Abusive head trauma in infants: An observational single centre study comparing developmental and functional outcome between 18 months and 5 years.

BACKGROUND: Abusive head trauma (AHT) is a major cause of traumatic brain injury in infancy. This exploratory study compared standardized developmental assessment versus functional outcome assessment between 18 months and 5 years of age following AHT in infancy. METHODS: Observational cross-sectional study after surviving AHT in infancy. Seventeen children between 18 months and 5 years of age underwent clinical examination, developmental assessment using the Schedule of Growing Skills II (SGS II) and functional assessment using the Glasgow Outcome Scale-Extended Pediatric Revision (GOS-E Peds). Additional clinical information was extracted from medical records. RESULTS: Age at assessment ranged from 19 to 53 months (median 26 months). Most (n = 14) were delayed in at least 1 domain, even without neurological or visual impairment or visible cortical injury on neuroimaging, including 8 children with favourable GOS-E Peds scores. The most affected domain was hearing and language. Delay in the manipulative domain (n = 6) was associated with visual and/or neurological impairment and greater severity of delay across multiple domains. Eleven (64.7 %) had GOS-E Peds scores indicating good recovery, with positive correlation between GOS-Peds scores and number of domains delayed (r = 0.805, p < 0.05). CONCLUSION: The SGS-II detects behavioural and cognitive deficits not picked up by the GOS-E Peds. Combining both tools for assessment of AHT survivors under 5 years of age provides a comprehensive profile which addresses multiple domains of development and function, facilitating targeted intervention. Detection of developmental problems in the majority of survivors makes AHT prevention a public health priority.

Sensory processing and its relationship to participation among childhood occupations in children with autism spectrum disorder: exploring the profile of differences.

Autism is a condition manifested by persistent deficits in social communication and social interaction across multiple contexts, and, sensory processing difficulties may further affect childhood-occupation and hinders their overall development. This study examines the sensory-processing and childhood participation of children with autism (6 to 10 years), and 'age/gender-matched typical children as control. The Sensory Processing (SSP) and the Participation of childhood-occupation (PICO) measures were used to collect data from 93 parents of children with autism and 95 parents of typically-developing' children, recruited from hospitals, school and care centres. This study had 74 percent (n = 72) male participants (i.e. 4:1 male to female ratio) in the autism group, and found sensory processing difficulties were associated with specific childhood-participation limitation. Children with autism had lower participation (across level, frequency and enjoyment) than the typical children. Sensory-processing' difficulties for the children with autism (n = 93) were at 68.8 percent, compared to 21.5 percent in the typical group (n = 95), and were significantly different (p < 0.001). The differences in sensory-processing difficulties were significant (p < 0.05) between groups, across all domains, except for movement sensitivity (p > 0.28). Auditory filtering was the sole sensory-processing difficulty with significant correlations with all three dimensions of participation [i.e. difficulty (r = 0.36, p < 0.01), frequency (r = 0.22, p < 0.05) and enjoyment (r = 0.27, p < 0.01)]. Our finding highlighted that auditory-filtering difficulties is a key sensory processing difficulty, and it significantly lower the childhood-participation in the autism group. Adding to a growing body of literature on assessment in autism, there is a need for early screening, and to engage parents in early intervention to improve specific sensory processing deficits but also to focus on the child's strengths, for a comprehensive supportive care.

Outcome of abusive head trauma in children less than 2 years: A single center study from a middle-income country.

BACKGROUND: Abusive head trauma (AHT) is a severe manifestation of physical abuse in young children. This study examines the outcome of AHT in children under 2 years and features associated with mortality and disability. METHODS: Retrospective chart review of 72 children under 2 years diagnosed to have AHT between 2011 and 2018 at a tertiary teaching hospital in Malaysia. Demographic variables, clinical features, results of neuroimaging and their associations with outcome were explored. RESULTS: The median age at presentation was 4 months, 78% were six months or younger and 68% were male. Two-thirds became unwell in the care of an alternative caregiver. Subdural hemorrhage was present in 98%. Mortality was 10%. Forty-nine survivors returned with median interval of 16 months (IQR 5-44 months) between discharge and last follow-up. At least 35% of 65 survivors were disabled with 29% having multiple disabilities. Multiple disabilities (61.1% versus 25.8%) and cognitive impairment (61.1% versus 22.6%) were significantly higher in children 3 years or older at last follow-up (p < 0.05). Signs of brainstem dysfunction at presentation, requirement for ventilation and hypoxic-ischemic injury on neuroimaging were associated with mortality. Needing ventilation, cerebral edema and neurological or visual impairment at discharge were associated with disability. CONCLUSIONS: Outcomes of death or disability in 42% make prevention of AHT a public health priority. Survivors require long-term multi-disciplinary follow-up for coordination of rehabilitation and educational support. Prevention should be directed at improving resources and services to support families in the care of young infants under 6 months.

Victimization After Meeting With Online Acquaintances: A Cross-Sectional Survey of Adolescents in Malaysia.

This study aimed to determine contact and privacy risks encountered by Malaysian adolescents with access to the Internet and mobile phones and factors associated with face-to-face meetings with online acquaintances as well as to estimate the prevalence of subsequent victimization. Secondary school students from randomly selected public schools in Selangor and Kuala Lumpur responded to an anonymous self-administered questionnaire (78% response rate). Out of 3,349 Internet or mobile phone users, 51% had been invited to meet offline with an online-meeting acquaintance and 30% complied. Of the 1,005 respondents who went to offline meetings, 55% had meetings with more than six people. Male gender, Malay ethnicity, online access at an Internet café, viewing pornography on the Internet, the absence of parental restrictions on visiting certain website and chat rooms, not being explicitly forbidden to meet strangers encountered online, and disclosure of personal information were significantly associated with increased odds of face-to-face meetings with online acquaintances. Verbal, physical, or sexual assaults were reported by 5.5% of the 1,005 including 13 males and five females who reported forced sexual intercourse. Similarities as well as differences in factors associated with risk-taking behavior compared with adolescents in Western countries have important implications on policy and intervention.

Factors associated with online victimisation among Malaysian adolescents who use social networking sites: a cross-sectional study.

OBJECTIVE: To determine the prevalence of online interpersonal victimisation and its association with patterns of social networking site (SNS) use, offline victimisation, offline perpetration and parental conflict among Malaysian adolescents using SNS. METHODS: A cross-sectional study of students from randomly selected public secondary schools in the state of Negeri Sembilan was conducted using an anonymous self-administered questionnaire. The questionnaire examined patterns of SNS use and included measures of online victimisation, online perpetration, offline victimisation and parental conflict. A response rate of 91% from a total of 1634 yielded a sample of 1487 students between 15 years and 16 years of age. RESULTS: Ninety-two per cent of respondents had used at least one SNS. More than half of SNS users (52.2%) reported experiences of online victimisation over the past 12 months. Boys were significantly more likely to experience online harassment compared with girls (52.2% vs 43.3%, p<0.001). There were no significant gender differences in experiences of unwanted sexual solicitation. Adolescents who engaged in perpetration behaviours online had almost six times higher odds of reporting frequent online victimisation compared with online behaviours involving personal disclosure. There was a significant dose-response relationship between engagement in multiple types of online behaviour and the risk of frequent online victimisation. Both online and offline perpetrations were associated with an increased risk of victimisation. Those who were victimised offline or experienced parental conflict were twice as likely to report online victimisation. CONCLUSION: Interventions to prevent online electronic aggression should target perpetration behaviour both online and offline. Youth should be equipped with skills in communication and decision-making in relationships that can be applied across a spectrum of contexts both online and offline.

Cross-Cultural Adaptation and Psychometric Properties of the Malay Version of the Short Sensory Profile.

AIMS: To translate, culturally adapt, and examine psychometric properties of the Malay version Short Sensory Profile (SSP-M). METHODS: Pretesting (n = 30) of the original English SSP established its applicability for use with Malaysian children aged 3-10 years. This was followed by the translation and cross-cultural adaptation of the SSP-M. Two forward and two back translations were compared and reviewed by a committee of 10 experts who validated the content of the SSP-M, before pilot testing (n = 30). The final SSP-M questionnaire was completed by 419 parents of typically developing children aged 3-10 years. RESULTS: Cronbach's alpha of each section of the SSP-M ranged from 0.73 to 0.93 and the intraclass correlation coefficient (ICC) indicated good reliability (0.62-0.93). The seven factor model of the SSP-M had an adequate fit with evidence of convergent and discriminant validity. CONCLUSIONS: We conclude that the SSP-M is a valid and reliable screening tool for use in Malaysia with Malay-speaking parents of children aged 3-10 years. The SSP-M enables Malay-speaking parents to answer the questionnaire with better reliability, and provides occupational therapists with a valid tool to screen for sensory processing difficulties.

Victimization experiences of adolescents in Malaysia.

PURPOSE: There has been little community-based research regarding multiple-type victimization experiences of young people in Asia, and none in Malaysia. This study aimed to estimate prevalence, explore gender differences, as well as describe typical perpetrators and family and social risk factors among Malaysian adolescents. METHODS: A cross-sectional survey of 1,870 students was conducted in 20 randomly selected secondary schools in Selangor state (mean age: 16 years; 58.8% female). The questionnaire included items on individual, family, and social background and different types of victimization experiences in childhood. RESULTS: Emotional and physical types of victimization were most common. A significant proportion of adolescents (22.1%) were exposed to more than one type, with 3% reporting all four types. Compared with females, males reported more physical, emotional, and sexual victimization. The excess of sexual victimization among boys was due to higher exposure to noncontact events, whereas prevalence of forced intercourse was equal for both genders (3.0%). Although adult male perpetrators predominate, female adults and peers of both genders also contribute substantially. Low quality of parent-child relationships and poor school and neighborhood environments had the strongest associations with victimization. Family structure (parental divorce, presence of step-parent or single parent, or household size), parental drug use, and rural/urban location were not influential in this sample. CONCLUSION: This study extends the analysis of multiple-type victimization to a Malaysian population. Although some personal, familial, and social factors correlate with those found in western nations, there are cross-cultural differences, especially with regard to the nature of sexual violence based on gender and the influence of family structure.

Eikenella corrodens from a brain abscess.

A 2-year-old boy with underlying congenital cyanotic heart disease presented with seizures and fever and was found to have bilateral parietal cerebral abscesses. Drainage of the pus from the abscesses was done in stages; on the day of admission, four days after admission and 3 weeks after admission. Although the pus from the first drainage did not grow any organisms, the pus from the second drainage on the fourth day of admission yielded a mixed growth of Eikenella corrodens and Streptococcus milleri. Following the second drainage of pus, the child was noted to have mild weakness (grade 3/5) and increased tone in the left upper limb. Three weeks after admission, due to recurring fever, further neurological signs and findings of an enlarging right cerebral abscess on a repeat CT scan, a third drainage was carried out. However no growth was obtained from this specimen. This patient was managed both surgically and with appropriate antibiotics. Over the next four months, serial CT scans revealed gradual resolution of the abscesses with disappearance of the surrounding oedema. The child showed gradual recovery of his left sided weakness with resolution of tone and reflexes to normal.