ABSTRACT
One of the oldest and probably well-known examples of cerebral palsy is the mummy of the Pharaoh Siptah about 1196-1190 B.C., and a letter from Hippocrates (460-390 B.C.). Cerebral palsy (CP) is one of the most common congenital or acquired neurological impairments in paediatric patients, and refers to a group of children with motor disability and related functional defects. The visible core of CP is characterized by abnormal coordination of movements and/or muscle tone which manifest very early in the development. Resulting from pre- or perinatal brain damage CP is not a progressive condition per se. However, without systematic medical and physiotherapeutic support the dystonia leads to muscle contractions and to deterioration of the handicap. Here we review the three general spastic manifestations of CP hemiplegia, diplegia and tetraplegia, describe the diagnostic procedures and delineate a time schedule for an early intervention.
ABSTRACT
BACKGROUND: Cognitive therapies are intended to improve basic cognitive functions, whatever the cause of the deficiency may be. Children and adolescents with various cognitive deficits are treated with behavioral therapeutic and computer-supported training programs. We here report the first meta-analysis of the efficacy of such programs. METHODS: We systematically searched the Medline, Embase, PsycINFO, PSYNDEX, and ERIC databases to find pertinent publications for a meta-analysis of cognitive training programs that are used in children and adolescents to improve attention, memory, and executive performance (primary goals) as well as behavior/psychopathology, intelligence, and school performance (secondary goals). The mean differences between the treatment and control groups are given here as standard deviation (SD) scores. RESULTS: 1661 potentially relevant publications were found, including 22 studies that were considered in the meta-analysis, 17 of which were randomized controlled trials. The target variables were measured with more than 90 different testing techniques. The overall effects of cognitive training on attention (SD 0.18, 95% CI -0.11-0.47) and executive function (SD 0.17, 95% CI -0.12-0.46) were consistently small. A relatively strong effect was found on memory performance (0.65 SD, 95% [-0.12-1.42), albeit with marked heterogeneity (I (2)= 82%) owing to two studies. The largest effect was found in the area of behavior and psychopathology (SD 0.58, 95% CI 0.31-0.85), but this last figure is derived mainly from studies that lacked an active control group. CONCLUSION: Cognitive therapies for children and adolescents have generally favorable, but probably nonspecific effects on behavior. On the other hand, the specific effects, however, were weak overall. Therapeutic benefit has been demonstrated only for certain individual types of therapy for specific indications.
Subject(s)
Cognition Disorders/epidemiology , Cognition Disorders/rehabilitation , Cognitive Behavioral Therapy/statistics & numerical data , Mental Disorders/epidemiology , Mental Disorders/rehabilitation , Adolescent , Age Distribution , Child , Child, Preschool , Cognition Disorders/psychology , Comorbidity , Female , Humans , Male , Mental Disorders/psychology , Risk Factors , Sex Distribution , Treatment Outcome , Young AdultABSTRACT
Studies on the effectiveness of parent trainings, especially for children treated with stimulants, yielded conflicting results. This study investigated the effectiveness of parent training (PT) as a part of routine clinical care. Compared to a waitlist control (n=16) PT-mothers (n=16) reported significantly fewer ADHD-symptoms, better acceptance of their children and a trend to better relationship satisfaction. No differences were found between children treated with or without stimulants. Contrary to the high level of consumer satisfaction fathers didn't report any improvements on all outcome domains.
Subject(s)
Attention Deficit Disorder with Hyperactivity/therapy , Education/methods , Psychotherapy, Group/methods , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/psychology , Central Nervous System Stimulants/therapeutic use , Child , Family Conflict/psychology , Female , Humans , Male , Mother-Child Relations , Outcome and Process Assessment, Health CareABSTRACT
Starting from a discussion of the validity of neuropsychological methods for the diagnosis of ADHD the results of an own study are presented. What is the diagnostic value of the German version of the CPT (Continuous Performance Task) and the DAT (Dortmunder Aufmerksamkeitstest) in discriminating ADHD subtypes (according to DSM-IV) and in which areas do the children of each subtype differ from a control group of normal children? The computer versions of the CPT and DAT were administered to 14 boys with the "combined subtype" of ADHD, 14 boys with the "predominantly inattentive type" of ADHD and 18 boys without clinical signs; all groups were matched in age and intelligence. Subsequently the mean differences between the various test parameters were assessed as to their significance. Contrary to other studies there were no significant differences either between both ADHS types or relative to the control group with regard to the CPT omission errors and the reaction time. There were differences in the reaction variability both between the ADHD subtypes and relative to the control group. Only the "combined subtype", not the "pre-dominantly inattentive type" differed from the control group as to the CPT commission errors. Regarding the DAT, there were significant differences between all three groups regarding both the solution quality and the response delay.
Subject(s)
Attention Deficit Disorder with Hyperactivity/diagnosis , Diagnosis, Computer-Assisted , Neuropsychological Tests/statistics & numerical data , Attention , Attention Deficit Disorder with Hyperactivity/classification , Attention Deficit Disorder with Hyperactivity/psychology , Attention Deficit and Disruptive Behavior Disorders/classification , Attention Deficit and Disruptive Behavior Disorders/diagnosis , Attention Deficit and Disruptive Behavior Disorders/psychology , Child , Child Behavior Disorders/classification , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Diagnostic and Statistical Manual of Mental Disorders , Humans , Language Development Disorders/classification , Language Development Disorders/diagnosis , Language Development Disorders/psychology , Learning Disabilities/classification , Learning Disabilities/diagnosis , Learning Disabilities/psychology , Male , Psychometrics/statistics & numerical data , Psychomotor Disorders/classification , Psychomotor Disorders/diagnosis , Psychomotor Disorders/psychology , Reaction Time , Reference Values , Reproducibility of Results , SoftwareABSTRACT
In the last few years, several genes involved in X-specific mental retardation (MR) have been identified by using genetic analysis. Although it is likely that additional genes responsible for idiopathic MR are also localized on the autosomes, cloning and characterization of such genes have been elusive so far. Here, we report the isolation of a previously uncharacterized gene, MEGAP, which is disrupted and functionally inactivated by a translocation breakpoint in a patient who shares some characteristic clinical features, such as hypotonia and severe MR, with the 3p(-) syndrome. By fluorescence in situ hybridization and loss of heterozygosity analysis, we demonstrated that this gene resides on chromosome 3p25 and is deleted in 3p(-) patients that present MR. MEGAP/srGAP3 mRNA is predominantly and highly expressed in fetal and adult brain, specifically in the neurons of the hippocampus and cortex, structures known to play a pivotal role in higher cognitive function, learning, and memory. We describe several MEGAP/srGAP3 transcript isoforms and show that MEGAP/srGAP3a and -b represent functional GTPase-activating proteins (GAP) by an in vitro GAP assay. MEGAP/srGAP3 has recently been shown to be part of the Slit-Robo pathway regulating neuronal migration and axonal branching, highlighting the important role of MEGAP/srGAP3 in mental development. We propose that haploinsufficiency of MEGAP/srGAP3 leads to the abnormal development of neuronal structures that are important for normal cognitive function.
