A 2-year dyadic longitudinal study of mothers' and fathers' marital adjustment when caring for a child with cancer.

OBJECTIVE: Studies examining interrelationships within parental couples confronted with pediatric cancer are scarce. This study explored dyadic longitudinal associations between both partners' family functioning and mood at diagnosis, and marital adjustment 2 years later. METHOD: Parents of children (n = 47 couples) with acute lymphoblastic leukemia (ALL) completed the Family Well-Being Assessment and Profile of Mood States-Bipolar Form at diagnosis, and the Locke-Wallace Marital Adjustment Test 2 years post diagnosis. Multilevel linear models using the actor-partner interdependence model (APIM) and controlling for baseline marital adjustment were conducted to evaluate within subject and dyadic longitudinal effects. RESULTS: For mothers, better marital adjustment 2 years post diagnosis was associated with perception of greater family support and less role conflict and role overload at diagnosis. For fathers, better marital adjustment 2 years post-diagnosis was associated with perception of less role conflict, greater role ambiguity, and being more tired at diagnosis, as well as their partner's perception of less role conflict at diagnosis. CONCLUSIONS: These findings highlight the importance of considering both partners' perspectives in understanding marital adjustment across treatment phases in parents of children with ALL. Early interventions for couples should be tailored to meet each partner's needs in order to foster resilience within the couple.

Effects of early high-dose levothyroxine treatment on auditory brain event-related potentials at school entry in children with congenital hypothyroidism.

AIMS: We tested whether brain event-related potentials (ERPs) are normal in children with congenital hypothyroidism (CH) after early high-dose levothyroxine treatment. METHODS: Auditory ERPs were recorded in 33 normal controls and in 15 children with CH at 5 years 9/12. Based on bone maturation at diagnosis, the CH group was divided into severe (n = 8) and moderate (n = 7) subgroups. CH patients were treated at a median age of 14 days with a mean initial dose of levothyroxine of 11.6 microg/kgxday. Two ERP components (N100 and N200) were measured and clinical follow-up variables collected. RESULTS: The functional anatomical and cognitive organisation of the auditory system, as revealed by the analyses of ERP measures, did not differ between CH and controls, or between severe and moderate CH subjects. However, N200 latency was globally longer in the CH than in the control group (p = 0.01) and was positively correlated with the over-treatment index (r = 0.61; p < 0.05) and verbal IQ. N200 amplitude was negatively correlated with initial dose (r = -0.74; p < 0.005). CONCLUSION: These data suggest that sensitive tools such as ERPs can reveal differences between CH and controls and relate these differences to the adequacy of treatment of CH.

Cognition and behavior at school entry in children with congenital hypothyroidism treated early with high-dose levothyroxine.

OBJECTIVE: To document cognition and behavior at school entry in these patients. Study design Eighteen children with congenital hypothyroidism (CH; 9 severe and 9 moderate, based on a surface of the knee epiphyses at diagnosisor=0.05 cm(2)) treated from a median of 14 days with a median of 12.0 microg/kg per day of levothyroxine were evaluated at 5 years, 9 months, with the McCarthy Scale and the Questionnaire for Evaluation of Social Behavior, as were 40 control children. RESULTS: The global IQs at 5 years, 9 months, were similar: medians (range) were 102 (87 to 133), 102 (84 to 135), and 115 (88 to 136) (not significant) for severe CH, moderate CH, and control children, respectively. The behavioral scores of CH children were within the normal range. However, the number of times when plasma TSH was >6.0 mIU/L during treatment was correlated positively with anxiety (P=.02) and inattention (P=.05), whereas the number of times TSH was <0.8 mIU/L was correlated with lower verbal scores (P=.05). CONCLUSIONS: Children with severe CH treated early with a high dose of levothyroxine have normal global development and behavior at school entry.

Mediators of behavioral problems in 7-year-old children born after 24 to 28 weeks of gestation.

We tested the hypothesis that prematurity acts through its association with neuromotor and intellectual functioning to explain behavior problems at school age. Sixty-one extremely preterm (EP) very low birth weight (VLBW) children (< 29 wk and < 1,500 g) born in 1987-1990 and 44 normal birth weight children (NBW) (> 37 wk and > 2,500 g) were matched for age, sex, and socioeconomic status (SES). Mediator variables were evaluated at a hospital at 5 years and 9 months. Behaviors were evaluated at school at 7 years by peers, teachers, and parents. When compared with NBW children, EP/VLBW children had poorer IQ and neuromotor development. At school, EP/VLBW children were evaluated by peers as more sensitive/ isolated, and by teachers and parents as more inattentive and hyperactive than NBW. When mediators were introduced, the previously significant relation between prematurity and behavior problems disappeared. Hyperactive and inattentive behaviors were explained by a specific working memory factor for the latter, and by a general intellectual delay for the former, whereas sensitive/isolated behaviors were best explained by neuromotor delays. Inattentive behaviors were also related to family adversity. At school age, extreme prematurity had thus an indirect effect on behaviors via specific and nonspecific intellectual and neuromotor delays.

Predictors of physical outcomes in pediatric bone marrow transplantation.

The purpose of the present study was to investigate the hypothesis that family factors, in conjunction with clinical factors, are associated with physical outcomes in pediatric BMT. A prospective study of 68 pediatric patients (mean age = 7.5 years; ranging from 4 months to 18 years) undergoing BMT was carried out over a 6.5 year period. Physicians rated initial prognosis on a (0-5) scale which incorporated the child's diagnosis, known risk factors, and type of donor. Both parents individually completed two psychometrically sound questionnaires assessing family well-being and marital satisfaction. Cox proportional hazards survival analyses were performed to determine predictors of death (44% of the patients died). Potential predictor variables included were: initial prognosis, type of transplant, patient's age, socioeconomic status, marital satisfaction and family status, and family stress. Initial prognosis, as estimated by the physician, (RR = 0.62, 95% CI = 0.40, 0.97) was the best predictor of survival. Initial clinical factors are clearly critical in outcomes for pediatric BMT patients.

Stimulus-response incompatibility effects on event-related potentials in children with attention-deficit hyperactivity disorder.

In order to test the hypothesis of a response choice deficit in attention-deficit hyperactivity disorder (ADHD) children, event-related potentials (ERPs) were recorded from 30 scalp electrodes in 21 ADHD and 21 normal boys during a spatial stimulus-response compatibility (SRC) task. ADHD children made fewer correct responses than control children, but did not show a larger incompatibility effect on response speed and accuracy. In ERPs, ADHD children had longer N1 latency and larger condition effect on the frontal N2, which would reflect a greater frontal involvement for the correct responses. The ADHD group who performed the SRC task first showed a larger condition effect on an early occipital P3 only, while the ADHD group who performed the SRC task second showed a larger condition effect on a later central P650 component and on a late parietal NSW, as compared with normal controls. These results suggest strategic differences in information processing in ADHD children, rather than a specific deficit.

ERPs and behavioral inhibition in a Go/No-go task in children with attention-deficit hyperactivity disorder.

In order to study the behavioral responses and the brain inhibition process in children with attention-deficit hyperactivity disorder (ADHD), Event-Related Potentials (ERPs) were recorded from 30 scalp electrodes in 21 ADHD and 21 normal boys during performing a Go/No-go task. ADHD children made fewer correct responses to both Go and No-go stimuli than normal controls. The frontal N2 amplitude was larger for No-go stimuli than Go stimuli in both groups, reflecting inhibition of responding. Smaller N2 amplitudes to No-go stimuli were found in ADHD children, but only when the Go/No-go task was performed after a first stimulus-response compatibility (SRC) task. In addition, the controls exhibited a prolonged N2 only when the Go/No-go task was performed second. However, the ADHD subjects exhibited this prolonged N2 when the task was first, but not when it was second. These results suggest an inhibitory regulation problem rather an inhibition deficit in ADHD children.

ERP differences in visual attention processing between attention-deficit hyperactivity disorder and control boys in the absence of performance differences.

Event-related potentials (ERPs) were recorded during a visual two-choice reaction time (RT) task in attention-deficit hyperactivity disorder (ADHD) and control boys selected using strict inclusion and exclusion criteria. No group differences were found in mean RT and correct responses. Although early occipital ERPs were not affected in the ADHD group, the peak latency of early anterior ERPs (N1, P1, N2) was significantly delayed. ADHD showed a larger effect of stimulus type on the frontal negativity (N530) and the posterior late negativity (nSW) and a smaller effect of stimulus type on anterior N2 and posterior P3b amplitude. The development of N530 and P450 amplitude across blocks of five trials was analyzed using orthogonal polynomial trend analysis of variance software. In the control group, P450 amplitude to "frequent" stimuli reduced across blocks. In the ADHD group, N530 amplitude increased for "rare" stimuli across blocks. It is suggested that the ADHD group showed a lack of automatization of the categorization process with increasing time on task for which they compensated by controlled attentional processes.

Perceptual processing among high-functioning persons with autism.

Two tasks were used to assess the processing of whole versus parts of objects in a group of high-functioning children and adolescents with autism (N = 11) and a comparison group of typically developing peers (N = 11) matched for chronological age and IQ. In the first task, only the children with autism showed a global advantage, and the two groups showed similar interference between levels. In the second task, the children with autism, despite longer RTs, showed similar performance to the comparison group with regard to the effect of goodness on visual parsing. Contrary to expectations based on the central coherence and hierarchisation deficit theories, these findings indicate intact holistic processing among persons with autism. The implications of these findings are discussed in relation to apparently discrepant evidence from other studies.

Extreme prematurity in healthy 5-year-old children: a re-analysis of sex effects on event-related brain activity.

A male disadvantage has been reported in several outcome studies of children born preterm. Twenty-two healthy premature children (10 girls, 12 boys) born between 25 and 28 weeks of gestation and 20 controls born full-term (10 boys, 10 girls) were matched on socioeconomical status and age. Event-related potentials (ERPs) were recorded by using 14 electrodes in a visual oddball task, with 75% frequent and 25% rare stimuli. This task elicited a larger P3 to the rare than to the frequent stimuli, with a prominent parietocentral localization. However, the amplitude was larger in full-term boys than in full-term girls, a difference that was not observed between preterm boys and preterm girls, especially to targets and on the central electrodes. In addition, the preterm group was characterized by a frontal slow wave larger in boys than in girls. In these prematures, the lack of the sex-related difference may be accounted by differences in the strength of the neuronal generators in males, as they might have been affected by the high level of androgens by the fetal testis under the control of placental gonadotropes during the first two thirds of gestation.

Developmental pathways leading to externalizing behaviors in 5 year olds born before 29 weeks of gestation.

Longitudinal data for 62 infants born before 29 weeks of gestation were used to assess the influence of four factors (i.e., neonatal health, family environment, language skill, and nonverbal ability) on the parental report of hyperactive and oppositional behaviors of children at 5 years 9 months. The proposed path analysis model tested the following: (1) whether neonatal health and family environment have a direct influence on language skill and nonverbal ability both measured at 18 months corrected age, (2) the predictive value of language skill and nonverbal ability on oppositional and hyperactive behaviors, and (3) whether the effects of neonatal health and/or family environment on oppositional and hyperactive behaviors can be conceived as mediated by language skill and/or nonverbal ability. The results revealed three main pathways. First, family environment predicted language skill, which, in turn, was negatively associated with children's hyperactivity. Second, neonatal health predicted nonverbal ability, which was positively linked to oppositional behaviors. Third, a direct negative relation between neonatal health and hyperactive outcome was observed. The implications of these substantially different pathways for hyperactive and oppositional behaviors are discussed.

Psychometric properties of the Health Utilities Index Mark 2 system in paediatric oncology patients.

This study examined the reliability and validity of the Health Utilities Index (HUI) Mark 2 system, a health-related quality of life (QoL) instrument, in children with cancer. The sample consisted of 61 mothers of paediatric oncology patients, aged 4.1-17.3 years, who were either on treatment (n = 20) or off treatment (n = 41). The test-retest reliability was very good for the HUI Mark 2 system global score and all of its dimensions except pain. The HUI Mark 2 dimensions of emotion, pain and self-care as well as its overall score showed moderate convergent validity with other measures. In addition, the HUI Mark 2 system demonstrated good discriminant validity. However, the content validity of the HUI Mark 2 system when considered as a multiattribute descriptive health profile is questionable because it falls to assess domains such as neuropsychological and psychosocial functioning. Overall, the results indicate that the HUI Mark 2 system is reliable and valid as a measure of health-related QoL for paediatric oncology patients.

Posttraumatic stress symptoms and medical procedures in children.

OBJECTIVE: To focus on posttraumatic stress symptoms after childhood diseases such as cancer, organ transplantation, and severe burns. METHODS: Differential diagnoses, risk factors, and treatment aspects (psychological and pharmacological) are discussed. RESULTS: The concept of adjustment problems in chronic or severe illnesses is widely used in pediatrics. Many aspects of severe childhood diseases are traumatic, as defined by the DSM-IV: severe illnesses are life-threatening, medical procedures threaten the child's physical integrity, and disorganized behaviour periods are common. CONCLUSION: This concept, which remains insufficiently investigated, is a promising area of investigation for prospective and prevention studies.

A topographical ERP study of healthy premature 5-year-old children in the auditory and visual modalities.

The aim of this research is to study the impact of extreme prematurity on the cognitive development of the child as assessed at age 5 years 9 months. Our samples include 15 healthy prematures born between 25 and 28 weeks of gestational age carefully matched with 15 full-term controls. In the first experiment, two different auditory stimuli were presented to the subjects who listened passively without instruction. The second experiment consisted of a standard visual oddball task in which the subjects were instructed to 'catch' two different animals, by pushing a left or right button for a moose (n = 120) or a raccoon (n = 40), respectively. In the auditory task, 3 ERP peaks were analyzed (frontal N100 and P3a, temporal P2). All premature children demonstrated normal early frontal N100 and temporal P2 responses. The group differences were apparent in the late positivity (P3a) where controls showed a larger amplitude to the rare tones applied evenly to both ears. In contrast, the prematures did not show sensitivity to rare tones but showed a larger P3a upon left ear stimulation, when compared to the right. Also, the ERPs to the visual oddball task showed normal early positivities (P250-300) in the premature group. Once again, deviations from the normal were evident in late waves. The ERPs recorded from prematures showed a more diffuse topography especially between 500 and 600 ms post-stimulus and around the posterior area (P550). The succeeding negativity (SW) was not altered in the premature group. The ERP data suggest that premature children, even without clinically apparent problems, convey specific ERP singularity when engaged in a task that involves complex processing.

A comparative study of ERP correlates of psychometric and Piagetian intelligence measures in normal and hyperactive children.

Verbal and performance scores of the Wechsler Intelligence Scale for Children-Revised (WISC-R 1981) and of a Piagetian battery, the Cognitive Development Scale for Children (EDC 1984), were obtained on 30 normal control and 19 hyperactive 6-8-year-old children. Amplitudes and latencies of a fronto-central P250 and of the parieto-occipital N250, P350 and P500 were measured concurrently in 4 categorization tasks derived from tests of the WISC-R and EDC batteries. Spearman correlations were computed between the intelligence and the ERP factor scores. Results showed that age-related and age-corrected Wechsler's scores were correlated with similar ERP changes (reduced amplitude, decreased latency). With regard to the amplitude changes, each type of intelligence was associated with a specific ERP pattern. The verbal scores were correlated with the P350 and the P500 amplitudes, and the performance scores with the frontal P250 and occipital N250 amplitudes. By contrast, Piagetian development and intelligence scores yielded ERP correlates in the opposite direction: P500 amplitude was negatively correlated with raw EDC scores, but positively with scaled EDC scores. In addition, Piagetian intelligence was not related to the general peak latency decrease with age. In hyperactive children, additional negative correlations were found between P250 amplitude and the subjects' verbal test scores. Correlations with some performance tests that were negative in normal controls, were positive in hyperactive children. In addition, latency-based correlations found in normal controls were lacking in hyperactive children. These findings provide strong evidence that intelligence comprises different components related to different subsets of cognitive processes, as indexed by different ERP waves. They also suggest that the development and intelligence do not always rely on the same changes, and that intelligence forms may not be referred to the same use of the same processes in hyperactive and normal children.

[Experimental principles of hyperactive behavior in children]. / Bases expérimentales du comportement hyperactif de l'enfant.

Neurophysiological studies have demonstrated that processing of information is defective in hyperactive children. Converging lines of evidence suggest that both perception and attention are normal in these patients. In contrast, there are alterations in motor processes and in the regulation of energy resources used for motor output. The clinical and therapeutic implications of clinical research data are discussed.

An event-related potential study of controlled and automatic processes in 6-8-year-old boys with attention deficit hyperactivity disorder.

Event-related potentials (ERPs) were recorded from 2 groups (attention deficit hyperactivity disorder (ADHD) and normal control) of 12 boys aged from 6 to 8 years. Subjects were submitted to 2 different types of categorization tasks (with rare targets and frequent standards) implying either the use of a verbal class or that of an ordered series. Each type of task was performed twice, the first with reading and the second without. Amplitudes and latencies of a fronto-central N150-P250 complex, a parieto-occipital N250-P350 complex and a parieto-occipital P500 were measured. Regardless of the task, hyperactive children showed larger fronto-central P250, larger parieto-occipital N250 and smaller parieto-occipital P350s and P500s; moreover, the latencies of their parieto-occipital P350s were shortened. When the categorization depended on the use of a verbal class, ERP reading effects were significantly smaller in hyperactives than in normal controls for the parieto-occipital waves only. Alternatively, the target effects were significantly larger in hyperactive children but for the fronto-central P250 only. These results suggest that in ADHD automatic processes were enhanced when higher-order controlled processes were inadequate.