Spatial and cumulative organochlorine and mercury exposure assessments in Steller Sea lions of Alaska: Emphasizing pups.

Steller sea lions (SSL) are sentinels for monitoring environmental contaminants in remote areas of the Aleutian Islands, Alaska. Therefore, concentrations of several organochlorines (OCs) were measured in blood from 123 SSL pups sampled from 3 regions; the western Aleutian Islands (WAI), central Aleutian Islands (CAI), and the central Gulf of Alaska. Blood, blubber, and milk from 12 adult female SSL from WAI, CAI and southeast Alaska also were analyzed. Findings included the following. SSL pups had higher concentrations of some OCs and mercury (Hg) on rookeries in the WAI than those more easterly. Pups had significantly higher blood concentrations of many OC classes than adult females sampled within the same region; some pups had PCB concentrations exceeding thresholds of concern (∑PCBs >8600 ng/g lw). ∑PCB concentration in pup whole blood was positively correlated with the trophic marker, δ15N within the regions sampled, along with two PCB congeners (PCB138 and PCB153). This suggests that the dams of pups with higher ∑PCBs, PCB138, and PCB153 concentrations were feeding on more predatory prey. Adult female blubber ∑DDT and hexachlorocyclohexane concentrations were also positively correlated with δ15N values. Several pups (mostly from WAI) had blood Hg concentrations and/or blood PCB concentrations (surrogate for overall OC exposures) of concern. The finding that WAI SSL pups have been exposed to multiple contaminants calls for future investigation of their cumulative exposure to a mixture of contaminants especially their transplacental and then transmammary exposure routes.

Co-occurring disorders: a possible key to visual perceptual deficits in children with developmental coordination disorder?

A study was conducted to examine how visual perceptual functioning in children with DCD may be influenced by co-occurring learning problems such as reading disabilities (RD) and/or attention deficit hyperactivity disorder (ADHD). Participants included seven groups of children: 27 children with DCD only, 11 with ADHD only, 14 with RD only, 63 with DCD and at least one other disorder (i.e., DCD + ADHD, DCD + RD, DCD + ADHD + RD), and 73 typically developing controls. Visual perceptual skills were assessed using the Test of Visual Perceptual Skills (TVPS) and the Rey Osterreith Complex Figure (ROCF; copy and delayed recall). Children with DCD and at least one other disorder were found to have impairments on the TVPS compared to children with DCD only, ADHD only, and typically developing controls, particularly on subtests assessing visual memory. On the ROCF, children with DCD and at least one other disorder scored significantly lower than children with ADHD only or RD only. Children with DCD plus one other disorder were then subdivided into three groups: DCD + ADHD, DCD + RD, and DCD + ADHD + RD and compared to children with DCD only, ADHD only, and RD only. Results indicated that children with DCD + ADHD + RD had significant impairments on the TVPS compared to children with DCD only and children with ADHD only. On the ROCF, children with DCD + ADHD + RD scored significantly lower than all of the groups, except the DCD+RD group. These findings suggest that DCD on its own is not associated with visual perceptual problems; rather, it is the presence of co-occurring disorders that is a possible key to visual perceptual deficits in children with DCD. The number of co-occurring disorders present with DCD is associated with the severity of the visual perceptual dysfunction. Deficits in visual memory skills appear to be a specific area of difficulty for children with DCD and co-occurring RD and/or ADHD.

Screening children with asthma for psychosocial adjustment problems: a tool for health care professionals.

OBJECTIVE: To develop a brief questionnaire for health care professionals to use in screening children with asthma for psychosocial adjustment problems. METHOD: The initial version of the Childhood Asthma Resiliency Questionnaire (CARQ) listed 85 items focusing on self-esteem, medical fears, peer relationships, family relations, stress, and depression. The number of items was reduced after focus groups and pilot testing. In pilot tests, 100 children with asthma completed the CARQ. Parents completed the Child Behavior Checklist (CBCL). Another sample of 73 children with mild asthma was also obtained. RESULTS: The total CARQ score was significantly correlated (p < 0.001) with Total Problems, Internalizing, and Externalizing Problems on the CBCL. Children with more hospitalizations and more days of school missed from asthma had significantly higher scores on the CARQ compared to children with less functional morbidity. CONCLUSION: The CARQ appears to be a useful brief measure to help clinicians identify children at risk for problems adjusting to asthma.

Predictive accuracy of the wide range assessment of memory and learning in children with attention deficit hyperactivity disorder and reading difficulties.

The predictive accuracy of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990) over and above more standardized diagnostic tools in children with attention deficit hyperactivity disorder (ADHD) and reading disabilities (RD) was examined. Fifty-three children with ADHD, 63 with RD, 63 with ADHD-RD, and 112 normal comparison children were administered the WRAML, the Wechsler Intelligence Scale for Children-Third Edition (WISC-III; Wechsler, 1991), the Achenbach (1991) Child Behavior Checklist (CBCL), and the Woodcock-Johnson Psycho-Educational Battery-Revised (WJ-R; Woodcock & Johnson, 1989). Results of a series of discriminant function analyses revealed that the academic, intellectual, and behavioral measures could correctly classify 73.1% of children, but the WRAML subtests alone were able to correctly classify only 58.5% of participants. Combining all of the memory, academic, intellectual, and behavioral measures resulted in 77.5% of cases being correctly classified. These results suggest that the use of a measure of memory functioning such as the WRAML did not significantly improve the predictive accuracy of a diagnosis of ADHD, RD, or both over and above more standard diagnostic academic, intellectual, and behavioral measures.

Identifying developmental coordination disorder: consistency between tests.

In the absence of a gold standard to identify the presence of developmental coordination disorder in children, it is useful to examine the consistency of different tests used in physical and occupational therapy. This study examined three measures of motor skills to determine whether they consistently identified the same children. In total, 379 children participated in this study. The final matched samples consisted of 202 children ranging in age from 8 to 17 years: 101 met criteria for DCD and 101 children did not show any evidence of DCD. The results indicated that the overall agreement between the Bruininks Oseretsky Test of Motor Proficiency (BOT), the Movement Assessment Battery for Children (M-ABC) and the Developmental Coordination Disorder Questionnaire (DCDQ) was less than 80%. The difference in structure and style of administration between the BOT and the M-ABC appears to contribute to their tendency to identify different children. This study emphasizes the need for therapists to use clinical reasoning to examine multiple sources of information about a child's abilities.

The term comorbidity is of questionable value in reference to developmental disorders: data and theory.

Over the last decade, there has been an enormous increase in the number of studies evaluating the overlap of developmental syndromes or disorders in both children and adults. This overlap of symptoms is often referred to as comorbidity, a term we criticize in this article because of its unsubstantiated presumption of independent etiologies. The premise of this article is that discrete categories do not exist in real life, and that it is misleading to refer to overlapping categories or symptoms as "comorbidities." We illustrate our point by presenting data from 179 school-age children evaluated with rigorous research criteria for seven disorders: reading disability (RD), attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD), oppositional defiant disorder (ODD), conduct disorder (CD), depression, and anxiety. Fully 50% of this sample met the criteria for at least two diagnoses. The children with ADHD were at higher risk of having at least a second disorder compared to the children with RD. Overall, the high rates of overlap of these behavioral, emotional, and educational deficits in this broadly ascertained sample support the idea that the concept of comorbidity is inadequate. We discuss the concept of atypical brain development as an explanatory idea to interpret the high rate of overlap of developmental disorders.

Effective mood stabilization with a chelated mineral supplement: an open-label trial in bipolar disorder.

BACKGROUND: To determine in open trials the therapeutic benefit of a nutritional supplement for bipolar disorder. METHOD: The sample consisted of 11 patients with DSM-IV-diagnosed bipolar disorder aged 19 to 46 years, who were taking a mean of 2.7 psychotropic medications each at study entry. Three additional patients dropped out prematurely. The intervention is a broad-based nutritional supplement of dietary nutrients, primarily chelated trace minerals and vitamins, administered in high doses. At study entry and periodically thereafter, patients were assessed with the Hamilton Rating Scale for Depression (HAM-D), the Brief Psychiatric Rating Scale (BPRS), and the Young Mania Rating Scale (YMRS). RESULTS: For those who completed the minimum 6-month open trial, symptom reduction ranged from 55% to 66% on the outcome measures; need for psychotropic medications decreased by more than 50%. Paired t tests revealed treatment benefit on all measures for patients completing the trial: HAM-D mean score at entry = 19.0, mean score at last visit = 5.4, t = 5.59, df = 9, p < 01; BPRS mean score at entry = 35.3, mean score at last visit = 7.4, t = 2.57, df = 9, p <.05; YMRS mean score at entry = 15.1, mean score at last visit = 6.0, t = 4.11, df = 9, p < .01. The effect size for the intervention was large (> .80) for each measure. The number of psychotropic medications decreased significantly to a mean +/- SD of 1.0+/-1.1 (t = 3.54, df = 10, p < .01). In some cases, the supplement replaced psychotropic medications and the patients remained well. The only reported side effect (i.e., nausea) was infrequent, minor, and transitory. CONCLUSION: Some cases of bipolar illness may be ameliorated by nutritional supplementation. A randomized, placebo-controlled trial in adults with bipolar I disorder is currently underway, as well as open trials in children.

Reliability and validity of a parent questionnaire on childhood motor skills.

OBJECTIVE: As the consequences of clumsiness in children become better understood, the need for valid measurement tools is apparent. Parent report has the potential for providing historical knowledge of the child's motor skills, as well as perceptions of their children's motor difficulties. The objective was to develop a parent questionnaire to identify motor difficulties in children. METHOD: A sample of 306 children participated in the development of a 17-item parent questionnaire, called the Developmental Coordination Disorder Questionnaire (DCDQ). Internal consistency, concurrent and construct validity were examined. RESULTS: The DCDQ proved capable of distinguishing children who had motor problems (as measured by standardized tests) from children without motor problems. Correlations with standardized tests were significant. Two other studies confirmed the construct validity of the DCDQ. Factor analysis revealed four distinct factors, useful in defining the nature of the difficulties. CONCLUSION: The DCDQ is a succinct and useful measure for use by occupational therapists.

Parents' ratings of everyday cognitive abilities in very low birth weight children.

Parents' ratings of everyday cognitive functioning in very low birth weight (VLBW) children free of sensorineural impairments and normal birth weight (NBW) children were compared with the children's actual performance on psychometric measures of cognitive and motor skills. Subjects included 19 VLBW children identified at age 3 years as "suspect" for developmental problems, 19 VLBW children identified at age 3 years as "developing normally," and 30 NBW full-term peers. Results indicated that parents of the suspect VLBW group rated their children as having significant impairments in memory, language, cognitive, and motor skills, findings which were consistent with the results of concurrent psychometric assessments. When compared with psychometric test results, parents identified more children as displaying difficulties in memory, language, and cognitive skills, but fewer children with coordination difficulties. These findings suggest that the parents' ratings and the psychometric measures may be assessing somewhat different aspects of the children's functioning.

The IQs of children with ADHD are normally distributed.

The purpose of this investigation was to determine whether or not attention-deficit/hyperactivity disorder (ADHD)-when there was an absence of reading problems-was associated with having a high IQ. The vocabulary and block design short forms of the Wechsler Intelligence Scale for Children-Third Edition were administered to 63 children with ADHD, 69 children with reading difficulties (RD), and 68 children with comorbid ADHD + RD. Results indicated that the distributions of estimated Full Scale IQs (FSIQ) for each of the three groups of children did not differ significantly from a normal distribution, with the majority of children (more than 50%) in each group scoring in the average range. The percentage of children with ADHD who scored in the above-average range for FSIQ was not significantly higher than the percentages of children in the other two groups. No significant group differences emerged for estimated FSIQ, vocabulary, or block design. It was concluded that children with ADHD are no more likely to have an above-average IQ than are other children.

Long-term neuropsychological outcomes in very low birth weight children free of sensorineural impairments.

This study investigated the neuropsychological outcomes at school age of children with very low birth weight (VLBW) free of sensorineural impairments. Subjects included 19 children with VLBW identified at age 3 as 'suspect' for developmental problems, 19 children with VLBW identified at age 3 as developing normally, and 30 children of normal birth weight (NBW). Results indicated that children in the VLBW 'suspect' group performed significantly more poorly on all of the neuropsychological measures compared to children of NBW. These findings suggest that VLBW children identified as 'suspect' for developmental problems because of impairments in cognitive skills at age 3 continued to show deficits at school age on intellectual and neuropsychological measures.

Deficits in long-term memory are not characteristic of ADHD. Attention Deficit Hyperactivity Disorder.

To separate the influence of inattentiveness from memory, we examined savings scores on material previously learned in 53 children with Attention Deficit Hyperactivity Disorder (ADHD), 63 with a reading disability (RD), 63 with both ADHD and RD combined, and 112 controls. Children with reading disabilities were impaired in their ability to remember previously-learned material unless it was repeated over four trials, whereas children with only ADHD performed as well as the controls for material presented only once. Children with ADHD did perform poorly on three subtests that are sensitive to attention/ concentration. We conclude that ADHD is associated with impaired initial learning due to attention deficits, but that long-term retention of learned material is normal.

The influence of systemic lupus erythematosus on fetal development: cognitive, behavioral, and health trends.

In 1985, Gualtieri and Hicks proposed the immunoreactive theory to explain the higher prevalence of childhood neurodevelopmental disorders in males. The theory claimed that male fetuses are more antigenic to mothers, resulting in increased immunologic attack on the developing central nervous system, and increased probability of atypical brain development. Individuals with systemic lupus erythematosus (SLE) provide a unique situation in which to investigate this theory. We evaluated the parent-reported prevalence of five developmental problems (stuttering, other speech problems, hyperactivity, attention deficit, and reading problems) in two groups: 154 individuals ages 8-20 years born to women with SLE, drawn from six cities, and 154 controls of comparable age and sex whose mothers did not have SLE. Controls were drawn from a comparison group ascertained from randomly selected schools in one of the cities. Questions about handedness, immune disorders, and pregnancy and birth complications were also evaluated. Children of SLE mothers were shown to have more evidence of developmental difficulties, immune related disorders, and nonrighthandedness. For developmental problems, these findings were most marked in male children of SLE mothers. These results suggest that maternal immunoreactivity, as represented by women with SLE, may present a special risk factor for subsequent learning difficulties in their children, particularly males.

Absence of an association between insulin-dependent diabetes mellitus and developmental learning difficulties.

For several years, investigators have been examining the relationship between learning difficulties and a variety of immunological disorders. Two recent studies by Hansen and colleagues reported a negative association between Type 1 diabetes and reading disabilities (dyslexia): subjects with Type 1 diabetes had a lower prevalence of dyslexia than their nondiabetic relatives. In order to control for the impact of environmental variables on learning, we investigated the relationship between Type 1 diabetes and learning problems in 27 sibling pairs, ranging in age from 6 to 20 years. One child in each pair had Type 1 diabetes, and the other child was the unaffected sibling closest in age. Children were assessed for cognitive skills, academic achievement in reading, mathematics, and written language, as well as for speech articulation and motor coordination. Other variables that were examined included handedness, behavioural variables, medical history, and pregnancy and birth complications. We found no significant differences between the 27 children with Type 1 diabetes and their unaffected siblings on any of the cognitive, academic achievement, or speech articulation measures. There were also no significant differences on handedness, behavioural variables, or health history.

The GBG model: is there more to consider than handedness?

It is peculiar that Bryden and his colleagues admit to the inadequacy of handedness as an index for cerebral anomalous dominance and then attack a model of anomalous dominance using primarily handedness data. In reality, the GBG model (which was intended to be "a hypothesis and program for research," to quote the exact titles of the 1985 articles) is not nearly as narrow as Bryden's worldview. We present here the rest of the literature on the link between immune disorders and language disorders which Bryden et al. neglected and argue that the data are sufficient to have warranted a +2 in their evaluation. The strength of this link is worthy of further investigation, even though the hormonal mechanism proposed in the GBG model may be erroneous.

Are families of children with reading difficulties at risk for immune disorders and nonrighthandedness?

This study used questionnaire data to examine immune disorders and nonrighthandedness in the families of children enrolled in a learning disabilities school and children attending regular classrooms in public schools. Groups were organized according to their performance on a standardized test of reading comprehension to avoid overlap. In total, 468 questionnaires were returned, from which we were able to derive a final sample of carefully matched subjects: 55 subjects undergoing remediation for reading problems and 55 age- and sex-matched control subjects. The results indicated that children with reading problems and their families more frequently suffered from some immune and autoimmune disorders, particularly those involving the gastrointestinal tract and the thyroid gland. In addition, symptoms of attention deficit hyperactivity disorder were associated with Crohn's disease and migraine headache in the families. There was no evidence of an elevated prevalence of nonrighthandedness in the children with reading problems and their families.

The effects of parental immunoreactivity on pregnancy, birth, and cognitive development: maternal immune attack on the fetus?

The effects of parental immunoreactivity were tested in two ways on questionnaire data collected from 468 children and their families. (1) It was found that the presence of learning difficulties in boys was associated with pregnancy and birth complications, as well as with maternal immunoreactivity. Paternal immunoreactivity did not appear to be related to any of the variables in question. (2) The antecedent brother effect, that children, particularly males, with older brothers have higher rates of the same set of variables, was not found. Maternal immunoreactivity emerges as a risk factor for pregnancy, birth, and cognitive development, but not exclusively by the proposed mechanism of maternal immune attack on the fetus.