Motor performance and dyslexia in a national cohort of 10-year-old children.

Data from the 10-year follow-up of the 1970 British Births Survey were examined for associations between motor performance and dyslexia. Five tests of motor performance were used: (a) balancing on one leg, (b) throwing a ball in the air, clapping and catching it, (c) walking backwards, (d) sorting matches and (e) graphaesthesia (recognizing shapes drawn on the palm of the hand). These tests were given to 12 950 children aged between 10 and 11 years old. The cohort was divided into nine groups based on three levels of literacy achievement and three levels of possible indicators of dyslexia. The group with the most severe underachievement and most possible indicators (children most likely to be severely dyslexic) comprised about 2% of the total. Of this group, 35.3% failed one motor test and 16.4% failed more than one (51.7% in total), compared with 26.8% and 7.7% of normal achievers. The children had greater problems with balance than those in the other two severely underachieving groups but the effects were small. It is suggested that the use of a balance test only as a screener for dyslexia could result in a proportion of dyslexics being missed and that remedial motor training programmes for children with dyslexia should be offered only to those with co-occurring motor difficulties.

Cognitive outcomes of multiple mild head injuries in children.

This study assessed cumulative effects of multiple mild head injuries on cognitive functioning in children. Subjects included 1586 children with one mild head injury, 278 with two, and 51 with three or more head injuries between birth and age 10 years and controls without head injuries matched on gender and total number of injuries. The number of head injuries and injuries not to the head was associated with decreasing performance on measures of intelligence (p < .01), reading (p < .01), and math (p = .02). There was no interaction between case-control status and number of injuries, indicating a similar relationship between cognitive outcomes and number of injuries in head-injured cases and controls. After adjustment for covariates, the relationship between number of injuries and cognitive outcomes became nonsignificant. This study suggests that cognitive deficits associated with multiple mild head injury are due to social and personal factors related to multiple injuries and not to specific damage to the head.

Cognitive and behavioral sequelae of mild head injury in children.

Data from a longitudinal study of 13,000 British children were used to assess the sequelae of mild head injury 1 to 5 years after injury. One hundred fourteen children with parental reports of mild head injury treated with ambulatory care or admission to hospital for one night were compared with 601 children with limb fractures, 605 with lacerations, 136 with burns, and 1726 children without injury. Scores at age 10 were adjusted for intelligence, aggressive and hyperactive behavior at age 5, sex, socioeconomic status, and six other social factors. Children with head injuries were statistically indistinguishable from uninjured children on all outcomes except teacher's report of hyperactivity. After control of hyperactivity at age 5 and the social and personal factors, the head-injured children's mean hyperactivity score was four tenths of a standard deviation above that of the uninjured children. Children with lacerations and burns scored as badly or worse on measures of intelligence, mathematics, reading, and aggression as the children with head injuries. The small magnitude of the hyperactivity association coupled with the overall negative results suggests that mild head injury in school-aged children does not have an adverse effect on global measures of cognition, achievement, and behavior 1 to 5 years after injury.

Does fetal heart rate predict subsequent heart rate in childhood?

An investigation to determine whether there is any relationship between extremes of fetal heart rate during labour and subsequent heart rate at the age of 10 was carried out using data from the 1970 cohort of British Births. In 11,000 nationally representative children it was found that low fetal heart rate (below 120 beats/min) was associated with a heart rate at age 10 which was significantly lower than in those children whose fetal heart rate had remained between 120 and 160 beats/min (P less than 0.01). This relationship could not be explained by fetal asphyxiation, maternal antenatal hypotension or the method of pain relief during labour. There was no equivalent relationship with high fetal heart rate during labour. This could imply that some fetuses with low heart rates are not exhibiting fetal distress but have an inherent tendency to relatively slow heart rates.

Height, weight, and blood pressures in ten-year-old children.

Multiple regression techniques were used to determine the most efficient combination of height, weight and body mass index in the prediction of systolic and diastolic blood pressures for a national sample of 13,723 10-year-old children. In every analysis an adjustment was made for the depth of sphygomomanometer cuff used when taking the blood pressure. The variables which together best predicted the systolic blood pressures in boys were weight, height and (height)2, and in girls weight/(height)2 and height. Diastolic blood pressures were predicted best by weight only for boys and by weight/(height)2 and height for girls. Once these factors had been taken into account there was no difference in blood pressures in those children for whom there were signs of puberty.

Weight-for-height in two national cohorts with particular reference to 10-year-old children.

The idea of representing obesity or degree of malnutrition using a weight-for-height power index has existed for many years and several authors believe that such an index should be uncorrelated with height. Data from the 1958 National Child Development Study and the 1970 Child Health and Education Study have therefore been used to determine the values of the constant k which lead to the weight-for-height power index weight/[height]k being uncorrelated with height for specific age groups. Different values of k were needed both for the various age groups, and for the two sexes. For boys and girls respectively, the values of k needed at age 7 years were 2.02 and 2.12, at age 10 the values were 2.53 and 2.58, at age 11, 2.53 and 2.50 and at age 16, 2.42 and 1.71. Different values were also needed for West Indians and Asians and pubertal and pre-pubertal children. The relationships between this power index and other measurements of weight-for-height (including weight/height; weight/[height]2--the Quetelet index; weight/[height]3--the Ponderal index; relative weight for height, and standardized weight for height), the examining doctor's assessment of obesity and weight and height themselves were investigated for 10-year-old children born in 1970 to determine which of them could be thought of as best at estimating obesity. We found that there was little to choose between the index which was uncorrelated with height (using derived values of the power), and the Quetelet index.

Behavioral predictors of injury in school-age children.

The behavior of 10,394 British children was related prospectively to their injury history between ages 5 and 10 years, obtained from parents. Aggressive and overactive behaviors at age 5 years were measured by subscales of the Rutter Child Behavior Questionnaire completed by the parents. Multivariate techniques were used to assess the association between behavior and injuries while controlling for social, demographic, and psychological characteristics. Boys' behavior at age 5 years was more strongly predictive of injuries in the subsequent five years than was girls' behavior. The odds of experiencing injuries resulting in hospitalization in boys with high aggression scores was 2.4 times that of boys with low aggression scores. The identification of high-risk children provides the foundation for understanding the behavioral mechanisms that contribute to injuries and for developing preventive strategies tailored to the needs of these children.

Measuring psychosocial adaptation to diabetes in adolescence.

We have developed a psychometric test to assess psychosocial adaptation to diabetes in young people aged from 10 to 17 years. This includes subscales which describe emotional difficulty with, and attitude to, diabetes. The content of the scales was drawn from unstructured discussions with 27 young people with diabetes. The scales were piloted on two further unselected groups of adolescents (n = 50, n = 99) to examine their reliability, validity, and acceptability. Highly significant correlations were found between the results of the scales and measures of psychosocial function (p less than 0.001), parents' perceptions. Performance on the scale also correlated with a number of behaviour variables and differentiated those who were reported to be restricted by their diabetes (p less than 0.005) and those who had had a previous psychiatric referral (p less than 0.05). The scales appear reliable within the constraints of the small population examined.

Persistence of occurrence of injury: can injuries of preschool children predict injuries of school-aged children?

Data regarding 10,394 children from the 1970 British birth cohort were used to assess the consistency of injuries reported by parents as occurring between birth and 5 years of age and injuries reported between 5 and 10 years of age. Children with three or more separate injury events reported between birth and 5 years of age were 5.9 times more likely to have three or more injuries reported between 5 and 10 years of age than children without early injuries (95% confidence interval = 4.4 to 8.0). Children with one or more injuries resulting in hospitalization before 5 years of age were 2.5 times as likely to have one or more admissions to the hospital for injuries after 5 years of age than children with no early hospitalizations for injuries (95% confidence interval = 2.0 to 3.3). Stepwise regression was used to identify other predictors of injury. The number of injuries before 5 years of age were the best predictors of injuries reported between 5 and 10 years of age, followed by male sex, aggressive child behavior, young maternal age, many older, and few younger siblings. The findings of this study are consistent with two other large studies that relied on medical records rather than parental report and that focused on more severe injuries. Children with several of the identified risk factors can be predicted to have high rates of accidental injuries and may benefit from focused intervention.

Screening of vision in school: could we do better by doing less?

Assessment of vision in schoolchildren is routinely performed, but the effectiveness of the screening programmes has not been reviewed. A survey of health district screening programmes for vision in schools was performed at the end of 1984. The response rate from districts in England and Wales was 81%. All 165 of the districts that responded screened for loss of distant visual acuity; 96% screened for loss of colour vision, 73% for squint, and 67% for loss of near visual acuity. The frequency with which districts screened varied considerably. Some districts screened yearly, and various different types of tests were used. In many districts children were screened in unsuitable places, such as corridors, assembly halls, and toilets. Criteria for referral varied from one district to another, and few districts collected data appropriate for monitoring their screening programmes. Many districts screened more intensively than could be justified on the basis of the conditions tested for and the likely benefit of remedial treatment.

Length of preschool hospitalization, multiple admissions and later educational attainment and behaviour.

Differences in educational performance and behaviour at age 10 years between 2900 hospitalized and 11,000 non-hospitalized children in the 1970 British Births Cohort were described previously. In the present analysis associations were found between the length of time children spent in hospital before the age of 5 years and performance on vocabulary tests at age 5 and age 10. Children whose first admission occurred between 2 and 5 years of age were particularly likely to show this association. There was also a relationship between the length of preschool hospitalization and reading and mathematics attainment at age 10. It was the number of times a child was admitted to hospital before the age of 5, rather than the length of stay, which was associated with antisocial and anxious behaviour at age 5. The association was evident when the first admission occurred between 2 and 5 years of age and not before age 2. There was no association with such behaviour at age 10 once social and family factors and readmission between ages 5 and 10 were taken into account. There was a strong association between admission between ages 5 and 10 and behaviour scores at age 10. The results are interpreted as providing evidence for a need to develop the hospital educational service to ameliorate these associations and to review schemes which reduce the anxiety-provoking aspects of hospitalization for young children.

Preschool vision screening: a service in need of rationalisation.

A survey of health districts in England and Wales was carried out at the end of 1984 to ascertain among other things the range of current programmes for preschool vision screening. The response rate was 81.3%. Altogether 94% of districts reported screening for both reduced visual acuity and squint; two districts screened for neither. A great variety of different types of tests were in use and screening was carried out at a variety of different ages. A high proportion of districts were screening children for reduced visual acuity in infancy, although screening tests applicable at this age have not been shown to be effective. Districts screened for squint between one and four times. Collection of routine monitoring information by districts was poor.

Partial sight and blindness in children of the 1970 birth cohort at 10 years of age.

The prevalence and causes of partial sight and blindness (best corrected distant visual acuity of 6/24 or less) have been studied in a nationally representative sample of 15,000 10-year-old children. The prevalence of blindness (acuity less than 6/60) was between 3.4 and 4.0/10,000. All these children had been registered as blind; less than half were in schools for the blind, the remainder were all in other special schools. The prevalence of partial sight (acuity less than or equal to 6/24 greater than or equal to 6/60) was between 5.4 and 8.7/10,000; less than half of these children were in schools for the visually handicapped or partially sighted; most were in ordinary schools; half were neither registered as partially sighted nor ascertained as in need of special education for visual handicap. The most common cause of partial sight or blindness in this cohort was congenital cataract; the second most common was congenital nystagmus. The study identified a number of children whose best acuity on examination was 6/24 or less who had either no ophthalmological diagnosis or who had been diagnosed as suffering from a refractive error. These children have been included in the study because at the time of the survey they had either not been prescribed spectacles or they had spectacles which they were not wearing; the functional visual level of these children was therefore equivalent to that of those defined as partially sighted.

Screening for hearing loss in childhood: a study of national practice.

A questionnaire survey of all health districts in England and Wales was carried out at the end of 1984 to document screening programmes for identifying hearing loss in childhood. The response rate was 81.3%. All districts performed distraction testing, all but nine aiming at doing so at 7-9 months of age. All districts tested children's hearing at school, generally before 7 years of age. The number of times that children were screened both before school and at school varied considerably, from one to six times before school and one to six times at school. Few districts collected information that would allow them to make judgments about the efficiency of effectiveness of their screening programmes.

Dyslexia: Anomaly or normal variation?

This paper is an interim report on a large-scale survey. The background to the authors' research into dyslexia is briefly outlined. Next comes an explication of the contrast between "anomaly" and "normal variation." Some details are then provided of a survey of 12,905 children, age ten, who were given a variety of educational and cognitive tests relevant to a diagnosis of dyslexia. It is shown that the resultant distributions of scores are incompatible with the hypothesis of normal variation. The counter-hypothesis, viz. that dyslexia involves some kind of anomaly, has, therefore, to that extent resisted refutation.

Educational attainment of 10-year-old children with treated and untreated visual defects.

Children with visual defects who took part in a 10-year survey were compared with their peers on measures of intelligence, reading, mathematics and sporting ability. Results are consistent with earlier findings of increased intelligence among children with myopia and slightly reduced intelligence among children with amblyopia. Those with other visual defects had normal intelligence scores. Once intelligence had been taken into account, only children with mild hypermetropia were under-achieving at reading. Those with severe myopia were reading better than expected. None of the children could be shown to be over- or under-achieving at maths, any variation being due to intelligence. The mothers of children with visual defects perceived them to be less able at sport. Comparison of the performances of children with minor visual defects who had and had not been prescribed spectacles did not suggest any disadvantage for those without spectacles, with the possible exception of children with mild hypermetropia. It is concluded that the majority of visual defects do not affect children's learning, and that current indications for prescribing spectacles need to be validated.

Evidence for increasing prevalence of diabetes mellitus in childhood.

The prevalence of diabetes mellitus among the cohort of children in the Child Health and Education Study studied at age 10 was 1.3/1000. Comparison with prevalences found in the two previous British birth cohort studies suggested that the prevalence of diabetes is doubling roughly every decade. The data suggested that childhood diabetics are a socially advantaged group. These findings have important implications and should be taken into account by health service planners if the needs of these children are to be met in the future.

Recent findings from the 1970 child health and education study: preliminary communication.

The progress is described of the longtudinal cohort study based on all children born in England, Scotland and Wales in one week of April 1970. The children and their mothers have been surveyed at birth, at five, and recently, at ten. Analyses of the data presented include the finding of improved intellectual outcome in children who had been immunized against pertussis, compared with poor intellectual outcome in children who had had hospital admissions for the disease itself. Preliminary data collected at 10 show that routine hearing and vision testing during the child's school life fell short of recommended standards. The major aim of the 10-year-old contact, however, is to establish details of the national prevalence and pathogenesis of disability. The identification of disability uses a life skills questionnaire, medical history and examination.