Joseph M. Byrne

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.

Clinical assessment of sustained attention in preschoolers

Abstract In this study we developed preschool versions of two commonly used measures of sustained attention, the continuous performance task (Continuous Performance Task for Preschoolers; CPTP) and the cancellation task(Picture Deletion Task for Preschoolers; PDTP). Sixty children, 20 at each of 3,4, and5 years of age, who were healthy and free of developmental or behavioral problems, were tested. Our findings indicate that the level of difficulty of the revised tasks is age appropriate. Further, the tasks appear to be measuring sustained attention because performance decrements were demonstrated across the course of the session and developmental decreases in the frequency of errors were noted. Performances on the CPTP and PDTP were significantly related, but at a modest value, suggesting that the CPTP and the PDTP may be measuring somewhat different dimensions of attention. We conclude that both instruments may be valuable for the assessment of sustained attention in preschoolers.

An innovative method to assess the receptive vocabulary of children with cerebral palsy using event-related brain potentials

This single-case, multiple-control study illustrates the clinical use of ERPs as part of the linguistic and cognitive assessment of individuals who are unable to provide verbal or motor responses due to their multiple handicaps. The single-word receptive vocabulary of a 17-year-old patient with Cerebral Palsy (CP) and three age-matched controls was measured using an event-related potential (ERP) paradigm. The Peabody Picture Vocabulary Test-Revised (PPVT-R) was adapted for computer presentation, with three levels of difficulty (Preschool, Child, Adult). Individual pictures were presented successively, and correctly (congruent) or incorrectly (incongruent) named auditorially. ERP components were derived for both the congruent and incongruent picture-word pairs. As predicted, the N400 ERP component had a higher peak for the incongruent picture-word pairs at the Preschool and Child levels. At the Adult level, the ERP pattern was reversed (higher peak in congruent condition) for the CP patient and for two of the three controls and, it was substantially attenuated for the third control. These ERP findings indicated that picture-word pairs within the range of acquired receptive vocabulary were identified as correct or incorrect but picture-word pairs above an individuals level could not be differentiated as clearly. The findings demonstrate the clinical application of this paradigm to assessing receptive vocabulary in motor- and communication-impaired patients.

Effect of timing of cerebral ultrasonography on the prediction of later neurodevelopmental outcome in high-risk preterm infants

To determine the predictive value of cranial ultrasonographic examination in high-risk preterm infants at different postnatal ages, we scanned 110 infants less than or equal to 32 weeks gestational age at 1, 2, 3, and 6 weeks postnatal ages and at 40 weeks postconceptional age (PCA). Cranial abnormalities detected by ultrasonography at each postnatal age of examination were classified as minor (periventricular superolateral echogenicity with or without intraventricular hemorrhage, grades 1 to 3) or major (cystic periventricular leukomalacia with or without intraventricular hemorrhage, grade 4) and correlated with neurodevelopmental outcome determined by 1 year of age. Major abnormalities detected by ultrasonography were present in four infants at 1 week, four at 2 weeks, eight at 3 weeks, and 11 infants at 6 weeks and 40 weeks PCA, respectively. Nineteen infants (17%) had moderate to severe functional handicaps defined as cerebral palsy, cognitive or visual deficit, or deafness. The positive and negative predictive values of ultrasound examinations, with regard to later neurodevelopmental outcome, improved with increasing postnatal age at examination and was best at 40 weeks PCA. Negative results of ultrasound study at 40 weeks PCA most correctly predicted satisfactory outcome. Although only 58% of moderately to severely handicapped infants were correctly identified by ultrasound examination at 40 weeks PCA, all infants with major ultrasonographic abnormalities at 40 weeks PCA had moderate or severe handicap. Our data demonstrate that the timing of cerebral ultrasonography is important in the prediction of later neurodevelopmental outcome in high-risk preterm infants.

Language development in low birth weight infants: the first two years of life.

ABSTRACT. The four main aims of this cohort study were to (1) determine the number of consecutively referred low birth weight (LBW) infants presenting with delayed language at 12 and 24 months of age, (2) examine language profiles by measuring both functional and spontaneous language ability in 24-month-olds, (3) examine the relationship between perinatal medical history and language status at 12 and 24 months, and (4) examine the clinical validity of the Early Language Milestone (ELM) scale, a brief language screening instrument. Only infants without serious sensory impairment or mental handicap were included in the final sample. Seventy-one LBW infants (36 12-month-olds, 35 24-month-olds) were seen for developmental and language assessments. The findings suggest that within the first 2 years of life, low to moderate rates of language delay are evident in LBW infants who have already been screened for serious sensory or mental handicap. At 12 months of age, 8.3% of the infants had delayed expressive language; none had delayed receptive language. At 24 months of age, 28% of the infants had delayed expressive language; 5.7% had delayed receptive language. Furthermore, only 32% of those with normal expressive language and sufficient language sample had a mean length of response within the normal range. Language status was not related to a specific perinatal medical variable. Additional study into the clinical validity of the ELM as a screening measure for the LBW population is warranted. The ELM specificity for both receptive and expressive language domains was good at both ages (80 to 100%), but sensitivity was low to moderate (0 to 68%). J Dev Behav Pediatr 14:21–27, 1993. Index terms: language development, low birth weight.

Brain activity and language assessment using event-related potentials: development of a clinical protocol.

To test the validity of a new computerized task to assess childrens receptive vocabulary, event‐related potentials (ERPs) were recorded from 56 typically developing children ranging in age from 5 to 12 years. This ERP‐computerized vocabulary task does not require a child to give a verbal or motor (i.e. pointing) response. Single pictures, from an existing standardized test of receptive vocabulary, were presented on a computer screen and simultaneously named either correctly (congruent) or incorrectly (incongruent) via a computer. As predicted, the N400 amplitude was found to be significantly higher to the incongruent picture‐word pair (i.e. the child knew it was an incorrect pairing) than to the congruent picture‐word pair (i.e. the child knew it was a correct pairing). This effect was found for each of the four age groups (5 to 6 years, 7 to 8 years, 9 to 10 years, 11 to 12 years). This task accurately estimated current receptive vocabulary in typically developing children. Although still in the development stage, it may eventually serve as an adjunct to a thorough neurological and neurodevelopmental assessment of some children presenting with moderate to severe cerebral palsy.

Preschoolers Classified as Having Attention-Deficit Hyperactivity Disorder (ADHD): DSM-IV Symptom Endorsement Pattern

In the present study, 50 preschoolers were formally and independently classified using both the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and third edition-revised (DSM-III-R) criteria for attention-deficit hyperactivity disorder (ADHD). The sample consisted of 25 preschoolers classified as having ADHD and 25 typically developing preschoolers for comparison; the sample was matched on gender, age, and socioeconomic status. All 50 preschoolers were without neurologic or neurodevelopmental disorders, oppositional defiant disorder, or language delay. There were four key findings: first, of the 25 preschoolers with ADHD, DSM-IV classification was as follows: hyperactive-impulsivity type (68%), combined type (28%), and inattentive type (4%). Second, the DSM-IV profiles showed that several symptoms were either infrequently endorsed by parents, reflecting limited applicability to preschoolers with ADHD, or frequently endorsed by parents of typically developing preschoolers, thus reducing their diagnostic value. Third, of the 25 preschoolers classified as having ADHD using DSM-IV criteria, 16% would not have been classified as having ADHD using the DSM-III-R criteria. The DSM-IV criteria therefore appear to be more lenient than the DSM-III-R criteria for this age group. Fourth, two symptoms that were not included in the DSM-IV, but were part of the DSM-III-R, were found to have clinical value for differentiating preschoolers with ADHD from their typically developing peers. (J Child Neurol 2000;15:533-538).

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.

Assessment of children's receptive vocabulary using event-related brain potentials: Development of a clinically valid test

Abstract The combined verbal and motor impairments characteristic of children with disorders such as Cerebral Palsy (CP) frequently compromise the accuracy of standard psychometric assessments. What is needed is a test to measure language that does not require verbal or motor responses. This study was designed to determine whether single-word receptive vocabulary could be assessed in young children without CP, using an ERP-compatible test based on Form M of the Peabody Picture Vocabulary Test-Revised (PPVT-R). Fifteen 10-year-old children with normal levels of psychometric intelligence participated. Ninety pictures were selected from the PPVT-R (Form M), representing three levels of single-word receptive vocabulary (Preschool, Child-Adolescent, Adult). Each picture was presented twice (pseudo-random), once paired with a spoken word that was semantically congruent with the picture and once paired with a semantically incongruent word. The childrens N400 was significantly larger to incongruent than to congr...

Psychophysiologic and behavioral response to auditory stimuli in the newborn

Although there exists a large body of data on neonatal responsiveness to auditory stimuli, comparability across studies is generally lacking in many features of method, thus obscuring a comprehensive interpretation of this literature. In the present study, we monitored changes in the heart rate (HR), behavioral state, and bodily activity of 24 neonates (30–72 hours of age) in response to two parameters of auditory stimuli. The stimuli were variations of the computer-synthesized diphthong [ai] independently varying in both the duration of the transition between the component vowels (1 msec, 500 msec), and in the manner of presenting stimulus repetitions (pulsed vs. continuous). Each infant began testing in a state of light sleep and received a 2-minute presentation of each of two of the four stimulus conditions. The results showed that the HR acceleration, observed across all conditions, varied in shape and magnitude as a function of both stimulus manipulations, whereas behavioral state seemed influenced primarily by the pulsed/continuous manipulation. Differential changes in bodily activity were not observed. Although there were significant correlations between HR and activity changes, in general, the three response measures appeared not to be equivalent in their sensitivity to various stimulus features. The results are discussed with respect to: (a) newborn responsiveness to these different features of auditory stimuli; and (b) the integration and organization of different response systems in the newborn.