To study the agreement between three tests for aspiration, barium videofluoroscopy, salivagram, and milk scan we studied 63 children with severe non-ambulant spastic quadriplegic cerebral palsy (CP) aged 14 months to 16 years (32 males, 31 females). The salivagram was most frequently positive (56%, 95% confidence interval 43 to 68%); the next most frequently positive was barium videofluoroscopy when aspiration was defined as the presence of either laryngeal penetration of material or frank aspiration (39%, 95% confidence interval 26 to 53%). The milk scan was rarely positive (6%, 95% confidence interval 2 to 16%). Agreement between the tests of aspiration was poor. The maximum agreement (kappa=0.20) was between aspiration as diagnosed with the salivagram and by barium videofluoroscopy. Positive tests for aspiration are frequent in children with severe CP. Frequency varies widely depending on the investigation used. There is poor agreement between tests used for the diagnosis of aspiration. This information is of importance in assessing the significance of test results.

this report concerns the development and stability of recall memory at 12, 24, and 36 months of age in preterm (<1750g birthweight) and term children from a prospective, longitudinal study. there were 56 preterm children (55.4% male; mean birthweight 1119.5g [sd 279.2], range 551 to 1742g; mean gestational age 29.7 weeks [sd 2.9], range 25 to 36wks) and 126 term controls (51.6% male; mean birthweight 3453.8g [sd 438.2], range 2500 to 4564g; mean gestational age 40.2 weeks [sd 1.1], range 38 to 42wks). recall memory was assessed using an elicited imitation task in which children attempted to reproduce a sequence of actions 15 minutes after they were modeled by the examiner. relative to term children, the preterm group performed poorly at all three ages: they reproduced fewer actions overall and fewer in the correct order. lower birthweight and lengthier postnatal hospitalization were associated with poorer performance in preterm children at 24 and 36 months. although performance improved considerably for both groups with age, there was no evidence of preterm ‘catch-up’: the deficits detected at 12 months did not diminish with age. individual differences in recall were modestly stable from one year to the next, with cross-age correlations highest from 24 to 36 months (r=0.43 to 0.49). these results suggest that preterm children have deficits in recall memory that emerge by 12 months and persist into early childhood.

The objective of the study was to evaluate the effectiveness of modified constraint-induced movement therapy in young children with hemiplegia. It was a single-case experimental design using children as their own controls. Assessment was at entry to the study and subsequently at 4-weekly intervals. A 4-week baseline period with no hand treatment, controlling for maturation, was followed by a 4-week treatment period and a second 4-week period with no hand treatment to measure carry-over. Treatment consisted of twice-weekly 1-hour sessions of structured activities with a therapist and a home programme for non-treatment days. Only verbal instruction and gentle restraint of the unaffected arm were used to encourage use of the affected arm. Nine children (six males, three females; median age 31mo, age range 21 to 61mo) presenting with congenital spastic hemiplegia (five right side, four left side) were involved in the study. Changes in hand function were evaluated with the Quality of Upper Extremity Skills Test. Improvement was seen throughout the study with statistical significance, using the Wilcoxon signed rank test, of 0.01 immediately after treatment. Results of this pilot study suggest that this modification of constraint-induced movement therapy may be an effective way of treating young children with hemiplegia. Future work is planned to consolidate and develop these results.

Abnormalities of growth and development are prevalent in children with cerebral palsy (CP). The purpose of this study was to assess skeletal maturation (‘bone age’) in this population and to identify those factors related to alterations in this aspect of development. The study group was a convenience sample of 80 participants (47 males, 33 females; age range 2y 6mo to 21y 1mo; mean age 10y 10mo, SD 4y 2mo). All had moderate to severe spastic or mixed spastic CP at Gross Motor Function Classification System level III (n=8, 10%); level IV (n=21, 26%); or level V (n=51, 64%). Skeletal maturation was assessed by the detailed Fels method of scoring hand–wrist radiographs. Each evaluation included clinical and anthropometric assessments, Tanner staging, bone density measurements, and the Children's Health Status Questionnaire. Follow-up evaluations were obtained for 41 participants, providing a total of 143 evaluations. Median interval between first and last evaluations was 24.7 months (range 11.9 to 45mo). For the study group as a whole there was no significant difference between a child's skeletal age and chronological age. However, there was a high prevalence of individual participants in whom skeletal age was advanced (7%) or delayed (10%), relative to chronological age, by more than 2 years. In multivariant analyses it was found that diminished linear growth (height), low lumbar-spine bone density, and low body fat as measured by triceps skinfolds were all independently associated with delays in skeletal maturation. Multiple aspects of skeletal growth and development, including skeletal maturation, are frequently altered in children with moderate to severe CP.

The occurrence of the International Workshop on Definition and Classification of Cerebral Palsy, in Bethesda, Maryland, USA, July 2004, was an encouraging sign of progress towards a collaborative attempt to reach an internationally accepted definition and classification system for cerebral palsy (CP). The definition given in this issue, apparently submitted by a small subset of workshop attendees, is disappointing in that it does little to address the four areas of imprecision encountered in previous definitions of CP, as described by Stanley et al. These four areas are:

This study aimed to determine whether neonatal feeding performance can predict the neurodevelopmental outcome of infants at 18 months of age. We measured the expression and sucking pressures of 65 infants (32 males and 33 females, mean gestational age 37.8 weeks [SD 0.5]; range 35.1 to 42.7 weeks and mean birthweight 2722g [SD 92]) with feeding problems and assessed their neurodevelopmental outcome at 18 months of age. Their diagnoses varied from mild asphyxia and transient tachypnea to Chiari malformation. A neurological examination was performed at 40 to 42 weeks postmenstrual age by means of an Amiel-Tison examination. Feeding performance at 1 and 2 weeks after initiation of oral feeding was divided into four classes: class 1, no suction and weak expression; class 2, arrhythmic alternation of expression/suction and weak pressures; class 3, rhythmic alternation, but weak pressures; and class 4, rhythmic alternation with normal pressures. Neurodevelopmental outcome was evaluated with the Bayley Scales of Infant Development–II and was divided into four categories: severe disability, moderate delay, minor delay, and normal. We examined the brain ultrasound on the day of feeding assessment, and compared the prognostic value of ultrasound and feeding performance. There was a significant correlation between feeding assessment and neurodevelopmental outcome at 18 months (p<0.001). Improvements of feeding pattern at the second evaluation resulted in better neurodevelopmental outcome. The sensitivity and specificity of feeding assessment were higher than those of ultrasound assessment. Neonatal feeding performance is, therefore, of prognostic value in detecting future developmental problems.

Most studies on the frequency of autism have had methodological problems. Most notable of these have been differences in diagnostic criteria between studies, degree of cases overlooked by the initial screening, and type of measurement. This study aimed to replicate the first report on childhood autism to address cumulative incidence as well as prevalence, as defined in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) Diagnostic Criteria for Research. Here, the same methodological accuracy (exactness of a measurement to the true value) as the first study was used, but population size was four times larger to achieve greater precision (reduction of random error). A community-oriented system of early detection and early intervention for developmental disorders was established in the northern part of Yokohama, Japan. The city's routine health checkup for 18-month-old children served as the initial mass screening, and all facilities that provided child care services aimed to detect all cases of childhood autism and refer them to the Yokohama Rehabilitation Center. Cumulative incidence up to age 5 years was calculated for childhood autism among a birth cohort from four successive years (1988 to 1991). Cumulative incidence of childhood autism was 27.2 per 10 000. Cumulative incidences by sex were 38.4 per 10 000 in males, and 15.5 per 10 000 in females. The male:female ratio was 2.5:1. The proportions of children with high-functioning autism who had Binet IQs of 70 and over and those with Binet IQs of 85 and over were 25.3% and 13.7% respectively. Data on cumulative incidence of childhood autism derived from this study are the first to be drawn from an accurate, as well as precise, screening methodology.

This study examined attention abilities of children with 22q.11 deletion syndrome. Thirty children (14 males, 16 females; age range 7 to 13y) were given comprehensive neuropsychological and neuropsychiatric assessments. Learning disability was found in 13 children. Superiority in verbal over performance IQ was very common. Attention-deficit–hyperactivity disorder (mainly of inattentive subtype) was diagnosed in 13 children. There appeared to be a relation between low IQ and presence of autism spectrum problems. The presence of attention deficits was clearly supported by the scores on the Child Behavior Checklist and the Conners Questionnaire. On the Becker attention tests the reaction times were significantly longer in the two visual and auditory tests, indicating that the ability to sustain attention is critically impaired in this group. A tendency of inferiority on auditory compared with visual tests was noted but there were no specific problems with the focus–execute aspect of attention.

The objective of this study was to explore the behaviour, including sleep patterns, of children with neurofibromatosis type 1 (NF1). For this purpose we designed a cross-sectional descriptive survey conducted by postal enquiry with telephone follow-up. Simonds and Parraga's sleep questionnaire and the Strength and Difficulties Questionnaire were used to screen sleep patterns and behaviours respectively. Information was obtained for 64 children (39 male, mean age 10y 7mo, SD 4y 1mo, range 3 to 18y; 57% response rate). There were increased numbers of children with NF1 achieving scores in the borderline and abnormal range for ratings of peer problems (p<0.001), hyperactivity (p<0.001), emotional symptoms (p<0.001), and conduct disorder (p<0.05). Total difficulties score was also high (p<0.001) in the NF1 group. Only one group of sleep problems, parasomnias (in particular sleepwalking and sleep terrors), had a higher occurrence (p[les ]0.05) in the NF1 group than in the general population. Within the NF1 group, conduct problems (p[les ]0.05), hyperactivity (p[les ]0.01), emotional problems (p[les ]0.01), and the total difficulties score (p[les ]0.01) were all significantly higher in children with frequent sleep disturbance. We conclude that NF1 is associated with sleep and behavioural problems in a high proportion of children. Psychiatric conditions, e.g. attention-deficit–hyperactivity disorder, may be under-diagnosed on a large scale in children with NF1, and the use of simple screening tools in clinical settings may prove beneficial.

This study investigated sex and age differences in standing balance. Movement of the centre of pressure (COP) was calculated from ground reaction force data collected from a force platform during bipedal stance with eyes open and eyes closed. Three groups of 60 children, with 30 girls and 30 boys in each, were assessed. Mean ages of each group were as follows: 9 years 11 months (standard deviation [SD] 3mo); 12 years 11 months (SD2mo); and 15 years 11 months (SD3mo) respectively. Summary sway parameters and frequency domain variables were calculated in the anteroposterior and mediolateral directions. Boys exhibited greater COP movement than girls at 9 to 10 years of age. Age-related ‘improvements’ in sway occurred in boys, thus some aspects of postural control are still developing after 9 to 10 years of age. As very little age-related difference was seen in girls, boys may lag behind somewhat in terms of developing postural control. Thus there is a need to study the sexes separately when investigating balance in children.

There are few well-controlled, published evaluations of sleep interventions for children with developmental disabilities. This paper evaluates a parent training programme using behavioural principles to reduce sleep problems in children with autism or fragile X syndrome (FXS). Training included bedtime routines, reinforcement, effective instructions, partner support, and extinction (removing reinforcement to reduce a behaviour). Programme efficacy was demonstrated by using a multiple baseline across-participant design. Social validity was also assessed. Five children with autism and one with Asperger syndrome (four males, two females; mean age 5y 6mo; age range 3y 5mo to 7y 4mo) and their parents; and seven children with FXS (six males, one female; mean age 4y 9mo; age range 1y 11mo to 9y 1mo) and their parents participated. Ten families completed intervention within the multiple baseline design. Most parents' goals were achieved and visual analysis of the sleep data indicated improvement. Settling problems, night waking, and co-sleeping were effectively reduced. The programme had high social validity and outcomes were clinically significant and maintained at follow-up.

The aims of this study were: (1) to perform the Amiel-Tison Neurological Assessment (ATNA) in a group of infants with different risk factors for brain damage; (2) to analyze the results of the examinations in light of the risk factors and presumed aetiology; (3) to compare results of examinations with results of cranial ultrasound, electroencephalography (EEG), and cerebral function monitoring (CFM); and (4) to evaluate neurological outcome at 12 to 15 months of age using the Amiel-Tison and Gosselin method, and developmental outcome using the Bayley Scales of Infant Development. Participants were 52 term, newborn infants (31 males, 21 females) with risk factors for brain damage. Mean birthweight was 3288g (SD 661g) and mean gestational age was 39.4wks (SD 1.2wks); range 38 to 41.3wks. Mean age at admission to a neonatal special care unit was 75h, (SD 13.7h). The group with a dynamic (evolving) clinical profile differed significantly from the group with a static (stable) profile in terms of aetiology, while the group with signs of prenatal brain damage differed from the group without these signs regarding aetiology and the level of severity of neurological signs. Sensitivity of the ATNA to detect infants with abnormal ultrasound was 0.97, with EEG 0.89, and with CFM 0.88. At follow-up at 12 to 15 months 47 children were examined: neurological examination was normal in 25 and five children had a minor, five a moderate, and 12 a severe neurological deficit. Agreement of the ATNA with neurological and developmental assessment at follow-up was very good. Our findings suggest that the ATNA is also of value in assessing aetiology and timing of brain lesions.

The aim of this study was to investigate the difference in rates of cerebral palsy (CP) between singletons and twins by considering factors that may be predictive of CP. Data were taken from the Scottish Register of Children with a Motor Deficit of Central Origin and the Scottish Morbidity Record series. All children born in Scotland between 1984 and 1990 inclusive comprised the cohort. There were 646 children with CP (370 males, 276 females) of whom 57 were from twin pregnancies. Prevalence of CP was higher in twins than in singletons. Also, for singleton and twin births, the prevalence of CP was higher for infants who had low birthweight for gestational age (GA), were preterm, and who were male. Prevalence of CP by GA followed a different pattern for twins than for singletons, being lower for twins in the middle range of GAs than for singletons. After allowing for GA and birthweight, twins appeared to be at increased risk for CP compared with singletons. The type of CP in singletons and twins also differed with 64.9% of twins having spastic bilateral CP compared with 48.5% for singletons. The aetiology of CP in twins and singletons may differ.

In this study we describe the development and preliminary psychometric testing of the Spinal Alignment and Range of Motion Measure (SAROMM). Through consultation with pediatric physiotherapists, the items were refined. Subsequently 25 children and adolescents with cerebral palsy (CP; 17 males, 8 females) with a mean age of 9 years 8 months (SD 4y 4mo), stratified by the Gross Motor Function Classification System (GMFCS, n=5 in each group), were recruited. Twenty-two children had spastic CP, and one each was also diagnosed with hypotonic, athetoid, and mixed CP. Three children had hemiplegia, 12 had diplegia, and 10 had quadriplegia. These participants were examined by two physiotherapists on one occasion and by the primary physiotherapist again two weeks later. The intraclass correlation coefficients reflecting interrater and test–retest reliabilities for the spine and range of motion subscales and the total scores were all above 0.80. Validity was supported by a significant contribution of GMFCS level and age to the SAROMM score (r2=0.44). The SAROMM has sufficient reliability and validity for use with children with CP in clinical and research settings by rehabilitation therapists.

Participation and activity performance (motor and cognitive or behavioural) were examined in 148 children with cerebral palsy (CP; 87 males, 61 females; mean age 9y 8mo, SD 1y 11mo; range 6y 1mo to 13y 7mo), mainstreamed in fully inclusive (n=100) and in self-contained classes (n=48) within general schools in Israel, using the School Function Assessment. Differences in participation within these groups were analyzed in relation to the type of CP (mainly spastic hemiplegia, spastic diplegia, and spastic tetraplegia), the level of impairment according to the Gross Motor Function Classification System (GMFCS; level II 55%, level III 37%, and level IV 8%), and additional neuroimpairments. Univariate analyses of variance revealed significant differences in levels of participation and levels of activity performance between different types of CP and GMFCS levels. With regard to additional neuroimpairments, significant differences in participation were found for fully included children with speech and language impairments and those with learning disability within the self-contained group. Physical activity performance partly accounted for differences in participation between children with different types of CP and different levels of motor impairment. These findings suggest that within the mainstreamed environment, participation and activity performance increase as motor disability and/or additional neuroimpairments (speech and language impairments and learning disability) decrease.

This purpose of this study was to investigate visual-object and visual-spatial long-term memory (LTM) abilities in individuals with Williams syndrome (WS) and Down syndrome (DS). Four groups comprised of 15 participants were included: WS group (10 males) with a mean chronological age (CA) of 18 years 5 months, SD 6 years 4 months, and mean mental age (MA) of 6 years 8 months, SD 1 year 5 months; WS control group (eight males) comprised of typically developing children (CA mean 6y 7mo, SD 8mo); DS group, (10 males, CA mean 16y 5mo, SD 5y 10mo; MA mean 5y 4mo, SD 8mo); and DS control group (seven males) formed by typically developing children (CA mean 5y 6mo, SD 7mo). In the WS and DS groups mental age and IQ were evaluated with the Form L-M of the Stanford-Binet Intelligence Scale. Results showed that individuals with WS showed decreased learning of visual-spatial material but substantially typical learning of visual-object patterns as compared to a group of mental-age-matched typically developing children. Individuals with DS showed the opposite profile, i.e. typical learning of visual-spatial sequences but impaired learning of visual-object patterns. These results, showing an interesting double dissociation between these two genetic syndromes in the learning of visual-object patterns as opposed to visual-spatial data, support the interpretation of learning disability as a heterogeneous condition, characterized by potentially very different qualitative profiles of cognitive impairment.

adaptive behavior requires the integration of body movement and attention. therefore, individual differences in integration of movement and attention during infancy may have significance for development. we contacted families whose 8-year-old children (n=26; 16 females, 10 males; mean age 8y 2mo, sd 8mo) participated in a previous study of movement–attention coupling at 1 or 3 months of age, to assess parent-reported attention or hyperactivity problems using the child behavior checklist and diagnostic and statistical manual of mental disorders (4th edn) criteria. parent-reported attention problems at 8 years of age were associated with less suppression of body movement at onset of looking, and greater rebound of body movement following its initial suppression at 3 months, but not at 1 month. parent-reported hyperactivity was not related to any of the infant movement–attention measures. results suggests that the dynamic integration of movement and attention early in life may have functional significance for the development of attention problems in childhood.

Preterm infants are at high risk for developmental impairments at school age. However, the impact of these impairments on important life skills, such as handwriting, is unknown. Forty-eight first-grade children (27 males, 21 females; mean age 6y 7mo, SD 3.9mo; range 6y 1mo to 7y 3mo) born preterm (birthweight <1250g; gestational age <34wks), without major physical or cognitive disabilities, were matched to 69 healthy, term control children (32 males, 37 females; mean age 6y 10mo, SD 3.6mo; range 6y 3mo to 7y 4mo) by sex and school class. All children were assessed using the Evaluation Tool of Children's Handwriting-Manuscript and several sensorimotor measures. Preterm children demonstrated significantly lower legibility and slower speed scores (p<0.01) compared with control children for most of the handwriting tasks. Factors associated with legibility were visual perception and eye–hand coordination (r[les ]0.50; p<0.05) and sex (r[les ]0.12; p=0.01). In-hand manipulation and finger identification (r[les ]0.43; p<0.01) were significantly correlated with slow handwriting speeds. Behaviour difficulties associated with hyperactivity and poor attention (Connors Abbreviated Symptoms Questionnaire) had a confounding influence on both legibility and speed. These findings may help guide early identification efforts and medical/therapeutic interventions for preterm children.

‘Cerebral palsy (CP) describes a group of disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder.’

This study aimed to determine whether supine sleep-positioned infants have delayed motor skills at age 4 and 6 months, and if delays are associated with decreased exposure to prone position. One 4 and one 6-month-old sample of healthy infants born at term were recruited. Motor assessments included the Peabody Developmental Motor Scale (PDMS) and Alberta Infant Motor Scale (AIMS). Parents completed an infant behavior diary for 3 consecutive days. Seventy-one 4-month-old infants were assessed (38 males; mean age 4.4mo, standard deviation [SD] 0.2). Mean motor scores were close to normative standards (AIMS 47.7, SD19.6; PDMS gross motor quotient [GMQ] 96.3, SD 6.5; PDMS fine motor quotient [FMQ] 99.2, SD4.8). No infant scored below cut-off values used to identify motor delay. Milestones less likely to be achieved included extended arm support in prone, hands to feet in supine, and sitting with arm support. Exposure to ‘tummy time’ while awake was correlated with AIMS scores (r=0.38, p<0.01). Fifty 6-month-old infants were assessed (21 males; mean age 6.4mo, SD0.4). Mean scores were shifted down for all scales, and as much as 1SD for PDMS (AIMS 44.5, SD 21.6; PDMS GMQ 85.7, SD7.6; PDMS FMQ 88.9, SD9.0). Only 22% of 6-month-olds could sit without arm support versus 50% expected in a normative sample. Remarkably, 22% of our sample exhibited gross motor delays (quotient<78). Tummy time (awake) was significantly associated with the AIMS (r=0.64) and PDMS GMQ (r=0.55) and FMQ (r=0.33) quotients, even after adjusting for confounders. Typically developing infants who were sleep-positioned in supine had delayed motor development by age 6 months, and this was significantly associated with limited exposure to awake prone positioning. This has important implications for interpreting motor assessments of infants at risk and for preventing inappropriate referrals.