J. Kenneth Whitt

Neuropsychologic and academic functioning of children with sickle cell anemia

This study compared neuropsychologic test results and academic functioning among 28 school-age children with sickle cell anemia (SCA), and 28 healthy, age-, sex-, and socioeconomically matched black peers followed at a tertiary care center. Children with SCA scored significantly lower on reading and spelling achievement scores than healthy matched peers. Also, older children with SCA performed significantly less well on tests of visual-motor and attention skills than younger children with SCA. These results were unrelated to most measures of physical illness severity. The data suggest that sickle cell anemia may be associated with subtle neuropsychological and learning deficits that can contribute to decreased school performance. J Dev Behav Pediatr 9:213–220, 1988. Index terms: neuropsychologic, academic function, sickle cell anemia.

Outcome in children with fetal mild ventriculomegaly : a case series

Mild enlargement of the lateral ventricles is associated with schizophrenia and other neurodevelopmental disorders. While it has been hypothesized that ventricle abnormalities associated with neurodevelopmental disorders arise during fetal brain development, there is little direct evidence to support this hypothesis. Using ultrasound, it is possible to image the fetal ventricles in utero. Fetal mild ventriculomegaly (MVM) has been associated with developmental delays in early childhood, though longer-term neurodevelopmental outcome has not been studied. Follow-up of five children (aged 4--9 years) with mild enlargement of the lateral ventricles on prenatal ultrasound and two unaffected co-twins is reported: one child had attention deficit hyperactivity disorder (ADHD), one had autism, and two had evidence of learning disorders. These cases suggest that the mild enlargement of the lateral ventricles associated with these neurodevelopmental disorders arises during fetal brain development and can be detected with prenatal ultrasound. In addition, the presence of mildly enlarged, asymmetric ventricles in two children on prenatal ultrasound and on follow-up MRI at age 6 years indicates that ventricle structure present in utero can persist well into childhood brain development. The study of fetal ventricle development with ultrasound may provide important insights into neurodevelopmental disorders and allow the identification of children at high risk.

Neuropsychologic functioning of human immunodeficiency virus-infected children with hemophilia.

Efforts to detect subtle but objective neuropsychologic deficits could clarify the early involvement of the central nervous system and the progression of human immunodeficiency virus (HIV) infection in older children and young adolescents. Baseline examinations of 63 children and adolescents with hemophilia were conducted by examiners unaware of HIV status or staging or of our studys major hypotheses. They measured six domains of neuropsychologic functioning (motor, language, memory, attention, visual processing, and problem solving), and no differences between groups of similar age, race, and socioeconomic status defined by HIV seropositivity (n = 25) and HIV seronegativity (n = 38) were revealed. A high incidence of subtle neuropsychologic deficits relative to (1) age norms and (2) individual cognitive potential was found on measures of motor performance, attention, and speeded visual processing within both infected and uninfected groups. On the basis of these baseline data, it seems premature to attribute early, subtle neuropsychologic deficits in seropositive children with hemophilia to the central nervous system effects of HIV infection.

Neurodevelopmental outcome of infants with acute lymphoblastic leukemia

Infants diagnosed with acute lymphoblastic leukemia (ALL) are considered the patient subgroup at the highest risk for central nervous system (CNS) disease, both at presentation and as an isolated extramedullary relapse. In addition, they are highly vulnerable to adverse developmental sequelae from CNS‐directed therapy.

Social Judgments by Children of Short Stature

Recent psychiatric literature suggests that short stature in childhood may be associated with poor social judgment and a lack of adaptive competitiveness. In the present study these personal characteristics were evaluated for short children using the Picture Arrangement subtest from the Wechsler Intelligence Scale for Children-Revised (WISC-R). The test was administered either under experimental-competitive or standard conditions to 31 short male children and to 29 age-matched boys of normal stature. Significant differences in mean scaled scores were found between the short and normal groups. Increased scores under the competitive condition were observed for both groups. In contrast to previous reports, these results suggest that short children respond positively to competitive tasks. The findings are discussed in terms of emphasizing coping mechanisms of short children.

Simulating normal MMPI profiles as a favourable prognostic sign in schizophrenia

An attempt was made to assess the validity of simulating normal MMPI profiles as a prognostic sign in schizophrenia. A reliable and valid system was used to establish the criterion diagnosis of schizophrenia through the use of a standardized structured interview and a diagnostic system based on the use of discriminant function analysis with non-pathognomonic symptom combination. Outcome criteria used included a variety of measures of schizophrenic thought disorder. The results indicated that the ability to simulate a normal MMPI profile upon request is a favourable prognostic sign. Weaknesses of the study are discussed.

Pediatric Liaison Psychiatry: A Forum for Separation and Loss

Separation and loss issues arise frequently in pediatric hospital settings. Three forms of psychiatry/psychology liaison are presented which demonstrate: 1. case-centered collaboration to address child and family concerns about death; 2. team-centered activities which link family and staff roles in the course of terminal illness; and 3. the development of a program mechanism to meet the needs of staff “survivors” of recurrent childhood deaths. These examples illustrate the enrichment which pediatric psychiatry/psychology liaison programs offer when the conceptual model of liaison service and teaching operates flexibly on case, team, and program levels.