Children with behavioral problems and motor problems have a worse neurological condition than children with behavioral problems only

Background: Some evidence suggests that children with specific behavioral problems are at risk for motor problems. It is unclear whether neurological condition plays a role in the propensity of children with behavioral problems to develop Motor problems. Aims: To examine the relation between behavioral problems, motor performance and neurological condition in school-aged children. Study design: Cross-sectional study. Subjects: 174 children (95 boys) receiving mainstream education and 106 children (82 boys) receiving special education aged 6 to 13 years (mean 9 y 7 m, SD 1 y 10 m). Outcome measures: Behavior was assessed with questionnaires: the parental Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF). Motor performance was assessed with the Movement Assessment Battery for Children (MABC). MABC-scores >= 5th percentile were considered as age-adequate and scores Results: The majority of specific behavioral problems were associated with definite motor problems, except somatic complaints and rule breaking behavior. Children with externalizing problems, according to the CBCL or TRF, and motor problems had more often MND than children with externalizing problems only. The same holds true for internalizing problems according to the CBCL Conclusions: The present study demonstrated that various forms of behavioral problems were associated with motor problems. Especially children with motor and behavioral problems showed MND. (C) 2014 Elsevier Ireland Ltd. All rights reserved

Development of postural adjustments during reaching in typically developing infants from 4 to 18 months

Knowledge on the development of postural adjustments during infancy, in particular on the development of postural muscle coordination, is limited. This study aimed at the evaluation of the development of postural control during reaching in a supported sitting condition. Eleven typically developing infants participated in the study and were assessed at the ages of 4, 6, 10 and 18 months. We elicited reaching movements by presenting small toys at an arm’s length distance, whilst activity of multiple arm, neck and trunk muscles was recorded using surface EMG. A model-based computer algorithm was used to detect the onset of phasic muscle activity. The results indicated that postural muscle activity during reaching whilst sitting supported is highly variable. Direction-specific postural activity was inconsistently present from early age onwards and increased between 10 and 18 months without reaching a 100 % consistency. The dominant pattern of activation at all ages was the ‘complete pattern’, in which all direction-specific muscles were recruited. At 4 months, a slight preference for top-down recruitment existed, which was gradually replaced by a preference for bottom-up recruitment. We conclude that postural control during the ecological task of reaching during supported sitting between 4 and 18 months of age is primarily characterized by variation. Already from 4 months onwards, infants are—within the variation—sometimes able to select muscle recruitment strategies that are optimal to the task at hand

Explanation and relations. How do general practitioners deal with patients with persistent medically unexplained symptoms: a focus group study

Contains fulltext : 80758.pdf (publisher's version ) (Open Access)BACKGROUND: Persistent presentation of medically unexplained symptoms (MUS) is troublesome for general practitioners (GPs) and causes pressure on the doctor-patient relationship. As a consequence, GPs face the problem of establishing an ongoing, preferably effective relationship with these patients. This study aims at exploring GPs' perceptions about explaining MUS to patients and about how relationships with these patients evolve over time in daily practice. METHODS: A qualitative approach, interviewing a purposive sample of twenty-two Dutch GPs within five focus groups. Data were analyzed according to the principles of constant comparative analysis. RESULTS: GPs recognise the importance of an adequate explanation of the diagnosis of MUS but often feel incapable of being able to explain it clearly to their patients. GPs therefore indicate that they try to reassure patients in non-specific ways, for example by telling patients that there is no disease, by using metaphors and by normalizing the symptoms. When patients keep returning with MUS, GPs report the importance of maintaining the doctor-patient relationship. GPs describe three different models to do this; mutual alliance characterized by ritual care (e.g. regular physical examination, regular doctor visits) with approval of the patient and the doctor, ambivalent alliance characterized by ritual care without approval of the doctor and non-alliance characterized by cutting off all reasons for encounter in which symptoms are not of somatic origin. CONCLUSION: GPs feel difficulties in explaining the symptoms. GPs report that, when patients keep presenting with MUS, they focus on maintaining the doctor-patient relationship by using ritual care. In this care they meticulously balance between maintaining a good doctor-patient relationship and the prevention of unintended consequences of unnecessary interventions

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Limited motor performance and minor neurological dysfunction at school age

Aim: To investigate the relationship between motor performance and minor neurological dysfunction (MND) at school age. Methods: Two hundred and fifty-three children (158 boys, 95 girls; mean age 8 years and 7 months) of whom 167 children received mainstream education and 86 children special education were neurologically examined according to Touwen. Special attention was paid to the severity of MND (simple or complex form) and type of dysfunction. Motor performance was assessed with the Movement Assessment Battery for Children (MABC), a parental questionnaire (Developmental Coordination Disorder Questionnaire; DCD-Q) and a teacher's questionnaire (Motor Observation Questionnaire for Teachers; MOQ-T). Results: Total scores of MABC, DCD-Q and MOQ-T were strongly related to the severity of MND and to dysfunctional coordination and fine manipulation. Mild dysfunction in posture and muscle tone was only weakly related to limited motor performance. Children with a MABC score <5th percentile showed significantly more often complex MND than children with scores between the 5th and 15th percentile or > 15th percentile (54% vs 17% and 10%). Conclusion: Limited motor performance is related to the severity and type of MND. Coordination problems and fine manipulative disability are strongly related to poor motor performance, mild dysfunctions of posture and muscle tone to a lesser extent

Neural correlates of developmental coordination disorder

AIM To review neuroimaging studies in children with developmental coordination disorder (DCD) systematically. Because only a few studies addressed this, we broadened our search and included neuroimaging studies in children with perinatal adversities and motor impairment without cerebral palsy. METHOD Two searches were performed in PubMed, PsycINFO, and Web of Science addressing (1) neuroimaging in DCD and (2) neuroimaging in children with perinatal adversities and motor impairment. RESULTS Five studies in children with DCD were identified. Four functional magnetic resonance imaging (MRI) studies showed that children with DCD activate multiple brain areas differently than controls. One diffusion tensor imaging study indicated that the internal capsule in children with DCD showed differences. The second search identified seven studies: three showed that white matter abnormalities and severe abnormalities on MRI were related to motor impairment; four were unable to demonstrate similar relationships. INTERPRETATION Data on neuroimaging in DCD are scarce; data available suggest that multiple brain areas are involved in the neuropathophysiology of DCD. Motor impairment in children with perinatal adversities is related especially to white matter abnormalities and severe abnormalities on MRI. We hypothesize that in some children with DCD the neural substrate mimics that of cerebral palsy. More neuroimaging studies are needed to understand the neural correlates of DCD better

Handwriting, visuomotor integration, and neurological condition at school age

Aim The study investigated the relationships between handwriting, visuomotor integration, and neurological condition. We paid particular attention to the presence of minor neurological dysfunction (MND). Method Participants were 200 children (131 males, 69 females; age range 8-13y) of whom 118 received mainstream education (mean age 10y 5mo, SD 1y 4mo) and 82 special education (mean age 10y 8mo, SD 1y 2mo). Each child had four assessments: a neurological examination, which paid attention to the type and severity of MND, a test to measure motor performance, a handwriting test, and the Developmental Test of Visual Motor Integration. Results Dysgraphic handwriting and slow writing speed were closely related to the severity of neurological dysfunction (both p <0.001); impaired visuomotor integration was related to the presence of MND (p <0.001) but somewhat less to its severity. Impaired handwriting and visuomotor integration were strongly related to two specific dysfunctions: fine manipulative disability and coordination problems (both p <0.001). Impaired visuomotor integration was weakly related to dysfunctional muscle tone regulation (p=0.009) and sensory dysfunction (p=0.042). Interpretation Poor handwriting and impaired visuomotor integration are related to MND, but in a differential way. Poor handwriting is related to the severity of neurological dysfunction and to dysfunctions of complex supraspinal circuitries. Impaired visuomotor integration is associated with the presence of any of the most common types of MND

Test-retest, inter-assessor and intra-assessor reliability of the modified Touwen examination

Interest in the Touwen examination (1979) for the assessment of minor neurological dysfunction (MND) is growing. However, information on psychometric properties of this assessment is scarce. Therefore the present study aimed at assessing the test's test-retest, inter- and intra-assessor reliability. Eleven boys and 14 girls, visiting a mainstream school, aged 4-12 years, were tested neurologically by 3 investigators. Inter- and intra-assessor reliability were based on videotapes of the assessments. To determine test-retest reliability children were reassessed after about 1 month. The various forms of reliability were calculated for neurological classification (normal, simple MND, complex MND), clusters of dysfunction and single items. Twelve girls and 7 boys showed a normal neurological condition; 2 girls and 1 boy were classified as having simple MND and 3 boys as having complex MND. The 3 forms of reliability for neurological classification were good (kappa = 0.71-0.83). Reliability for the majority of cluster scores was good. Test-retest agreement was moderate for the clusters reflexes and coordination and poor for fine manipulation; inter-assessor agreement was moderate for the clusters coordination and fine manipulation; intra-assessor agreement moderate for fine manipulation. Reliability for the majority of items was good. In conclusion, the Touwen examination has a moderate to good reliability when applied in a relatively healthy population. Whether reliability is similarly good in populations of children with minor developmental disorders has to be determined. (C) 2007 European Paediatric Neurology Society Published by Elsevier Ltd. All rights reserved

Destination unknown: Parents and healthcare professionals' perspectives on transition from paediatric to adult care in Down syndrome

Background Transitioning from paediatric medical care to adult care is a challenging process for children, parents and healthcare professionals. The aim of this study was to explore the experiences, concerns and needs of parents of children with Down syndrome and of professionals regarding this transition. Method A qualitative study was performed using semi-structured interviews with 20 parents of children with Down syndrome and six healthcare professionals. Results We showed that parents and professionals have concerns during each of the three distinct phases of transition (preparation, transfer and integration). Data disclose specific concerns regarding communication, continuity of care and rebuilding trust. We propose a framework for the transition to adult care. Conclusions The transition in medical care for children with Down syndrome should be flexible, patient-centred and coordinated together with patients and parents. Only in ensuring continuity of care will individuals with Down syndrome not get lost in transition

Destination unknown: Parents and healthcare professionals' perspectives on transition from paediatric to adult care in Down syndrome

Background Transitioning from paediatric medical care to adult care is a challenging process for children, parents and healthcare professionals. The aim of this study was to explore the experiences, concerns and needs of parents of children with Down syndrome and of professionals regarding this transition. Method A qualitative study was performed using semi-structured interviews with 20 parents of children with Down syndrome and six healthcare professionals. Results We showed that parents and professionals have concerns during each of the three distinct phases of transition (preparation, transfer and integration). Data disclose specific concerns regarding communication, continuity of care and rebuilding trust. We propose a framework for the transition to adult care. Conclusions The transition in medical care for children with Down syndrome should be flexible, patient-centred and coordinated together with patients and parents. Only in ensuring continuity of care will individuals with Down syndrome not get lost in transition