Association between habitual snoring, middle ear disease, and speech problems in young children with non-syndromic cleft palate anomalies.

The purpose of this study was to investigate the association between habitual snoring (HS), middle ear disease (MED), and speech problems in children with cleft palate. This cross-sectional study included children aged 2.0-7.9 years with non-syndromic cleft palate anomalies. Parents completed the Pediatric Sleep Questionnaire and a questionnaire about MED. Audiograms and speech assessment were also conducted. Ninety-five children were enrolled; 15.2% of families reported HS, 97.6% MED, and 17.1% speech problems. HS (37.5% vs 10.3%, P = 0.007) and early episodes of MED (92.3% vs 58.2%, P = 0.021) were more likely to be reported for children with isolated cleft palate when compared to those with cleft lip and palate. Children with cleft lip and palate had a higher frequency of MED with effusion compared to those with Robin sequence (86.4% vs 57.1%, P = 0.049). The odds ratio for HS in children with ≥1 episode of MED in the last year was 7.37 (95% confidence interval 1.55-35.15, P = 0.012). There was a trend for children with speech problems reported by parents to have HS (30.8% vs 11.5%, P= 0.076). Anatomical factors play a role in the frequency of upper airway symptoms in children with cleft palate. A recent history of at least one episode of MED was associated with an increased frequency of HS.

Factors associated with depression and anxiety in children with intellectual disabilities.

BACKGROUND: Individuals with intellectual disabilities (ID) are at increased risk for depression and anxiety disorders; however, there is a paucity of research that pertains to associative factors for these mental health disorders in this population. The objective of this investigation was to determine factors associated with depression and anxiety problems in children with ID. METHODS: Children 6-17 years with ID (n = 423; 63% male) from the 2016 National Survey of Children's Health were included in this cross-sectional study. Outcome measures included depression and anxiety problems. Predictor variables included sociodemographics, ID severity, co-morbid conditions (autism spectrum disorders, epilepsy, cerebral palsy, Down syndrome and attention-deficit/hyperactivity disorder), physical factors (i.e. physical activity, sleep duration and pain) and social factors (e.g. participation in activities and bully victimisation). Multivariable logistic regression was performed to determine the association between all factors and depression and/or anxiety problems among children with ID. RESULTS: The prevalence of depression and/or anxiety problems was 35.4%. After adjusting for sociodemographics, Hispanic race was associated with lower odds [odds ratio (OR), 0.3; 95% confidence interval (CI), 0.1-0.8] of depression and/or anxiety problems. After adjusting for race, co-morbid conditions, and physical and social factors, autism spectrum disorders (OR, 4.4; 95% CI, 1.1-10.1), Down syndrome (OR, 0.2; 95% CI, 0.1-0.8), attention-deficit/hyperactivity disorder (OR, 5.9; 95% CI, 2.5-14.3), pain (OR, 7.0; 95% CI, 2.9-17.1) and bully victimisation (OR 2.3; 95% CI, 1.0-5.3) were each associated with depression and/or anxiety problems. CONCLUSIONS: The present study identified both treatable and modifiable, as well as unmodifiable, factors associated with depression and/or anxiety problems in children with ID.

Asynchronous brain-computer interface for cognitive assessment in people with cerebral palsy.

OBJECTIVE: Typically, clinical measures of cognition require motor or speech responses. Thus, a significant percentage of people with disabilities are not able to complete standardized assessments. This situation could be resolved by employing a more accessible test administration method, such as a brain-computer interface (BCI). A BCI can circumvent motor and speech requirements by translating brain activity to identify a subject's response. By eliminating the need for motor or speech input, one could use a BCI to assess an individual who previously did not have access to clinical tests. APPROACH: We developed an asynchronous, event-related potential BCI-facilitated administration procedure for the peabody picture vocabulary test (PPVT-IV). We then tested our system in typically developing individuals (N = 11), as well as people with cerebral palsy (N = 19) to compare results to the standardized PPVT-IV format and administration. MAIN RESULTS: Standard scores on the BCI-facilitated PPVT-IV, and the standard PPVT-IV were highly correlated (r = 0.95, p < 0.001), with a mean difference of 2.0 ± 6.4 points, which is within the standard error of the PPVT-IV. SIGNIFICANCE: Thus, our BCI-facilitated PPVT-IV provided comparable results to the standard PPVT-IV, suggesting that populations for whom standardized cognitive tests are not accessible could benefit from our BCI-facilitated approach.

The quality of life of ventilator-assisted children.

Although an increasing number of ventilator-assisted children are being cared for in the home, few studies in the literature evaluate the resulting quality of life from multiple informant perspectives. A questionnaire was used to gather data on 38 ventilator-assisted children from the children themselves and their caregivers about activities of daily living, measures of independence, and psychological state. The majority (79.4%) of ventilator-assisted children were perceived as either satisfied or very satisfied with how they spent their time, and most (77.1%) were rated as having an excellent or good emotional adjustment to the need for mechanical ventilation. Children older than 12 years were reported to be significantly less satisfied with their daily activities than the younger children, but greater activity levels correlated with greater levels of total satisfaction. A higher total satisfaction did not correlate with the age at onset of assisted ventilation, or the amount of time spent in other activities. Adolescents and primary caregivers had similar responses to most activity and independence parameters on the survey. There were no significant differences in parents' perceptions of the adolescents' emotional status as compared to the adolescents' self- assessment of their emotional status in any parameter.

Hierarchical linear modeling of FIM instrument growth curve characteristics after spinal cord injury.

OBJECTIVE: To examine the recovery of aspects of functional independence as a continuous process using growth curve analysis. DESIGN: Retrospective database review of functional outcome assessment data from inception cohort. SETTING: Inpatient rehabilitation unit; community. PATIENTS: A total of 142 subjects (79.6% men; age range, 18-77yr; mean age +/- standard deviation, 36.2 +/- 15.5yr) who were admitted to a rehabilitation unit between March 1986 and November 1994 with a minimum of 4 postinjury FIM assessments. Neurologic subgroups included 63 individuals with paraplegia, 36 with low tetraplegia, 24 with high tetraplegia, and 19 with incomplete injury. MAIN OUTCOME MEASURE: FIM instrument. RESULTS: Growth curve analyses with hierarchical linear modeling using a decelerating recovery function yielded a reliable model in which longer rehabilitation length of stay was associated with a more rapid rate of recovery but lower plateau. Neurologic injury category had expected effects on rate and degree of recovery. Level of impairment-specific results included an age effect in which older age was associated with lower level of plateau. In specific neurologic groups there was a significant gender effect, in which men made more rapid recovery than women, and a significant effect of level of education, in which higher education was associated with more rapid rate of recovery. Rate of FIM recovery was reliably modeled in the sample with incomplete injuries, but none of the demographic predictors was significant. CONCLUSIONS: Functional recovery can be modeled as a decelerating rather than simple linear function. The study of predictors of recovery characteristics, including rate of recovery and plateau, offers a valuable way of understanding rehabilitative needs and outcomes. Gender and education effects on the recovery process are intriguing and warrant further investigation.

Assessment of speed of processing after paediatric head trauma: need for better norms.

The neuropsychological test scores of 47 children with traumatic head injury (THI), aged 9-14 years, were evaluated to determine the relative contributions of severity of injury (length of coma) and age on performance. Stepwise regression analyses revealed that age consistently explained a statistically significant proportion of the variance on the Trail Making Test (TMT) and Finger Tapping Test (FTT), even after accounting for injury severity. However, logistic regression analyses indicated that currently available age-based norms for these tests did not improve classification of mild-moderate vs. severe injuries, as compared to a system based exclusively on raw scores. It is concluded that, whereas age is an important consideration when assessing children with THI, available age-based norms for some common paediatric neuropsychological tests do not appear to be sufficiently stratified or robust to fully capture these age effects. It is suggested that more comprehensive age-referenced norms, based on larger and more adequately stratified samples, are needed. In addition, some practical implications of these findings are discussed.

WISC-III index growth curve characteristics following traumatic brain injury. Wechsler Intelligence Scale for Children--Third Edition.

Previous studies have replicated the four-factor structure of the WISC-III in children with traumatic brain injury (TBI) and demonstrated the sensitivity of WISC-III indexes to severity of injury. This archival study examined the growth curve characteristics of the indexes following traumatic brain injury. The primary hypothesis was that there is systematic variability in the components (e.g., slope) of the curves. Subjects included 40 children with documented loss of consciousness, age at injury 9.3 years (SD = 2.6), 68% severe TBI, evaluated with a full WISC-III a minimum of three times post-injury. Growth curve analyses with hierarchical linear modeling, conducted with factor scores recalculated as non-age-standardized z scores, indicated that although the intercept was reliable and could be predicted by injury characteristics, there was little systematic variation in index growth rates. Findings suggest that WISC-III indexes are of limited utility as repeated measures of recovery following TBI.

Empirically supported psychological and behavioral therapies in pediatric rehabilitation of TBI.

This article examines the empirical support for psychological therapies for children with traumatic brain injury (TBI). Empirical support for psychological treatments of noninjured children provides a foundation upon and a framework in which to discuss applications to children with neurobehavioral dysfunction. Behavioral interventions to address externalizing behaviors have received the greatest focus, whereas there is a paucity of work that pertains to internalizing features and prosocial behavior such as assertiveness. Although the systematic study of psychological intervention lags far behind the rapidly increasing knowledge of neurobehavioral sequelae to TBI, there are promising directions that stem from initial findings.

Social problem-solving skills of children with traumatic brain injury.

Studies of specific social skill deficits in adults with traumatic brain injury (TBI) have begun to appear [1,2], but there are few empirical studies of children with TBI. This study examined social problem-solving skills in boys and girls with TBI and a matched group of non-injured peers, ages 7-13. The TBI group generated fewer total solutions on a social problem-solving measure, largely reflecting situation-specific differences in generated solutions. The TBI group also generated fewer positive assertive, and more indirect responses to peer group entry situations than the comparison group. Implications are discussed for a model of social information processing in paediatric brain injury.

Lower extremity lawn-mower injuries in children.

Lower extremity lawn-mower injuries in children result in significant morbidity with a significant financial burden to the family and society. We reviewed 24 children with lower extremity lawn-mower injuries; all mothers completed standardized psychologic assessments of their children, and 18 children were interviewed. Fifty percent of the mothers had defensive profiles on the standardized psychologic assessment, suggesting the likelihood of denial or underreporting of the child's psychologic difficulties. Therefore, we found the interview with the child to be a more accurate measure of psychologic distress. Prevention measures aimed at parents must emphasize that a child must not be allowed in a yard that is being mowed with a riding mower.

Attentional performance of children with traumatic brain injury: a quantitative and qualitative analysis of digit span.

Previous studies have indicated that digit span performance is not particularly sensitive to the effects of traumatic brain injury (Baddeley & Warrington, 1970; Brooks, 1975; Sterne, 1969). However, clinical lore posits poorer backward vs. forward performance compared to normals due to the greater attentional demands of the backward task. This study examined qualitative aspects of Digit Span performance including forward/backward span discrepancies and error patterns in children with traumatic brain injury (n = 20) and normals (n = 19). The hypothesis of greater forward/backward discrepancy with traumatic brain injury was not supported. Children with traumatic brain injury make a significantly greater number of preceiling errors than normals, consistent with other findings of increased performance variability. Preceiling errors are errors that occur in trials prior to the two failed trials, resulting in discontinuation of the task. In addition, cognitive correlates of error types, such as WISC-R factor scores, were significantly different between groups. The results of this study suggest that a more detailed analysis of performance on attentional tasks previously described as resilient to brain injury may shed further light on the nature of acquired attentional deficits.

The psychosocial characteristics of children with fractures.

We examined the psychosocial characteristics of 52 children with fractures. The parents completed questionnaires regarding injury circumstances, family functioning, home environment, and child behavior. Established psychosocial questionnaires were used: the McMaster Family Assessment Device (family environment), the Conners Parent Symptom Questionnaire, and Achenback Child Behavior Checklist (child behavior). Parent's perception of family functioning fell within the average range. The children exhibited a significantly high degree of social competence problems as well as behavioral difficulties. These behavioral difficulties included conduct disorder features, psychosomatic complaints, and impulsive/hyperactive behavior. To the extent that these variables constitute risk factors unique to children with fractures, prevention strategies can be designed to decrease the incidence of pediatric fractures.

Maternal distress and perceptions of infant development following extracorporeal membrane oxygenation and conventional ventilation for persistent pulmonary hypertension.

Neurodevelopmental outcome and concurrent maternal distress were examined for infants who suffered persistent pulmonary hypertension at birth and were treated with either extracorporeal membrane oxygenation (ECMO) (n = 19) or conventional ventilation (CV) (n = 15). Mothers were asked to complete inventories assessing their infant's (mean age 8.74 months) developmental growth as well as their own psychological health. Relevant sociodemographic and treatment parameters were also entered into the analysis. The results indicated that ECMO and CV infants did not differ on developmental indices and impairment rates were 15-23% respectively, similar to previous reports. In addition, ECMO and CV mothers did not differ in their reports of psychological distress. Correlational analyses revealed that length of treatment for ECMO but not CV infants significantly predicted developmental delay and maternal distress. For CV mothers, maternal distress was associated with the perception of delayed language. The results are discussed in terms of the limited morbidity associated with ECMO and CV interventions and the possible role of a 'vulnerable child syndrome' in understanding the maternal-infant relationship following ECMO therapy.