The emergence and stability of attention deficit hyperactivity disorder in boys with fragile X syndrome.

BACKGROUND: Children with fragile X syndrome (FXS) are at high risk for developing a range of behavioural disorders, including attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorders (ASD). However, very few studies have investigated the comorbid profile of FXS and ADHD and the possible dissociation from the FXS and ASD profile. The present study examined the relationship of childhood temperament characteristics of the Surgency facet (activity level, impulsivity, approach, shyness, and smiling and laughter) and the severity of ADHD and ASD features at two measurement time points in childhood, preschool (ages 3-4) and at school entry (ages 5-6). METHODS: The study consisted of males with FXS measured at each time point (preschool and school entry), as well as comparison of typically developing (TD) boys at the preschool measurement time point. Parent reported measures of temperament and behavioural symptoms were collected at each time point. Multiple regression analyses were used to analyse obtained data. RESULTS: Elevated activity level scores are associated with ADHD scores at preschool age and elevated shyness and decreased smiling and laughter are strongly associated with ADHD scores upon school entry. Impulsivity emerges as a strong indicator of elevated ADHD scores around school age, but even preschool impulsivity scores demonstrate some predictive value for higher ADHD scores later in school. Finally, no Surgency characteristic was significantly related to ASD scores at any age. CONCLUSIONS: Impulsivity serves as an indicator of elevated ADHD symptoms across development periods in boys with FXS, while activity level is just indicative of higher ADHD scores at the preschool age. The Surgency facet of temperament at either age does not predict strong relationships of comorbid pathologies of ADHD and ASD in FXS. However, Surgency characteristics may serve as informative discriminative factors when studying behavioural outcomes in boys with FXS.

Lateral ligamentous instability of the ankle: a method of surgical reconstruction by a modified Watson-Jones technique.

Forty-nine cases of lateral ligamentous instability of the ankle have been reviewed. Forty-one have been personally examined. Eight have been evaluated by questionnaire follow-up. The end results have been universally good. The results have been based on a subjective evaluation by the patient, 92% regarding the end results of the procedure to be excellent. In regard to function, 92% of the patients have been able to resume their preinjury activity. The evidence of instability of the ankle joint can be determined by preoperative x-ray examination. However, careful history and physical examination obviate the need for x-ray studies in most cases. Operative findings have confirmed our preoperative evaluation in all cases. The modification of the Watson-Jones procedure, using the peroneus longus, enables the operating surgeon use of a much greater tendon in reconstruction of the lateral ligamentous structures. No change in the function of the foot has been noted in the reported cases.