Borderline intellectual functioning: an increased risk of severe psychiatric problems and inability to work.

BACKGROUND: The use of facilities such as disability pension, psychiatric care, health care and services for people with intellectual disabilities and borderline intellectual functioning (BIF) were compared with the general population and two other study groups comprising people with mild intellectual disabilities (MIDs) and learning problems (LPs). METHODS: The population-based sample (N = 416,973), 'Finland-in-Miniature', was gathered in 1962 and followed until 1998. For the purpose of the present study, three groups were formed: BIF (n = 416), MID (n = 312) and LP (n = 284). The use of services was examined with the help of national registers. RESULTS: As compared with the general population, people with BIF had been granted disability pension 2.7 times more often and had been patients in psychiatric care 3.4 times more often. They had also systematically used more services than people with LP. CONCLUSIONS: People with BIF are at risk of inability to work and facing severe mental health problems. They also seem to have more severe psychiatric problems than people with MID and LP. There is, therefore, a crucial need for increasing the awareness in society of BIF. Although this study's follow-up data were collected about 20 years ago, it is still relevant because people with BIF are a neglected group and still face growing demands in school and work life with no marked changes in services.

Psychometric properties of observational tools for identifying motor difficulties - a systematic review.

BACKGROUND: Early identification of children with motor difficulties, such as developmental coordination disorder (DCD), is essential. At present only a fraction of children with DCD are identified. The purpose of the study was to systematically review the literature from 1994 to 2017 on observational screening tools and to evaluate the validity, reliability and usability of the questionnaires used. METHODS: The review of the literature was conducted to synthesize the data from five electronic databases for children aged 6-12 years. The following databases were searched: Academic search Elite (EBSCO), ERIC (ProQuest), MEDLINE (Ovid), PsycINFO (ProQuest), and SPORTDiscus with Full Text (EBSCO). The studies meeting our inclusion criteria were analyzed to assess the psychometric properties and feasibility of the measures. RESULTS: The literature search retrieved 1907 potentially relevant publications. The final number of studies that met the inclusion criteria of our systematic review was 45. There were 11 questionnaires for parents, teachers and children. None of the questionnaires was valid for population-based screening as the only measurement tool. CONCLUSIONS: There are many challenges in using initial screening tools to identify children with motor difficulties. Nevertheless, many promising questionnaires are being developed that can provide information on functional skills and limitations across a variety of tasks and settings in the daily lives of children with DCD. The review provides much needed information about the current scales used in many clinical, educational and research settings. Implications for assessing psychometric properties of the developed questionnaires and further research are discussed. TRIAL REGISTRATION: PROSPERO, CRD42018087532 .

Reliability and validity of the Finnish version of the motor observation questionnaire for teachers.

OBJECTIVES: Observational screening instruments are often used as an effective, economical first step in the identification of children with Developmental Coordination Disorder (DCD). The aim was to investigate the psychometric properties of the Finnish version of the Motor Observation Questionnaire for Teachers (MOQ-T-FI). METHODS: The psychometric properties were tested using two separate samples (S1: age range 6-12, M 9y 5mo, females 101, males 92; S2: age range 6-9, M 7y 7mo, females 404, males 446). Teachers completed the MOQ-T-FI in both samples, and in sample 2 teachers' ratings were compared to student's performance on the Movement Assessment Battery for Children-Second Edition (MABC-2). Internal consistency was investigated by using Cronbach's alpha, predictive validity by receiver operating characteristic (ROC) analysis, concurrent validity by correlation analysis, and construct validity by factor analysis. RESULTS: The MOQ-T-FI behaves consistently with its original Dutch version. The internal consistency was excellent (α=0.97). The bifactor model, with one general factor and two specific factors, fit the data significantly better than the first-order model. The concurrent validity with the MABC-2 was moderate (r=0.37 p<0.001). Sensitivity was 82.5% and specificity 44.5%, respectively. CONCLUSION: Notwithstanding the low specificity the MOQ-T-FI can be considered as a promising screening tool in the school environment for Finnish children at risk of motor learning problems.

Psychosocial Functioning of Children with and without Dyslexia: A Follow-up Study from Ages Four to Nine.

This longitudinal study compares developmental changes in psychosocial functioning during the transition into school of children with and without dyslexia. In addition, it examines the effects of gender and family risk for dyslexia in terms of the associations between dyslexia and psychosocial functioning. Children's psychosocial functioning (social skills, inattention and externalizing and internalizing problems) was evaluated by their parents at ages 4, 6 and 9, and diagnosis for dyslexia was made at age 8 (in grade 2). The findings indicated that children with dyslexia were already rated as having poorer social skills and being more inattentive than were typical readers before their entry into school. Significant interactions of gender and diagnosis of dyslexia emerged for social skills and inattention. The social skills of boys with dyslexia improved after school entry as compared to the level of girls without dyslexia, whereas the social skills of girls with dyslexia did not improve. Boys with dyslexia were rated as showing a high level of inattention both prior to and after school entry, whereas, for girls with dyslexia, inattention ratings increased after school entry, eventually matching the boys' levels.

The association of adiponectin and low-grade inflammation with the course of metabolic syndrome.

BACKGROUND AND AIMS: Metabolic syndrome (MetS) is associated with low-grade inflammation. The connections of adiponectin and inflammatory cytokines with the course of MetS are not well-known. The aim of this study was to investigate the relation of adiponectin and low-grade inflammation with the development or resolution of MetS. METHODS AND RESULTS: In the town of Pieksämäki, Finland, five complete age groups (n = 1.294) were invited for health check-ups in 1997-1998 for the first time and in 2003-2004 for the second time. The final study population included 284 men and 396 women. MetS was defined according to the National Cholesterol Education Program criteria in the beginning and at the end of the 6-year research period, and adiponectin, high-sensitivity C-reactive protein (hs-CRP), interleukin-1 receptor antagonist (IL-1Ra) and interleukin-1 beta (IL-1ß) levels were determined from baseline samples. Both male and female study subjects were divided into four groups according to the diagnosis of MetS in the two check-ups: not diagnosed at either check-up (No MetS), diagnosed only at the second check-up (Incident MetS), diagnosed only at the first check-up (Resolute MetS), and diagnosed at both check-ups (Persistent MetS). Baseline adiponectin, IL-1Ra and IL-1ß levels and IL-1ß/IL-1Ra -ratio were found to predict Incident MetS, when adjusted for the change in BMI, age, smoking status and physical activity. Our data also suggested that a high adiponectin level and low hs-CRP and IL-1Ra levels predict the resolution of MetS. CONCLUSION: Adiponectin and inflammatory markers can predict the course of MetS.

Do fatty acids help in overcoming reading difficulties? A double-blind, placebo-controlled study of the effects of eicosapentaenoic acid and carnosine supplementation on children with dyslexia.

BACKGROUND: There are claims that dietary supplementation of unsaturated fatty acids could help children with dyslexia to overcome their reading problems. However, these claims have not yet been empirically tested. METHODS: This study was designed to test whether dietary supplementation was superior to placebo in treating reading, spelling or other reading-related skills of children with dyslexia. The experimental group (eicosapentaenoic acid, EPA, n = 30) ate dietary supplements and the control group (placebo, n = 31) placebos during the 90-day treatment period. The supplements contained omega-3 fatty acid (ethyl-EPA, 500 mg/day) and carnosine (400 mg/day). The groups were matched for reading skills, grade, gender, attention problems, intelligence and amount of special education. The literacy-related skills of the two groups were assessed before and after the treatment period. RESULTS: No group differences were observed between EPA and placebo in measures of reading accuracy or speed, spelling, decoding fluency, arithmetical skills, reading-related language skills, attention or behavioural problems. CONCLUSION: The present findings do not support the hypothesis that omega-3 fatty acid (ethyl-EPA) or carnosine has a role in the treatment of reading and spelling problems in children with dyslexia.

In vivo response-based identification of direct hormone target cell populations using high-density tissue arrays.

To identify cell populations directly responsive to prolactin (PRL), GH, erythropoietin, or granulocyte-colony stimulating factor within the physiological setting of an intact mammal, we combined in situ detection of hormone-activated signal transducer and activator of transcription (Stat)-5 in rats with high-throughput tissue array analysis using cutting-edge matrix assembly (CEMA). Inducible activation of Stat5a/b, as judged by levels of nuclear-localized, phosphoTyr694/699-Stat5a/b, served as an immediate and sensitive in situ marker of receptor signaling in rat tissues after injection into male and female rats of a single, receptor-saturating dose of hormone for maximal receptor activation. CEMA tissue arrays facilitated analysis of most tissues, including architecturally complex, thin-walled, and stratified tissues such as gut and skin. In 40 tissues analyzed, 35 PRL-responsive and 32 GH-responsive cell types were detected, of which 22 cell types were responsive to both hormones. Interestingly, PRL but not GH activated Stat5 in nearly all of the endocrine glands. In mammary glands, PRL activated Stat5 in a majority of luminal epithelial cells but not myoepithelial cells, stromal fibroblasts, or adipocytes, whereas GH activated Stat5 in a significant fraction of myoepithelial cells, fibroblasts, and adipocytes but only in a minority of luminal cells. Finally, the organism-wide screening revealed a yet-to-be identified erythropoietin-responsive cell type in connective tissue. CEMA tissue arrays provide cost-effective in situ analysis of large numbers of tissues. Biomarker-based identification of cell populations responsive to individual hormones may shed new light on endocrine disease as well as improve understanding of effects and side effects of hormones and drugs.

Early development of children at familial risk for dyslexia--follow-up from birth to school age.

We review the main findings of the Jyväskylä Longitudinal study of Dyslexia (JLD) which follows the development of children at familial risk for dyslexia (N = 107) and their controls (N = 93). We will illustrate the development of these two groups of children at ages from birth to school entry in the skill domains that have been connected to reading and reading disability in the prior literature. At school entry, the highest score on the decoding task among the poorer half (median) of the at risk children--i.e. of those presumably being most likely genetically affected--is 1 SD below the mean of the control group. Thus, the familial risk for dyslexia shows expected consequences. Among the earliest measures in which group differences as well as significant predictive associations with the first steps in reading have emerged, are indices of speech processing in infancy. Likewise, various measures of early language including pronunciation accuracy, phonological, and morphological skills (but not performance IQ) show both group differences and predictive correlations, the majority of which become stronger as the reliability of the measures increases by age. Predictive relationships tend to be strong in general but higher in the at risk group because of its larger variance in both the predictor variables and in the dependent measures, such as early acquisition of reading. The results are thus promising in increasing our understanding needed for early identification and prevention of dyslexia.

A dominant gene for developmental dyslexia on chromosome 3.

Developmental dyslexia is a neurofunctional disorder characterised by an unexpected difficulty in learning to read and write despite adequate intelligence, motivation, and education. Previous studies have suggested mostly quantitative susceptibility loci for dyslexia on chromosomes 1, 2, 6, and 15, but no genes have been identified yet. We studied a large pedigree, ascertained from 140 families considered, segregating pronounced dyslexia in an autosomal dominant fashion. Affected status and the subtype of dyslexia were determined by neuropsychological tests. A genome scan with 320 markers showed a novel dominant locus linked to dyslexia in the pericentromeric region of chromosome 3 with a multipoint lod score of 3.84. Nineteen out of 21 affected pedigree members shared this region identical by descent (corrected p<0.001). Previously implicated genomic regions showed no evidence for linkage. Sequencing of two positional candidate genes, 5HT1F and DRD3, did not support their role in dyslexia. The new locus on chromosome 3 is associated with deficits in all three essential components involved in the reading process, namely phonological awareness, rapid naming, and verbal short term memory.

Practice effects on visuomotor and problem-solving tests by children.

Practice effects on a visuomotor test (the Developmental Test of Visuo-Motor Integration), a timed visual discrimination test (the Underlining Test), and two problem-solving tests (the Porteus Mazes Test and the Tower of Hanoi Test) were analyzed. Children of two age groups (Ms: 7.7 and 11.6 yr.) were chosen to study the effect of age on practice effects. The tests were repeated nine times with test-retest intervals of 2 mo. The Developmental Test of Visuo-Motor Integration showed no practice effects, while the Porteus Mazes Test, the Underlining Test, and the Tower of Hanoi Test showed significant practice effects. Practice effects were larger for the older age group on all the tests, except the Developmental Test of Visuo-Motor Integration. The Developmental Test of Visuo-Motor Integration and the Underlining Test showed good reliability, but those of the problem-solving tasks were less satisfactory. The stability of all the tests, except the Tower of Hanoi Test, was good.

Working memory and everyday cognition in adults with Down's syndrome.

A number of previous studies have suggested that young people with Down's syndrome (DS) have a specific deficit of the phonological loop component of the working memory. However, there have also been studies which have proposed a specific deficit of the central executive component of working memory and suggested similarities of working memory functioning with patients with Alzheimer's disease. Fifteen middle-aged people with DS were matched for their individual scores of non-verbal intelligence to 15 individuals with mixed aetiology of intellectual disability. A versatile range of tasks was used in order to evaluate the functioning of working memory components. In addition, several everyday cognition skills were assessed. The subjects with DS performed significantly more poorly in all tasks assessing the phonological loop. Performance in other working memory tasks and compound variables representing different working memory components was equal in the groups. In addition, both groups had equal everyday cognition skills. The functioning of the phonological loop seems to be clearly deficient in people with DS. Interestingly, the deficit does not seem to affect the vocabulary or other everyday cognition skills in individuals with DS. No signs of specific deficit of the central executive component of working memory were found.

Predicting delay in reading achievement in a highly transparent language.

A random sample of 91 preschool children was assessed prior to receiving formal reading instruction. Verbal and nonverbal measures were used as predictors for the time of instruction required to accurately decode pseudowords in the highly orthographically regular Finnish language. After 2 years, participants were divided into four groups depending on the duration of instruction they had required to reach 90 % accuracy in their reading of pseudowords. Participants were classified as precocious decoders (PD), who could read at school entry; early decoders (ED), who learned to read within the first 4 months of Grade 1; ordinary decoders (OD), who learned to read within 9 months; and late decoders (LD), who failed to reach the criterion after 18 months of reading instruction at Grade 2. Phonological awareness played a significant role only in differentiating PD from ED and OD. However, phonological awareness failed to predict the delayed learning process of LD. LD differed from all other groups in visual analogical reasoning in an analysis not containing phonological awareness measures. Letter knowledge and visual analogical reasoning explained above 90% of the PD-LD difference. Preschool composite (objects, colors, and digits) naming speed measures best predicted reading fluency at the end of Grade 2. The supportive role of orthographic knowledge in phonological awareness, the role of visual analogical reasoning, and the inability of phonological measures to discriminate late decoders are discussed.

Clinical significance of test refusal among young children.

The present study describes the incidence of test refusal at neuropsychological assessment, investigates its correlates, and its stability. The participants were 124 children aged 3.5 years whose development has been followed from birth in the Jyväskylä Longitudinal Study of Dyslexia (JLD). The frequency of test refusal on the Finnish version of the NEPSY was analyzed with respect to the children's concurrent and earlier cognitive and language skills, assessed using tests and parental ratings. Refusal during test-taking was found to be relatively common at this age, and high frequency of refusal at an earlier age was associated with similar tendency at a later age. High test refusal was associated with compromised neuropsychological and linguistic test scores. Missing data due to refusal were more common in neuropsychological tasks requiring verbal production. It is concluded that test refusals reflect a child's poor underlying skills and an attempt to avoid failure, rather than noncompliant or oppositional behavior.

Performance of Zambian children on the NEPSY: a pilot study.

Forty-five literate schoolchildren aged 9 (n = 25) and 11 (n = 20) from urban Zambia were given core and expanded tests on the NEPSY and their performance was scored according to age-equivalent norms for U.S. children. This study indicates that in urban, literate Zambian children, the NEPSY is relatively insensitive to language and cultural influences that often compromise the applicability of Western tests in the developing world. No consistent improvement in the standard scores was found as a function of educational experience. Comparison against the U.S. normative average revealed that both age groups were poorer in the domains of language and attention and executive functions, whereas their performance was better in the visuospatial processing domain. It is concluded that the NEPSY in its present form may be clinically useful, but its results should still be treated with caution, taking into account cultural, language, and personal demographic information. More studies, with divergent and larger samples of varying age ranges are required. It seems that the NEPSY could serve as the initial step in the development of neuropsychological practices in Zambia.

Treating missing data in a clinical neuropsychological dataset--data imputation.

Missing data frequently reduce the applicability of clinically collected data in research requiring multivariate statistics. In data imputation, missing values are replaced by predicted values obtained from models based on auxiliary information. Our aim was to complete a clinical child neuropsychological data set containing 5.2% of missing observations. This was to be used in research requiring multivariate statistics. We compared four data imputation methods by artificially deleting some data. A real-donor imputation method which preserved the parameter estimates and which predicted the observed values with acceptable accuracy was used to complete the data set. In addressing the lack of studies with regard to treatment of missing data in neuropsychological data sets, this study presents information on the outcomes of applying data imputation methods to such data. The imputation modeling described can be applied to a variety of clinical neuropsychological data sets.

Developmental pathways of children with and without familial risk for dyslexia during the first years of life.

Comparisons of the developmental pathways of the first 5 years of life for children with (N = 107) and without (N = 93) familial risk for dyslexia observed in the Jyväskylä Longitudinal study of Dyslexia are reviewed. The earliest differences between groups were found at the ages of a few days and at 6 months in brain event-related potential responses to speech sounds and in head-turn responses (at 6 months), conditioned to reflect categorical perception of speech stimuli. The development of vocalization and motor behavior, based on parental report of the time of reaching significant milestones, or the growth of vocabulary (using the MacArthur Communicative Development Inventories) failed to reveal differences before age 2. Similarly, no group differences were found in cognitive and language development assessed by the Bayley Scales of Infant Development and the Reynell Developmental Language Scales before age 2.5. The earliest language measure that showed lower scores among the at-risk group was maximum sentence length at age 2. Early gross motor development had higher correlation to later language skills among the at-risk group rather than the control children. The most consistent predictor of differential development between groups was the onset of talking. Children who were identified as late talkers at age 2 were still delayed at the age 3.5 in most features of language-related skills-but only if they belonged to the group at familial risk for dyslexia. Several phonological and naming measures known to correlate with reading from preschool age differentiated the groups consistently from age 3.5. Our findings imply that a marked proportion of children at familial risk for dyslexia follow atypical neurodevelopmental paths. The signs listed previously comprise a pool of candidates for early predictors and precursors of dyslexia, which await validation.

Working memory structure and intellectual disability.

The working memory of people with intellectual disability has been found to generally lag behind their mental age. However, studies concerning the structure of working memory or its connections to other cognitive functions are rare. The present study employs a versatile battery of tests for the evaluation of working memory structure in adults with intellectual disability of unknown aetiology. In addition, connections between working memory and cognitive skills valid for everyday functioning are evaluated. Working memory performance in the study participants was found to stem from two distinct components which could be regarded to represent phonological and general working memory. General working memory was closely related to intelligence, whereas phonological working memory was not. The subjects in the study group differed in their working memory profiles. These distinct profiles were significantly related to academic skills (e.g. reading, writing and mathematics) and sentence comprehension because the profile of the working memory predicted these abilities even when the intelligence and educational background of the participants was taken into consideration.

Repeated assessment of the Tower of Hanoi test: reliability and age effects.

The purpose of this research was to analyze the effects of repeating an executive function test. Three versions of the Tower of Hanoi (TOH) test were repeated three times each, with test-retest intervals of 2 months. Two groups of children participated in the research (7.7 and 11.6 years, n = 22 and n = 28). Repeating the assessment improved the performance and decreased the total performance time in both of the groups. The older participants improved their performance faster than the younger ones. The reliability of all the scores, besides the error scores, seemed to be satisfactory after the first few assessments. The stability of the scores was maintained through all the assessments. The planning time did not explain the variations of the achieved score. The reasons for the initially low reliabilities are discussed, and modifications for the test administration and scoring are suggested.

Suggestions for revised scoring of the Tower of Hanoi test.

Detailed time and error analyses of the Tower of Hanoi (TOH) test was performed using four repeated assessments of eight children (ages 9-12 years), who had perceptual and problem solving deficits. The time before each move was measured. In addition to the traditionally counted time scores, new, relative time scores were computed in order to separate the planning time from the general reaction speed. New error scores were defined and sum scores of serious errors (perserative moves, illegal moves, and wrong results) and mild errors (self-corrected moves, almost performed moves, and interrupted trials) were computed. The relative planning time correlated positively with the achieved score, and negatively with the serious errors. The serious errors correlated negatively with the achieved score. The relative planning time seems to measure the quality of planning better than does the raw planning time, and it is a recommended score for TOH analysis. The value of new error scores requires additional research.

Epithelial defect in prostates of Stat5a-null mice.

The transcription factor Stat5a critically mediates prolactin (PRL)-induced mammary gland development and lactogenesis. PRL also stimulates growth and differentiation of prostate tissue. Specifically, hyperprolactinemia gives rise to prostate hyperplasia, and prostate size is reduced in PRL-deficient mice. We therefore investigated the importance of Stat5a for prostate development and function by examining Stat5a-null mice. The absence of Stat5a in mice was associated with a distinct prostate morphology characterized by an increased prevalence of local disorganization within acinar epithelium of ventral prostates. Affected acini were typically filled with desquamated, granular epithelial cells that had become embedded in dense, coagulated secretory material. These features were reminiscent of acinar cyst formation and degeneration frequently observed in human benign prostate hyperplasia, however, cystic changes in prostate acini of Stat5a-deficient mice were not associated with increased prostate size or morphologic hallmarks of epithelial hyperplasia. Instead, immunohistochemistry of the prostate-specific secretory marker, probasin, suggested that hypersecretory function of the epithelium could underlie local congestion and cyst formation in prostates of Stat5a-null mice. Serum testosterone and PRL levels were normal in Stat5a knockout mice, but prostate PRL receptor expression was reduced as determined by immunohistochemistry. Expression levels or activation states of other PRL signal transduction proteins, including Stat5b, Stat3, Stat1, ERK1, and ERK2 were not altered. The present study offers the first evidence for a direct role of Stat5a in the maintenance of normal tissue architecture and function of the mouse prostate.