Unimpaired Children Research Articles

School-age outcomes of children without cerebral palsy cooled for neonatal hypoxic–ischaemic encephalopathy in 2008–2010

ObjectiveSince therapeutic hypothermia became standard care for neonatal hypoxic–ischaemic encephalopathy (HIE), even fewer infants die or have disability at 18-month assessment than in the clinical trials. However, longer term follow-up...

Association of physical activity and cardiorespiratory function or BMI and body composition in preterm-born individuals: a systematic review.

To evaluate the association of physical activity (PA) and forced expiratory volume in one second (FEV1), peak oxygen consumption (pVO2), body mass index (BMI) and body composition in preterm-born individuals. Cochrane Library, EMBASE, MEDLINE, AMED, ERIC, Web of Science and PsycInfo were searched with no restriction on language and date of publication from inception to January 2018. Data were extracted comparing preterm-born individuals with different frequencies of PA and the outcome of interest. One randomized controlled, two longitudinal and thirteen cross-sectional studies comprising 1922 preterm-born individuals aged 5-25 were included. Assessment varied from a PA program to accelerometer data, interviews and self-report questionnaires. In preterm-born children, more PA was associated with better cardiorespiratory function in those groups with impaired lung function or with lower BMI in those groups with increased risk factors, but no association was found in unimpaired children. In preterm-born adults, more PA was associated with higher pVO2 and lower BMI. Only tentative conclusions can be drawn, especially regarding differences of the association of PA between preterm- and term-born populations. Further studies are needed to analyse the association of PA in preterm-born individuals with reduced cardiorespiratory function.

Inflectional morphology: evidence for an advantage of bilingualism in dyslexia

ABSTRACT It has been shown that morphological skills are particularly enhanced in bilingual children, whereas they are compromised in dyslexics. The aim of this work is that of investigating how bilingualism interacts with dyslexia in a task measuring the subject’s morphological abilities, to verify if the advantage typically found in bilingualism arises also in presence of a linguistic pathology such as dyslexia. We administered a task assessing the ability to generate plural noun inflections of nonwords to 106 children: 24 Italian monolingual dyslexics (mean age 10;0 y.o.), 30 Italian monolingual typically developing children (10;1), 22 bilingual dyslexic children with Italian as L2 (10;4) and 30 bilingual typically developing children with Italian as L2 (10;2). Results point to a positive effect of bilingualism, which also extends to dyslexia, with bilingual dyslexics performing consistently better than monolingual dyslexics, approaching and even surpassing, as in the most difficult conditions, the performance of monolingual unimpaired children.

APD in First Graders. Which tests discriminate between normal and impaired children?

In a controlled group comparison it was shown for 2nd, 3th and 4th graders that children with auditory processing disorders (APD) could be distinguished from those without (Non-APD) by three to four diagnostic tools. The hit rate was 93.6 % resp. 97.5 % 1, 2. The current study investigated whether such a separation is also possible in first graders. Performance of 77 first graders in two clinically and diagnostically confirmed groups (n = 40 with APD, mean age: 6.93, SD 0.53 yrs; n = 37 Non APD, mean age: 6.90, SD 0.52 yrs) in 8 auditory processing tests of an eclectic test battery were compared (Dichotic Words Test; Phoneme Discrimination and Phoneme Identification; Word-Understanding in Background Noise; Binaural Summation Word Test; Sound Blending; Auditory Sequential Memory of Digits; Nonword Repetition). A differentiation of each clinical group with a multivariate statistical tool (discriminant analysis) functioned successfully. Children with APD were significantly distinguished from unimpaired children with an accuracy of 94.8 % (cross-validated in 92.2 %) via four test variables: (1) Auditory Sequential Memory of digits; (2) Phoneme Discrimination; (3) Nonword Repetition; (4) Word Understanding in Background Noise. The quality of the diagnostic a-priori-grouping using a multivariate statistics (discriminant analysis) could be confirmed for first graders too.

Phonological Errors among Dyslexic and Non-Dyslexic Children Learning Persian

The aim of this study was to examine the phonological errors made by dyslexics and non-dyslexic children in Persian orthography which is transcribed with two distinct spelling: words spelled with long vowels (transparent) and words spelled with short vowels (diacritics) are called opaque words. The sample of the study consisted of Fifteen dyslexic students with the mean age of 9.6, (SD= 1.5) and fifteen unimpaired elementary students with the mean age of 9.6 (SD= 1.4) who were Persian residents of 6th district of Tehran. All the participants were controlled for IQ, social class and behavioral disorders. The instrument used in this research was a set of phonological awareness task (rhymed word detection, rhymed word production, first sound detection, final sound detection, blending syllables and syllable deletion). Participants were required to do each of these phonological awareness tasks in order to compare their error rates in transparent and opaque words. The performance of the two groups was examined according to the effect of transparency variable. Data analysis was done using SPSS software. Overall, the finding showed that dyslexic children encountered more problems in both transparent and opaque words than did unimpaired children and the difference was statistically significant (P<0/05). On the other hand, correlation analysis (Pearson) showed a significant negative interaction between two variables (transparency and subjects) (P< 0/001). This means that dyslexic children in compare to normal ones committed more errors in phonological awareness tasks. The results of this research show that the degree of the transparency of writing systems affects the phonological processing ability of individuals.

Sind AVWS mit und ohne Sprachentwicklungsstörung testdiagnostisch trennbar?

A small number of variables already permit a reliable diagnostic classification of patients into the group "Auditory Processing Disorder" (APD) or unimpaired (Non-APD) in second-graders of primary schools. To test whether the separation of children into the diagnostic group APD or SLI (Specific Language Impairment)+APD-symptomatology or Non-APD is possible, stepwise discrimination analysis were performed with 10 variables from the database of the study from Kiese-Himmel & Nickisch (2012). Two clinically and diagnostically confirmed groups of second-graders: (1) Monosymptomatic APD (n=24; mean age 7.7 [SD 0.75] years); (2) SLI + APD-symptomatology (n=21; mean age 8.0 [SD 0.55] years) and a control group of unimpaired children (Non-APD; n=48; mean age 7.6 [SD 0.49] years). A statistical separation of each clinical group of unimpaired children functioned successfully. Children with APD were differentiated from unimpaired children via 4 variables of which 2 focused on phonological retention (non-words; sentences), and 2 on language comprehension (word understanding in background noise; dichotic word recognition). Children with SLI + APD-symptomatology were separated from unimpaired by 2 phonological retention variables. Children with APD could only be differentiated significantly from those with SLI + APD-symptomatology when introducing a linguistic variable (grammatical structure comprehension). Answering the question whether a selective discrimination of children with APD from children with SLI + APD-symptomatology is possible respectively whether it is the same or different requires further attention.

Free Recall Behaviour in Children with and without Spelling Impairment: The Impact of Working Memory Subcapacities

This study examined supraspan free recall in children with and without spelling impairment. A repeated free recall task involving overt rehearsal and three computer-based adaptive working memory tasks were administered to 54 eight-year-old children. Children without spelling impairments tended to recall more items than did those children with spelling deficits. Video analyses revealed that recall behaviour was similar in impaired and unimpaired children, indicating that both groups applied similar learning activities. Group differences in number of recalled items were attributed to differences in working memory subcapacities between children with and without spelling impairment, especially with regard to central executive and phonological loop functioning.

Compressive tibiofemoral force during crouch gait

Crouch gait, a common walking pattern in individuals with cerebral palsy, is characterized by excessive flexion of the hip and knee. Many subjects with crouch gait experience knee pain, perhaps because of elevated muscle forces and joint loading. The goal of this study was to examine how muscle forces and compressive tibiofemoral force change with the increasing knee flexion associated with crouch gait. Muscle forces and tibiofemoral force were estimated for three unimpaired children and nine children with cerebral palsy who walked with varying degrees of knee flexion. We scaled a generic musculoskeletal model to each subject and used the model to estimate muscle forces and compressive tibiofemoral forces during walking. Mild crouch gait (minimum knee flexion 20–35°) produced a peak compressive tibiofemoral force similar to unimpaired walking; however, severe crouch gait (minimum knee flexion>50°) increased the peak force to greater than 6 times body-weight, more than double the load experienced during unimpaired gait. This increase in compressive tibiofemoral force was primarily due to increases in quadriceps force during crouch gait, which increased quadratically with average stance phase knee flexion (i.e., crouch severity). Increased quadriceps force contributes to larger tibiofemoral and patellofemoral loading which may contribute to knee pain in individuals with crouch gait.

Identifying a distinctive familial frequency band in reaction time fluctuations in ADHD.

Patients with ADHD are typically more variable in their reaction times (RT) than control children. Signal processing analyses have shown that time series RT data of children with ADHD have a distinctive low frequency periodic structure suggestive of a pattern of occasional spontaneous performance lapses. Here we use a fine-grained analysis of spectral power across a broader frequency range to differentiate the periodic qualities of ADHD time series RT data from (a) 1/frequency noise, and (b) control performance. We also assess the familiality of these frequencies by using a proband-sibling design. Seventy-one children with ADHD, one of their siblings, and 50 control participants completed a simple RT task. Power across the RT frequency spectrum was calculated. The frequencies significantly differentiating the two groups were identified. Familiality was assessed in two ways: first, by comparing probands with their unaffected siblings and controls, and, second, by investigating the siblings of neuropsychologically impaired and unimpaired children with ADHD. Analyses converged to highlight the potential importance of the .20-.26 Hz band in differentiating the periodic structure of ADHD RT time series data from both 1/frequency noise and control performance. This frequency band also showed the strongest evidence of familiality. RT performance of children with ADHD had a distinctive periodic structure. The band identified as most differentiating and familial was at a higher frequency than in most previous reports. This highlights the importance of employing tasks with faster interstimulus intervals that will allow a larger portion of the frequency spectrum to be examined.

Abnormal patterns of cerebral lateralisation as revealed by the universal chimeric faces task in individuals with autistic disorder

A previous study by Workman, Chilvers, Yeomans, and Taylor (2006), using the “Universal” Chimeric Faces Task (UCFT) for six emotional expressions, demonstrated that an overall left hemispatial/right hemisphere (RH) advantage has begun to develop by the age of 7–8. Moreover, the development of this left hemispatial advantage was observed to correlate positively with the ability to read emotions in the faces of others. Adopting the UCFT, the current study compared autistic children (11–15) with unimpaired children of two age groups (5–6 and 7–8) from this previous study. The autistic children showed a left hemispatial/RH advantage only for the two emotional expressions of “happiness” and “anger”. Results for the autistic children revealed a similar overall pattern of lateralisation to the 5–6-year-olds and one that is less lateralised than the pattern for the 7–8-year-olds. Autistic children appear to show a developmental deficit for left hemispatial/RH advantage for emotional expression with the exception of “happiness” and “anger.” The findings are discussed in terms of role hemisphericity and an approach-avoidance model.

Evaluating the GAPS test as a screener for language impairment in young children

The early identification of children is one of five themes identified by the Bercow review of 2008. The review also notes that there is a wide range in the methods used to identify children and it goes on to recommend that there needs to be a more systematic approach. One such approach would be to screen children before, or shortly after, school entry. The GAPS test has been designed as a screening tool to identify young children with language impairment and is reported to be of value in identifying children with language difficulties. However, the test has previously only been evaluated by its authors and the sensitivity of the test for identifying children from an unselected sample has not been evaluated. This study evaluated the ability of the GAPS test to identify language-impaired children in an unselected sample. In addition, the effect of tester status (a trained researcher and a teaching assistant) was investigated. A total of 106 children aged 3-6 years completed the GAPS test, the Early Repetition Battery (ERB) and the core language scales from the Clinical Evaluation of Language Fundamentals-Preschool 2 with a trained researcher. Half the children completed the GAPS test a second time with a teaching assistant. There was a significant effect of tester only for the non-word repetition subtest of the GAPS test in the nursery age group; the teaching assistants awarded higher scores than trained researchers. Of the 106 children, ten were language impaired according to the CELF-Preschool 2 core language score. The GAPS test identified two of these children at the 10th percentile cut-off, resulting in a low sensitivity estimate of 20%. However, the GAPS test only identified four of the 96 remaining unimpaired children resulting in a high specificity value of 96%. These values were similar when the 15th percentile cut-off was used and when parental concern or a family history of reading difficulties were used as the criterion measure. These data show that although the GAPS test can be used by a range of people who work with young children, it is not a sensitive screener for language impairment when used by trained researchers.

Diagnostische Zuverlässigkeit eines Elternfragebogens (SBE-3-KT) zur Erfassung von Kindern mit Sprachentwicklungsstörungen bei der U7a

Up to now, no German language test for children has been controlled for diagnostic accuracy. Therefore the application of language tests in clinical diagnostics is limited. The aim of the study was to determine the diagnostic validity of the SBE-3-KT, a parent questionnaire for identification of children with developmental language disorders at the age of 3 years. Language skills of 91 children (aged from 33 to 38 months) were assessed by clinical examination and language tests (SETK 3-5, SSV) blinded against SBE-3-KT results. To calculate validity scores SBE-3-KT results were referenced to expert rating and results on language tests. All children who were sorted in the language disorders group according to the expert rating were also classified as having language impairment on SBE-3-KT (high sensitivity) and all children with normal results on SBE-3-KT were sorted by experts in the unimpaired group (high negative predictive value). On the other hand, 8% of the unimpaired children according to experts were false positive classified by SBE-3-KT (specificity 92%, positive predictive value 50%). The correlations between subtest measures of SBE-3-KT and SETK 3-5 varied between rSp=0.42 and 0.63 (p<0.001). The parent questionnaire SBE-3-KT can be recommended for routine use in pediatric praxis. Three year old children with developmental language disorders are identified with high accuracy. In cases of subnormal results on parent report a further assessment is necessary to clarify the subtype and the etiology of the language abnormalities.

The clinical relevance of selecting resting data at different points in an energy cost of walking test in cerebral palsy

Energy cost of walking (ECOW) is defined as 'walking oxygen consumption minus resting oxygen consumption divided by speed', where 'resting' data can be obtained either at the start or cessation of a test. This study aimed to ascertain when resting data should be taken during an ECOW test in children with cerebral palsy (CP). Resting oxygen consumption per unit mass (VO(2) ) and heart rate were recorded in children without physical impairment (18 males, 13 females; mean age 11 y [SD 2 y 1 mo]) and children with diplegic CP (18 males, 13 females; mean age 11 y [SD 2 y 6 mo, Gross Motor Function Classification System levels I and II]) at three stages, namely pre- and posttest sitting and pretest standing before and after an 8-minute ECOW test using the Cosmed K4b. Heart rate and VO(2) differed significantly between groups and stages (p ≤ 0.05) except for heart rate in standing and posttest sitting in the unimpaired children and for VO(2) during pretest sitting between groups. These differences impacted on the calculation of non-dimensional net oxygen cost (NDNOC) and physiological cost index (PCI) in CP but not in the unimpaired group. PCI was correlated with NDNOC in CP but not in the unimpaired cohort. Pretest sitting resting data appear to be the most appropriate for use in the calculation of NDNOC and PCI. PCI may still have relevance in pathology where walking efficiency is compromised.

Energy cost of walking: A comparison of two recognised methods for defining steady state in a group of unimpaired children and children with cerebral palsy

Measurement of VO 2 based ‘energy cost of walking’ indices provide quantitative information that can be used clinically to ascertain progress and relative functional impairment in pathology. The accuracy and validity of these indices relies on being able to identify periods of steady state conditions, since it is only in steady state that there is a direct and predictable relationship between VO 2 consumption and energy expenditure. This paper presents a comparison of two new mathematically based approaches that have recently gained recognition as methods for identifying steady state during an energy cost assessment. The first applies a mathematically defined threshold for steady state within a (non-treadmill) walking trial. This method is compared with a statistically based approach that relies on the calculation of the correlation coefficient, Kendall's Tau to define steady state data. To examine the impact of both methods on the calculation of the energy cost of walking, each was applied to the calculation of two oxygen based energy cost of walking parameters, the non-dimensional net oxygen cost and the net oxygen cost with speed normalised to height in a cohort of unimpaired subjects and children with cerebral palsy. The results revealed that overall there were no clinically significant differences between the two methods. It is suggested that the methods can be used interchangeably to calculate the energy cost of walking.

Developmental dyslexics and unimpaired children’s reading and memory for words in a transparent orthography

Word reading and short-term memory performance of forty two developmental dyslexics (mean age 10.1 years, SD = .7) and thirty three unimpaired reading age matched (mean age of 8.5, SD = .5) and thirty six unimpaired chronological age matched children (mean age of 10.6, SD = .7) was investigated in transparent Polish orthography. Fifty of the children were instructed that they were expected to recall the list of (12 high frequency mainly concrete) words after reading them aloud (Condition A), whilst others had no such instructions (Condition B). Word reading was tested by recording the time taken to read aloud the list of words in seconds and by taking into account errors in pronunciation. Overall, word reading was significantly slower for developmental dyslexics compared to reading age (RA) and chronological age (CA) controls. However, developmental dyslexics’ recall of words was comparable to CA and significantly superior to RA both in conditions A and B of the experiment. The implications of these results in relation to the impact of spelling transparency on memory performance of impaired and unimpaired readers are discussed.

Impact of laparoscopic anterior 270° fundoplication on the quality of life and symptoms profile of neurodevelopmentally delayed versus neurologically unimpaired children and their parents

This prospective study investigated the therapy-induced changes in the quality of life (QoL) experienced by neurologically healthy and neurodevelopmentally delayed children and their parents after laparoscopic anterior 270 degrees fundoplication (LAF). In this study, 40 patients (21 impaired) with a mean age of 7.8 years underwent LAF for gastroesophageal reflux disease (GERD) and were evaluated before surgery and then 3 and 6 months afterward using the Gastrointestinal Quality-of-Life Index (GIQLI) supplemented by conventional symptom markers. Growth, proton pump inhibitor use, and frequency of supraesophageal/respiratory symptoms improved significantly (p < 0.001) as did feeding parameters (p < 0.05). The global GIQLI score improved by 49 +/- 21% (p < 0.001). The greatest improvement occurred in the symptoms domain (p < 0.001). However, positive alterations also were found in the dimensions of emotions (58%), social functions (37%) and physical functions (27%) (p < 0.001). Comparison of the overall benefit did not show any differences between the subgroups of neurologically fit and impaired children. However, for the child-centered symptoms domain, the benefit increased stepwise with the degree of impairment. This was counterbalanced by an inverse relationship for the parent-centered emotions domain (p < 0.05). Besides the known improvement in symptoms, LAF achieves a significant improvement in QoL for children and their parents. There is no overall difference in the benefit experienced by neurologically impaired and healthy children.

Inflection in Williams Syndrome

This study presents experimental results from elicited production and judgment tasks examining perfective past-tense forms of Greek in seven individuals with Williams Syndrome (WS) in comparison to three age groups of typically-developing children. We found that the WS group relied more on the regular (‘sigmatic’) past tense and less on the irregular (‘non-sigmatic’) one than typically-developing children. While for the sigmatic past tense, individuals with WS achieved the same or even higher scores as the controls, they had lower scores on several measures involving non-sigmatic forms and produced more overgeneralizations of sigmatic forms than the controls. We also found developmental changes in the performance of the WS group that were largely parallel to those seen for unimpaired children. Our conclusion is that apart from difficulties accessing irregular word forms in production, the inflectional system of people with WS is unimpaired.

An evidence‐based approach to the child who drools saliva

Drooling is a common dysfunction in children with cerebral palsy and may also affect neurologically unimpaired children. It causes significant social handicap to both children and their families. The data in this article are supported by a Medline search (November 2008) utilising the keywords drooling, sialorrhea, botulinum toxin, salivary duct ligation and also by the use of the personal bibliographies of the senior authors. The majority of the published literature for drooling is of level III/IV evidence. Multiple therapeutic interventions are available for paediatric drooling. These are most appropriately introduced in a stepwise progression from behaviour therapy, to pharmacotherapy to surgical procedures.

Analysis of Acoustic Features in Speakers with Cognitive Disorders and Speech Impairments

This work presents the results in the analysis of the acoustic features (formants and the three suprasegmental features: tone, intensity and duration) of the vowel production in a group of 14 young speakers suffering different kinds of speech impairments due to physical and cognitive disorders. A corpus with unimpaired children's speech is used to determine the reference values for these features in speakers without any kind of speech impairment within the same domain of the impaired speakers; this is 57 isolated words. The signal processing to extract the formant and pitch values is based on a Linear Prediction Coefficients (LPCs) analysis of the segments considered as vowels in a Hidden Markov Model (HMM) based Viterbi forced alignment. Intensity and duration are also based in the outcome of the automated segmentation. As main conclusion of the work, it is shown that intelligibility of the vowel production is lowered in impaired speakers even when the vowel is perceived as correct by human labelers. The decrease in intelligibility is due to a 30% of increase in confusability in the formants map, a reduction of 50% in the discriminative power in energy between stressed and unstressed vowels and to a 50% increase of the standard deviation in the length of the vowels. On the other hand, impaired speakers keep good control of tone in the production of stressed and unstressed vowels.

Facts, values, and attention-deficit hyperactivity disorder (ADHD): an update on the controversies.

The Hastings Center, a bioethics research institute, is holding a series of 5 workshops to examine the controversies surrounding the use of medication to treat emotional and behavioral disturbances in children. These workshops bring together clinicians, researchers, scholars, and advocates with diverse perspectives and from diverse fields. Our first commentary in CAPMH, which grew out of our first workshop, explained our method and explored the controversies in general. This commentary, which grows out of our second workshop, explains why informed people can disagree about ADHD diagnosis and treatment. Based on what workshop participants said and our understanding of the literature, we make 8 points. (1) The ADHD label is based on the interpretation of a heterogeneous set of symptoms that cause impairment. (2) Because symptoms and impairments are dimensional, there is an inevitable "zone of ambiguity," which reasonable people will interpret differently. (3) Many other variables, from different systems and tools of diagnosis to different parenting styles and expectations, also help explain why behaviors associated with ADHD can be interpreted differently. (4) Because people hold competing views about the proper goals of psychiatry and parenting, some people will be more, and others less, concerned about treating children in the zone of ambiguity. (5) To recognize that nature has written no bright line between impaired and unimpaired children, and that it is the responsibility of humans to choose who should receive a diagnosis, does not diminish the significance of ADHD. (6) Once ADHD is diagnosed, the facts surrounding the most effective treatment are complicated and incomplete; contrary to some popular wisdom, behavioral treatments, alone or in combination with low doses of medication, can be effective in the long-term reduction of core ADHD symptoms and at improving many aspects of overall functioning. (7) Especially when a child occupies the zone of ambiguity, different people will emphasize different values embedded in the pharmacological and behavioral approaches. (8) Truly informed decision-making requires that parents (and to the extent they are able, children) have some sense of the complicated and incomplete facts regarding the diagnosis and treatment of ADHD.