Improvement in specific aspects of neurocognitive performance in children after renal transplantation.

BACKGROUND: Chronic renal failure in childhood is considered to affect neurocognitive function adversely, and kidney transplantation may ameliorate the deficits. However, previous studies have suffered from the use of poorly matched control groups, comparison of transplant with uncorrected uremia, lack of standardization of dialysis, and insufficiently sensitive neuropsychological tests. METHODS: We studied nine medically stable children and adolescents age 14.2 +/- 3.5 years with end-stage renal disease prior to and again one year after successful renal transplant. At baseline, the Wechsler Intelligence Scale for Children-III (WISC-III) or the Wechsler Adult Intelligence Scale-Revised (WAIS-R) was performed. Repeatable tests used before and after transplant included the Paced Auditory Serial Addition Test (PASAT) or the Children's Paced Auditory Serial Addition Test (CHIPASAT), the Stroop Color-Word Naming Test, the Buschke Selective Reminding Test, the Meier Visual Discrimination Test, the Grooved Pegboard Test, the WISC-III or the WAIS-R Coding subtests and the Trailmaking Test. Computer-based measures of mental processing speed, reaction time, and discrimination sensitivity included the Cognitive Abilities Test (CAT) and the Connors Continuous Performance Test (CPT). Formal kinetic modeling of dialysis delivery ensured adequate renal replacement therapy. Transplant function was good on stable doses of immunosuppressives, without recent rejections at the time of testing. RESULTS: Within-subject comparison showed statistically significant improvement in mental processing speed by CAT, reaction time and discrimination sensitivity by CPT, and working memory by PASAT/CHIPASAT after renal transplant. Other measures were unchanged. CONCLUSION: Mental processing speed and sustained attention improved in children after renal transplantation in a carefully controlled prospective cross-over study.

The role of genetic counseling in visually impaired adolescents.

The presence of genetic disorders in a high percentage of adolescents with significant visual impairments emphasizes the important role that genetic counseling can play in this population. However, its intended goals have been controversial. Responses to structured interviews about genetic counseling services from three groups of former students from the Kentucky School for the Blind were compared. One group consisted of students who had received genetic counseling; another, of students who had declined it; and a third, of students who had graduated before the service was available. In all groups, genetic counseling was viewed as a valuable service which would have been pursued by the majority of those who did not have the opportunity to receive it, and by many of those who refused it initially. Although genetic counseling did little to enhance knowledge of the cause of the specific visual impairment, it appeared to be useful in providing information regarding the risk of visual impairment in future offspring. A relatively high rate of unplanned pregnancies was noted in the group who had refused genetic counseling. The significance of this observation is uncertain. One interpretation is that the group refusing genetic counseling may have consisted of individuals who had fewer concerns as adolescents about family planning issues. These observations suggest that it may be appropriate to recommend to adolescents with significant visual impairments to defer childbearing until independent life experiences are accumulated outside the school setting. Then, prior to considering childbearing, genetic counseling should be sought.

Variability in adaptive behavior in children with developmental delay.

Although diagnosticians have become increasingly sensitized to the importance of assessing adaptive behavior in persons with intellectual delay, few empirical data have been available with respect to the relationship between these two dimensions of development in referred clinical populations. Subjects in this study were 117 children aged 9 to 111 months who had significantly intellectual delay. All subjects were administered the Developmental Profile II (DPII), a parent-report measure of functional and adaptive skills. Seventy-nine percent of the children with mild intellectual delay obtained Self-Help age scores on the DPII and 74.2% Social Age scores that were within broad chronological age expectations. A surprising percentage of children with moderate and severe intellectual delays also obtained adaptive age scores at this level.

Comparison of parent-completed behavior rating scales: differentiating boys with ADD from psychiatric and normal controls.

Three parent-completed behavior rating scales, the Conners Abbreviated Rating Scale (ARS), Child Behavior Checklist (CBCL), and Self-Control Rating Scale (SCRS), were studied in boys with attention deficit disorder (ADD), psychiatric controls, and a normal comparison group. The ability of the scales to discriminate these groups was determined via univariate analyses of variance (ANOVA) and discriminant function analyses. All three rating scales revealed group differences. In discriminant function analyses, the ARS was the single best predictor of group membership, but it frequently misclassified psychiatric controls. Externalizing behavior indexes from the SCRS and CBCL yielded similar results. The addition of CBCL internalizing and social competence scales improved overall group classification, facilitating the identification of psychiatric controls. Results encourage the use of multidimensional rating scales such as the CBCL in clinical differential diagnosis, but suggest that unidimensional scales such as the ARS are also useful for assessing change or treatment effects in ADD.

Differential validity of the K-ABC for lower functioning preschool children versus those of higher ability.

The Kaufman Assessment Battery for Children (K-ABC) and the Stanford-Binet Intelligence Scale, Form L-M, were administered to 93 preschool children at risk for learning problems. Lower and higher functioning groups were determined by a Stanford-Binet IQ median split. Although the Stanford-Binet and K-ABC yielded nearly identical results in the higher group, K-ABC standard scores were significantly higher than Stanford-Binet IQ in the lower group. The Stanford-Binet and K-ABC correlated more strongly in the higher group than in the lower group. These findings question the ability of the K-ABC to discriminate among at-risk preschoolers functioning in the lower ranges of cognitive ability.

Children's consensual knowledge about the experiential determinants of emotion.

Kindergarten, third-, and sixth-grade children were given vignettes describing experiences that were likely to produce emotional states, and their consensus about the probable affective reaction was determined. A sample of eight social and personal (private) experiences was utilized in the vignettes: success, failure, dishonesty (caught or not caught), experiencing nurturance or aggression, and experiencing justified or unjustified punishment. The potential affective reactions that children were asked to choose among included happiness, sadness, anger, fear, and neutral affect. There were no sex differences. Children of all ages agreed that relatively simple experiences such as success and nurturance would elicit a happy reaction. For other categories of experience, multiple consensuses appeared for more than one affective reaction. There were developmental differences in the affective reactions anticipated to five of the eight experience categories. Results are discussed in terms of cognitive and social learning determinants of knowledge about the experimental antecedents of emotion for oneself and others.