Typically Developing Children Research Articles

Early- and Late-Stage Auditory Processing of Speech Versus Non-Speech Sounds in Children With Autism Spectrum Disorder: An ERP and Oscillatory Activity Study.

Individuals with autism spectrum disorder (ASD) often exhibit greater sensitivity to non-speech sounds, reduced sensitivity to speech, and increased variability in cortical activity during auditory speech processing. We assessed differences in cortical responses and variability in early and later processing stages of auditory speech versus non-speech sounds in typically developing (TD) children and children with ASD. Twenty-eight 4- to 9-year-old children (14 ASDs) listened to speech and non-speech sounds during an electroencephalography session. We measured peak amplitudes for early (P2) and later (P3a) stages of auditory processing and inter-trial theta phase coherence as a marker of cortical variability. TD children were more sensitive to speech sounds during early and later processing stages than ASD children, reflected in larger P2 and P3a amplitudes. Individually, twice as many TD children showed reliable differentiation between speech and non-speech sounds compared to children with ASD. Children with ASD showed greater intra-individual variability in theta responses to speech sounds during early and later processing stages. Children with ASD show atypical auditory processing of fundamental speech sounds, perhaps due to reduced and more variable cortical activation. These atypicalities in the consistency of cortical responses to fundamental speech features may impact the development of cortical networks and have downstream effects on more complex forms of language processing.

Coparenting Representations and Interactions Among Parents of Preschoolers with an Autism Spectrum Disorder

SYNOPSIS Objective. Coparenting (CP) representations as assessed using self-report or interviews are associated with coparental behavior among families with typically developing (TD) children. The current study examined whether the same would apply among families with children with an Autism Spectrum Disorder (ASD), or that there would be no such association due to the communication and behavioral difficulties related to children’s diagnosis. Design. The CP representations of parents of 80 preschooler boys with ASD were assessed using self-report, and CP behaviors were assessed in the Lausanne Trilogue Play (LTP) procedure and in a novel Coparental conversation task. Results. More positive CP representations as reported by mothers, but not fathers, were associated with more positive Coparental behaviors during the LTP and during the parental conversation task, even after controlling for children’s cognitive level and severity of symptoms and for parents’ Broad Autism Phenotype and years of education. Conclusions. Coparenting as studied in families of TD children is applicable in families with children with ASD.

Evaluation of the Social Attention Hypothesis: Do Children with Autism Prefer to See Objects Rather than People?

A growing body of research shows that children with autism exhibit selective limitations in their ability to direct their visual attention to social stimuli. The cause of this selective limitation, however, remains unknown. The main purpose of this study is to determine whether the limitations in social attention are influenced by the objects in the environment. Specifically,the study examines the differences in visual attention between children with autism and typically developing (TD) children as they view videos of social interactions under two conditions, with and without objects. The sample consisted of 53 children with autism and 74 TD children, aged between 18 and 36 months. The findings indicated that young children with autism exhibited differences in their social attention compared to their TD peers. The results revealed that the presence of objects did not affect the visual attention differences between the two groups. However, removing objects from the environment positively impacted the social attention of both groups. In the condition without objects, both groups directed more visual attention more toward the Face and Body Areas of Interests (AoIs), whereas in the condition with objects, both groups prioritized looking at the Toy AoI. These findings have important implications for evidence-based decision-making, especially in designing early intervention environments for children with autism.

Strength and dexterity of less affected hand of children with unilateral cerebral palsy: a comparison study with normal peers.

A key aspect of hand function is dexterity, which is described as fine voluntary movements used to manipulate small objects during a specific task. The contralateral hand in children with unilateral cerebral palsy (U-CP); is commonly referred to as a "good" and "unimpaired" hand, while others have noted that it has subtle limitations. Therefore, this study aimed to assess and compare between the strength and dexterity of less-affected hand of children with U-CP and the dominant hand of normal peers. A sample of 120 volunteer children from both sexes and age ranged from 6 to 10 years participated in this study. Out of the 120 children, sixty were normal typically developing (TD) and sixty children with U-CP. Assessment of fine motor dexterity and grip and pinch strength were carried out by the Functional dexterity test (FDT) and Pneumatic squeeze Blub Dynamometer respectively. The results showed that there was a significant lower in pinch and grip strength (p < 0.01) and significant higher FDT scores of children with U-CP compared with that of TD children (p = 0.001). Moreover, there was a significant higher functional levels in TD children compared with that of children with U-CP (p < 0.001) with no significant difference between groups in penalty distribution (p > 0.05). Children with U-CP underperformed with their less-affected hand than the dominant hand of TD age matched peers. Future researches on bilateral hand function may be used to determine the best rehabilitation interventions.

Exaggerated T‐wave alternans in children with Angelman syndrome

AbstractObjectiveWe aimed to test whether T‐wave alternans (TWA), which is a marker of susceptibility to ventricular fibrillation, is abnormal in children with Angelman syndrome (AS) compared with typically developing children (TDC), and whether it can be used as a biomarker of AS.Materials and MethodsUsing surface electrocardiogram (ECG), we calculated TWA in AS and compared it between AS and TDC (Wilcoxon rank sum test). We then performed logistic regression to test TWA ability to distinguish AS from TDC.ResultsWe observed higher TWA in AS than TDC (44 vs. 33 uV, p = 0.009), while heart rate did not differ (p = 0.26), nor its variability (p = 0.72). TWA values enabled discrimination between AS and TDC (p = 0.0008) with accuracy of 81%, positive predictive value of 72%, and negative predictive value of 100%.InterpretationOur findings suggest that ECG in children with AS contains evidence of acquired cardiac abnormality via pathologically increased TWA.

Impaired emotional multimodal integration in inhibition of return in children with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children. Previous studies have shown that children with ADHD have impaired processing of emotional stimuli, but it is unclear whether their ability to integrate multimodal emotional stimuli is impaired and at which processing pathway this impairment exists. The present study investigated the ability of children with ADHD to integrate emotional audiovisual stimuli under different emotional conditions, and the effect of audiovisual integration on IOR to reveal the impaired processing pathway of their emotional audiovisual integration. Fifty-eight school-age children (29 with ADHD and 29 matched typically developing (TD) children) performed an emotional valence discrimination task with a cue-target paradigm. The results showed that children with ADHD did not exhibit audiovisual integration of emotional stimuli in all experimental conditions. In addition, the IOR effect was significantly smaller for audiovisual targets than for visual targets under the negative but not the neutral emotion condition in children with ADHD, whereas this effect was present in all emotion conditions in TD children. These results indicate that the ability to integrate emotional audiovisual information is impaired in children with ADHD and this impairment exists in both bottom-up and top-down pathways. Additionally, although presenting emotional auditory stimuli at the same time as emotional faces reduced IOR both in children with ADHD and TD, the manner of reduction differed. These findings provide new evidence of emotional processing deficits and multimodal integration deficits in children with ADHD, and help provide support for children in educational settings.

Recognition of psychoneurological state of children with autism spectrum disorder by features of speech: acoustic and perceptual features

The work is devoted to studying of recognition of psychoneurological state of children aged 5–14 with autism spectrum disorder (ASD), n = 35, and typically developing (TD) children, n = 45, by adults. A perceptual analysis was carried out, in which adult native speakers of the Russian language (auditors), n = 206, took part. Test sequences (audiotests) with words and phrases of ASD and TD children selected from spontaneous speech recordings were created for perceptual research. Auditors’ task was to determine psychoneurological state of children (typical/atypical development) based on auditory perception. A spectrographic analysis of phrases of children was carried out. Phrases of ASD children in comparison with TD children are characterized by lower speech rate, fewer words, great stressed and unstressed vowel duration, great values of pitch in phrase, word, stressed and unstressed vowel.

On the clinical interpretation of overground gait stability indices in children with cerebral palsy

Several indices have been devised to quantify a person’s stability from its gait pattern during overground walking. However, clinical interpretation of the indices is difficult because the link between being stable and adopting a mechanically stable gait pattern may not be straightforward. This is particularly true for one of these indices, the margin of stability, for which opposite interpretations are available in the literature. We collected overground walking data in two groups of 20 children, with unilateral cerebral palsy (CP) and typically developing (TD), for two conditions, on flat and on uneven grounds (UG). We postulated that TD children were more stable during gait than children with CP and that both groups were more stable on flat compared to UG. We explored the coherent association between several indices and the two postulates to clarify clinical interpretation. Our results showed that increased margin of stability, increased amplitude of the whole-body angular momentum, decreased duration of single limb support, increased variability (gait kinematics, step length, and step width) were associated with reduced stability for both postulates. However, results for the margin of stability were paradoxical between the sides in the CP group where small margin of stability was indicative of a fall forward strategy on the affected side rather than improved stability. Whole-body angular momentum and duration of single limb support appeared as the most sensitive indices. However, walking speed influenced these and would need to be considered when comparing groups of different walking speed.

Does food selectivity drive differences in dietary resemblance between children with intellectual disabilities and typical development?

Although children's dietary intake often resembles that of their parents', dietary resemblance has not been examined among children with intellectual disabilities (ID), where food selectivity is a common parental concern. We compared dietary resemblance in children with typical development (TD), ID, and ID and co-occurring autism (ID + A) in parent-child dyads, and examined whether child food selectivity mediated between-group differences. Dietary data from parents and their children (3–8 years, male = 61.8%, TD = 52.9%, ID = 18.6%, ID + A = 28.4%) were analyzed as mother-child (n = 100) and father-child (n = 70) dyads. Dietary resemblance was operationalized as the proportion of foods that were reported as eaten/not eaten by both parent and child in parent-completed Food Frequency Questionnaires. Food refusal rate was used to capture food selectivity (total foods children would not eat/total foods offered). Among mother-child dyads, dietary resemblance did not differ between children with ID compared to TD (P = 0.243). Among father-child dyads, dietary resemblance was 10% lower in children with ID than TD (66.4% vs. 74.1%, P = 0.032), and the difference was partially explained (mediated) by food refusal. Among mother-child dyads, dietary resemblance was 19% lower among children with ID + A than TD (61.5% vs. 75.6%, P = 0.001), and the difference was completely explained by food refusal. Among father-child dyads, dietary resemblance was 22% lower among children with ID + A than TD (57.9% vs. 74.1%, P < 0.001), and the difference was completely explained by food refusal. Subanalyses by food groups produced similar results. Compared to TD children, dietary resemblance was lower in children with ID + A, but not children with ID, and differences were explained by food selectivity. Our findings suggest parents of children with ID + A may have less influence over their child's dietary intake than parents of children with ID or TD.

MUSIC THERAPY AS A HOLISTIC APPROACH

This abstract summarizes a quantitative and a qualitative study that explored the typology of activities in music therapy for the inclusion of children with special educational needs. The aim of this research study is to test the possible relationship between musical acoustics and vocal discrimination in children of typical development and in children with special educational techniques of preschool and primary school age, as well as in comparison with each other. Moreover, to offer a thorough understanding of music therapy in order to explore how general school teachers perceive and approach the integration of music therapy within a single inclusive school environment. Data were collected through demographic questionnaires, assessments of music audibility, phonemic discrimination tests and semi-structured interviews. Notably, we utilized the L-a-T-o Criterion, a psychometric test tailored for the Greek language, alongside Gordon's Elementary Measures of Music Audibility. The findings of the research revealed that there is a positive impact of music in education and well-being of children, particularly those with special needs. Differences among groups were established (Typology), and also the research demonstrated the educators' positive attitudes toward integrating music therapy into the school curriculum. Quantitative results supported qualitative claims about the positive correlation between musical experiences and phonemic awareness. Both approaches identify challenges, such as the need for better infrastructure and trained music therapists. The outcomes of this research confirmed the existing theory on the profound impact of Music, both tonal and rhythmic, on Children's development in Greece, highlighting that phonological awareness, a crucial skill for language development and reading, is significantly influenced by musical audibility in young children and identified positive attitudes toward integrating music therapy into the school curriculum, despite limited awareness in Greece.

Investigating morphosyntactic and semantic measures in bilingual Azeri-Persian speaking children aged 5.5 to 6.5 years with and without language impairment

The present study aims to investigate morphosyntactic and semantic measures in bilingual Azeri-Persian-speaking children aged 5.5–6.5 years with and without language impairment. In this cross-sectional study, the bilingual participants were thirty children with language impairment (LI) and fifteen typically developing children (TD) who were selected from nurseries and Speech therapy clinics. The language samples were collected through story-telling in Azeri and Persian languages, separately. The linguistic analysis was done based on morphosyntactic and semantic parameters. The Alberta Language and Development Questionnaire (ALDeQ) parent report questionnaire was completed via interviewing with the parents to differentiate language impairment from language differences. Study findings revealed a significant difference between the morphosyntactic and semantic scores in two groups of bilingual Azeri-Persian speaking LI and TD children (p ˂ 0.05). Also, the results demonstrated no significant relationship between the scores of linguistic scores and age in LI and TD children (p < 0.05). According to the result of the study, morphosyntactic and semantic parameters of language samples in bilingual Azeri-Persian-speaking children could be utilized to provide diagnostic information for speech and language pathologists in LI children among bilingual Azeri-Persian communities.

Enhanced ADHD classification through deep learning and dynamic resting state fMRI analysis.

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by deficits in attention, hyperactivity, and/or impulsivity. Resting-state functional connectivity analysis has emerged as a promising approach for ADHD classification using resting-state functional magnetic resonance imaging (rs-fMRI), although with limited accuracy. Recent studies have highlighted dynamic changes in functional connectivity patterns among ADHD children. In this study, we introduce Skip-Vote-Net, a novel deep learning-based network designed for classifying ADHD from typically developing children (TDC) by leveraging dynamic connectivity analysis on rs-fMRI data collected from 222 participants included in the NYU dataset within the ADHD-200 database. Initially, for each subject, functional connectivity matrices were constructed from overlapping segments using Pearson's correlation between mean time series of 116 regions of interest defined by the Automated Anatomical Labeling (AAL) 116 atlas. Skip-Vote-Net was then developed, employing a majority voting mechanism to classify ADHD/TDC children, as well as distinguishing between the two main subtypes: the inattentive subtype (ADHDI) and the predominantly combined subtype (ADHDC). The proposed method was evaluated across four classification scenarios: (1) two-class classification of ADHD from TD children using balanced data, (2) two-class classification between ADHD and TD children using unbalanced data, (3) two-class classification between ADHDI and ADHDC, and (4) three-class classification among ADHDI, ADHDC, and TD children. Using Skip-Vote-Net, we achieved mean classification accuracies of 97% ± 1.87 and 97.7% ± 2.2 for the balanced and unbalanced classification cases, respectively. Furthermore, the mean classification accuracy for discriminating between ADHDI and ADHDC reached 99.4% ± 1.21. Finally, the proposed method demonstrated an average accuracy of 98.86% ± 1.03 in classifying ADHDI, ADHDC, and TD children collectively. Our findings highlight the superior performance of Skip-Vote-Net over existing methods in the classification of ADHD, showcasing its potential as an effective diagnostic tool for identifying ADHD subtypes and distinguishing ADHD from typically developing children.

How Does Understanding of Social Situations and Other's Intention Contribute to Idiom and Irony Comprehension in Autism Spectrum Disorder?

Background/Objectives: Figurative language is a central tool for enriching spoken and written languages, and it is important for building social relationships. Difficulties in figurative language understanding may impair social adjustment. Some studies have found more gaps in the understanding of irony and idioms among children with autism spectrum disorder (ASD) compared to those of their peers with typical development (TD). To date, no studies have examined the relationship between the ability to understand social situations (as a separate ability) and the ability to understand irony and idioms. The present study examined the roles of theory of mind (ToM) and social situation understanding in the comprehension of idioms and ironic criticism. Methods: The current study included 58 participants aged 8-11, including 28 children with high-functioning ASD and 30 children with TD matched by age, gender, and nonverbal intelligence. All the participants completed a ToM questionnaire that assesses their understanding of others' intentions, as well as a questionnaire pertaining to their comprehension of social situations, ironic criticism, and idioms. Results: TD children outperformed the autistic children in idiom and irony understanding, as well as in ToM and social situation understanding. Understanding social situations and ToM contributed to idiom and irony understanding, with ToM ability uniquely contributing to irony (but not to idiom) understanding. Path analysis revealed that social cognitive abilities mediated the link between group affiliation and vocabulary, affecting figurative language comprehension. Conclusions: The present study demonstrates that social cognition skills influence the ability to understand ironic criticism and idioms, mediating the association between vocabulary and figurative language comprehension.

Caregivers' Perceptions of COVID-19 Educational Disruptions on Children With Developmental Language Disorder and Typically Developing Peers.

Understanding the experiences of families of children with developmental language disorder (DLD) during COVID-19 educational disruptions is essential for designing responsive supports during pandemic recovery efforts and beyond. This qualitative study describes the experiences of families of first- and second-grade children with DLD during the pandemic as compared to the experiences of families of typically developing (TD) peers. A conventional content analysis approach was used to analyze caregivers' written responses to open-ended questions regarding their perceptions of COVID-19 educational disruptions. Responses were analyzed separately by group: caregivers of children with DLD (n = 23) and caregivers of TD children (n = 22). Four categories of caregiver responses were generated for each group: impacts on children, remote learning challenges, impacts on caregivers, and protective factors. For both groups, concerns about the child's well-being and literacy learning were most prevalent and prevailed over concerns about oral language. Most caregivers in each group described negative impacts of educational disruptions on their cdhildren. As compared to caregivers of TD children, caregivers of children with DLD reported higher rates of remote learning challenges and more negative impacts on literacy learning, speech and/or language, and education in general. DLD caregivers also shared fewer positive comments and remarks related to protective factors. Results indicate that families of children with DLD may have experienced more challenges during COVID-19 educational disruptions as compared to families of TD peers. Thus, responsive research and supports for these families is essential.

Self-Perceived Stress and the Personality of Mothers of Children with Central Auditory Processing Disorder, as Well as in Mothers of Typically Developing Children, Before and Late in the COVID-19 Pandemic.

This study aims to measure, at two time points, the relationship between self-perceived global stress and the personality traits of the mothers of children who have central auditory processing disorder (APD) and compare it with the results from mothers of typically developing (TD) children. The comparisons were made before the COVID-19 pandemic, as well as late in the pandemic. The level of stress was assessed using the Perceived Stress Scale (PSS-10), while the Short Big Five Markers (IPIP-BFM-20) were used to assess Big Five personality traits. The study used two independent samples: one evaluated before the COVID-19 pandemic and the other late in the pandemic. Each sample consisted of 108 mothers of children with APD and 79 mothers whose children did not have APD (TD children) as controls. The average global stress levels were similar in mothers of children with APD and in mothers of TD children, both before and in the late stage of the COVID-19 pandemic. During the late stage, both sets of mothers scored similarly on all personality dimensions, but significantly, mothers of TD children exhibited lower emotional stability compared to during the pre-pandemic period. In both groups, emotional stability predicted global stress level at both time points; however, during the pandemic, conscientiousness also became a predictor of global stress level but only in the group of mothers of TD children. Mothers of APD children might be more resistant to additional stressors. It would be prudent to watch mothers of APD and TD children for signs of needing psychological intervention.

Developmental trajectories in infants and pre-school children with Neurofibromatosis 1

BackgroundChildren with Neurofibromatosis 1 (NF1) show cognitive, behavioural and social differences compared to their peers. However, the age and sequence at which these differences begin to emerge is not fully understood. This prospective cohort study examines the cognitive, behavioural, ADHD trait and autism symptom development in infant and pre-school children with NF1 compared with typically developing (TD) children without a family history of neurodevelopmental conditions.MethodsData from standardised tests was gathered at 5, 10, 14, 24 and 36 months of age (NF1 n = 35, TD n = 29). Developmental trajectories of cognitive (Mullen Scales of Early Learning, MSEL) and adaptive behavioural (Vineland Adaptive Behavior Scales, VABS) development from 5 to 36 months were analysed using linear mixed modelling. Measures of ADHD (Child Behavior Checklist) and autism traits (ADOS-2, BOSA-MV and ADI-R) were assessed at 24 and 36 months.ResultsThe developmental trajectory of cognitive skills (all domains of the MSEL) and behavioural skills (four domains of the VABS) differed significantly between NF1 and TD groups. Post-hoc tests demonstrated that the NF1 participants scored significantly lower than TD participants at 24 months on all MSEL and VABS domains. The NF1 cohort demonstrated higher mean autism and ADHD traits at 24 months and 14% of the NF1 cohort met a research diagnostic classification for autism at 36 months.LimitationsThe study has a relatively small sample size due to variable retention and rolling recruitment. Due to limitations imposed by the COVID-19 pandemic, we utilised the Brief Observation of Symptoms of Autism for Minimally Verbal children (BOSA-MV) for some participants, which was administered online and may not gather as accurate a picture of traits as ADOS-2. The BOSA-MV was utilised for 41% of participants with NF1 at 36 months compared to 11% at 24 months. This may explain the reduction in the percentage of children with NF1 that met autism criteria at 36 months.ConclusionsBy 24 months of age, the NF1 cohort show lower cognitive skills and adaptive behaviour and higher levels of autism and ADHD traits as compared to TD children. This has implications for developmental monitoring and referral for early interventions.Trial registrationNot applicable.

Early Oral Language and Cognitive Predictors of Emergent Literacy Skills in Arabic-Speaking Children: Evidence From Saudi Children With Developmental Language Disorder.

Although children with developmental language disorder (DLD) are known to have difficulties with emergent literacy skills, few available studies have examined emergent literacy skills in Arabic-speaking children with DLD. Even though Arabic language characteristics, such as diglossia and orthographic structure, influence the acquisition of literacy in Arabic-speaking children, research shows that oral language skills, such as vocabulary, and cognitive skills, such as verbal short-term memory (VSTM), predict literacy in Arabic-speaking children. Moreover, linguistic and memory abilities are impaired in children with DLD, including Arabic-speaking children. The current study examines the relationships between oral language, VSTM, and emergent literacy skills in Arabic-speaking typically developing (TD) children and children with DLD. Participants were 40 TD children (20 girls; aged 4;0-6;11 [years;months]) and 26 children with DLD (nine girls, aged 4;0-6;11). All participants were monolingual Arabic speakers and matched on age and socioeconomic status. A set of comprehensive Arabic language (vocabulary knowledge, morphosyntactic, and listening comprehension skills), VSTM, and emergent literacy (phonological awareness and letter knowledge skills) tests were administered. The DLD group scored significantly lower than the TD group on language, VSTM, and emergent literacy measures. Results revealed that the contributions of oral language and VSTM to emergent literacy skills across TD and DLD groups were different. In the TD group, VSTM predicted emergent literacy skills, whereas in the DLD groups, both vocabulary knowledge and VSTM predicted emergent literacy skills. This study represents an important first step in understanding emergent literacy skills and their relationships to language and memory in Arabic-speaking children with and without DLD. The implications of these findings for clinical and education provision are discussed.

Exploratory Investigation of Head Stability in Children with Cerebral Palsy and Typically Developing Children during a Targeted Stepping Task

Children with cerebral palsy (CP) exhibit head instability during simple overground walking, which may comprise sensory input and reduce stepping accuracy. Investigations of head stability during more challenging tasks, where fall risk may be increased, are limited. This study explored differences in head stability between ambulatory children with hemiplegic CP (N = 9) and diplegia (N = 9) (GMFCS I and II) and typically developing (TD) children (N = 8) during a targeted stepping task. All children completed five trials stepping into two successive rectangular floor-based targets whilst walking along an 8 m walkway. Three-dimensional motion capture enabled calculation of head stability and foot placement within and before each target. A two-way mixed-design ANOVA compared differences between all groups and target approach. Children with diplegic CP showed greater sagittal, frontal, and resultant head-to-laboratory and head-to-trunk head instability compared to children with hemiplegic CP and TD children. Anteroposterior foot placement error was significantly greater in children with hemiplegic CP (8.5 ± 5.0 cm) compared to TD children (3.8 ± 1.5 cm). Group differences in head instability were not consistent with group differences in foot placement error. To better understand how head instability might affect fall risk in children with CP, more challenging environments should be tested in future.

A continuum of balance performance between children with developmental coordination disorder, spastic cerebral palsy, and typical development.

Balance deficits are one of the most common impairments in developmental coordination disorder (DCD) and cerebral palsy (CP), with shared characteristics between both groups. However, balance deficits in DCD are very heterogeneous, but unlike in CP, they are poorly understood. To unravel the heterogeneity of balance performance in children with DCD by comparing them with CP and typical development (TD). Cross-sectional case-control study. Different outpatient settings and the community. Children aged 5-10.9 years with TD (N.=64, boys: 34, mean [SD] age: 8.1 [1.6]), DCD (N.=39, boys: 32, mean [SD] age: 8.1 [1.5], formal diagnosis [N.=27]), and CP (N.=24, boys: 14, mean [SD] age: 7.5 [1.4], GMFCS level I [N.=14]/II [N.=10], unilateral [N.=13]/bilateral [N.=11]). We evaluated balance performance with the extended version of the Kids-Balance Evaluation Systems Test (Kids-BESTest). Between-group differences in domain and total scores (%) were assessed via ANCOVA (covariate: age), with Tukey post-hoc analyses (P≤0.01). Children with DCD and CP performed poorer than TD children on total and domain scores with large effects (domains: η2=0.25-0.66 [P<0.001], total: η2=0.71 [P<0.001]). Still, post hoc comparisons revealed that DCD children scored significantly better than CP on the total score and four domains (P≤0.009), while performing similarly on tasks related to stability limits (P=0.999) and gait stability (P=0.012). There is a continuum of balance performance between children with TD, DCD and CP, but with great inter- and intra-individual heterogeneity in DCD and CP. DCD and CP children have difficulties with tasks requiring anticipatory postural adjustments, fast reactive responses, and with tasks that require complex sensory integration, suggesting an internal modeling deficit in both groups. This implies that these children must rely on slow conscious feedback-based control rather than fast feedforward control and fast automatic feedback. The performance of both DCD and CP children on their stability limits/verticality is similarly poor which further emphasizes a potential deficit in their sensory input and/or integration. Future research must focus on unraveling the control mechanisms, to further understand the heterogeneity of these balance deficits. The heterogeneous balance performances in both children with DCD and CP underscore the importance of comprehensively evaluating balance deficits in both groups. This comprehensive assessment contributes to a better understanding of individual balance deficits, thereby facilitating more tailored treatment programs.

The test of masticating and swallowing solids (ToMaSS): An investigation of applicability and clinical utility in children with orofacial myofunctional disorders.

Orofacial myofunctional disorders (OMD) are often associated with limitations of oral ingestion of solid food. The Test of Masticating and Swallowing Solids (ToMaSS) is a simple diagnostic tool to assess and quantify oropharyngeal efficiency while eating a standardised cracker. The objective of this study was to investigate the applicability and clinical utility of the ToMaSS in children with OMD. In this case-control study, data were collected from 18 children between 4 and 11 years with confirmed OMD. Inter-rater reliability and age effects on the ToMaSS parameters were investigated and the specific performance profile of the OMD children was identified. Inter-rater reliability was excellent for the ToMaSS parameters 'bites' (ICC = .999), 'masticatory cycles' (ICC = .961), 'time'(ICC≧ .999) and good for 'number of swallows' (ICC = .810). 'Masticatory cycles' and 'time' decreased as a function of age with a significant difference in the 'number of masticatory cycles' between the youngest (4-6 years) and oldest (10-14 years) participants (p = .006, Z = -2.739). Deviations from normative data in at least one of the four ToMaSS parameters were found in 90% of the OMD children with 'bites', and 'masticatory cycles' predominantly corresponding to the performances expected in typically-developing children in younger age groups. The ToMaSS is a reliable diagnostic instrument and clinically useful to detect limited efficiency of oral solid bolus intake and specific impairments in chewing function and duration of food intake in children with OMD. Our data suggest that OMD is associated with delayed development of efficient solid bolus preparation.