Cornelius Ani

A Review of Studies on the Effect of Iron Deficiency on Cognitive Development in Children

Studies on the effect of iron deficiency on childrens cognition and behavior are selectively reviewed, looking for evidence of a causal relationship. Most correlational studies have found associations between iron-deficiency anemia and poor cognitive and motor development and behavioral problems. Longitudinal studies consistently indicate that children anemic in infancy continue to have poorer cognition, school achievement, and more behavior problems into middle childhood. However, the possible confounding effects of poor socioeconomic backgrounds prevent causal inferences from being made. In anemic children <2 y old, short-term trials of iron treatment have generally failed to benefit development. Most longer trials lacked randomized placebo groups and failed to produce benefits. Only one small randomized controlled trial (RCT) has shown clear benefits. It therefore remains uncertain whether the poor development of iron-deficient infants is due to poor social backgrounds or irreversible damage or is remediable with iron treatment. Similarly, the few preventive trials have had design problems or produced no or questionable benefits only. For children >2 y old, the evidence from RCT is reasonably convincing but not conclusive. RCT of iron treatment are warranted especially in younger children.

Supplementation with antioxidants and folinic acid for children with Down’s syndrome: randomised controlled trial

Objectives To assess whether supplementation with antioxidants, folinic acid, or both improves the psychomotor and language development of children with Down’s syndrome. Design Randomised controlled trial with two by two factorial design. Setting Children living in the Midlands, Greater London, and the south west of England. Participants 156 infants aged under 7 months with trisomy 21. Intervention Daily oral supplementation with antioxidants (selenium 10 μg, zinc 5 mg, vitamin A 0.9 mg, vitamin E 100 mg, and vitamin C 50 mg), folinic acid (0.1 mg), antioxidants and folinic acid combined, or placebo. Main outcome measures Griffiths developmental quotient and an adapted MacArthur communicative development inventory 18 months after starting supplementation; biochemical markers in blood and urine at age 12 months. Results Children randomised to antioxidant supplements attained similar developmental outcomes to those without antioxidants (mean Griffiths developmental quotient 57.3 v 56.1; adjusted mean difference 1.2 points, 95% confidence interval −2.2 to 4.6). Comparison of children randomised to folinic acid supplements or no folinic acid also showed no significant differences in Griffiths developmental quotient (mean 57.6 v 55.9; adjusted mean difference 1.7, −1.7 to 5.1). No between group differences were seen in the mean numbers of words said or signed: for antioxidants versus none the ratio of means was 0.85 (95% confidence interval 0.6 to 1.2), and for folinic acid versus none it was 1.24 (0.87 to 1.77). No significant differences were found between any of the groups in the biochemical outcomes measured. Adjustment for potential confounders did not appreciably change the results. Conclusions This study provides no evidence to support the use of antioxidant or folinic acid supplements in children with Down’s syndrome. Trial registration Clinical trials NCT00378456.

Incidence and 12-month outcome of non-transient childhood conversion disorder in the UK and Ireland

BACKGROUND Little is known about conversion disorder in childhood. AIMS To document clinical incidence, features, management and 12-month outcome of non-transient conversion disorder in under 16-year-olds in the U.K. and Ireland. METHOD Surveillance through the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System. RESULTS In total, 204 cases (age range 7-15 years) were reported, giving a 12-month incidence of 1.30/100 000 (95% CI 1.11-1.52). The most common symptoms were motor weakness and abnormal movements. Presentation with multiple symptoms was the norm. Antecedent stressors were reported for 80.8%, most commonly bullying in school. Most children required in-patient admission with frequent medical investigations. Follow-up at 12 months was available for 147 children, when all conversion disorder symptoms were reported as improved. Most families (91%) accepted a non-medical explanation of the symptoms either fully or partially. CONCLUSIONS Childhood conversion disorder represents an infrequent but significant clinical burden in the UK and Ireland.

Nutritional supplementation in down syndrome: theoretical considerations and current status.

Down syndrome (DS) is the most common inherited cause of learning disability1, and affected individuals are more prone to infections, leukaemia, congenital heart disease and other anomalies, thyroid dysfunction, early senescence and Alzheimer’s disease2. These complications create a heavy burden for carers of individuals with DS and the social and health services. Consequently, any intervention that ameliorates some of these complications will have a significant impact on the quality of life of individuals with DS and their carers. However, before investing resources in interventions, it is important to ascertain their scientific validity. The Internet and the lay press make many claims that certain expensive nutritional supplements improve the outcome in DS. These claims have left some health professionals confused and parents of children with DS vulnerable to pressures to spend large amounts of money on nutritional supplements whose benefits have not been proved. This review was undertaken firstly, to determine whether there is a theoretical basis to expect that nutritional supplements may improve the pathology of DS, and secondly, to critically examine published trials of nutritional supplements in DS to determine whether the existing evidence supports claims that nutritional supplements improve the outcome in DS.

Family and personal characteristics of aggressive Nigerian boys: differences from and similarities with Western findings

PURPOSE To identify the family and child determinants of aggressive behaviour in Nigerian elementary school boys and to compare the findings with previous ones from Western studies. METHODS Forty-seven aggressive boys from four elementary schools in Lagos, Nigeria were compared with 47 matched pro-social boys. Teacher rating and peer nomination were combined to select subjects. The subjects and their parents were given structured questionnaires to obtain information on possible risk factors for aggression. RESULTS Compared with pro-social boys, it was found that significantly more aggressive boys came from polygamous families and crowded homes, had more siblings, received less parental affection, were more physically punished, less supervised at home, witnessed more domestic conflicts, did poorly at school, had poorer verbal intelligence and attributed malice more readily than pro-social boys. Logistic regression indicated that the independent family predictors of aggression were crowding, little paternal affection, and corporal punishment. The independent child predictors were biased attribution and poor school achievement. Corporal punishment at school was also an independent predictor of aggression. CONCLUSIONS The family and child determinants of aggressive behaviour in Nigeria are similar to those found in Western studies except for the small contribution of family instability and overwhelming influence of corporal punishment in our sample. Models of intervention developed in the West may therefore be cautiously applied to Nigerian children.

Developing primary mental healthcare for children and adolescents.

Purpose of review Governmental initiatives to enhance child and adolescent mental healthcare are giving renewed impetus to work in primary care. This review identifies and discusses critically new findings in this area. Recent findings Research reviews and new studies continue to highlight the burden of unidentified and hence untreated psychopathology among children attending primary care. Expression of parental concern appears to provide important help in improving recognition. Shared protocols have been developed for primary care use for clinical conditions such as attention deficit hyperactivity disorder, but adherence to protocols is still limited. Randomized controlled trials have shown the feasibility and efficacy of suitably adapted therapeutic interventions for adolescent depression in primary healthcare and in educational settings. Surveys indicate a significant amount of child and adolescent mental health work by social services in countries such as the UK, and attest to the usefulness of protocols to attend to children in foster care. The new role of primary mental health worker has the potential to help support the interface between primary and specialist child and adolescent mental health services. Summary There is increased interest in further clarifying and enhancing the role of primary care child and adolescent mental health services.

Anxiety and depression predicted by medically unexplained symptoms in Pakistani children: A case-control study☆

OBJECTIVE To explore association between medically unexplained symptoms in children in Pakistan with emotional difficulties and functional impairments. METHODS We conducted a matched three-group case-control study of 186 children aged 8-16 years in Lahore, Pakistan. Cases were 62 children with chronic somatic symptoms for which no organic cause was identified after investigations. Two control groups of 62 children with chronic medical paediatric conditions, and 62 healthy children were identified. Cases and controls were matched for gender, age, and school class. Somatisation was measured with the Childrens Somatisation Inventory (CSI-24) while anxiety and depression were measured with the Spencer Childrens Anxiety Scale and the Short Mood and Feelings Questionnaire respectively. All questionnaires were translated into Urdu. RESULTS Mean age was 11.7 years (SD=2.1). Cases scored significantly higher on somatisation (CSI-24), anxiety and depression than both control groups. Paediatric controls scored significantly higher than healthy controls on all three measures. Two hierarchical linear regression models were used to explore if somatisation predicted depression and anxiety while controlling for several confounders. Somatisation (higher CSI-24 scores) independently and significantly predicted higher anxiety (β=.37, p=.0001) and depression (β=.41, p=.0001) scores. CONCLUSION This is the first study to show an association between medically unexplained symptoms and anxiety and depression in Pakistani children. This highlights the importance of screening for emotional difficulties in children presenting with unexplained somatic symptoms in this region.

School children's stigmatising attitude towards peers with epilepsy in Nigeria

Very few studies have examined stigmatising attitudes towards epilepsy by school children in Africa. We explored attitude towards epilepsy among 205 secondary school students in Lagos, Nigeria. Stigmatising attitude was measured by a modified Bogardus Social Distance Scale. A significant proportion of the students endorsed negative attitudes towards peers with epilepsy. For example, only 24% thought most students would invite an affected person to their birthday party and only 31% thought most students would like to study together with a person with epilepsy. Whereas 40% believed that epilepsy is caused by evil spirits, 24% believed it is infectious. Also, 37% believe their families consider epilepsy shameful, and 29% believe their families would not approve of friendship with a peer with epilepsy. Regression analysis identified significant predictors of increased stigmatising attitude as follows: perceived negative family attitude, limited familiarity with epilepsy and belief that epilepsy is caused by evil spirits. Our finding that the childrens perception of their familys negative attitude predicted their own stigmatising attitude towards epilepsy is unique. It suggests that interventions to reduce negative attitudes towards epilepsy by school children in this region may be more effective if the strategies include their families. Such intervention should include provision of accurate information on epilepsy.

Effects of psycho-education plus basic cognitive behavioural therapy strategies on medication-treated adolescents with depressive disorder in Nigeria

Objective: Limited data exists on psychological interventions for adolescent depression in African countries such as Nigeria. This study therefore investigates the effects of a psychological intervention that includes psycho-education and basic elements of cognitive behavioural therapy (CBT) on depressed medication-treated adolescents in Nigeria. Methodology: This was a pre-post one-group intervention study of 18 adolescents aged 13–18 years with clinically diagnosed depressive disorder, attending a specialist psychiatric hospital. They had been on antidepressants for 3 months or longer. Depressive symptoms, knowledge of depression, hope, and attitudes towards treatment adherence were measured at baseline and repeated at 1 and 4 weeks post-intervention. The adolescents received four sessions of a group-based manualised intervention focused on psycho-education and basic CBT strategies. Results: Statistically significant reductions in depressive symptoms were recorded, as were improvements in the adolescents’ knowledge of depression, hope, and attitude towards treatment adherence one week after the intervention (all p = 0.001). All differences were sustained at 4 weeks post-intervention. Participants’ satisfaction with the intervention was high. Conclusion: This study suggests that adding psycho-education with elements of CBT to antidepressant treatment is feasible, acceptable and can produce further benefits to depressed adolescents in this region.