Harry N. Bawden

Peer Relationship Problems in Children with Tourette's Disorder or Diabetes Mellitus

Peer relationships, social skills, self-esteem, parental psychopathology, and family functioning of children with Tourettes disorder and a chronic disease control group of children with diabetes mellitus were compared. Children with Tourettes disorder had poorer peer relationships than their classmates and were more likely to have extreme scores reflecting increased risk for peer relationship problems than children with diabetes mellitus, but did not report self-esteem problems or social skills deficits. Measures of peer relationships were not related to severity or duration of tics. Children with Tourettes disorder and Attention Deficit Hyperactivity Disorder were at increased risk for poor peer relationships. The psychosocial problems of children with Tourettes disorder do not appear to be the generic result of having a chronic disease.

Risk for Injury in Preschoolers: Relationship to Attention Deficit Hyperactivity Disorder

Parental ratings of preschoolers’ risk for injury, direct assessment of preschoolers’ behavior thought related to risk for injury (e.g., Inattention, impulsivity) and number of documented injuries were examined in preschoolers with Attention Deficit Hyperactivity Disorder (ADHD) and their non-ADHD peers (Control). Of preschoolers with ADHD, 58.3% exhibited behavior which placed them at-risk for physical injury (0% Control), and their performance was significantly poorer on clinic-based tests. Nonetheless, preschoolers with ADHD did not actually sustain significantly more injuries which warranted medical treatment in an emergency department. Although preschoolers with ADHD may be at increased risk for minor injuries, further research is needed to determine whether they more frequently sustain more serious injuries.

Treatment of Children With Williams Syndrome With Methylphenidate

Children with Williams syndrome frequently present with symptoms of attention deficit hyperactivity disorder (ADHD), but there is little information that stimulant medication is useful in this population. A series of double-blind, placebo-controlled case studies was used to evaluate the cognitive and behavioral effects of methylphenidate on four children with Williams syndrome. Teachers and mothers completed behavioral rating scales and cognitive tests of attention, learning and memory, and academic productivity and accuracy in mathematics in each medication condition. Two of the children responded favorably in terms of decreased impulsivity, decreased irritability, and lower activity level as well as improved ability to pay attention. Methylphenidate is a useful adjunct in the treatment of some children with Williams syndrome. (J Child Neurol 1997;12:248—252).

Valproic Acid Treatment of Learning Disorder and Severely Epileptiform EEG Without Clinical Seizures

Using a single-patient (n = 1) clinical trial, we studied a 7-year-old boy who presented with unsatisfactory progress in school and whose electroencephalogram had very active independent frontal spike discharges. He had not had clinical seizures. The patient was randomized to receive valproic acid, 125 mg twice daily, (four periods) or matching placebo (four periods) over 8 weeks. Primary endpoints were the Wechsler Intelligence Scale for Children-Revised Coding subtest and a handwriting sample. Behavior was monitored using teachers and parents Conners questionnaires. His score on the Wechsler Intelligence Scale for Children-Revised Coding subtest was significantly improved while he was taking valproic acid (P = .03). His electroencephalogram improved from a pretreatment recording of 28 spike discharges per minute to a normal recording while on valproic acid. We conclude that in this patient, valproic acid had a cognitive enhancing effect, probably by reducing epileptiform discharges. (J Child Neurol 1996;11:41-43).

MRI and nonverbal cognitive deficits in children with neurofibromatosis 1

Magnetic resonance imaging brain scans and neuropsychological assessments of 17 children who met the NIH consensus diagnostic criteria for neurofibromatosis Type 1 were carried out in order to determine if there is a relationship between presence of high intensity signal abnormalities on MRI scans and nonverbal cognitive deficits. Cranial MRI scans in 10 patients (58.8%) demonstrated high intensity signal abnormalities, most frequently in the cerebral peduncles. Fifteen patients had nonverbal cognitive deficits (88.2%), including difficulty judging the orientation of lines, matching complex visual stimulus configurations, recalling pictures of faces, as well as copying and drawing from memory a complex geometric figure. There was not a significant association between nonverbal neuropsychological deficits and presence of high intensity signal abnormalities on MRI scans, possibly because the location of these hyperintense abnormalities was typically below the level of the basal ganglia. These findings suggest that the high intensity signal lesions seen on the MRI scans of children with neurofibromatosis Type 1 do not predict or explain their nonverbal cognitive deficits.

Early clinical assessment of attention.

Fifty preschoolers participated in this study. Twenty-five preschoolers classified as ADHD were matched with 25 typically developing preschoolers, and assessed using three tests of attention (two vigilance tests, one visual-search test). Their behavior exhibited during these attention tests was also assessed. Compared to their peers, preschoolers classified as ADHD exhibited significantly more omission and commission errors on the visual attention test. On the visual-search attention test, preschoolers classified as ADHD exhibited significantly more commission errors, and they took significantly longer to complete it. They did not exhibit significantly more omission or commission errors on the auditory attention test. The preschoolers classified as ADHD were also more vocal, more often off-task and out-of-seat, and they required more adult redirectives to return to task. Discussion is focused on the clinical value of developmentally appropriate attention tests and behavioral observation systems in the early clinical assessment of attention in very young children.

Neuropsychological functioning following craniopharyngioma removal

The neuropsychological functioning of patients who had undergone surgical removal of craniopharyngiomas was compared to that of an endocrine control group composed of patients with nontumor hypopituitarism, an obese control group, and a normal control group. Neuropsychological assessments consisting of measures of intelligence, memory, attention, and executive functioning were carried out. The craniopharyngioma group had lower Performance IQ than did the normal control group, but their Performance IQ was comparable to that of the hypopituitarism and obese control groups. The craniopharyngioma patients did not differ in Verbal or Full Scale IQs from the remaining groups. There were no group differences on measures of verbal or nonverbal memory, ability to sustain attention, or executive functioning including measures of verbal or figural fluency, nonverbal problem solving, ability to copy a complex geometric figure, and visual motor and visual sequencing skills. The group mean scores on the measures of intelligence and neuropsychological abilities for the craniopharyngioma patients were in the low-average to average range. While craniopharyngioma patients can have significant morbidity including endocrine and visual deficits as well as obesity resulting from hyperphagia, neuropsychological deficits are not always present. Their neuropsychological outcome is more benign than some previous studies have suggested.

Neuropsychological outcome in children with acquired or congenital renal disease.

Abstract. The neuropsychological abilities of children with congenital (n=13) or acquired (n=11) end-stage renal disease (ESRD) were compared. Patients were being treated with or being prepared for dialysis and were awaiting transplantation. None of the children had an identifiable syndrome with associated central nervous system (CNS) dysfunction or had exposure to drugs with known CNS toxicity. There were no group differences in intelligence, academic achievement, behavior, or immediate memory. Children with congenital ESRD had poorer fine motor coordination and more difficulty on tests of verbal and nonverbal long-term memory than children with acquired ESRD. However, the neuropsychological outcome for congenital ESRD is more favorable than previously described. Psychological and education treatment recommendations should be considered.

Preschool inattention and impulsivity-hyperactivity: Development of a clinic-based assessment protocol

Objective: To determine whether preschoolers classified as ADHD exhibited significantly more inattention and/or impulsivity-hyperactivity in the clinic than their typically-developing peers, using a developmentally appropriate clinical assessment protocol similar to protocols used with school-age children. Method: Fifty preschoolers participated; 25 preschoolers were classified with ADHD and matched with 25 typically-developing preschoolers. Direct clinic-based observations of behavior were analyzed and subsumed under two dimensions: inattention and impulsivity-hyperactivity. Results: In regard to inattention, compared to their typically-developing controls, the preschoolers classified with ADHD were significantly more often off-task in both low and high structure settings, and their episodes of play were significantly shorter in duration, though they did not shift activities more frequently. With regard to impulsivity-hyperactivity, preschoolers classified with ADHD were significantly more active and more talkative than their typicallydeveloping peers. Conclusions: Developmentally appropriate assessment protocols do provide convergent, clinically valuable information that may assist in the early assessment of ADHD and facilitate continuity of monitoring/assessment of ADHD symptoms into the school-age years.

Neuropsychological and Behavioural Outcomes in Children with Acquired and Congenital Renal Disease 1795

Neuropsychological and Behavioural Outcomes in Children with Acquired and Congenital Renal Disease 1795