Delayed transplantation may affect intellectual ability in children.

BACKGROUND: Decline in neurocognitive function is a reported complication in children with chronic illness. Concerns have been increasing that exposure to a major surgery or trauma may negatively affect cognitive performance in children. This study evaluated cognitive function in 43 Korean children who received organ transplantation (Tx), and sought to identify associated clinical factors. METHODS: Pediatric recipients of kidney (KT) or liver Tx (LT) from 1999 to 2011 were recruited for cognitive tests. Cognitive function was evaluated using intelligence quotient (IQ), social quotient (SQ), and Continuous Performance Test using Advanced Test for Attention scores, which reflect attention ability. Intellectual delay was graded as intellectual disability (ID; IQ <70) or low intelligence (LI; IQ<85). Diagnosis for attention-deficit-hyperactivity disorder (ADHD) was made by pediatric psychiatrists. RESULTS: The subjects consisted of 43 pediatric recipients of 28 LT and 15 KT. There were 20 boys (46.5%). Median age was 3.1 years (range, 0.5-15.3 years) at Tx. Median age at cognitive evaluation was 12.9 years (range, 3.4-18.4 years). Median pre-Tx duration of illness was 1.6 years (range, 0-13.5 years). The prevalence of ID, LI, and ADHD was 11.6%, 32.5%, and 32.5%, respectively. On multivariate analysis, longer pre-Tx duration of illness was a significant factor for LI (OR, 1.263; 95%CI: 1.033-1.544, P = 0.023). CONCLUSION: Longer pre-Tx duration may negatively affect intellectual ability in Korean children. Pre-Tx duration was more significant than the age at Tx or total disease duration per se. Early Tx may be beneficial for cognitive function in children.

A Validation Study of the CARS-2 Compared With the ADOS-2 in the Diagnosis of Autism Spectrum Disorder: A Suggestion for Cutoff Scores.

Objectives: This study examined the validity of the Childhood Autism Rating Scale, Second Edition (CARS-2) compared with the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) in identifying autism spectrum disorder (ASD). Methods: A total of 237 children were tested using both the CARS-2 and ADOS-2. We examined the correlation using Pearson's correlation analysis. In addition, we used a receiver operating characteristic graph to determine the optimal standard version of the CARS-2 (CARS2-ST) cutoff score for ASD diagnosis using the ADOS-2. Results: The concurrent validity of the CARS2-ST was demonstrated by a significant correlation with the ADOS-2 (r=0.864, p<0.001). The optimal CARS2-ST cutoff scores were 30 and 28.5 for identifying autism and autism spectrum, respectively, based on the ADOS-2. Conclusion: We suggest a newly derived CARS2-ST cutoff score of 28.5 for screening ASD and providing early intervention.

Comparison of the Autism Diagnostic Observation Schedule and Childhood Autism Rating Scale in the Diagnosis of Autism Spectrum Disorder: A Preliminary Study.

OBJECTIVES: We examined the agreement between the Autism Diagnostic Observation Schedule (ADOS) and the Childhood Autism Rating Scale (CARS) in the diagnosis of autism spectrum disorder. METHODS: The ADOS and CARS scores of 78 children were retrospectively collected from a chart review. A correlation analysis was performed to examine the concurrent validity between the two measures. Using the receiver operating characteristic (ROC) curve, we determined the optimal cut-off score of the CARS for identifying autism spectrum disorder. RESULTS: The CARS score was significantly correlated with the ADOS score (r=0.808, p<0.001). Taking ADOS as the ideal standard, the optimal cut-off scores of CARS for identifying autism and autism spectrum were 30 and 24.5, respectively. CONCLUSION: We determined the optimal cut-off scores of CARS for screening and diagnosing autism spectrum disorder.