Neurodevelopmental outcome of patients with congenital gastrointestinal malformations: a systematic review and meta-analysis.

AIM: Children with congenital gastrointestinal malformations may be at risk of neurodevelopmental impairment due to challenges to the developing brain, including perioperative haemodynamic changes, exposure to anaesthetics and postoperative inflammatory influences. This study aggregates existing evidence on neurodevelopmental outcome in these patients using meta-analysis. METHOD: PubMed, Embase and Web of Science were searched for peer-reviewed articles published until October 2019. Out of the 5316 unique articles that were identified, 47 studies met the inclusion criteria and were included. Standardised mean differences (Cohen's d) between cognitive, motor and language outcome of patients with congenital gastrointestinal malformations and normative data (39 studies) or the studies' control group (8 studies) were aggregated across studies using random-effects meta-analysis. The value of (clinical) moderators was studied using meta-regression and diagnostic subgroups were compared. RESULTS: The 47 included studies encompassed 62 cohorts, representing 2312 patients. Children with congenital gastrointestinal malformations had small-sized cognitive impairment (d=-0.435, p<0.001; 95% CI -0.567 to -0.302), medium-sized motor impairment (d=-0.610, p<0.001; 95% CI -0.769 to -0.451) and medium-sized language impairment (d=-0.670, p<0.001; 95% CI -0.914 to -0.425). Patients with short bowel syndrome had worse motor outcome. Neurodevelopmental outcome was related to the number of surgeries and length of total hospital stay, while no relations were observed with gestational age, birth weight, age and sex. INTERPRETATION: This study shows that children with congenital gastrointestinal malformations exhibit impairments in neurodevelopmental outcome, highlighting the need for routine screening of neurodevelopment during follow-up.

Changes in Neurodevelopmental Outcomes From Age 2 to 10 Years for Children Born Extremely Preterm.

OBJECTIVES: Evidence-based care of extremely preterm infants (<28 weeks' gestation) depends heavily on research in which a primary outcome is infant neurodevelopmental impairment (NDI), yet it is unclear how well NDI in infancy predicts long-term NDI. In this study, we aim to assess the relationship between 2- and 10-year neurodevelopment using a well-known 2-year definition and a 10-year definition developed by an expert panel. METHODS: Using data from the Extremely Low Gestational Age Newborn Study cohort, we classified 2-year NDI using definitions developed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. We classified 10-year NDI using definitions developed by an expert panel, which added epilepsy and ASD at 10 years. RESULTS: Of 1506 infants, 80% survived. Data sufficient to classify severity of NDI at both 2 and 10 years were available for 67% of survivors (n = 802). Among children classified as having moderate to severe NDI at 2 years, 63% had none to mild NDI at 10 years; among children classified as having profound NDI at 2 years, 36% had none to mild NDI at 10 years. Cohen's κ statistic indicated minimal to fair agreement between NDI at 2 and 10 years (0.34, P < .001). CONCLUSIONS: NDI in infancy, as defined in this study, only weakly predicts NDI in middle childhood. For the parents at risk for delivery of an extremely preterm infant, a hopeful message can be taken from our findings that one-third of surviving children classified as having profound NDI and nearly two-thirds of those classified as having moderate to severe NDI at 2 years had none to mild NDI at 10 years.

Distinct genetic patterns of shared and unique genes across four neurodevelopmental disorders.

Neurodevelopmental disorders, including autism spectrum disorder (ASD), intellectual disability (ID), developmental disorders (DD) and epileptic encephalopathy (EE), have a strong clinical comorbidity, which indicates a common genetic etiology across various disorders. However, the underlying genetic mechanisms of comorbidity and specificity remain unknown across neurodevelopmental disorders. Based on de novo mutations, we compared systematically the functional characteristics between shared and unique genes under these disorders, as well as the spatiotemporal trajectory of development in brain and common molecular pathways of all shared genes. We observed that shared genes present more constrained against functional rare genetic variation, and harbor more pathogenic rare variants than do unique genes in each disorder. Furthermore, 71 shared genes formed two clusters related to synaptic transmission, transcription regulation and chromatin regulator. Particularly, we also found that two core genes STXBP1 and SCN2A, that were shared by the four neurodevelopmental disorders showed prominent pleiotropy. Our findings shed light on the shared and specific patterns across neurodevelopmental disorders and will enable us to further comprehend the etiology and provide valuable information for the diagnosis of neurodevelopmental disorders.

Changes from ICD-10 to ICD-11 and future directions in psychiatric classification
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This article provides a brief overview of the changes from ICD-10 to ICD-11 regarding the classification of mental, behavioral, or neurodevelopmental disorders. These changes include a new chapter structure, new diagnostic categories, changes in diagnostic criteria, and steps towards dimensionality. Additionally, we review evaluative field studies of ICD-11, which provide preliminary evidence for higher reliability and clinical utility of ICD-11 compared with ICD-10. Despite the extensive revision process, changes from ICD-10 to ICD-11 were relatively modest in that both systems are categorical, classifying mental phenomena based on self-reported or clinically observable symptoms. Other recent approaches to psychiatric nosology and classification (eg, neurobiology-based or hierarchical) are discussed. To meet the needs of different user groups, we propose expanding the stepwise approach to diagnosis introduced for some diagnostic categories in ICD-11, which includes categorical and dimensional elements.
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Este artículo entrega una breve descripción de los cambios de la CIE-10 a la CIE-11 con respecto a la clasificación de los trastornos mentales, conductuales o trastornos del neurodesarrollo. Estos cambios incluyen una nueva estructura del capítulo, nuevas categorías diagnósticas, cambios en los criterios diagnósticos y pasos hacia un enfoque dimensional. Además, se revisan los estudios de campo de evaluación para la CIE-11, que proporcionan evidencia preliminar de una mayor confiabilidad y utilidad clínica de la CIE-11 en comparación con la CIE-10. A pesar del extenso proceso de revisión, los cambios de la CIE-10 a la CIE-11 fueron relativamente pocos en el sentido de que ambos sistemas son categoriales y clasifican los fenómenos mentales en base a síntomas auto-reportados o que sean clínicamente observables. Se discuten otros enfoques recientes de la nosología y de la clasificación psiquiátrica (por ejemplo, basados en la neurobiología o de acuerdo a jerarquías). Para satisfacer las necesidades de diferentes grupos de usuarios, se propone expandir el enfoque gradual del diagnóstico introducido para algunas categorías diagnósticas de la CIE-11, que incluye elementos categoriales y dimensionales.

Cet article propose un aperçu des évolutions entre la CIM-10 et la CIM-11 concernant la classification des troubles mentaux, comportementaux ou neurodéveloppementaux. Un nouveau chapitre, de nouvelles catégories diagnostiques, des critères diagnostiques modifiés et des étapes dimensionnelles ont été ajoutés. De plus, nous examinons les données préliminaires issues d'études de terrain d'évaluation de la CIM-11, en faveur d'une plus grande fiabilité et utilité de cette dernière comparée à la CIM-10. Les modifications de la CIM-10 vers la CIM-11 sont relativement modestes malgré une révision étendue, les deux systèmes restant catégoriels et les troubles mentaux étant classés d'après des symptômes auto-rapportés ou cliniquement observables. Nous analysons d'autres approches récentes de la nosologie et de la classification psychiatriques (selon la neurobiologie ou hiérarchiquement par exemple). Certaines catégories diagnostiques de la CIM-11 pourraient bénéficier selon nous de cette méthode progressive en incluant des éléments catégoriels et dimensionnels.

Ensuring the rights of children with neurodevelopmental disabilities within child justice systems.

A recent UN general comment on criminal justice systems includes guidance to state parties regarding the implementation of the Convention on the Rights of the Child for children with developmental delays or neurodevelopmental disorders or disabilities. This guidance asserts that these children "should not be in the child justice system at all", but when present "should be individually assessed" to enable appropriate safeguards and accommodations to ensure the protection of their rights without discrimination. In this Viewpoint, we examine the significant barriers faced by children who are affected by neurodevelopmental disabilities to the realisation of their rights under international law and standards. These barriers include systemic and cultural barriers created by a lack of awareness among justice professionals about how to identify and work with children who have neurodevelopmental disabilities, as well as procedural barriers, which arise from the complexity and rigidity of many criminal justice processes. The effect of these barriers is that the child is denied their rights on an equal basis with other children without such disabilities.

Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies.

An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO's focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.

Déficits ejecutivos y trastornos del neurodesarrollo en la infancia y en la adolescencia / Executive function deficits and neurodevelopmental disorders in childhood and adolescence

Introducción: Actualmente, en el Manual diagnóstico y estadístico de los trastornos mentales (DSM-5) se incluye una nueva categoría diagnóstica referida a trastornos del neurodesarrollo. Son diversos los trastornos del neurodesarrollo que, aun siendo entidades diagnósticas independientes, comparten manifestaciones comunes a las que presentan personas con daño cerebral o disfunción en la corteza prefrontal, es decir, presentan diferentes alteraciones de las funciones ejecutivas. Desarrollo: El propósito de este estudio es ofrecer una visión de los hallazgos actuales sobre el funcionamiento ejecutivo en niños y jóvenes con diferentes trastornos del neurodesarrollo: trastorno del espectro autista, trastorno por déficit de atención/hiperactividad y trastorno específico del aprendizaje. Con este objetivo se revisaron 27 artículos. Los resultados de los análisis indican una asociación estadísticamente significativa entre dimensión de flexibilidad y trastorno por déficit de atención/hiperactividad (W de Wilcoxon = 123; p = 0,011) y dimensión de flexibilidad y trastorno del espectro autista (W de Wilcoxon = 101,5; p = 0,003), y ausencia de asociación estadísticamente significativa entre las diferentes dimensiones evaluadas y trastorno específico del aprendizaje. Conclusiones: Las dimensiones ejecutivas se encuentran afectadas en los diferentes trastornos del neurodesarrollo en grado variable. Podemos hipotetizar la existencia de un continuo en las dimensiones que se encuentran afectadas en los diferentes trastornos del neurodesarrollo; en ocasiones, es complejo establecer límites categoriales cuando se comparan distintos trastornos

Introduction: Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has new criteria that include a diagnostic reference to neurodevelopmental disorders. Neurodevelopmental disorders are diverse, and even though they are independent diagnostic entities they share common manifestations in people with brain damage or dysfunction of the prefrontal cortex; that is, neurodevelopmental disorders present different alterations in executive functions. Development: The aim of the present study was to offer an overview of the recent findings on executive functioning in children, adolescents and young adults with different neurodevelopmental disorders: autistic spectrum disorder, attention-deficit/hyperactivity disorder and specific learning disorder. Hence, with this objective, 27 studies from the literature were reviewed. The results indicate a statistically significant association between the dimension of flexibility and attention deficit/hyperactivity disorder (W of Wilcoxon = 123.0; p = 0.011), and flexibility with autistic spectrum disorder (W of Wilcoxon = 101.5; p = 0.003); and absence of a statistically significant association between the different assessed dimensions and specific learning disorder. Conclusions: The dimensions of executive functioning are affected to a variable degree in different neurodevelopmental disorders. We can hypothesis that the dimensions that are affected in the different neurodevelopmental disorders can be characterized in terms of the existence of a continuum, and occasionally those dimensions are too complex to establish categorical limits when comparing different neurodevelopmental disorders

What are neurodevelopmental disorders?

PURPOSE OF REVIEW: The purpose of this review is to highlight the origin and evolution of the field of neurodevelopmental disabilities and describe the main construct(s) upon which the current classification of neurodevelopmental disorders is based. RECENT FINDINGS: We address the following questions: Are neurodevelopmental disorders independent entities? Why is it desirable to understand the neurobiological substrate for these disorders? What new knowledge have we generated by leveraging advances in neuroscience, genetics, and neuroimaging? And finally, is the current construct, that is based on functional classification, still useful? SUMMARY: As our biological understanding of brain-behavior disorders evolves, we ought to re-evaluate the current classification system and expand it into a multidimensional classification that takes into account behavioral profiles and underlying mechanisms.

Closing the medical mortality gap in patients with major psychiatric conditions.

This article discusses options for closing the mortality gap between the general population and people with major psychiatric conditions such as psychosis, autism, learning disability and dementia. Most of the mortality (85%) involves physical disease, with most deaths occurring in general hospitals or care homes, so is relevant to all doctors. The main focus of psychiatric treatments has been to reduce suicide, although there is no evidence that they achieve this. This article calls for psychiatrists to collaborate with medical colleagues to help reduce excess deaths from physical causes. The practicalities of combined physical and mental health monitoring and prescribing clinics are discussed, based on experience in Whitby. Potential national solutions are summarized including options for smoking cessation, sugar restriction, nutritional supplementation and flu vaccination.

ADHD, CD, and ODD: Systematic review of genetic and environmental risk factors.

This review aims to analyze the relationships between Attention-Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD), particularly regarding the relative importance of genetic and environmental factors in the development of these disorders. Studies that examined at least two of these disorders were obtained from multiple databases, following the procedures of the Cochrane Collaboration initiative. Of the 279 documents obtained, nine were retained for in-depth analysis and were considered eligible for inclusion. In addition, eight studies from the manual search were included. The objectives, methodological aspects (sample and instruments), and the main conclusions were extracted from each study. Overall, the results suggest that (a) the causes for the onset and maintenance of these disorders are more associated with genetic factors than environmental factors, although the importance of the latter is recognized, and (b) children with ADHD have a predisposition to manifest behaviors that are common to ODD and CD, including the antisocial behavior that these children often display.

Discriminant validity of spatial and temporal postural index in children with neurodevelopmental disorders.

Autism, learning disabilities and attention deficit/hyperactive disorder are often comorbid disorders. In order to try and find some markers that might be transnosographic, we hypothesized that abnormal postural sway profiles may discriminate children with neurodevelopmental disorders (NDDs) from typically developing children. The aim of our study was thus to compare spatial and temporal measures of the Center of Pressure in three distinct groups of children with NDDs (high functioning autism spectrum disorders, learning disabilities (dyslexia) and attention deficit/hyperactive disorders) and in typically developing children. Postural performances were thus evaluated in 92 children (23 per group, sex-, age- and IQ-matched groups) by using the Multitest Equilibre platform (Framiral®). Two viewing conditions (eyes open and eyes closed) were tested on a stable and unstable platform. Results reported similar poor postural instability for the three groups of children with NDDs with respect to the typically developing children, and this was observed for both spatial as well as temporal analysis of displacement of the center of pressure. Such postural instability observed in children with NDDs could be due to impairment in using sensorial inputs to eliminate body sway, probably due to poor cerebellar integration.

Sleep Disturbances in Neurodevelopmental Disorders.

Sleep disturbances are extremely prevalent in children with neurodevelopmental disorders compared to typically developing children. The diagnostic criteria for many neurodevelopmental disorders include sleep disturbances. Sleep disturbance in this population is often multifactorial and caused by the interplay of genetic, neurobiological and environmental overlap. These disturbances often present either as insomnia or hypersomnia. Different sleep disorders present with these complaints and based on the clinical history and findings from diagnostic tests, an appropriate diagnosis can be made. This review aims to provide an overview of causes, diagnosis, and treatment of sleep disturbances in neurodevelopmental disorders that present primarily with symptoms of hypersomnia and/or insomnia.