Arnold J. Capute

Primitive reflex profile: a quantitation of primitive reflexes in infancy.

This report describes quantitative standardization data on nine primitive reflexes for a cohort of 381 normal infants evaluated longitudinally at each visit between birth and two years of age. Normality was confirmed by the use of the Bayley Scales of Infant Development at one year of age. The standardization of this new examination technique complements the traditional infant neurological examination and may allow primitive reflexes to become a useful adjunct to the prediction of motor disability in early infancy.

CAT/CLAMS A Tool for the Pediatric Evaluation of Infants and Young Children With Developmental Delay

The American Academy of Pediatrics recommends regular developmental screening as a part of routine child health supervision. However, the pediatrician has a limited number of tools available to further evaluate a child who is found to be suspect or abnormal on a developmental screening test. The Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) was therefore developed to provide pediatricians with a technique to assess infants and toddlers with suspected developmental delay. The CAT/CLAMS demonstrated strong psychometric properties. Concurrent validity with the Bayley Scales of Infant Development (BSID) was demonstrated in 43 children ages 12 to 19 months who were tested on three occasions with both instruments (correlation coefficient ranging between 0.63 and 0.87; P<.001). Predictive validity 6 and 12 months later was also demonstrated in this population with correlation coefficients ranging between 0.73 and .077, significant at the P=.001 level. Utilizing the CAT/CLAMS as part of the pediatricians evaluation of children with developmental concerns would allow the pediatrician to compare language and nonlanguage problem-solving abilities and, therefore, aid in diagnosis and appropriate referral.

Age of presentation in developmental disability.

ABSTRACT. It has not been determined whether severity of handicap or other associated factors are more important in determining the age of presentation for developmental disabilities. The relationship between age at presentation and referral source, presenting complaint, diagnosis, and associated factors (medical illness, motor signs, or behavioral disturbances) was examined in 738 consecutive children referred for developmental evaluation during 1982–1983. The nature of the complaint or diagnosis (motor, language, behavioral, or educational) was a far better predictor of age of presentation than the severity of the disorder. The degree of mental retardation did not affect age of presentation. Behavior problems did not affect the age of presentation for school failure or learning disability, but were associated with later presentation for motor delay, language delay, communication disorder, and within all IQ groups. The association of topography of handicap rather than severity with age of presentation should be considered when establishing or evaluating efforts at early identification of developmental disability.

ASSESSMENT OF EARLY AUDITORY AND VISUAL ABILITIES OF EXTREMELY PREMATURE INFANTS

The early auditory and visual abilities of 47 extremely premature infants (31 born ≤28 weeks gestation) were assessed with a bell, a light and an optokinetic nystagmus drum. All the infants alerted to the bell and blinked to the light from 25 weeks postconceptional age (PCA) and beyond. A few infants at first had only a change in heart rate or respiratory rate in response to the bell, or required a high‐intensity light to elicit a blink. The majority appeared to habituate to the bell and light during their first examination at one week of age. None of the infants blinked in response to a threatening gesture. Optokinetic nystagmus could be elicited as early as 30 weeks PCA, could be elicited in the majority by 36 weeks PCA, and universally by term (40 weeks PCA). The responses of 15 fullterm newborn infants were not significantly different from those of the preterm infants at term. Alerting to a bell, blinking to light and habituation to both are simple bedside maneuvers for assessing extremely premature infants <30 weeks PCA. Optokinetic nystagmus may be useful in assessing the visual abilities of premature infants closer to term.

Using the Clinical Linguistic and Auditory Milestone Scale for Developmental Screening in High-Risk Preterm Infants

Eighty-one preterm infants (mean gestational age 29 weeks, range 24-36 weeks) discharged from The Johns Hopkins Hospital Neonatal Intensive Care Unit were followed up sequentially from birth to 2 years of age by use of the Clinical Linguistic and Auditory Milestone Scale (CLAM,S) to evaluate language development. Children were studied during three time intervals: Interval 1: 3-5 months chronologic age (CA); Interval 2: 9-14 months (CA); and Interval 3: 18-24 months (CA). Psychometric test scores were compared with CLAMS Language Quotients (LQ) by use of full, partial (75%, 50%, 25%), and no ‘correction’ for weeks of prematurity to determine whether ‘correcting’ for prematurity would yield a more accurate estimate of eventual cognitive outcome. CLAMS LQ at Interval 1 was highly correlated with CLAMS LQ at Interval 2 and CLAMS LQ at Interval 2 correlated well with CLAMS LQ at Interval 3 (r=0.57 and 0.64, respectively, P=0.0001). Correlations indicated that there was an orderly, sequential development of language in the preterm infant. CLAMS evaluations correlated significantly with psychometric test results during Interval 2 and Interval 3 (r=0.34, P<0.02 and r=0.75, P=0.0001, respectively). The CLAMS proved to be a useful instrument for monitoring preterm language development in the primary pediatric care setting.

Giftedness: Can it be Predicted in Infancy?

A cohort of 200 children, who were followed from birth and periodically evaluated as part of a longitudinal study of child development, was used to determine the ability of the Bayley Scales of Infant Development (BSID) to predict children who would be considered intellectually gifted at 7.5 years. The cohort was predominantly white (91%), upper middle class (70% in Hollingshead class 1 or 2), and had preschool educational experiences (94%). At outcome, 36 children had WISC-R verbal, performance, or full scale IQs greater than 135 and were called gifted. On average, gifted children walked 0.7 months earlier and spoke two-word sentences 2.2 months earlier than the non-gifted group. As a group, gifted children showed statistically significant, but clinically small, advantages for age of walking, age of speaking two-word sentences, BSID, and Stanford Binet IQ. Of the 36 children who later proved to be gifted, only two had BSID IQs greater than 134. Of the four children who had BSID IQs greater than 134, two maintained their superior function but 2 did not. A discriminant function analysis was used to predict giftedness for individual children based on BSID performance. The resulting classification achieved sensitivity = 0.69 and specificity = 0.39. Although groups of infants who will be gifted have higher BSID scores, the BSID cannot be endorsed as a method of identifying individual infants who will later demonstrate superior cognitive function.A cohort of 200 children, who were followed from birth and periodically evaluated as part of a longitudinal study of child development, was used to determine the ability of the Bayley Scales of Infant Development (BSID) to predict children who would be considered intellectually gifted at 7.5 years. The cohort was predominantly white (91%), upper middle class (70% in Hollingshead class 1 or 2), and had preschool educational experiences (94% ). At outcome, 36 children had WISC-R verbal, performance, or full scale IQs greater than 135 and were called gifted. On average, gifted children walked 0.7 months earlier and spoke two-word sentences 2.2 months earlier than the non-gifted group. As a group, gifted children showed statistically significant, but clinically small, advantages for age of walking, age of speaking two-word sentences, BSID, and Stanford Binet IQ. Of the 36 children who later proved to be gifted, only two had BSID IQs > 134. Of the four children who had BSID IQs > 134, two maintained their superior function but 2 did not. A discriminant function analysis was used to predict giftedness for individual children based on BSID performance. The resulting classification achieved sensitivity = 0.69 and specificity = 0.39. Although groups of infants who will be gifted have higher BSID scores, the BSID cannot be endorsed as a method of identifying individual infants who will later demonstrate superior cognitive function.

The Diagnostic Value of the Neurodevelopmental Examination

The neurodevelopmental examination is a pediatric approach to developmental diagnosis that relies on evaluation of multiple streams of development. The value of the neurodevelopmental examination for the early diagnosis of cerebral palsy and mental retardation was studied by a retrospective analysis of prospectively (longitudinally) collected data. Both conditions were found to be accurately diagnosed in the first year of life. For cerebral palsy, sensitivity was 0.81 and specificity 1.00; for mental retardation, sensitivity was 0.56 and specificity 0.96. The trained pediatrician can make early diagnoses of developmental disabilities.

Detection of Young Children in Need of Reading Help Evaluation of Specific Reading Disability Formulas

To determine whether formula-based definitions of specific reading disability (SRD) were related to the actual classroom performance of children aged 7½, the authors applied five definitions of SRD to a cohort of 243 children. The children were followed from birth and not selected on the basis of cognitive, reading, or academic performance criteria. The authors determined the concurrent validity of each of the formulas by comparing the prediction of each definition to whether the child received additional reading help in the classroom. Although the years behind method was significantly better than other approaches, no method identified more than 48 percent of the children who were given additional reading help. This study questions the ability of formula-based definitions adequately to identify young children with reading dysfunction.

Book Review: Neurobiology of Infantile Autism, edited by Hiroshi Naruse and Edward M. Ornitz. Published in 1992 by Elsevier Science Publishing Company, New York, 416 pages,

This reviewer is prejudiced, witnessing daily children within the spectrum of developmental disabilities exhibiting a neurobehavioral profile depicted as autistic-like behavior. These children possess various degrees of mental retardation, communicative disorders, brain injury, selfinjurious behavior, dual diagnoses, degenerative disorders (Rett syndrome), chromosomal aberrations (fragile X), intrauterine infections, and cerebral palsy. Professionals dealing with children having neurodevelopmental disabilities will be pleased to have this text available, which reports the proceedings of the International Symposium on Neurobiology of Infantile Autism, held in Tokyo, November 10-11, 1991, to keep them abreast of the updated clinical and research issues that are addressed. This text might well serve as a reference, although it is recommended that it be read in toto. Its neuroscience approach, using the medical interdisciplinary sharing of research and clinical issues, is of great assistance in developing a more realistic approach to children having this syndrome represented by