Adaptive learning: interventions for verbal and motor deficits.

Advances in basic and clinical neuroscience are uniting to form new optimism for treatment and rehabilitation of persons with a variety of neurologic disorders. Both cognitive and motor systems have shown remarkable degrees of plasticity in response to incoming stimuli. Understanding the brain (and spinal cord) capacity for change will lead to new topics for research as well as new approaches to rehabilitation. Adaptive learning has been shown to be a fundamental part of the developmental process and has been used in remediation of a variety of language difficulties. Using such principles to approach motor functions also is showing promise. Expanding these observations to encompass other areas of disease and rehabilitation is an area for further research. Interdisciplinary approaches including the fields of computer technology, imaging, and genetic analysis will provide new tools. Contribution of new concepts within adaptive learning must address such topics as the relation between motor and sensory responses, measures that accurately indicate cognitive health, the brain and spinal cord areas involved in particular learning tasks, the optimal time windows for intervention, and the importance of behavior and motivation in treatment and rehabilitation.

Maternal and neonatal risk factors for mental retardation: defining the 'at-risk' child.

OBJECTIVE: To determine how mental retardation at age seven is related to certain maternal, perinatal, and neonatal characteristics. METHOD: A sample of 35,704 children followed from the prenatal period to age 7 years in the Collaborative Perinatal Project provided data on nine maternal and pregnancy characteristics and 12 neonatal factors. RESULTS: Low socioeconomic status of the family (SES) accounted for 44-50% of mental retardation and a low level of maternal education accounted for 20%. Other prenatal factors with significantly elevated relative risks, (P < 0.05) were maternal IQ score less than 70, weight gain in pregnancy less than 10 pounds and multiple birth. Maternal anemia in pregnancy accounted for 14% of mental retardation in blacks, and, urinary tract infections accounted for 6% of mental retardation in whites. Significant elevations in relative risk were found for major genetic and post-infection syndromes, CNS malformations, cerebral palsy, seizures, abnormal movements or tone, and low birth weight. Relative risk was also significantly increased with low 1 minute APGAR, primary apnea, and head circumference and length more than 2 SD below average but only in the low SES black subgroup. CONCLUSION: Early developmental events can be ranked on the basis of the strength of their association with mental retardation and such rankings can be used as a guide for defining risk status in early infancy.

Effects of prenatal exposure to neuroleptic drugs on children's growth.

The effect of prenatal exposure to neuroleptic drugs on height and weight from birth to 7 years was examined in children of psychiatrically normal parents and of parents with a history of psychiatric treatment, using data from the Collaborative Perinatal Project of the National Institute of Neurological Diseases, Communicative Disorders, and Stroke. Analysis of covariance was used to control for potential confounding factors. We found that prenatal exposure to dopamine receptor-blocking neuroleptic drugs was associated with increased height in one or more of our groups at 4 months, 1 year, and 7 years and less consistently with increased weight. Seven-year-old children who had been exposed to these drugs for more than 2 months during gestation were approximately 3 cm taller than unexposed controls (p less than 0.05). Prenatal exposure to dopamine-depleting agents was associated with decreased height at 4 months but not later. Possible mechanisms for these effects, including a permanent decrease in the number of brain dopamine receptors and effects on various hormones, are discussed.

Perinatal risk factors in children with serious motor and mental handicaps.

Fifty children with marked neurological abnormality manifested by moderate or severe motor disability and severe mental retardation were compared with a large control population with respect to prospectively ascertained perinatal characteristics. None of 60 prenatal factors distinguished the affected group from controls. In labor and delivery, lowest fetal heart rate in the second stage of labor, arrested progress of labor, and use of midforceps discriminated between the two groups. Neonatal characteristics of children who were later severely handicapped differed from controls, particularly with respect to difficulty in initiating and maintaining respiration, intracranial hemorrhage, neonatal seizures, low birth weight and small head circumference, lowest hemoglobin or hematocrit, and overall neurological status. Multivariate analysis, including factors from all epochs, indicated that intracranial hemorrhage and neonatal seizures were the strongest independent discriminators between the neurologically impaired children and controls.

The offspring of schizophrenics. II. Perinatal factors and IQ.

Within a sample of 60 children of schizophrenic parents, IQ and the correlates of IQ were examined. The Wechsler Intelligence Scale for Children was administered at age 7. The offspring of parents with schizophrenia were found to have a slightly lower IQ than their matched controls. This deficit could be attributed entirely to the male offspring. Using a second comparison group numbering several thousand, we computed correlations for various perinatal and socioeconomic factors with seven-year IQ. These correlations were also computed for the children of schizophrenics, and the difference in correlations was examined. IQs for the offspring of "continuous schizophrenics" (chronic, borderline, and chronic schizo-affective schizophrenics) were found to have lower correlations with socioeconomic indices and higher correlations, in a negative direction, with certain perinatal events. The findings were found to a lesser, nonsignificant degree among the small sample of offspring of acute schizophrenics. If these perinatal events are more negatively correlated with IQ because the children of continuous schizophrenics are specifically susceptible to them, it is possible that these factors are also influential in the later development of schizophrenia.

Intellectual development of twins -- comparison with singletons.

Analysis of mental and motor tests scores and intelligence test performance of twins born in the Collaborative Perinatal Project shows that twins perform more poorly than singletons from the same population and that the differences are greater in Negroes than in whites. The poor performance of twins relative to that of singletons is of complex etiology. It is partly due to poor prenatal environment, for twins brought up as singletons perform at the intelligence level of twins and not of singletons. It may also be partly due to the higher incidence of congenital malformations in twins, especially those of the central nervous system. But the performance of twins, relative to that of singletons, tends to improve as they get older, at least from 4 to 7 years, suggesting that prematurity is also a contributing factor, whose detrimental effects may be reversible.

Relationship of Apgar scores and Bayley mental and motor scores.

Infants with 0-3 Apgar scores at 1 minute had significantly lower 8-month mental and motor scores than infants with 7-10 scores and significantly lower mental but not motor scores than infants with 4-6 Apgar scores. Correlations indicated significant relationships (independent of birth weight) between Apgar scores and Bayley mental and motor scores for random, Colored Portuguese, and total samples but not for Negroes and whites. Results demonstrated a significant difference in Apgar scores by 8-month classifications with significantly lower scores for children classified as abnormal, and by longevity with significantly lower scores for neonates who died within 2 days.