Specific Developmental Disorders Research Articles

Diagnostic concordance between paediatric and mental health

To analyse the diagnostic concordance between the paediatric and mental health (MH) services. Two hundred and seven patients from 0 to 16 years referred from paediatrics to the Estella Mental Health Centre during 2006 and 2007. Concordance between global Kappa Index and specific diagnosis was calculated with Epidat 3.1. An analysis was made for each diagnostic category of the percentage of cases where the diagnosis made in paediatrics was confirmed in Mental Health. The global diagnostic concordance between both medical care levels has a Kappa Index of 0.58. There is a wide variability in the concordance between the different diagnoses. The concordance is weak (0.2-0.4) for specific developmental disorder, affective disorders and adaptative disorders. A moderate concordance (0.41-0.6) is obtained for mental retardation, pervasive developmental disorder, z diagnostics, and sibling rivalry disorder. Concordance is good for attention deficit disorder with hyperactivity, anxiety disorder and conduct disorder. Finally, the diagnostic concordance is very good for enuresis and encopresis and for eating disorders. The diagnostic concordance obtained between paediatric services and the mental health centre is moderate. A wide variability is obtained in the concordance between different diagnoses.

The rise in autism and the role of age at diagnosis.

Autism prevalence in California, based on individuals eligible for state-funded services, rose throughout the 1990s. The extent to which this trend is explained by changes in age at diagnosis or inclusion of milder cases has not been previously evaluated. Autism cases were identified from 1990 through 2006 in databases of the California Department of Developmental Services, which coordinates services for individuals with specific developmental disorders. The main outcomes were population incident cases younger than age 10 years for each quarter, cumulative incidence by age and birth year, age-specific incidence rates stratified by birth year, and proportions of diagnoses by age across birth years. Autism incidence in children rose throughout the period. Cumulative incidence to 5 years of age per 10,000 births rose consistently from 6.2 for 1990 births to 42.5 for 2001 births. Age-specific incidence rates increased most steeply for 2- and 3-year olds. The proportion diagnosed by age 5 years increased only slightly, from 54% for 1990 births to 61% for 1996 births. Changing age at diagnosis can explain a 12% increase, and inclusion of milder cases, a 56% increase. Autism incidence in California shows no sign yet of plateauing. Younger ages at diagnosis, differential migration, changes in diagnostic criteria, and inclusion of milder cases do not fully explain the observed increases. Other artifacts have yet to be quantified, and as a result, the extent to which the continued rise represents a true increase in the occurrence of autism remains unclear.

Motor and cognitive control in a normative sample of 7‐year‐olds

The aim of the present study was to explore the relationship between cognitive and motor control by correlating individual performance on a variety of complex tasks in a normative sample of over 100 7-year-olds. While there are a few studies including children with specific developmental disorders (i.e. ADHD and DCD) showing that they share similar comorbid deficits, it is still unclear whether control processes share variance in normative samples. Results presented here reveal on the one hand that some aspects of cognitive and motor control are significantly interrelated, even when controlling for age. On the other hand, individuals' ability to efficiently respond to the speed and accuracy demands of any of the included tasks appeared to constitute an important aspect of executive functioning.

Using developmental cognitive neuroscience to study behavioral and attentional control

Adult cognitive neuroscience employs a wide variety of techniques to investigate a broad range of behavioral and cognitive functions. One prominent area of study is that of executive control, complemented by a smaller but growing literature exploring the developmental cognitive neuroscience of executive control. To date this approach has often compared children with specific developmental disorders, such as ADHD and ASD, with typically developing controls. Whilst these comparisons have done much to advance our understanding of the neural markers that underpin behavioral difficulties at specific time-points in development, we contend that they should leave developmental cognitive neuroscientists wanting. Studying the neural correlates of typical changes in executive control in their own right can reveal how different neural mechanisms characteristic of the adult end-state emerge, and it can therefore inform the adult cognitive neuroscience of executive control itself. The current review addresses the extent to which developmentalists and adult cognitive neuroscientists have tapped this common ground. Some very elegant investigations illustrate how seemingly common processes in adulthood present as separable in childhood, on the basis of their distinctive developmental trajectories. These demonstrations have implications not only for an understanding of changing behavior from infancy through childhood and adolescence into adulthood, but, moreover, for our grasp of the adult end-state per se. We contend that, if used appropriately, developmental cognitive neuroscience could enable us to construct a more mechanistic account of executive control.

"Well, It Is Complicated ...": Edwards, L. & Crocker, S. (Eds.). (2008). Psychological Processes in Deaf Children With Complex Needs: An Evidence-Based Practical Guide. London: Jessica Kingsley Publishers. 204 pages. $34.95.

The quote above, used by Marc Marschark to start off his forward to this book, aptly summarizes working with deaf children and the difficulties of writing about that work. Edwards and Crocker have taken on the daunting challenge of reviewing and summarizing the literature on the development of deaf and hard-ofhearing children with the goal of providing ‘‘evidencebased’’ guidelines. Furthermore, they have attempted to make the book appropriate for professionals in mental health and education as well as parents and families. This requires a rather delicate balance. Edwards and Crocker may teeter from time to time but never completely fall. The book is divided into eight chapters, one introductory overview of the ‘‘experience’’ of childhood deafness, five that cover specific developmental disorders or difficulties, one on cochlear implants and a last chapter on professional issues. Edwards and Crocker live and work in the United Kingdom, so the professional issues are most pertinent to that country but do have relevance to others. In each of the ‘‘disorders’’ chapters, the authors seek to present what is currently known about the disorder in deaf children, any formal data on assessment and intervention approaches, the implications for professionals working with deaf children and the parents of these children, as well as occasional case descriptions. The literature reviews are fairly comprehensive, and they cover cognitive, social/emotional, and developmental difficulties. Additionally, one chapter is devoted to tinnitus, a pervasive and potentially troubling symptom that is not frequently covered. While reading this book, our limited knowledge

Mothers’ experience with their developmentally disordered children: Specificity of internal representations

The purpose of the present study was to examine mothers' internal representations of experience with their developmentally disordered children. Maternal perceptions of children have been considered important in clinical work with developmentally disordered children and their families. Using developmental disability sample of 17-34-month-old children, we compared mothers' representations of their children in clinically referred and not referred groups, using the Working Model of the Child Interview. Twenty mothers of children with developmental disorders and twenty matched controls participated. Six (30%) children of experiment group had a diagnosis of cerebral palsy; 5 (25%) were diagnosed with Down's syndrome, while the remaining 9 (45%) had a diagnosis of mixed specific developmental disorder. Many children with disability also were diagnosed with heart disease, epilepsy, and hydrocephalus. Maternal representations' measures were compared to their self-perceived impact of child disability on family, their sensitivity to child, and some demographic and family characteristics. Compared to controls, mothers of children with developmental disability had representations of their children that were significantly more likely to be classified distorted or disengaged (chi(2)=7.24; df=2; P<0.05). More severe disability status was significantly associated with mothers' disengaged representations, fear for safety of children, and intensity of involvement in care giving (P<0.05). The study did not confirm relationships between maternal representation classifications and their self-perceived impact of child disability on family. No differences were found concerning mothers' emotional empathy index in clinical and control groups. The differences in mean emotional empathy scores were related to many aspects of maternal internal representations and to some areas of self-perceived stress. The results of Working Model of the Child Interview did not correlate with child age and gender, birth order, and parents' level of education.

Neurological Soft Signs in Indian Children with Specific Developmental Disorders of Scholastic Skills

Neurological Soft Signs in Indian Children with Specific Developmental Disorders of Scholastic Skills

Clinical neuropsychiatric correlates and EEG findings among children with developmental disorders in Lagos, Nigeria

Developmental disorders with or without associated neuropsychiatric complications continue to be one of the major health problems in Africa. The grossly inadequate management/ rehabilitative facilities further worsen this. A prospective study aimed at finding the types of developmental disorders and associated neuropsychiatric complications among children aged </=15 years that presented with developmental disorder in the study centers over 36 month study duration. The study was carried out in the paediatric and child psychiatric clinics as well as the Electroencephalographic (EEG) unit of two major health facilities in Lagos, Nigeria: Lagos University Teaching Hospital (LUTH) and Psychiatric Hospital, Yaba, Lagos. For each subject, socio-demographic data was obtained and appropriate clinical evaluation was carried out to obtain the necessary data and clinical diagnoses. Furthermore, each of the subjects had waking EEG recording using 20-channel computerized Medelec(R)EEG machine. The EEG interpretation was blinded to the clinical history of the subjects. Overall, one hundred and eleven (111) subjects were evaluated over the 36 month study period. The cohort was made up of 63 (56.8%) males and 48 (43.2%) females. The mean age was 4.8 (+/-3.9) years, with most subjects falling in the age group of 0-5 years(69.4%). Mixed specific developmental disorders were most common (55%) followed by that of specific developmental disorders of speech and language (34.2%). Forty-one (36.9%) subjects suffered from one or more types of complications, with seizure, 22(19.8%) being the most common. The waking EEG recording was normal in 22 (19.8%) subjects; while abnormal epileptiform activities were found in 85 (76.6%) of recordings. No statistically significant relationship existed between EEG abnormalities and the factors of age and clinical diagnoses (i.e developmental abnormalities). The small number of subjects in this study is a major hindrance to drawing a general conclusion. However, it has been shown that a number of the cohort in addition to their developmental disorders suffered from such complications as seizures, hyperactivity etc. Furthermore, a significant proportion had EEG abnormalities of the epileptiform types possibly reinforcing the previously known fact of prevalent subtle brain damage among African children. The need for preventive health care is therefore emphasized.

Working Memory Deficits in Children With Specific Learning Disorders

This article examines working memory functioning in children with specific developmental disorders of scholastic skills as defined by ICD-10. Ninety-seven second to fourth graders with a minimum IQ of 80 are compared using a 2 x 2 factorial (dyscalculia vs. no dyscalculia; dyslexia vs. no dyslexia) design. An extensive test battery assesses the three subcomponents of working memory described by Baddeley (1986): phonological loop, visual-spatial sketchpad, and central executive. Children with dyscalculia show deficits in visual-spatial memory; children with dyslexia show deficits in phonological and central executive functioning. When controlling for the influence of the phonological loop on the performance of the central executive, however, the effect is no longer significant. Although children with both reading and arithmetic disorders are consistently outperformed by all other groups, there is no significant interaction between the factors dyscalculia and dyslexia.

Comparing language profiles: children with specific language impairment and developmental coordination disorder

Although it is widely recognized that substantial heterogeneity exists in the cognitive profiles of children with Developmental Coordination Disorder (DCD), very little is known about the language skills of this group. To compare the language abilities of children with DCD with a group whose language impairment has been well described: children with Specific Language Impairment (SLI). Eleven children with DCD and 11 with SLI completed standardized and non-standardized assessments of vocabulary, grammatical skill, non-word repetition, sentence recall, story retelling, and articulation rate. Performance on the non-standardized measures was compared with a group of typically developing children of the same age. Children with DCD were impaired on tasks involving verbal recall and story retelling. Almost half of those in the DCD group performed similarly to the children with SLI over several expressive language measures, while 18% had deficits in non-word repetition and story retelling only. Poor non-word repetition was observed for both the DCD and the SLI groups. The articulation rate of the children with SLI was slower than that of the DCD group, which was slower than that of typically developing children. Language impairment is a common co-occurring condition in DCD. The language profile of children with either DCD or SLI was similar in the majority of, but not all, cases.

Anwendbarkeit der Child Behavior Checklist 1½-5 als orientierendes Untersuchungsinstrument bei Vorschulkindern mit Entwicklungsproblemen

The diagnostic evaluation of developmental problems and behavior problems in early childhood is difficult and time consuming. This study analyses the usefulness of the Child Behavior Checklist (CBCL) as a screening instrument in a special clinic for children with pervasive and specific developmental disorders. 106 children under the age of 6 years were enrolled in the study. All children were individually assessed. Psychiatric diagnoses were based on parent interview, observation of the child, speech and language assessment as well as cognitive assessment and extensive neurological examination. In addition, behavior and emotional problems were recorded with the CBCL. The results show that less than half of the children with a psychiatric diagnosis had a total score (CBCL) above the cut-off value. However, all children with a total score in the clinical range had a psychiatric diagnosis. The syndrome scales and diagnostic scales are not sensitive. The diagnostic scale "pervasive developmental disorder" is not specific enough to be used as a reliable instrument. In order to improve the usefulness of the checklist, a adjustment of the cut-off values should be considered.

Lese-Rechtschreibstörung (LRS) im Sprachenvergleich und im Fremdsprachenunterricht

Children with difficulties in reading and spelling who are being raised bilingually present a particular challenge to the professionals assessing and working with them. It must be decided whether the problems are due to a specific developmental disorder of written language or to limited contact with the second language. Language-specific aspects must be considered with regard to both the character of the developmental disorder and the proposed interventions. Speaking more than one language is expected not only of children of immigrants but also of native speakers in foreign language classes. For children with dyslexia the acquisition of a foreign language is especially challenging. Most of these children have difficulties learning to read and spell not only in their mother tongue but also in the new language. Parents need advice on which foreign language would be most suitable for their child to learn and what special techniques would facilitate acquisition of the foreign language. The present paper provides an overview of current knowledge about dyslexia and multilingualism. Recommendations are then made for how best to help chil-dren with dyslexia who are being raised with two languages and also those dyslexic children who are originally monolingual and are beginning foreign language instruction.

Specificities of Treatment in Pediatric Obsessive-Compulsive Disorder

AbstractObsessive-compulsive disorder (OCD) experienced in childhood or adolescence is often a chronic disorder with high subjective distress and impairment of family and social functioning. An early comprehensive intervention schedule can have a profound effect on outcome in later years. The clinical manifestations of OCD among children and adolescents do not seem to be inherently different from those of adult patients. In younger subjects, the clinical picture tends to be dominated by compulsions, and insight can be poor, with little recognition of the symptoms as a problem.There is often a shift in symptoms over time, with some symptoms being replaced by others, while in adults, the core obsessions and compulsions tend to be more stable. In addition to depression and anxiety disorders, the spectrum of comorbid psychopathology seen in pediatric OCD patients includes tic, disruptive behavior, and specific developmental disorders. The treatment of childhood and adolescent OCD relies on cognitive-behavioral techniques of psychotherapy and pharmacotherapeutic interventions similar to those recommended in adults. The efficacy of exposure and response prevention in pediatric OCD has been shown in numerous open studies, and four controlled trials. Pharmacotherapy relies on serotonergic medication, and all have been demonstrated to be significantly superior to placebo, as reported in a recently published meta-analysis. Current concerns with the use of SSRIs in children and adolescents were explored as regards OCD and anxiety disorders, and there is no evidence for an increase in suicide or related behaviors.

Fragile X Syndrome and Autism: Common Developmental Pathways?

Identifying atypical trajectories that distinguish children with differing developmental disorders from each other and from typically developing children is a potentially powerful tool for early ascertainment and treatment of syndrome specific proficiencies and deficiencies. The past decade has seen unparalleled advances in the fields of molecular genetics, pediatrics, developmental cognitive neuroscience and brain imaging. Collaboratively, these advances have facilitated our understanding of how genes can impact upon early development, through the identification of specific patterns of cognitive and behavior processing and the deficits in these domains that are typical to a specific developmental disorder. These advances have also made early diagnoses possible for many developmental disorders, including those for which genetic etiology has yet to be determined, such as is the case for most individuals with autism, or disorders such as fragile X syndrome that result from the silencing of a single gene. This early identification necessitates thorough investigation of the impact of a condition across the lifespan beginning in early childhood when interventions are most likely to have significant benefit. This is especially relevant for disorders that at first glance appear to share overlapping behavioral and clinical symptomology. In the case of autism and fragile X syndrome, commonalties in social and communication profiles are now well documented in early childhood. However, to what degree symptom overlap implies common developmental pathways or etiologies remains unclear. The focus of this review will be to critically evaluate whether so called commonalities in phenotypic outcomes actually reflect very different developmental pathways that diverge over developmental time and across syndromes. More detailed knowledge of these profiles will facilitate early timing of tailored interventions that will promote optimal development resulting in significant educational, clinical, and adaptive benefits across a childs lifespan.

ICD-10 classification in Danish child and adolescent psychiatry – Have diagnoses changed after the introduction of ICD-10?

The aim was to test this in a nationwide register study of diagnoses used in child and adolescents psychiatry in Denmark. A larger number of different diagnoses were expected to be applied after the introduction of the 10th version of the International Classification of Diseases (ICD-10). Reflecting the time trend, we particularly expected an increase in the number of neuropsychiatric diagnoses. From the Danish Psychiatric Central Register data were drawn on clinical discharge diagnoses. All patients aged 0–15 years examined at psychiatric hospitals from 1995–2002 were included; 22,469 children and adolescents with a first contact were registered. The most frequent discharge diagnoses were pervasive development disorders (PDD; 11.9%), adjustment disorders (10.6%), conduct disorder (9.5%), emotional and anxiety disorders (7.6%), hyperkinetic disorders (7.3%), and specific developmental disorders (7.3%). We found a significant increase in the number of neuropsychiatric and affective diagnoses and a significant decrease in the number of adjustment, conduct and anxiety diagnoses during the study period. Of the 22,469 diagnoses, 45% were only partly specified according to ICD-10. Thirty-four per cent had diagnoses unspecified on the four-character level (Fxx.9) and 11% had Z-diagnoses. A larger number of different diagnoses and an increase in the use of neuropsychiatric diagnoses were seen after the introduction of ICD-10. Many diagnoses were only partly specified; consequently, a more detailed specification of the ICD-10 is still required.

Trastorno específico del desarrollo del lenguaje: problema selectivo o generalizado de la cognición

Specific developmental language disorder (SDLD) is a diagnostic entity in which language is expected to be the only cognitive function that is affected. Nevertheless, difficulties in other cognitive functions may also appear, either because the language disorder is an expression of an underlying condition or because the retarded language development gives rise to cognitive deficits in general. To determine whether there are any differences in the cognitive performance of children with SDLD and that of children who have developed normally. The study involved a sample of 51 children with SDLD, aged between 6 and 16 years, and 49 children in a control group, who were paired by chronological age, sex and socioeconomic level. Verbal cognitive capacity, attention, memory, visual-constructional and executive functioning were all evaluated. Statistically and clinically significant differences were found in the verbal-type skills, such as language comprehension and verbal cognitive capacity, which showed effect sizes of -1.31 and -1.33, respectively. In the other functions that were assessed, the performance of the SDLD group was slightly lower than that of the control group, but with no clinically significant differences. These findings show that the group of children with SDLD was well selected, since the only differences between the two groups involve linguistic aspects; moreover, this evidence supports the idea that language and other cognitive functions are relatively independent and that a language disorder would only generate an unspecific general effect in the other cognitive functions.

Individual and Environmental Determinants of Engagement in Autism

Engagement is a core component of effective educational programs for children with autism. Analysis of 711 naturalistic goal-directed classroom behaviors of four school-age children with autism and four comparable children with Down syndrome (DS) was conducted. The definition of engagement was expanded to include child compliance and congruence. A main finding was both child and environmental factors influenced type of engagement. Children with DS produced 20% more goal-directed behaviors that were both congruent and compliant compared to children with autism. Large group instruction was associated with less congruent engagement but more compliant engagement for children with autism. These findings suggest specific types of engagement which may lead to advances in developing evidence-based practices for specific developmental disorders.

Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links With Immunizations

The prevalence of pervasive developmental disorders has increased in recent years. Links with the measles component of the measles-mumps-rubella vaccine and the cumulative exposure to thimerosal through other vaccines have been postulated. The purpose of this work was to estimate the pervasive developmental disorder prevalence in Montreal, Canada, in cohorts born from 1987 to 1998 and evaluate the relationship of trends in pervasive developmental disorder rates with: (1) changes in cumulative exposure to ethylmercury (thimerosal) occurring through modifications in the immunization schedule of young children and (2) trends in measles-mumps-rubella vaccination use rates and the introduction of a 2-measles-mumps-rubella dosing schedule during the study period. We surveyed 27749 children born from 1987 to 1998 attending 55 schools from the largest Anglophone school board. Children with pervasive developmental disorders were identified by a special needs team. The cumulative exposure by age 2 years to thimerosal was calculated for 1987-1998 birth cohorts. Ethylmercury exposure ranged from medium (100-125 microg) from 1987 to 1991 to high (200-225 microg) from 1992 to 1995 to nil from 1996 onwards when thimerosal was entirely discontinued. Measles-mumps-rubella coverage for each birth cohort was estimated through surveys of vaccination rates. The immunization schedule included a measles-mumps-rubella single dose at 12 months of age up to 1995, and a second measles-mumps-rubella dose at 18 months of age was added on after 1996. We found 180 children (82.8% males) with a pervasive developmental disorder diagnosis who attended the surveyed schools, yielding a prevalence for pervasive developmental disorder of 64.9 per 10000. The prevalence for specific pervasive developmental disorder subtypes were, for autistic disorder: 21.6 of 10000; for pervasive developmental disorder not otherwise specified: 32.8 of 10000; and for Asperger syndrome: 10.1 of 10000. A statistically significant linear increase in pervasive developmental disorder prevalence was noted during the study period. The prevalence of pervasive developmental disorder in thimerosal-free birth cohorts was significantly higher than that in thimerosal-exposed cohorts (82.7 of 10000 vs 59.5 of 10000). Using logistic regression models of the prevalence data, we found no significant effect of thimerosal exposure used either as a continuous or a categorical variable. Thus, thimerosal exposure was unrelated to the increasing trend in pervasive developmental disorder prevalence. These results were robust when additional analyses were performed to address possible limitations because of the ecological nature of the data and to evaluate potential effects of misclassification on exposure or diagnosis. Measles-mumps-rubella vaccination coverage averaged 93% during the study interval with a statistically significant decreasing trend from 96.1% in the older birth cohorts (1988-89) to approximately 92.4% in younger birth cohorts (1996-1998). Thus, pervasive developmental disorder rates significantly increased when measles-mumps-rubella vaccination uptake rates significantly decreased. In addition, pervasive developmental disorder prevalence increased at the same rate before and after the introduction in 1996 of the second measles-mumps-rubella dose, suggesting no increased risk of pervasive developmental disorder associated with a 2-measles-mumps-rubella dosing schedule before age 2 years. Results held true when additional analyses were performed to test for the potential effects of misclassification on exposure or diagnostic status. Thus, no relationship was found between pervasive developmental disorder rates and 1- or 2-dose measles-mumps-rubella immunization schedule. The prevalence of pervasive developmental disorder in Montreal was high, increasing in recent birth cohorts as found in most countries. Factors accounting for the increase include a broadening of diagnostic concepts and criteria, increased awareness and, therefore, better identification of children with pervasive developmental disorders in communities and epidemiologic surveys, and improved access to services. The findings ruled out an association between pervasive developmental disorder and either high levels of ethylmercury exposure comparable with those experienced in the United States in the 1990s or 1- or 2-dose measles-mumps-rubella vaccinations.

Evaluating mental health services in a Greek community

This study aims to evaluate rendered mental health services for children and adolescents through the investigation of those factors which are related to non-compliance with therapy and which affect treatment outcome. Data were collected from the files of all new cases who applied to a Community Mental Health Centre in Athens during 2000-2002 (N = 363). For each case, the following factors were examined: age, sex, family situation, parents' educational level, referral source, child's psychiatric and psychosocial diagnoses, type of proposed therapy, phase at which termination of therapy occurred and outcome. Around 45.7% of the sample did not complete therapy. The probability of treatment compliance increased when the patient was male, with a diagnosis of a specific developmental disorder, treated in a well-structured therapy programme, was from a healthy family environment and his mother was better educated. On the contrary, an adverse family situation (one-parent family, inadequate parental supervision) and the female sex had a negative association with treatment compliance. Most of the cases discontinued their treatment upon completion of the diagnostic procedure. Referral source did not influence treatment compliance. Evaluation of our service has shown that more attention should be paid to less-educated families and those in adverse situations, particularly when the patient is female.

Beeinträchtigen subklinische epileptische Entladungen wirklich das Kurzzeitgedächtnis von Kindern?

Deficits in concentration, specific developmental disorders, and behaviour problems often impair the educational abilities of children and adolescents with epilepsy, even if the subjects are seizure-free. The impact of subclinical epileptiform discharges that persist despite adequate antiepileptic treatment is not yet understood. Some studies suggest that these lead to simultaneous transitory cognitive impairment, thereby affecting short-term memory functions. This study examines the impact of subclinical discharges on memory functions. 40 seizure-free children (10.3 +/- 3.5 years) with subclinical epileptiform discharges were examined by means of computerized EEG-coupled tests focussing on visuo-spatial and verbal short-term memory, in order to assess the temporal relation between discharges and test performance. No significant differences in cognitive performance were detected in phases with and without epileptiform discharges; neither discharges > 1.5 sec, nor multiple discharges within a test impaired performance. Moreover, performance was independent of the localisation of discharges and of the time of their occurrence during the test. The present study showed no association between subclinical epileptiform discharges and error rates as indicators of transient cognitive impairment in visuo-spatial and verbal short-term memory. Hence, other mechanisms have to be taken into account to explain the known cognitive deficits in patients with epilepsy.