Voxel-Based Morphometry and fMRI Revealed Differences in Brain Gray Matter in Breastfed and Milk Formula-Fed Children.

BACKGROUND AND PURPOSE: Infant diets may have significant impact on brain development in children. The aim of this study was to evaluate brain gray matter structure and function in 8-year-old children who were predominantly breastfed or fed cow's milk formula as infants. MATERIALS AND METHODS: Forty-two healthy children (breastfed: n = 22, 10 boys and 12 girls; cow's milk formula: n = 20, 10 boys and 10 girls) were studied by using structural MR imaging (3D T1-weighted imaging) and blood oxygen level-dependent fMRI (while performing tasks involving visual perception and language functions). They were also administered standardized tests evaluating intelligence (Reynolds Intellectual Assessment Scales) and language skills (Clinical Evaluation of Language Fundamentals). RESULTS: Total brain gray matter volume did not differ between the breastfed and cow's milk formula groups. However, breastfed children had significantly higher (P < .05, corrected) regional gray matter volume measured by voxel-based morphometry in the left inferior temporal lobe and left superior parietal lobe compared with cow's milk formula-fed children. Breastfed children showed significantly more brain activation in the right frontal and left/right temporal lobes on fMRI when processing the perception task and in the left temporal/occipital lobe when processing the visual language task than cow's milk formula-fed children. The imaging findings were associated with significantly better performance for breastfed than cow's milk formula-fed children on both tasks. CONCLUSIONS: Our findings indicated greater regional gray matter development and better regional gray matter function in breastfed than cow's milk formula-fed children at 8 years of age and suggested that infant diets may have long-term influences on brain development in children.

Clinical use of the Benton Visual Retention Test for children and adolescents with learning disabilities.

This study examined the Benton Visual Retention Test (BVRT) with 130 children and adolescents with learning disabilities (LD) who were between the ages of 8 and 13 years of age. Results of factor analysis showed errors scores from the BVRT loaded on a visual processing/memory factor. The measure appears to be sensitive to developmental patterns which was supported by statistical analysis. Error and correct score patterns are also examined for different subgroups. The results of this study support the use of the BVRT with children and adolescents with LD.

Neuropsychological patterns of adolescents and young adults with spina bifida.

The purpose of this study was to examine neuropsychological profiles for patients with spina bifida. The sample consisted of 37 subjects with spina bifida between the ages of 14 and 23. Each of the subjects was seen individually and administered the Halstead-Reitan Neuropsychological Test Battery as well as the appropriate Wechsler Intelligence Scale. Scores from the Halstead-Reitan were subjected to cluster analysis to formulate clinical subtypes. The results indicated a three group solution was most appropriate, which appeared to reflect a continuum of dysfunction. Implications for rehabilitation programming are discussed.

Early maturation of motor-delayed children at school age.

Children underwent motor and sensory testing during each of 3 consecutive years beginning at kindergarten entrance. Children were assigned to either a motor-normal or motor-delayed group based on results from testing during the 1st year of the study. Motor-normal subjects (n = 17) had standard scores on a global motor-sensory test that fell within one standard deviation of the mean. Motor-delayed subjects (n = 12) had a global motor-sensory test standard score indicating greater than one standard deviation of motor delay and, in addition, were delayed by a minimum of one standard deviation on four of five of the motor-sensory test subtests. At the conclusion of the 3-year study, the mean standard score of the motor-delayed group remained greater than one standard deviation below the performance of the motor-normal group as measured by the global motor-sensory test. Statistical analysis using repeated measures analysis of variance indicated that the motor-delayed group made gains but did not close the gap between themselves and the motor-normal group during the 3-year study. Group x time interaction effects showed that during the study, significant gain was made by the motor-delayed group on the motor coordination subtest of the motor-sensory test. The study supports the conclusion that motor-delayed children without early intervention fail to outgrow their motor delays by age 8 years.

Longitudinal assessment of motor and sensory skills in academically disabled and control children.

Motor and tactile integration skills were sequentially assessed with academically average (N = 28) and academically disabled children (N = 17) over a 3-year period. The initial results demonstrated considerable differences between the groups. Analysis of variance and visual inspection of trends in the longitudinal data for the academically disabled group revealed a mixed pattern with catch-up in the motor areas and persistent delays in sensory areas. The results suggest different developmental patterns depending on the skill and group assessed. Right hand advantages were found across groups with motor speed whereas a left hand advantage was demonstrated on a stereognosis task. These right-left differences suggest an important developmental role for corpus callosum myelinization. The interpretation of soft neurological signs needs to be refined to allow for these sensory-motor, right-left parameters.

Mental flexibility and planning skills in children and adolescents with learning disabilities.

Mental flexibility (skill with shifting response set) and visual planning skills were examined with a group of 60 children and adolescents with learning disabilities. The sample consisted of 44 boys and 16 girls with an age range of 9 to 15. Scores from the Trail Making Test and the Wisconsin Card Sorting Test were cluster-analyzed and subgroups were formulated. The results of the cluster analysis indicated a two-group solution to be most appropriate. One subtype was clearly dysfunctional on the classifying variables, while the other subgroup approached average levels. The two subtypes were compared on measures of intellectual functions, academic skills, auditory memory, visual memory, visual-motor integration, motor speed, and tactile integration. Significance was found on several different tests. The results are discussed in terms of potential cortical dysfunction evidenced by the subgroups.

Neuropsychological skills with motor dysfunctional and motor normal children.

A group of 40 children was selected from a larger sample based on their performance on motor coordination, motor speed, and motor inhibition tasks. Twenty of the children were classified as Motor Dysfunctional (MD) and 20 were classified as Motor Normal (MN). The groups were compared on several neuropsychological measures. The results indicated the MD children were significantly lower on a number of measures, particularly those requiring sensory integration. There were not significant differences on several of the tasks, including those more complex in nature. The results are discussed in relation to developmental models of neuropsychological functioning.

Relationship of head circumference to measures of school performance.

To study the possible relationship of head circumference (HC) to learning problems in children, a retrospective study was done, using records from 360 subjects who had been evaluated between the years 1976 and 1981. The data selected from the records included standardized academic test results, e.g., IQ scores and school achievement test results, as well as determinations of visual motor abilities. Statistical analyses demonstrated a positive correlation between full scale IQ (FSIQ) and HC (p less than 0.005). The incidence of specific learning disabilities based on significant academic and achievement discrepancies was 54% in those with HC greater than 2 S.D., 39% for normocephalic, and 23% for those with HC less than 2 S.D. Comparison of HC with results from the Wide Range Achievement Test (WRAT) demonstrated a tendency for those children with HC greater than 2 S.D. to have lower arithmetic scores when compared to results of children with normocephaly. Scores for spelling and reading ability did not demonstrate this tendency. The results of this study were found to be somewhat incongruous to those of previous studies of similar children. Further studies using large unselected populations are needed to better define the risks to learning that may be related to the extremes of head circumference.

Integration of soft signs in academically normal and academically at-risk children.

The development of motor and sensory proficiency and the integration of soft signs were analyzed for 38 children with average achievement and 29 children achieving below grade level. Motor coordination, speed, and inhibition, as well as the development of sensory function, were evaluated at the time of entrance to kindergarten and again during the first grade. The performance of both groups progressed on tasks measuring motor speed and coordination as well as tactile integration. Although the children achieving below grade level continued to perform the majority of tasks poorly in comparison with the children performing at grade level, on most of the measures they evidenced definite catch-up or greater gain than the children performing at grade level. Their progress on the motor speed and coordination tasks supports the hypothesis of a developmental lag in these areas. Results of tests of motor inhibition were notable for an absence of progression. That children achieving below grade level did not advance in this area would argue against the hypothesis of a developmental lag for all soft signs. Although results of this longitudinal study are preliminary, findings to date would allow for the possibility that both deficits and lags are responsible for the differences between the academically normal and academically at-risk children.

Measures of attention deficit. Part II: Clinical perspectives and test interpretation.

After a detailed behavioral and developmental history has been supplemented by the use of formal questionnaires, the diagnosis of an attentional disorder can be further clarified by the judicious selection of psychoeducational and pediatric physical and neurodevelopmental examinations. The most common difficulty in the interpretation of psychoeducational test subscores and profiles is the significant overlap between the patterns generated by attentional deficits and those associated with memory-based learning disabilities. Certain other medical and behavioral conditions need to receive careful consideration prior to finalizing the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). A thorough but focused general examination coupled with the pediatric neurodevelopmental examination can contribute to this differentiation.

Measures of attention deficit. Part I: Questionnaires.

Despite much progress in the diagnosis and management of children with attentional problems, hyperactivity, and learning difficulties, current diagnostic techniques remain inadequate to readily distinguish a primary attentional disorder from a more complex secondary problem. Developmental and behavioral questionnaires to supplement office evaluation of hyperactivity, neuromaturation, and selected cognitive processes continue to be improved. These measures suffer from different biases, focus on different childhood characteristics and associated problems, and approach childhood interaction with the environment differently. Several are psychometrically more sound, and several provide the physician with developmental and social information that may help improve the habilitative prescription. The general pediatrician can use these questionnaires to complement his or her evaluation and follow-up of children who present with learning and behavioral problems. Prior to choosing an instrument, the clinician should review the advantages of each and choose the one most suited to his or her practice.

Motor and sensory abilities with normal and academically at-risk children.

Motor and sensory abilities were assessed with children identified as normal and children identified as academically at-risk. The children were grouped based on the results of a screening procedure which consisted of tasks designed to assess academic readiness skills. The results indicated that the academically at-risk children did significantly poorer on most of the measures of motor and sensory functioning. Discriminant analyses indicated that the measures were generally more effective at classifying the normal children than the academically at-risk children. The results are discussed in relation to developmental models of neuropsychological functioning.

Comparison of scintigraphy, sonography, and computed tomography in the evaluation of hepatic neoplasms.

A comparison of scintigraphy, ultrasonography, and computed tomography (CT) in 94 proven patients with clinically suspected liver disease is reported. CT proved to be the most accurate in detecting masses and assessing the complete extent of intrahepatic disease. The most reliable combination was CT and scintigraphy. The specific advantages and disadvantages of each method are discussed. The diagnostic scheme followed in the imaging evaluation of an hepatic mass in our clinical practice is discussed.