Cognitive functioning in children prenatally exposed to alcohol and psychotropic drugs.

Cognitive functioning was compared in 29 children diagnosed with fetal alcohol syndrome (FAS), 35 children with fetal alcohol effects (FAE), and 66 psychotropic drugs-exposed (PDE) children using Wechsler tests and the neuropsychological test battery NEPSY. In the FAS group, verbal IQ (VIQ=78), performance IQ (PIQ=77), and full scale IQ (FSIQ=75) were significantly lower as compared to the FAE and PDE groups. In the PDE group VIQ and FSIQ were significantly higher than in the FAE group. In the FAS group, processing speed (PS) was significantly lower than the other three factors. In the FAE group, perceptual organization (PO) was significantly higher, whereas PS was significantly lower than the other factors. In the PDE group, verbal comprehension (VC) was significantly higher than the other factors. Attention subscales on the NEPSY were significantly lower in all the three groups. Prenatal alcohol exposure affects IQ levels more than exposure to psychotropic drugs. Attentional problems were found in all children when tested with the NEPSY in all groups.

Intelligence in children with hydrocephalus, aged 4-15 years: a population-based, controlled study.

The aim of this population-based study is to investigate IQ and IQ-related factors in children with hydrocephalus (HC). Psychometric intelligence was assessed in subjects below the age of 7.3 years (N=52, F=18, M=34) with the Wechsler Preschool and Primary Scale of Intelligence - Revised (WPPSI-R) and for children above the age of 7.3 years (N=29, F=6, M=23) with the Wechsler Intelligence Scale for Children - Revised (WISC-R). The controls were matched according to age, gender, and geographic variables. All children were living in western Norway. 57 children had infantile HC (IH) and 24 had childhood HC (CH). Children with myelomeningocele (MMC), traumatic brain injury (TBI), or intracranial tumours were excluded. IQ levels were found to be significantly higher in the control group than in the HC groups. The Kaufman factors showed a similar pattern, with lowest values in IH, and CH intermediate between IH and NC. The results demonstrate that HC affects IQ. More specific cognitive profiles, such as non-verbal learning disabilities, are not detectable when using the Wechsler tests. For this purpose, other tests and models for analyses may be recommended.

Complexity of foetal alcohol or drug neuroimpairments.

AIMS: To describe children exposed to street drug during pregnancy (SDE) and compare these with children suffering from Foetal Alcohol Syndrome (FAS) and Foetal Alcohol Spectrum Disorders (FASD) regarding growth, somatic health and neuroimpairments. METHODS: In the region, Hordaland county an information program was carried out to educate health-care and social workers on symptoms and signs of SDE and FAS/FASD and referral was encouraged for suspected cases. Referred children received a neuropaediatric evaluation, and were categorized as FAS/FASD and SDE children. RESULTS: Among the referred children 50 were diagnosed with SDE and 47 children were diagnosed with FAS/FASD. SDE children had increased risk of neonatal abstinence symptoms but were somatic healthy and had no growth restriction and were performing well academically. Almost all children in both groups met the criteria of Attention Deficit Hyperactivity Disorder (ADHD). CONCLUSION: Children exposed to drugs are somatic healthy but have increased risk of neuroimpairments such as ADHD.

Lack of recognition and complexity of foetal alcohol neuroimpairments.

AIMS: To obtain the recorded prevalence of foetal alcohol syndrome (FAS) and foetal alcohol spectrum disorders (FASD) in Norway, and evaluate the effect of a general information program to increase the recognition of FAS/FASD for health care and social workers. METHODS: A questionnaire regarding prevalence of FAS/FASD was sent to all Norwegian paediatric and child psychiatry departments. In the region Hordaland county, an information program was carried out to educate health-care and social workers on symptoms and signs of FAS/FASD, and referral was encouraged for suspected cases. Referred children received a neuropaediatric evaluation, and the effect of the information program on recorded FAS/FASD was recorded. RESULTS: Based on the national survey, a prevalence of 0.3 per 1000 was calculated. After the information program, the estimated prevalence in Hordaland County increased to 1.5 per 1000. In 5 years, 25 children were diagnosed with FAS and 22 with FASD. One-third of all children were mentally retarded. Microcephaly and neuroimpairments were more common among FAS children. Almost all children met the criteria of ADHD. CONCLUSION: The rate of FAS/FASD may be greatly underestimated because of lack of knowledge. An information program aimed at health-care and social workers is effective.

Non-verbal learning disabilities in children with infantile hydrocephalus, aged 4-7 years: a population-based, controlled study.

The aim of this population-based, controlled study was to investigate non-verbal learning disabilities (NLD) in children with infantile hydrocephalus (IH). For this purpose, the results from subtests measuring either assets or deficits within Rourke's model of NLD were analyzed. Children with myelomeningocele (MMC), intracranial tumors, or IQ < 70 were excluded. Of the 52 IH children included in the study, 46 were shunt-treated, whereas 6 were not shunted. The 44 controls were matched according to age, gender, and geographic variables. The Neuropsychological Assessment of Children (NEPSY) was administered to 52 children (age 4-7) with IH; (F = 17, M = 35), and to 44 controls (F = 17, M = 27). The tests used were classified along each of the dimensions "assets" or "deficits", according to Rourke's model of the elements and the dynamics of the NLD syndrome. Differences between sum scores for the subtests classified as "assets", versus "deficits" were significantly higher in the IH group as compared with the controls (p < 0.005). These findings are compatible with a higher frequency of NLD in the IH group, in which neurological confounding factors have been excluded. In addition, the model of the elements and the dynamics of the NLD syndrome may be useful when analyzing neuropsychological test results obtained with traditional and comprehensive test batteries.