Predicting Mathematical Learning Difficulties Using Fundamental Calculative Ability Test (FCAT).

Background: Mathematical learning difficulty (MLD) during school years results from several factors, including dyscalculia. Traditional diagnostic tests for dyscalculia are time intensive and require skilled specialists. This prospective cohort study aimed to reveal that the less time intensive Fundamental Calculative Ability Test (FCAT), administered in first grade, can predict the outcome of mathematical school achievement, which was measured with the curriculum-based mathematical test for second grade (1.2 years after FCAT). Methods: A total of 362 Japanese first- and second-grade children participated. A new quick test measuring fundamental calculative abilities, the FCAT, ordinal, radix, addition, and subtraction, was conducted for the first graders (mean age: 7.1 years). Mathematical school achievement was measured during the tests [mathematics curriculum-based test in Tottori Prefecture (MCBT)] for first (MCBT-1, mean age: 7.3 years) and second graders (MCBT-2, mean age: 8.3 years). We analyzed the associations between FCAT and MCBT-1 and 2 using univariate regression analysis, and cutoff values for mathematical learning difficulty (MLD) at MCBT-2 using the rating operation curve and Youden index. MLD was set as a score of lower than 20% on the MCBT. Results: The FCAT score was significantly associated with the MCBT-1 (regression coefficient: 0.67, P < 0.001) and MCBT-2 scores (regression coefficient: 0.50, P < 0.001). A cutoff value of 47 points (deviation score: 47) at the FCAT score predicted MLD at MCBT-2 (sensitivity: 0.77, specificity: 0.73). For 62 participants with MLD at MCBT-1 score, FCAT scores below the cutoff value of 40 points (deviation score: 35) were at high risk of MLD at MCBT-2 (odds ratio: 6.2). Conclusion: The FCAT is easily conducted in a short time during regular schools and can predict mathematical school achievement. It can be used for the early diagnosis of children with mathematical problems.

Establishment of an objective index for the diagnosis of attention deficit/hyperactivity disorder by the continuous performance test "MOGRAZ".

OBJECTIVE: The diagnosis of attention deficit/hyperactivity disorder (AD/HD) in Japan is mainly based on information obtained from caregivers. There is therefore a need to establish an objectivity index that can be easily used in clinical practice. The purpose of the study was to create a predictive model for the diagnosis of AD/HD using the MOGRAZ, a visual continuous performance test developed in Japan. METHODS: We collected data from an AD/HD group and a non-AD/HD group. The AD/HD group included 75 children with predominantly inattentive type AD/HD and 48 with combined type AD/HD who were aged 6 to 12 years and diagnosed at our department. The non-AD/HD group included 153 Japanese children aged 6 to 11 years enrolled in regular classes at a public elementary school. In both groups, multiple logistic regression analysis was performed using the results of MOGRAZ, age, and sex as parameters, and algorithms for a predictive diagnostic model of AD/HD were created. RESULTS: The area under the receiver operating characteristic curve (ROC-AUC) between the predominantly inattentive type AD/HD subgroup and non-AD/HD group was 0.884 (95% confidence interval: 0.837-0.932), and the ROC-AUC between the combined type AD/HD subgroup and non-AD/HD group was 0.914 (95% CI: 0.869-0.959). CONCLUSION: The prediction model using the MOGRAZ score allowed us to create an objectivity index to determine the diagnosis of AD/HD that can be easily used in clinical practice. We plan additional verification of this prediction model with additional participants.

Trajectories of Healthcare Utilization Among Children and Adolescents With Autism Spectrum Disorder and/or Attention-Deficit/Hyperactivity Disorder in Japan.

BACKGROUND: Early intervention and prevention of psychiatric comorbidities of children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are urgent issues. However, the differences in the diagnoses of ASD and ADHD and psychiatric comorbidities associated with age, long-term healthcare utilization trajectories, and its associated diagnostic features have not been fully elucidated in Japan. METHOD: We conducted a retrospective observational study using the medical records. Member hospitals of three major consortiums of hospitals providing child and adolescent psychiatric services in Japan were recruited for the study. Children who accessed the psychiatry services of the participating hospitals in April 2015 were followed up for 5 years, and data on their clinical diagnoses, consultation numbers, and hospitalizations were collected. Non-hierarchical clustering was performed using two 10-timepoint longitudinal variables: consultation numbers and hospitalization. Among the major clusters, the differences in the prevalence of ASD, ADHD, comorbid intellectual disability, neurotic disorders, and other psychiatric disorders were assessed. RESULTS: A total of 44 facilities participated in the study (59.5%), and 1,003 participants were enrolled. Among them, 591 diagnosed with ASD and/or ADHD (58.9%) and 589 without missing data were assessed. The mean age was 10.1 years, and 363 (70.9%) were boys. Compared with the pre-schoolers, the school-aged children and adolescents had fewer ASD, more ADHD, and fewer comorbid intellectual disability diagnoses, as well as more diagnoses of other psychiatric disorders. A total of 309 participants (54.7%) continued consultation for 2 years, and 207 (35.1%) continued for 5 years. Clustering analysis identified three, two, and three major clusters among pre-schoolers, school-aged children, and adolescents, respectively. The largest cluster was characterized by early termination of the consultation and accounted for 55.4, 70.6, and 73.4% of pre-schoolers, school-aged children, and adolescents, respectively. Among the school-aged children, the diagnosis of ADHD was associated with a cluster that required longer periods of consultations. Among the adolescents, comorbid psychiatric disorders other than intellectual disability and neurotic disorders were associated with clusters that required hospitalization. CONCLUSION: Continuous healthcare needs were common and psychiatric comorbidities were associated with complex trajectory among adolescents. The promotion of early intervention and prevention of comorbidities are important.

Association between blood lead exposure and mental health in pregnant women: Results from the Japan environment and children's study.

OBJECTIVE: Although environmental lead exposure has decreased, several studies have shown that low-level lead exposure can result in adverse psychological symptoms. However, few studies have examined lead neurotoxicity in pregnant women. We investigated the association between lead exposure and psychological symptoms in pregnant women, and between socio-economic status and blood lead levels. METHODS: Blood lead levels were measured in 17,267 pregnant women in the Japan Environment and Children's Study. Odds ratios (ORs) for high blood lead levels were calculated using multinomial logistic regression. Psychological symptoms were assessed using the Kessler Psychological Distress Scale (K6). ORs for depression (K6 ≥ 13 or ≥5) were calculated using logistic regression with adjustment for potential confounders. RESULTS: The geometric mean of whole blood lead levels was 0.58 µg/dl (range 0.14-6.75 µg/dl). Higher blood lead levels were associated with older age (OR 1.79, 9 5% confidence interval [CI] 1.46-2.19), unmarried status (OR 1.75, 95 % CI 1.31-2.33), lower household income (OR 1.76, 95 % CI 1.38-2.24), and lower educational attainment (OR 1.34, 95 % CI 1.20-1.48). The percentage of women with K6 scores ≥13 and ≥5 was 3 % and 28.2 %, respectively. There was no significant association between lead exposure and K6 score (K6 ≥ 13: OR 1.00, 95 % CI 0.76-1.32; K6 ≥ 5: OR 0.98, 95 % CI 0.88-1.09). CONCLUSION: Our results indicate a small but significant association between higher blood lead levels and lower socio-economic status in a population with low blood lead levels, but no association between low-level lead exposure and psychological symptoms.

Differences between children and adults in functional connectivity between the inferior frontal gyrus and extrastriate body area for gestural interaction.

Gestural interaction, where a person initiates interaction (initiator) and another person responds to it (follower), changes during development. The neural network comprising the inferior frontal gyrus (IFG), inferior parietal lobule (IPL), and the lateral occipito-temporal cortex (LOTC) is relevant to gestural interaction. The LOTC includes the extrastriate body area (EBA). Activation of these brain regions depends on the initiating/following role in adults. We conducted functional magnetic resonance imaging study on 18 children and 18 adults, to elucidate developmental changes of the neural mechanism underlying gestural interaction. We manipulated the initiating/following role (initiating/following) and congruency (congruent/incongruent) of executed and observed actions. After analyzing regional brain activity, we assessed psycho-physiological interaction to examine functional connectivity. Activation in the IFG and connectivity between the IFG and EBA in the Initiating rather than Following condition, which might be associated with evaluating social relevance, was stronger in adults than in children. The increase of the incongruency effect in the following condition (relative to the initiating condition) in the bilateral IPL was significantly attenuated in children compared with adults. These results suggest that the fronto-parieto-temporal network, involved in gestural interactions, undergoes developmental changes.

Applied Machine Learning Method to Predict Children With ADHD Using Prefrontal Cortex Activity: A Multicenter Study in Japan.

Objective: To establish valid, objective biomarkers for ADHD using machine learning. Method: Machine learning was used to predict disorder severity from new brain function data, using a support vector machine (SVM). A multicenter approach was used to collect data for machine learning training, including behavioral and physiological indicators, age, and reverse Stroop task (RST) data from 108 children with ADHD and 108 typically developing (TD) children. Near-infrared spectroscopy (NIRS) was used to quantify change in prefrontal cortex oxygenated hemoglobin during RST. Verification data were from 62 children with ADHD and 37 TD children from six facilities in Japan. Results: The SVM general performance results showed sensitivity of 88.71%, specificity of 83.78%, and an overall discrimination rate of 86.25%. Conclusion: A SVM using an objective index from RST may be useful as an auxiliary biomarker for diagnosis for children with ADHD.

Psychometric profile of the Ages and Stages Questionnaires, Japanese translation.

BACKGROUND: This study assessed the psychometric profile of 10 questionnaires (every 6 months, from 6 to 60 months) from the Japanese translation of the Ages and Stages Questionnaires, third edition (J-ASQ-3). METHODS: Data from 439 children in a birth cohort were used to identify the J-ASQ-3 score distribution, establish cut-off scores, and calculate the instrument's internal consistency. Data were also collected from 491 outpatients to examine J-ASQ-3 test-retest reliability and concurrent validity, which was examined using the Kyoto Scale of Psychological Development (KSPD) and the Japanese version of the Denver Developmental Screening Test II (J-Denver II). Both the original and the alternative screening criteria of the ASQ-3 were used (failure in at least one and at least two domains, respectively). RESULTS: Cronbach's alpha for each J-ASQ-3 subscale on each questionnaire ranged from 0.45 to 0.89. Test-retest reliability was >0.75 for the subscales on almost all questionnaires. Concurrent validity was also adequate. In comparison with the screening results of the KSPD, the overall sensitivity and specificity were 96.0% and 48.8%, respectively, when the ASQ-3 original criterion was used, and 92.1% and 74.9%, respectively, when the alternative criterion was used. In comparison with the screening results of the J-Denver II, the overall sensitivity and specificity were 75.6% and 74.7%, respectively, when the ASQ-3 original criterion was used, and 56.3% and 93.0%, respectively, when the alternative criterion was used. CONCLUSIONS: This study quantified the psychometric profiles of the Japanese translations of 10 ASQ-3 questionnaires. We demonstrated the validity of the J-ASQ-3 and determined new cut-off scores. Further studies with larger samples from a greater range of locations are required to clarify the suitability of this tool for all Japanese children.

Age-related differences in frontal lobe function in children with ADHD.

BACKGROUND: The neural correlates of executive function disorders are thought to be predominantly localized within the prefrontal cortex (PFC). However, no study to date has investigated changes in this system across different age groups in children with attention deficit hyperactivity disorder (ADHD). Thus, this study aimed to explore changes in PFC function in children with ADHD. METHODS: Study participants included typically developing (TD) children (n = 140) and children with ADHD (n = 67) of primary school age. Behavioral executive functions and their neural basis were evaluated between the TD children and children with ADHD and also across different age periods (younger and older children). To examine executive function, inhibitory control was assessed using the reverse Stroop task, and PFC near-infrared spectroscopic measurements were used to investigate the neural mechanisms involved. RESULTS: Both ADHD symptoms and the ability to inhibit color interference improved with age. Compared to TD children, children with ADHD demonstrated decreased activation of the right and middle PFC across all age groups. Interestingly, the left PFC appeared to play a compensatory role. CONCLUSION: Children with ADHD exhibited changes in PFC function that varied with age. Longitudinal studies are required to assess the potential of using PFC function as an early biomarker of ADHD.

Reading disability due to an ocular motor disorder: A case of an adolescent girl with a previous diagnosis of dyslexia.

Dyslexia is a reading disability characterized by difficulties with accurate and/or fluent word recognition, which are thought to stem from a phonological processing impairment. Herein we report the case of a 13-year-old girl who received the diagnosis of dyslexia at age 12 years. We considered this diagnosis to be incorrect because her reading difficulty was caused by a spontaneously repeated eye movement toward the vertical direction; the eyes were likely to show slow, upward drifts followed by quick downward movement at the physical examination, and the amplitude of the downward movement was increased when she changed eye positions to look at the upper direction in the evaluation of the eye tracker. Although we considered there was the possibility that the spontaneously repeated eye movement was classified as the spontaneous downbeat nystagmus, the eye tracker showed the transition of the gaze starting from and returning to was inconsistent with nystagmus, and we concluded that the term of nystagmus like abnormal eye movement was appropriate for the expression of the spontaneously repeated eye movement. There was no apparent abnormality on head magnetic resonance imaging (MRI), and whole exome sequencing showed no known candidate genes to explain the cerebellar dysfunction. An accumulation of similar cases in the future should help elucidate the pathomechanism observed in this case, and we should fully pay attention to evaluate the neurological aspects of the patients before settling on the diagnosis of dyslexia.

Intelligence test at preschool-age predicts reading difficulty among school-aged very low birth weight infants in Japan.

OBJECTIVE: To elucidate whether the results of an intelligence test at preschool age are predictive of reading difficulty (RD) at school age among very low birth weight infants (VLBWI). METHODS: Subjects were 48 Japanese children whose birth weight was <1500 g and who regularly visited a follow-up clinic. All subjects completed the Wechsler Intelligence Scale for Children-III (WISC-III) during the last grade of kindergarten, and four reading tasks during the second to fourth grade of elementary school. All participants had a full-scale intelligence quotient score of 85 or higher. Subjects with a standard deviation reading time score greater than 2.0 in two or more tasks were considered to have RD. We evaluated the associations between each WISC-III score and RD using logistic regression analyses. Furthermore, we performed receiver operating characteristic (ROC) analysis to determine a cutoff WISC-III score predictive of RD. RESULTS: In the mutually-adjusted model, the adjusted odds ratio per 1 score increase of freedom from distractibility (FD) was 0.832 (95% confidence interval: 0.720-0.962). In the ROC analysis, an FD score of <95.5 was chosen as the cutoff value for predicting RD (sensitivity, 0.77; specificity, 0.74). CONCLUSION: The present study indicated that a lower FD score at preschool age, which was associated with deficits in verbal working memory and attention, is a risk factor for RD at school age among Japanese VLBWI. Further investigation is desired to clarify the cognitive deficits underlying RD in Japanese-speaking preterm children, and to establish appropriate interventions for these children.

Stigma associated with autism among college students in Japan and the United States: An online training study.

Misconceptions and stigma associated with autism vary across cultures and may be influenced by various factors. Undergraduates in Japan (N = 212) and the United States (US) (N = 365) completed an online autism training, with pre- and posttest surveys assessing autism-related stigma (i.e., social distance) and knowledge. Aims were to examine differences in autism stigma and knowledge in Japan and the US, while extending prior research demonstrating benefits of an online autism training in the US and Lebanon to Japan. The results revealed that Japanese students indicated greater autism-related stigma than US students, which was not attributable to differences in autism knowledge, prior experience with autism, or college major. In both countries, students majoring in "helping professions" exhibited greater willingness to engage with people with autism. Japanese and US students varied in their misconceptions about autism, with significant differences on about half of the knowledge items. Japanese students showed decreased stigma after completing the autism training, yet continued to exhibit greater social distance towards people with autism relative to US students. Future research should focus on identifying specific cultural factors (e.g., conformity to social norms and homogeneity within communities) that contribute to fear and exclusion of people with autism in different societies.

Age-dependent atypicalities in body- and face-sensitive activation of the EBA and FFA in individuals with ASD.

Individuals with autism spectrum disorder (ASD) have difficuly in recognizing bodies and faces, which are more pronounced in children than adults. If such difficulties originate from dysfunction of the extrastriate body area (EBA) and the fusiform face area (FFA), activation in these regions might be more atypical in children than in adults. We preformed functional magnetic resonance imaging while children and adults with ASD and age-matched typically developed (TD) individuals observed face, body, car, and scene. To examine various aspects, we performed individual region of interest (ROI) analysis, as well as conventional random effect group analysis. At individual ROI analysis, we examined the ratio of participants showing a category-sensitive response, the size of regions, location and activation patterns among the four object categories. Adults with ASD showed no atypicalities in activation of the EBA and FFA, whereas children with ASD showed atypical activation in these regions. Specifically, a smaller percentage of children with ASD showed face-sensitive activation of the FFA than TD children. Moreover, the size of the EBA was smaller in children with ASD than in TD children. Our results revealed atypicalities in both the FFA and EBA in children with ASD but not in adults with ASD.

Reading difficulty in school-aged very low birth weight infants in Japan.

OBJECTIVE: To investigate the prevalence of and the perinatal risk factors related to reading difficulty in school-aged very low birth weight infants (VLBWI) with normal intelligence. METHODS: Subjects were 79 Japanese children in the second to fourth grade of elementary school who had been born at very low birth weight and who regularly visited a follow-up clinic at one of four hospitals. All members had a full-scale IQ score of 80 or higher. Perinatal information was obtained retrospectively from medical records. Each subject underwent four reading tasks, testing monomoratic syllable reading, word reading, non-word reading and short sentence reading. Subjects with an SD reading time score greater than 2.0 in two or more tasks were considered to have reading difficulty (RD). Furthermore we investigated the relations between RD and perinatal factors using logistic regression analysis adjusted for potential confounding factors. RESULTS: Twenty-five (31.6%) out of 79 subjects had RD. We discovered that treated retinopathy of prematurity (tRoP) was a significant risk factor (adjusted OR=5.80, 95% confidence interval=1.51-22.33). CONCLUSION: The rate of RD in school-aged VLBWI was higher than the estimated prevalence of dyslexia in Japan. Even in children with normal intelligence, long-term developmental follow-up including support for reading skills is necessary for VLBWI. Further investigation is desired to elucidate the relations between visual problems and RD in school-aged children.

[The prospects of the future study and medical practice].

It is thought that dyslexia is caused by brain dysfunction--specifically, impairment of phonological processing. Dyslexia is classified into neurodevelopmental disorder in DSM-5 and is described as an alternative term for specific learning disorder that includes reading impairment. It seems that dyslexia will be recognized as a separate clinical entity. As in our country, clinical research for diagnosis and treatment is continually progressing. Our original reading aloud test is recognized as an official examination for dyslexia diagnosis and is indicated as a mark of the fee-for-service. The time has come when we must regard this disorder not only as a special needs education issue but also as a medical subject.

Buffering effect of parental engagement on the relationship between corporal punishment and children's emotional/behavioral problems.

BACKGROUND: Previous research has established links between corporal punishment and children's developmental problems, but few studies have investigated the moderating effect of positive parenting between corporal punishment and children's developmental difficulties in detail. This study investigated the buffering effect of parental engagement on the association between corporal punishment and children's emotional/behavioral problems. METHODS: The main caregivers completed the Evaluation of Environmental Stimulation Scale (EES), which is an evaluation of daily parenting behaviors, and the Strengths and Difficulties Questionnaire (SDQ), which evaluates children's developmental problems. RESULTS: Corporal punishment was associated with worse emotional and behavioral problems in children, whereas parental engagement in games or sports was associated with fewer emotional symptoms. Similarly, parental engagement in homework or housework significantly moderated the association between corporal punishment and children's behavioral problems. CONCLUSIONS: Parental engagement positively moderated the association between parental corporal punishment and children's developmental difficulties. This association varied with child gender.

[Early detection of specific reading disorder through response to intervention:a cohort study].

OBJECTIVE: The present study examined the effectiveness of response to intervention (RTI) for the early detection and intervention for specific reading disorder. METHOD: RTIs were applied to seventy-seven first graders (36 boys and 41 girls) for the early detection and intervention of specific reading disorders. The outcomes were examined when the children reached the third grade. RESULTS: Reading difficulties were detected in four children at the beginning of the first grade. Decoding training and vocabulary learning were conducted with these children as interventions for reading difficulties. Three children exhibited improvements in reading difficulties at the end of the first grade. The fourth child responded poorly and was diagnosed with specific reading disorder. The assessment of outcomes at the third grade showed that this child still had reading difficulties, whereas no other child displayed symptoms for being diagnosed with specific reading disorder. CONCLUSION: RTI is effective for the early detection and intervention of specific reading disorder.

Altered brain activity for phonological manipulation in dyslexic Japanese children.

Because of unique linguistic characteristics, the prevalence rate of developmental dyslexia is relatively low in the Japanese language. Paradoxically, Japanese children have serious difficulty analysing phonological processes when they have dyslexia. Neurobiological deficits in Japanese dyslexia remain unclear and need to be identified, and may lead to better understanding of the commonality and diversity in the disorder among different linguistic systems. The present study investigated brain activity that underlies deficits in phonological awareness in Japanese dyslexic children using functional magnetic resonance imaging. We developed and conducted a phonological manipulation task to extract phonological processing skills and to minimize the influence of auditory working memory on healthy adults, typically developing children, and dyslexic children. Current experiments revealed that several brain regions participated in manipulating the phonological information including left inferior and middle frontal gyrus, left superior temporal gyrus, and bilateral basal ganglia. Moreover, dyslexic children showed altered activity in two brain regions. They showed hyperactivity in the basal ganglia compared with the two other groups, which reflects inefficient phonological processing. Hypoactivity in the left superior temporal gyrus was also found, suggesting difficulty in composing and processing phonological information. The altered brain activity shares similarity with those of dyslexic children in countries speaking alphabetical languages, but disparity also occurs between these two populations. These are initial findings concerning the neurobiological impairments in dyslexic Japanese children.

[Development of a training program for Japanese dyslexic children and its short-term efficacy].

OBJECTIVE: The purpose of this study is to develop a computer training program of reading for the Japanese dyslexic children and to examine its short-term efficacy on their reading and writing abilities. METHODS: Fifteen dyslexic children underwent two sets of training programs, one for single-hiragana and non-word reading, and the other for the reading of real words, in which each hiragana was followed by the correctly read sound. Subjects were required to use a given program for five minutes a day for three weeks, switching to the other program after a three-week interval. Four kinds of reading test and one writing test were done at the beginning and end of each program period. RESULTS: The averages reading speeds increased, and the single-hiragana reading error average was lower after the training. Hiragana-writing errors also decreased, even though no writing procedure was involved in the programs. CONCLUSIONS: The results indicate the usefulness of these training programs as an early intervention of reading and writing for the Japanese dyslexic children.