Myra O'Regan

Autism symptoms in Attention-Deficit/Hyperactivity Disorder: A Familial trait which Correlates with Conduct, Oppositional Defiant, Language and Motor Disorders

It is hypothesised that autism symptoms are present in Attention-Deficit/Hyperactivity Disorder (ADHD), are familial and index subtypes of ADHD. Autism symptoms were compared in 821 ADHD probands, 1050 siblings and 149 controls. Shared familiality of autism symptoms and ADHD was calculated using DeFries-Fulker analysis. Autism symptoms were higher in probands than siblings or controls, and higher in male siblings than male controls. Autism symptoms were familial, partly shared with familiality of ADHD in males. Latent class analysis using SCQ-score yielded five classes; Class 1(31%) had few autism symptoms and low comorbidity; Classes 2–4 were intermediate; Class 5(7%) had high autism symptoms and comorbidity. Thus autism symptoms in ADHD represent a familial trait associated with increased neurodevelopmental and oppositional/conduct disorders.

Sleep disorders in children with cerebral palsy

To determine the frequency and predictors of sleep disorders in children with cerebral palsy (CP) we analyzed the responses of 173 parents who had completed the Sleep Disturbance Scale for Children. The study population included 100 males (57.8%) and 73 females (42.2%; mean age 8y 10mo [SD 1y 11mo]; range 6y-11y 11mo). Eighty-three children (48.0%) had spastic diplegia, 59 (34.1%) congenital hemiplegia, 18 (10.4%) spastic quadriplegia, and 13 (7.5%) dystonic/dyskinetic CP. Seventy-three children (42.2%) were in Gross Motor Function Classification System Level I, 33 (19.1%) in Level II, 30 (17.3%) in Level III, 23 (13.3%) in Level IV, and 14 (8.1%) in Level V. Thirty children (17.3%) had epilepsy. A total sleep problem score and six factors indicative of the most common areas of sleep disorder in childhood were obtained. Of the children in our study, 23% had a pathological total sleep score, in comparison with 5% of children in the general population. Difficulty in initiating and maintaining sleep, sleep-wake transition, and sleep breathing disorders were the most frequently identified problems. Active epilepsy was associated with the presence of a sleep disorder (odds ratio [OR]=17.1, 95% confidence interval [CI] 2.5-115.3), as was being the child of a single-parent family (OR=3.9, 95% CI 1.3-11.6). Disorders of initiation and maintenance of sleep were more frequent in children with spastic quadriplegia (OR=12.9, 95% CI 1.9-88.0), those with dyskinetic CP (OR=20.6, 95% CI 3.1-135.0), and those with severe visual impairment (OR=12.5, 95% CI 2.5-63.1). Both medical and environmental factors seem to contribute to the increased frequency of chronic sleep disorders in children with CP.

Nasalance Scores for Normal-Speaking Irish Children

Objective To obtain normal nasalance values during the production of a standardized speech sample for Irish children and determine whether significantly different scores exist for different speech stimuli for female and male speakers. Design Mean nasalance scores were obtained for normal-speaking children during the repetition of 16 test sentences that were categorized according to consonant type within the sentences (high-pressure consonants, low-pressure consonants, nasal consonants). Participants Seventy children (36 girls and 34 boys, aged 4 years 11 months to 13 years) with normal articulation, resonance, and voice were included. Procedures Children repeated each of the 16 test sentences individually. The sentences were presented in groups according to consonant type, referred to as sentence categories. Data were collected and analyzed using the Kay nasometer (model 6200.3). Nasalance scores were obtained for the total speech sample and each sentence category. Data were statistically analyzed to investigate the effects of gender, sentence category, and gender by sentence category. Results Normative nasalance scores were obtained for the total speech sample (26%), high-pressure consonant sentences (14%), low-pressure consonant sentences (16%), and a nasal consonant sentence (51%). There was no significant difference in nasalance scores between male and female speakers. Significant differences were found between each sentence category (p ≤ .001), except between the high-pressure and low-pressure consonant sentence categories (p = .09). Conclusion The present study provides normative nasalance data for English-speaking Irish children. There was a significant difference between nasalance scores for different speech stimuli.

Periocular triamcinolone for prevention of macular edema after plaque radiotherapy of uveal melanoma: a randomized controlled trial.

OBJECTIVE To determine the efficacy and safety of periocular triamcinolone acetonide (40 mg) for the prevention of macular edema in patients undergoing plaque radiotherapy for uveal melanoma. DESIGN Prospective, randomized, controlled clinical trial. PARTICIPANTS AND CONTROLS One-hundred sixty-three patients with newly diagnosed uveal melanoma undergoing iodine 125 plaque radiotherapy were entered into the study. Fifty-five patients were randomized to the control group and 108 to the triamcinolone group. Eighteen-month data were available for 143 (88%) of the 163 patients. INTERVENTION Periocular injection of triamcinolone acetonide (40 mg in 1 ml) at the time of plaque radiotherapy and 4 months and 8 months later. Optical coherence tomography was performed at each patient evaluation. MAIN OUTCOME MEASURES Optical coherence tomography-evident macular edema, moderate vision loss, and poor final visual acuity. RESULTS Optical coherence tomography-evident macular edema occurred significantly less often in the triamcinolone group compared with the control group up to 18 months after plaque radiotherapy (hazard estimate, 0.45; 95% confidence interval, 0.19-0.70; P = 0.001). At the 18-month follow-up, moderate vision loss (loss of 3 lines or more of best-corrected visual acuity [BCVA]) and severe vision loss (BCVA <5/200 Snellen) occurred significantly less frequently in the triamcinolone group than in the control group (31% vs. 48% [P = 0.039] and 5% vs. 15% [P = 0.048], respectively). Rates of elevated intraocular pressure and cataract progression were similar in both groups. CONCLUSIONS Periocular triamcinolone is beneficial in reducing the risk of macular edema up to 18 months after plaque radiotherapy for uveal melanoma and significantly reduces the risk of moderate vision loss and poor visual acuity in these patients.

The comparison of type of incision for transperitoneal abdominal aortic surgery based on postoperative respiratory complications and morbidity

Equal access to the abdominal aorta can be attained through midline and transverse abdominal incisions. The surgical literature suggests that transverse incisions cause less postoperative pain and morbidity. Fifty patients (10 females and 40 males, mean age 67 years) undergoing abdominal aortic surgery were randomised to a midline (n = 25) or transverse (n = 25) incision. All patients were evaluated preoperatively and postoperatively for seven days. Changes in pulmonary function (FVC and FEV1), time to open and close the incision, analgesia used (morphine mg/kg/h), clinical or X-ray evidence of chest infection, and the duration of ICU stay were recorded. In the transverse group there was a reduction in the incidence of chest complications (20% vs. 28%, p = ns) and these incisions took longer to open (13.9 +/- 4.6 vs. 9.9 +/- 5.1, p < 0.05), but overall there was no significant difference between any other parameter in the two groups. Our results show no statistically significant difference in morbidity or analgesia consumption following transverse or midline abdominal incisions and we conclude that the type of incision used can be left to the surgeons preference.

Recovery of the upper limb post ischaemic stroke and the predictive value of the Orpington Prognostic Score

Objective: To document upper limb recovery in stroke patients and investigate whether the Orpington Prognostic Score (OPS) performed within 48 hours of admission to hospital post ischaemic stroke was a predictor of upper limb function at six months and two years. Design: Inception cohort design. Setting: Teaching Hospital. Subjects: One hundred and fourteen patients hospitalized with acute ischaemic stroke were stratified into three groups based on their OPS within 48 hours of admission post stroke and underwent further assessments at two weeks, six months and two years after stroke onset. Main measures: Rivermead Arm Score (RAS), Nine Hole Peg Test (NHPT) and grip strength (GS). Results: Patients with a good OPS and intermediate OPS showed significant recovery in all outcome measures for up to six months post stroke (p < 0.05), while those with a poor OPS at 48 hours showed no significant improvement (p < 0.05). The OPS score at 48 hours was the most highly correlated variable with upper limb outcome at six months (r = -0.728) and at two years (r = -0.712) compared with other variables such as age, class of stroke, sensation, grip strength and RAS. Conclusion: Stroke patients demonstrate differential upper limb recovery patterns which need to be taken in consideration when designing studies that investigate efficacy of rehabilitation, and the OPS is highly correlated with upper limb recovery at six months and two years.

A new Stroke Activity Scale-results of a reliability study

Purpose : To investigate the internal consistency, inter-rater and intra-rater reliability of a disability stroke activity scale (SAS) for stroke patients. Its intended use is as a measure of motor function at the level of disability in stroke patients. Method : Twelve stroke in-patients were video-recorded performing the five activities from the SAS. Seven senior physiotherapists, experienced in stroke care, independently rated the recordings on two occasions, three weeks apart, using the SAS. Twelve hospital inpatients participated in the study. The subjects were aged between 48 and 86 and were between 6 and 87 days post stroke. Results : Reliability for total scores was found to be excellent (generalizability correlation co-efficient (GCC) values U 0.95) and reliability for individual item scores was good (kappa U 0.7). Internal consistency reliability using Cronbachs alpha was also good (0.68 at time 1 and 0.68 at time 2). Conclusion : The stroke activity scale is a reliable instrument for hospital stroke patients. It can be administered in less than 10 minutes and requires minimal equipment and training. Further work on the validity and responsiveness of the SAS is in progress.

The Stroke Activity Scale: Results of a validity study

Purpose. To establish the concurrent validity and time to complete of the Stroke Activity Scale (SAS) a recently developed stroke motor disability scale designed for use in a busy clinical setting. Method. Forty-one stroke patients with residual hemiplegia were recruited and assessed on a single occasion using both the SAS (five items) and modified Motor Assessment Scale (MMAS) (eight items) by a research physiotherapist. Performance was videotaped and assessed subsequently by a second physiotherapist. Results. Pearsons correlation coefficient between the two measures was 0.91. The SAS was significantly quicker to complete than the MMAS (2.8 vs. 10.4 min, p < 0.0001). Conclusion. The SAS had high concurrent validity with the MMAS but was much quicker to complete and therefore more suitable for use in clinical environments where time is at a premium.

Personality traits in parents of people with autism

O b j e c t i v e s: This study set out to explore if there were measurable personality characteristics specific to pare n t s of people with autism. M e t h o d: Parents of 12 people with a DSM-III-R diagnosis of autism presented for the study. Each of the people with autism were matched where possible with a c o u n t e r p a rt without autism but with a lifelong disability on parameters of age, sex and IQ level. Parents of the ‘autism’ and ‘non-autism’ groups were then interviewed in detail using four personality assessment instru m e n t s . S c o res were tabulated for both mothers and fathers in each group and intergroup comparisons were made. R e s u l t s: No significant personality profile diff e rence was identifiable between the two parental groups. C o n c l u s i o n s: Personality traits specific to parents of people with autism are not identifiable in this study thus casting doubt on the validity of personality phenotypes as measurable heritability factors in autism.