paper reports on normative data of the A§E® discrimination test in children aged 10 months and of the A§E® identification tests in children aged 2 to 4 years. Normally hearing children of these ages were tested and pass criteria were defined in such a way that 95% of the hearing infants would pass the tests. With these criteria, the A§E® discrimination test is feasible at 10 months of age and the A§E® identification test from 30 months of age. Copyright © 2006 John Wiley & Sons, Ltd.

Optimal fentanyl regimen for parent-controlled analgesia in preverbal children undergoing cleft palate repair

Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea

Short‐term longitudinal study of a child with Williams syndrome

The superiority of language and communication skills in children and adults with Williams syndrome (WS) is currently being debated. Whilst there have been a number of reports of precursors of language in WS in children who have already developed language, there have not been many studies that have prospectively investigated precursors of language in pre-verbal children with WS. To investigate the development of early social communication skills before the onset of language in WS. A short-term longitudinal single case study was carried out spanning 10 months. The child was assessed five times using parent report, observation of mother-child interactions and by administering the Pre-verbal Communication Schedule, the Pragmatics Profile of Early Communication Skills and the Pre-School Language Scale - 3. Longitudinal comparisons showed that the level of verbal communication in the child with WS always lagged behind the level of motor and cognitive development. The results indicate that rather than being a strength, social communication was an area of weakness relative to other aspects of development in this case. This case raises the potential desirability for early speech and language assessment and intervention in infants with WS.

Predicting Visual Acuity in Early Onset Nystagmus

In preverbal children, it is difficult to assess visual acuity accurately. If nystagmus waveforms can be used to predict visual acuity in these young patients, then they would be a useful additional clinical tool. Existing acuity predictors were assessed in 10 adults with idiopathic early onset nystagmus. The most reliable predictor in this group of patients was mean velocity of the waveform. The mean velocity of the waveform may be used in preverbal children to give an estimate of best potential visual acuity in adulthood, and estimated best potential visual acuity at the current age.

Normative data of the A§E® discrimination and identification tests in preverbal children

Normative data of the A§E® discrimination and identification tests in preverbal children

How can multimodal cues from child-directed interaction reduce learning complexity in robots?

Robots have to deal with an enormous amount of sensory stimuli. One solution in making sense of them is to enable a robot system to actively search for cues that help structuring the information. Studies with infants reveal that parents support the learning-process by modifying their interaction style, dependent on their child's developmental age. In our study, in which parents demonstrated everyday actions to their preverbal children (8–11 months old), our aim was to identify objective parameters for multimodal action modification. Our results reveal two action parameters being modified in adult–child interaction: roundness and pace. Furthermore, we found that language has the power to help children structuring actions sequences by synchrony and emphasis. These insights are discussed with respect to the built-in attention architecture of a socially interactive robot, which enables it to understand demonstrated actions. Our algorithmic approach towards automatically detecting the task structure in child-designed input demonstrates the potential impact of insights from developmental learning on robotics. The presented findings pave the way to automatically detect when to imitate in a demonstration task.

The effect of a hearing aid noise reduction algorithm on the acquisition of novel speech contrasts

Audiologists are reluctant to prescribe digital hearing aids with active digital noise reduction (DNR) to pre-verbal children due to their potential for an adverse effect on the acquisition of language. The present study investigated the relation between DNR and language acquisition by modeling pre-verbal language acquisition using adult listeners presented with a non-native speech contrast. Two groups of normal-hearing, monolingual Anglophone subjects were trained over four testing sessions to discriminate novel, difficult to discriminate, non-native Hindi speech contrasts in continuous noise, where one group listened to both speech items and noise processed with DNR, and where the other group listened to unprocessed speech in noise. Results did not reveal a significant difference in performance between groups across testing sessions. A significant learning effect was noted for both groups between the first and second testing sessions only. Overall, DNR does not appear to enhance or impair the acquisition of novel speech contrasts by adult listeners.

Does Lidocaine Gel Alleviate the Pain of Bladder Catheterization in Young Children? A Randomized, Controlled Trial

Bladder catheterization (BC) is a commonly performed, painful procedure in the pediatric emergency department (ED). A survey demonstrated that analgesia is infrequently used for several brief painful procedures, including BC, in pediatric patients. In this study, we evaluated the use of 2% lidocaine gel to alleviate the pain associated with BC in young children (<2 years) in the ED. We conducted a randomized, double-blind, placebo-controlled trial comparing pain scores during bladder catheterization with 2% lidocaine gel versus nonanesthetic lubricant. We used a previously validated scale for measuring brief procedure-related pain in preverbal children (Face Legs Arms Cry Consolability Pain Scale [FLACC]). A total of 115 patients were recruited; 56 patients were randomized to the control group, and 59 were randomized to the lidocaine group. Lubricant was applied to both the genital mucosa and the catheter. Pain measurements were recorded at 3 time intervals: before insertion of the catheter, during catheterization, and after catheterization. Interobserver reliability had been previously established in an observational pilot study. The difference in mean FLACC scores between the control (7.55 +/- 2.56) and study groups (7.37 +/- 2.87) during catheterization was not statistically significant. The change in FLACC from time 1 (preprocedure) to time 2 (during procedure) was statistically significant in both groups, suggesting that bladder catheterization is a painful procedure. Altering the standard practice of use of nonanesthetic lubricant with 2% lidocaine gel as lubricant during bladder catheterization in young children may not be helpful in alleviating the pain associated with the procedure.

Performance of the Pediatric Glasgow Coma Scale in Children with Blunt Head Trauma

To compare the accuracy of a pediatric Glasgow Coma Scale (GCS) score in preverbal children with blunt head trauma with the standard GCS score in older children. The authors prospectively enrolled children younger than 18 years with blunt head trauma. Patients were divided into cohorts of those 2 years and younger and those older than 2 years. The authors assigned a pediatric GCS score to the younger cohort and the standard GCS score to the older cohort. Outcomes were 1) traumatic brain injury (TBI) on computed tomography (CT) scan or 2) TBI in need of acute intervention. The authors created and compared receiver operating characteristic (ROC) curves between the age cohorts for the association of GCS scores and TBI. The authors enrolled 2,043 children, and 327 were 2 years and younger. Among these 327, 15 (7.7%; 95% confidence interval [CI] = 4.4% to 12.4%) of 194 who underwent imaging with CT had TBI visible and nine (2.8%; 95% CI = 1.3% to 5.2%) had TBI needing acute intervention. In children older than 2 years, 83 (7.7%; 95% CI = 6.2% to 9.5%) of the 1,077 who underwent imaging with CT had TBI visible and 96 (5.6%; 95% CI = 4.6% to 6.8%) had TBI needing acute intervention. For the pediatric GCS in children 2 years and younger, the area under the ROC curve was 0.72 (95% CI = 0.56 to 0.87) for TBI on CT scan and 0.97 (95% CI = 0.94 to 1.00) for TBI needing acute intervention. For the standard GCS in older children, the area under the ROC curve was 0.82 (95% CI = 0.76 to 0.87) for TBI on CT scan and 0.87 (95% CI = 0.83 to 0.92) for TBI needing acute intervention. This pediatric GCS for children 2 years and younger compares favorably with the standard GCS in the evaluation of children with blunt head trauma. The pediatric GCS is particularly accurate in evaluating preverbal children with blunt head trauma with regard to the need for acute intervention.