Emanuel Tirosh

LANGUAGE DEFICIT WITH ATTENTION-DEFICIT DISORDER : A PREVALENT COMORBIDITY

The aim of this study was to delineate the prevalence and behavioral patterns of children with attention-deficit and language problems as compared to children with attention-deficit hyperactivity disorder (ADHD) only Out of a cohort of 3208 children 6 to 11 years old, 5.2% were identified as having a primary ADHD. A teachers behavioral questionnaire, pediatric interview and assessment, IQ, attention tests, and language evaluation were employed. A 45% rate of language problems was identified. This comorbidity is more prevalent among girls (P = .02). Sequencing and short-term memory were significantly related to attention-deficit and language problems, but the attention scores were not. Language performance was the best predictor of group assignment and was superior to IQ in that regard. Correlation analysis revealed a different behavioral pattern for the two groups. It appears that a significant proportion of children with ADHD have a language comorbidity not reflected by IQ assessments; therefore, language tests should be considered as part of their routine assessment. Children with attention-deficit and language problems appear to have a different neurocognitive pattern underlying their problems as compared with their peers with ADHD only. (J Child Neurol 1998;13:493-497).

The relationship between sleep and temperament revisited: evidence for 12-month-olds: a research note.

This study measured the sleep attributes of 30 normal 12-month-old children with a computerized movement detector (Actigraph). Data on the childs temperament was based on the Carey Toddler Temperament Questionnaire, which the mother completed. The main finding was that rhythmic children went to sleep earlier and had longer sleep duration; however, their sleep pattern was not more efficient compared to children with irregular rhythmicity. The results of the present study provide only limited evidence to the association between the regulation of sleep-wake cycles and the temperamental characteristics of the child. Hence it may be concluded that within non-referred low-risk infants, temperament does not discriminate between good and poor sleepers. Alternatively, however, the marginal relationship between sleep and temperament demonstrated in the present study may reflect the limitation of maternal perception as a source for temperament assessment.

Executive Dysfunctions among Boys with Attention Deficit Hyperactivity Disorder (ADHD): Performance-Based Test and Parents Report.

Difficulty in executive functions (EF) is a core symptom of ADHD. Yet, the EF assessments are still in controversy. It is still unclear whether the everyday implementation of EF can be assessed under laboratory conditions. Therefore, the purposes of the present study are: (a) to examine EF among boys with ADHD both in everyday behavior (as reported by parents) and in a performance-based test. (b) To examine correlations between the two tests. Both the Behavior Assessment of Dysexecutive Functions for Children (BADS-C) and the Behavior Rating Inventory of Executive Functions (BRIEF) were independently applied to 25 boys aged 8-11 years with ADHD and 25 age-matched typical boys. Results of the two assessments were compared between the two groups to indicate differences in EF. Correlations between the two assessments for all participants were evaluated. Overall, significant differences in EF were found between the two groups on both assessments. Significant correlations were found between BADS-C and BRIEF, specifically in metacognition but not in behavioral regulation. Findings indicate that poor EF manifests itself in everyday behavior. These difficulties are found in metacognitive and behavioral regulation components. Nevertheless, applying a valid ecological assessment of behavior regulation merits future research.

Sleep patterns of infants and young children in Israel

The sleep habits of 661 Israeli children between the ages of 4 months and 4 years were described by their mothers. Twenty-eight per cent reported that their children woke up at least once a week. In the group of regular wakers, the mean number of interrupted nights per week was 4.7, and the mean number of awakenings per night was 2.0. Significant age-related changes in sleep patterns were indicated. The results of this study suggest that sleep and settling patterns in different sociocultural groups are quite similar. These data indicate the existence of an inherent pattern in the maturation of sleep behaviour in the developing child.

CPAP treatment of obstructive sleep apnoea and neurodevelopmental deficits.

Four boys aged 6‐16 years with neurodevelopmental deficits were treated with CPAP for obstructive sleep apnoea. Their diagnoses were: Obesity with mild mental retardation, (2) attention deficit hyperactivity disorder, (3) epilepsy associated with left hemiparesis and (4) mild mental retardation due to fragile X syndrome. Previous therapeutic attempts, including adenotonsillectomy, amitriptyline and methylphenidate in our patients prior to CPAP treatment were unsuccessful. A follow‐up period of 12‐48 months demonstrated a number of clinical benefits such as improvement in sleep quality and daily arousal, and a decrease in the frequency of seizures and episodes of pneumonia. Polysomno‐graphic studies indicated a significant improvement in sleep parameters such as apnoea frequency, awakenings, sleep efficiency and arterial oxygen saturation. Side effects were mild and readily alleviated. CPAP is a feasible therapeutic intervention in intractable obstructive sleep apnoea of childhood, even when associated with neurodevelopmental deficits. CPAP, neurological deficit

Prognosis of motor development and joint hypermobility.

In a study of 59 infants aged 18 months there were 20 with joint hypermobility and delayed motor development, 19 with joint hypermobility and normal motor development, and 20 normal controls. They were reassessed for motor function 3.5 years later at the age of 5 years. Both gross and fine motor performance were significantly delayed in the group of children who exhibited joint hypermobility and motor delay in infancy. No significant delay was evident in those with joint hypermobility only. Joint hypermobility resolved more frequently in children who presented normal motor development at age 18 months. Infants with joint hypermobility and motor delay are a subgroup associated with a less favourable motor outcome and careful follow up is indicated.

Role of Virtual Reality for Cerebral Palsy Management

Virtual reality is the use of interactive simulations to present users with opportunities to perform in virtual environments that appear, sound, and less frequently, feel similar to real-world objects and events. Interactive computer play refers to the use of a game where a child interacts and plays with virtual objects in a computer-generated environment. Because of their distinctive attributes that provide ecologically realistic and motivating opportunities for active learning, these technologies have been used in pediatric rehabilitation over the past 15 years. The ability of virtual reality to create opportunities for active repetitive motor/sensory practice adds to their potential for neuroplasticity and learning in individuals with neurologic disorders. The objectives of this article is to provide an overview of how virtual reality and gaming are used clinically, to present the results of several example studies that demonstrate their use in research, and to briefly remark on future developments.

The effects of methylphenidate on word decoding accuracy in boys with attention-deficit/hyperactivity disorder.

The investigation aimed to delineate the immediate effect of methylphenidate on decoding in the comorbid condition of attention-deficit/hyperactivity disorder and reading disorder. Boys with attention-deficit/hyperactivity and reading disorders (n = 25) between the ages of 7.9 and 11.7 years, with at least average intelligence and verbal processing abilities participated in a double-blind, acute, randomized, placebo-controlled crossover trial with a single dose of methylphenidate 0.3 to 0.4 mg/kg with weekly intervals between testing sessions. The test battery included tasks of attention/control functions and reading domain functions. Paired comparisons and first trial group comparison comparing performance under placebo and under methylphenidate were used. Methylphenidate selectively improved strategy/set shift (P = 0.004) and facilitated improvement both in rapid naming (P = 0.043) and word/nonword accuracy (P = 0.028/P = 0.035). These findings lend support to a possible influence of methylphenidate on cognitive attention functions related to reading skills in the comorbid group.

Sandifer syndrome reconsidered

ABSTRACT. Three children with Sandifer syndrome are described. One patient was at first erroneously diagnosed as having neurological disease; the two others had true neurological damage, which led initially to misinterpretation of their bizarre dystonic features. Awareness of this entity will spare such children needless investigations and suffering, while giving them the benefit of proper treatment.

Preferred sleep position and gross motor achievement in early infancy.

The aim of this study was to assess the effect of an infant’s favoured position on their motor development at the age of six months. Seventy-five full-term infants were prospectively observed at home for their preferred sleep, awake, play and uninterrupted positions. A parental log was completed daily and then weekly up to the age of six months, when the Alberta Infant Motor Scale (AIMS) was administered. No significant relationship between the preferred or sleep positions as well as the awake and mutual play positions and gross motor developmental attainment at six months of age was noted. A significant change in the preferred recumbent posture with increased prone positioning both during sleep and awake time over the first six months was noted. A balanced positioning policy while awake, regardless of the infant’s preference while recumbent, is not associated with gross motor delay.