Dugal Campbell

PSYCHIATRIC DISORDERS AT FIVE YEARS AMONG CHILDREN WITH BIRTHWEIGHTS < 1OOOg: A REGIONAL PERSPECTIVE

The relationship between extremely low birthweight (ELBW) and Psychiatric disorder was investigated in a cohort of children of 500 to 1000g birthweight, born between 1980 and 1982. At five years of age data were collected for 82 of 90 survivors on psychiatric symptoms, parent‐reported developmental delay and various aspects of psychosocial disadvantage. Compared with controls, ELBW children did not come from more disadvantaged environments, but were much more likely to experience developmental delay and problems with motor co‐ordination. 16 per cent had an attention deficit disorder with hyperactivity (ADDH), compared with 6–9 per cent of controls. Rates of conduct disorder and emotional disorder were not raised, indicting that ELBW is a specific risk factor for ADDH. Controlling for the effect of neurodevelopmental problems rendered the association between ELBW and ADDH non‐significant.

Intellectual and functional status at school entry of children who weighed 1000 grams or less at birth: A regional perspective of births in the 1980s

The intellectual and functional status of a regional cohort of children who weighed 501 to 1000 gm when born between 1980 and 1982 was evaluated at a mean age of 5 1/2 years by standard psychometric tests. Of 90 long-term survivors (survival rate 49%), 78 children (87%) had the full test battery, 5 children (6%) had other tests (4 were blind), and one child was untestable. Most of the mean scores were within 1 SD of the test norms; the lowest scores were in the McCarthy Motor scale and in the Beery Test of Visual-Motor Integration. Children without neurologic impairments and those with an IQ greater than or equal to 68 (n = 60) had higher overall scores but still performed poorly on the Motor subscale and the Beery test. Children who weighed less than 800 gm at birth (n = 28) were similar to those who weighed greater than 800 gm (n = 50), except in the Memory and Motor subscales, in which they performed significantly less well. At a functional level, determined by the Vineland Adaptive Behaviour Scales, two thirds of the children were performing in the adequate range and the remainder in the moderately low to low range. Of the 43 children with no neurosensory impairments and an IQ greater than or equal to 84, 49% were identified (by the Florida Kindergarten Screening Battery) to be at mild to high risk for future learning disabilities. The data from this unselected population provide an unbiased estimate of the prevalence of intellectual and functional problems in children who weighed less than or equal to 1000 gm at birth.

Psychopathology and adaptive functioning among extremely low birthweight children at eight years of age

The objective of this study was to explore the relationship among extremely low birthweight (ELBW), psychopathology, and impairments in adaptive functioning in a regional cohort of 7–8-year-old children with a birthweight of 501–1,000 g compared to a sample of full-term controls. One-hundred twenty-nine of 143 (90%) ELBW survivors and 145 controls, born between 1977 and 1981, agreed to participate in the study. The children were assessed at a mean, unadjusted age of 7.8 years. Results showed that parents of ELBW children were more likely than parents of controls to report specifically problems of attention-deficit hyperactivity disorder (ADHD). There were few differences between the groups in terms of impairments in adaptive functioning. Further analyses showed that the relationship between ELBW and ADHD could not be explained by confounding psychosocial risk factors, nor were ELBW children from disadvantaged environments more likely to have ADHD problems than ELBW children from nondisadvantaged environments. The relationships between ELBW and ADHD problems appeared to be associated with the lower IQ of the ELBW subjects.

Learning disabilities and school problems in a regional cohort of extremely low birth weight (<1000 g) children : A comparison with term controls

We compared the prevalence of learning disabilities at age 8 years in a subgroup of 68 of 129 (53%) regional cohort of extremely low birth weight (ELBW) children who were considered “normal‘’ neurologically and intellectually (IQ ± 85) with that of 114 term group matched controls (C). Both groups were tested with a battery of psychoeducational measures, and parents and teachers completed questionnaires on the school performance of the children. ELBW children were comparable with C on measures of intelligence (ELBW 101 ± 8, C 104 ± 11), language, and academic achievement but fared significantly less well in motor performance (p < .0001). The prevalence of learning disabilities (by predefined criteria) in ELBW children (26%) was not increased compared with C (19%). However, teachers rated significantly more ELBW children as performing below grade level than were C (31% vs 16%, p < .05), and by parent report, a higher proportion of ELBW children had received special assistance in school compared with C (37% vs 16%, p < .001). We conclude that although the prevalence of learning disabilities in normal ELBW children was not different from that in controls, ELBW children did less well and utilized more special resources.

A components analysis of biofeedback in the treatment of fecal incontinence

Fecal incontinence is a socially disabling symptom for which rectosphincteric biofeedback has been reported to be dramatically effective. The most commonly employed biofeedback procedure incorporates three separate and potentially effective components: (1) exercise of the external sphincter muscle, (2) training in discrimination of rectal sensations, and (3) training synchrony of the internal and external sphincter responses. This paper reports the results of single case experiments employed with eight incontinent patients to examine the contributions of each of these components. All eight patients improved, but only one required the biofeedback procedure as it was originally described. Three responded to sensory discrimination training, one to exercise training, and one to the training of synchronous sphincteric responses; three recovered independently of the effects of biofeedback. Despite the achievement of continence, the rectosphincteric reflexes following treatment continued to be abnormal in every case. These findings suggest that the character of the external sphincter response to rectal distension is an unreliable index of sphincter function and that exercise and sensory discrimination training procedures are effective for some cases of fecal incontinence.

Energy balance and nitrogen balance in growing low birthweight infants fed human milk or formula

Summary: Energy and nitrogen balances were measured in growing low birthweight infants fed either mothers expressed breast milk or a 20 kcal per ounce formula to determine whether or not there were differences between the two dietary groups in (1) the partition of energy among excretion, expenditure, and storage and (2) the relation of energy storage and nitrogen retention to weight gain.There were no significant differences between the human milk fed infants and formula fed infants in gross energy intake, metabolizable energy intake, nitrogen intake, or nitrogen retention. Energy expenditure was significantly lower in the human milk fed infants than in formula fed infants (221 kJ/(kg. day) and 244 kJ/(kg. day), respectively). There was no difference in mean energy storage between the two groups.Although weight gains were similar in both dietary groups, the ratio of energy storage to weight gain was significantly greater in infants fed with human milk (15.3 kJ/g, S.D. 2.0) than in infants fed formula (13.2 kJ/g S.D. 1.8). There was no significant difference between the two groups in the ratio of nitrogen stored to weight gain.

Irritable bowel syndrome: A test of the colonic hyperalgesia hypothesis

This study tested the hypothesis that, in patients with irritable bowel syndrome (IBS), there is a primary hyperalgesia of the colon. Previous work, which examined these patients and normals, has not included subjects who provide a control for relevant psychological characteristics. We compared ratings of pain, following varying degrees of distension of the sigmoid colon, in normals, patients with IBS, and patients who were psychologically disturbed but without bowel symptoms. Psychological characteristics were assessed by a psychiatric interview and psychometric inventories; response to distension was tested by placing a tube in the rectosigmoid colon and successively inflating and deflating a balloon at its tip at 10 cm3 increments up to 50 cm3. Ratings of pain were recorded at each volume. The results indicated that the two patient groups were psychologically similar and both were more disturbed than normals. A linear relation was found between reports of pain and volume of distension in all three groups. There were no significant differences between the proportions of subjects experiencing pain in each group or the average of the ratings. There were no significant associations between the pain ratings and measures of anxiety, depression, neuroticism, and extraversion. The data do not support the hypothesis that colonic hyperalgesia is an important contributory factor in the etiology of the irritable bowel syndrome.

A prospective study of hand preference and language development in 18‐ to 30‐month olds: I. hand preference

The time at which hand preference is established has long been of interest to developmentalists. In a prospective longitudinal study of 49 children (27 boys, 22 girls) an 11‐item hand preference inventory was given at 18, 24, and 30 months. At 18 months, nearly 75% of boys and girls had a clear hand preference (right or left); 73% of girls and 59% of boys were right‐handed. Evaluation of the stability of handedness showed that 60% to 70% of children maintained the same hand preference from 18 to 30 months of age. The results suggest that handedness is determined by at least 18 months and that preference for the same hand is retained 1 year later.

Randomized clinical trial of an oscillating air mattress in preterm infants: effect on apnea, growth, and development.

To investigate claims that oscillating mattresses reduce apnea of prematurity and improve growth and neurobehavioural development, we performed a randomized clinical trial using a predetermined sample size. Preterm infants weighing from 750 to 1750 gm at birth were randomly assigned, by 250 gm strata, to either a conventional mattress (n = 63) or to an air mattress (n = 59) oscillating at 14 to 16 regular pulses per minute. Infants remained on the oscillating air mattress for at least 7 days or until 34 weeks postmenstrual age. Apneic episodes occurred and required treatment equally in the two groups; this lack of an effect was seen for both sexes and all weight groups. Both weight and energy intake were similar. Neurobehavioral development as shown by sleep state, habituation testing, and behavioral assessment at term, 3, 6, and 12 months was similar in the two groups. There was no difference in the incidence of neurologic abnormalities. We conclude that an oscillating air mattress has no prophylactic value in reducing apnea and does not enhance growth and development.

A prospective study of hand preference and language development in 18- to 30-month-olds. II: Relations between hand preference and language development

Language development in relation to the establishment of handedness has long interested developmentalists. Forty‐nine children (27 boys, 22 girls) were given tests of hand preference and language expression and reception at 18, 24, and 30 months of age. The relations between handedness stability/ instability and language were examined within and between sexes. Children who did not change their handedness from 18 to 30 months were termed stable‐handers. Within‐sex analyses showed no differences in language reception or expression between stable‐ and unstable‐handers for either boys or girls. Between‐sex analyses showed that at 24 and 30 months, boys with unstable handedness had lower expressive language scores than girls with unstable handedness. Boys with stable handedness obtained lower expressive language scores than girls with stable handedness at 18 and 24 months but not at 30 months. There were no differences in language reception between stable‐handed boys and girls or between unstable‐handed boys a...