Movement scaling in children with ADHD-combined type

Objective
The aim of the study was to investigate motor performance in children with ADHD using a size-scaling handwriting task.

Method
In all, 14 male children with ADHD and 14 typically developing (TD) children (age 7-15) wrote 10-mm and 40-mm cursive letter “l.”

Results
Children with ADHD were unable to maintain their writing accurately at 40 mm, falling short by several millimeters; this was not evident in the TD children. Children with ADHD also had slightly faster and more fluent writing than TD children.

Conclusion
It was concluded that children with ADHD have difficulties scaling handwriting movement in the larger 40-mm condition that may reflect poor planning and modulation of movement, despite having faster and more fluent movements.

Recombinant human growth hormone for the treatment of growth disorders in children: a systematic review and economic evaluation

Recombinant human growth hormone (rhGH) is licensed for short stature associated with growth hormone deficiency (GHD), Turner syndrome (TS), Prader-Willi syndrome (PWS), chronic renal insufficiency (CRI), short stature homeobox-containing gene deficiency (SHOX-D) and being born small for gestational age (SGA). To assess the clinical effectiveness and cost-effectiveness of rhGH compared with treatment strategies without rhGH for children with GHD, TS, PWS, CRI, SHOX-D and those born SGA. The systematic review used a priori methods. Key databases were searched (e.g. MEDLINE, EMBASE, NHS Economic Evaluation Database and eight others) for relevant studies from their inception to June 2009. A decision-analytical model was developed to determine cost-effectiveness in the UK. Two reviewers assessed titles and abstracts of studies identified by the search strategy, obtained the full text of relevant papers, and screened them against inclusion criteria. Data from included studies were extracted by one reviewer and checked by a second. Quality of included studies was assessed using standard criteria, applied by one reviewer and checked by a second. Clinical effectiveness studies were synthesised through a narrative review. Twenty-eight randomised controlled trials (RCTs) in 34 publications were included in the systematic review. GHD: Children in the rhGH group grew 2.7 cm/year faster than untreated children and had a statistically significantly higher height standard deviation score (HtSDS) after 1 year: -2.3 ± 0.45 versus -2.8 ± 0.45. TS: In one study, treated girls grew 9.3 cm more than untreated girls. In a study of younger children, the difference was 7.6 cm after 2 years. HtSDS values were statistically significantly higher in treated girls. PWS: Infants receiving rhGH for 1 year grew significantly taller (6.2 cm more) than those untreated. Two studies reported a statistically significant difference in HtSDS in favour of rhGH. CRI: rhGH-treated children in a 1-year study grew an average of 3.6 cm more than untreated children. HtSDS was statistically significantly higher in treated children in two studies. SGA: Criteria were amended to include children of 3+ years with no catch-up growth, with no reference to mid-parental height. Only one of the RCTs used the licensed dose; the others used higher doses. Adult height (AH) was approximately 4 cm higher in rhGH-treated patients in the one study to report this outcome, and AH-gain SDS was also statistically significantly higher in this group. Mean HtSDS was higher in treated than untreated patients in four other studies (significant in two). SHOX-D: After 2 years' treatment, children were approximately 6 cm taller than the control group and HtSDS was statistically significantly higher in treated children. The incremental cost per quality adjusted life-year (QALY) estimates of rhGH compared with no treatment were: 23,196 pounds for GHD, 39,460 pounds for TS, 135,311 pounds for PWS, 39,273 pounds for CRI, 33,079 pounds for SGA and 40,531 pounds for SHOX-D. The probability of treatment of each of the conditions being cost-effective at 30,000 pounds was: 95% for GHD, 19% for TS, 1% for PWS, 16% for CRI, 38% for SGA and 15% for SHOX-D.

Simulated hyperopic anisometropia and reading, visual information processing, and reading-related eye movement performance in children.

Purpose: This study investigated the impact of simulated hyperopic anisometropia and sustained near work on performance of academic-related measures in children.
Methods: Participants included 16 children (mean age: 11.1 ± 0.8 years) with minimal refractive error. Academic-related outcome measures included a reading test (Neale Analysis of Reading Ability), visual information–processing tests (Coding and Symbol Search subtests from the Wechsler Intelligence Scale for Children), and a reading-related eye movement test (Developmental Eye Movement test). Performance was assessed with and without 0.75 diopters of simulated monocular hyperopic defocus (administered in a randomized order), before and after 20 minutes of sustained near work. Unilateral hyperopic defocus was systematically assigned to either the dominant or nondominant sighting eye to evaluate the impact of ocular dominance on any performance decrements.
Results: Simulated hyperopic anisometropia and sustained near work both independently reduced performance on all of the outcome measures (P < 0.001). A significant interaction was also observed between simulated anisometropia and near work (P < 0.05), with the greatest decrement in performance observed during simulated anisometropia in combination with sustained near work. Laterality of the refractive error simulation (ocular dominance) did not significantly influence the outcome measures (P > 0.05). A reduction of up to 12% in performance was observed across the range of academic-related measures following sustained near work undertaken during the anisometropic simulation.
Conclusions: Simulated hyperopic anisometropia significantly impaired academic-related performance, particularly in combination with sustained near work. The impact of uncorrected habitual anisometropia on academic-related performance in children requires further investigation. © 2014 The Association for Research in Vision and Ophthalmology, Inc.

A holistic measurement model of movement competency in children

Different countries have different methods for assessing movement competence in children; however, it is unclear whether the test batteries that are used measure the same aspects of movement competence. The aim of this paper was to (1) investigate whether the Test of Gross Motor Development (TGMD-2) and Körperkoordinations Test für Kinder (KTK) measure the same aspects of children’s movement competence and (2) examine the factorial structure of the TGMD-2 and KTK in a sample of Australian children. A total of 158 children participated (M age = 9.5; SD = 2.2). First, confirmatory factor analysis examined the independent factorial structure of the KTK and TGMD-2. Second, it was investigated whether locomotor, object control and body coordination loaded on the latent variable Movement Competency. Confirmatory factor analysis indicated an adequate fit for both the KTK and TGMD-2. An adequate fit was also achieved for the final model. In this model, locomotor (r = .86), object control (r = .71) and body coordination (r = .52) loaded on movement competence. Findings support our hypothesis that the TGMD-2 and KTK measure discrete aspects of movement competence. Future researchers and practitioners should consider using a wider range of test batteries to assess movement competence.

Characterization of language disorders in children with lead poisoning

Background: lead poisoning can have a negative impact on the neuropsychological functions, including language, due to the damage it causes to the developthent of the Central Nervous System. Aim: to verify the occurrence of language disorders in children who suffered from led poisoning and to verify the correlation between the lead concentration level in the blood and the language disorders presented by the children. Method: language evaluation of 20 preschoolers, with lead concentration level in the blood above 10μg/dl. Results: 13 children presented language impairment involving only phonology or more than one language subsystem. The statistical analysis indicated that no correlation exists between the severity of the language impairment and the concentration levels of lead. Conclusion: the number of children with language impairment indicates lead poisoning as a risk factor for the present alterations, even though other risk factors for language disorders were found and the absence of correlation between the investigated variables.

Voice disorders in children and its relationship with auditory, acoustic and vocal behavior parameters

Objective: Parameters to distinguish normal from deviant voices in early childhood have not been established. The current study sought to auditorily and acoustically characterize voices of children, and to study the relationship between vocal behavior reported by teachers and the presence of vocal aberrations. Methods: One hundred children between four and 6 years and 11 months, who attended early childhood educational institutions, were included. The sample comprised 50 children with normal voices (NVG) and 50 with deviant voices (DVG) matched by gender and age. All participants were submitted to auditory and acoustic analysis of vocal quality and had their vocal behaviors assessed by teachers through a specific protocol. Results: DVG had a higher incidence of breathiness (p < 0.001) and roughness (p < 0.001), but not vocal strain (p = 0.546), which was similar in both groups. The average F-0 was lower in the DVG and a higher noise component was observed in this group as well. Regarding the protocol used "Aspects Related to Phonotrauma - Children's Protocol", higher means were observed for children from DVG in all analyzed aspects and also on the overall means (DVG = 2.15; NVG = 1.12, p < 0.001). In NVG, a higher incidence of vocal behavior without alterations or with discrete alterations was observed, whereas a higher incidence of moderate, severe or extreme alterations of vocal behavior was observed in DVG. Conclusions: Perceptual assessment of voice, vocal acoustic parameters (F-0, noise and GNE), and aspects related to vocal trauma and vocal behavior differentiated the groups of children with normal voice and deviant voice. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Steroid disorders in children: Congenital adrenal hyperplasia and apparent mineralocorticoid excess

Our research team and laboratories have concentrated on two inherited endocrine disorders, congenital adrenal hyperplasia (CAH) and apparent mineralocorticoid excess, in thier investigations of the pathophysiology of adrenal steroid hormone disorders in children. CAH refers to a family of inherited disorders in which defects occur in one of the enzymatic steps required to synthesize cortisol from cholesterol in the adrenal gland. Because of the impaired cortisol secretion, adrenocorticotropic hormone levels rise due to impairment of a negative feedback system, which results in hyperplasia of the adrenal cortex. The majority of cases is due to 21-hydroxylase deficiency (21-OHD). Owing to the blocked enzymatic step, cortisol precursors accumulate in excess and are converted to potent androgens, which are secreted and cause in utero virilization of the affected female fetus genitalia in the classical form of CAH. A mild form of the 21-OHD, termed nonclassical 21-OHD, is the most common autosomal recessive disorder in humans, and occurs in 1/27 Ashkenazic Jews. Mutations in the CYP21 gene have been identified that cause both classical and nonclassical CAH. Apparent mineralocorticoid excess is a potentially fatal genetic disorder causing severe juvenile hypertension, pre- and postnatal growth failure, and low to undetectable levels of potassium, renin, and aldosterone. It is caused by autosomal recessive mutations in the HSD11B2 gene, which result in a deficiency of 11β-hydroxysteroid dehydrogenase type 2. In 1998, we reported a mild form of this disease, which may represent an important cause of low-renin hypertension.

Eating disorders in children and adolescents: an update

Purpose of review Children and adolescents with eating disorders frequently present to child mental health and paediatric services and have significant morbidity, psychosocial impairment and mortality. Efforts to treat these individuals have been hampered by a poor evidence base for effective interventions. This article reviews research published during 2004 with a primary focus on this challenging clinical area. Recent findings Research published during 2004 has replicated past epidemiological findings and expanded our understanding of the relationship of family meal structure and disordered eating. Research has provided assistance in the well known clinical conundrums of excessive exercising in anorexia nervosa and predicting when return of menses will occur. There has also been clarification of adolescent bingeing. Potential advances include a new, noninvasive method of measuring body composition and investigations in adolescents on leptin, neuro and gastrointestinal peptides. Importantly, further evidence of the effectiveness of family therapy for anorexia nervosa and short-term benefits from intervention programs have been published. Summary The research base that will influence clinical practice in child and adolescent eating disorders is increasing. More research is required in all areas of intervention.