Impairments in fine motor skills in children with Acute Lymphoblastic Leukaemia. A cross-sectional study.

AIM: We evaluated fine motor skills; precision, motor integration, manual dexterity, and upper-limb coordination according to sex and risk stratification in children with Acute Lymphoblastic Leukaemia (ALL). METHODS: We evaluated twenty-nine children in the maintenance phase aged 6 to 12 years with the Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-2), and sex and age-specific norm values of BOT-2 were used to compare our results. RESULTS: We found lower scores on the upper-limb coordination subtest, p = 0.003 and on the manual coordination composite, p = 0.008, than normative values. Most boys performed "average" on both the subtests and the composites, but girls showed lower scores with a mean difference of 7.69 (95%CI; 2.24 to 3.14), p = 0.009. Girls' scale scores on the upper-limb coordination subtest were lower than normative values, with mean difference 5.08 (95%CI; 2.35 to 7.81), p = 0.006. The mean standard score difference in high-risk patients was lower than normative on the manual coordination composite, 8.18 (95%CI; 2.26 to 14.1), p = 0.015. High-risk children also performed below the BOT-2 normative on manual dexterity 2.82 (95%CI; 0.14 to 5.78), p = 0.035 and upper limb coordination subtest 4.10 (95%CI; 1.13 to 7.05), p = 0.028. We found a decrease in fine motor precision in children with a higher BMI, rho= -0.87, p = 0.056 and a negative correlation between older age and lower manual dexterity, r= -0.41 p = 0.026; however, we did not find any correlation with the weeks in the maintenance phase. CONCLUSIONS: Fine motor impairments are common in children with ALL in the maintenance phase; it is important to identify these impairments to early rehabilitation.

Survey of autism spectrum disorder in Chandigarh, India.

Background & objectives: Prevalence of autism spectrum disorder (ASD) has been reportedly on the rise in western literature. However, accurate data from India are not available. The present study was planned to assess the community-based prevalence of ASD in Chandigarh, India. Methods: This study was a two-stage survey of representative child population of Chandigarh using stratified random sampling technique, covering 8820 children between the ages 1.5 and 10 yr. Proportionate population from urban (82.3%), rural (4.3%) and slum area (13.4%) were included in the study and screened using Chandigarh autism screening instrument (CASI). Thirty two children scored above cut-off, of whom two had shifted to other places before they could be assessed and 30 were assessed in detail. Detailed assessment was done using Autism Diagnostic Interview-Revised and Childhood Autism Rating Scale-2; diagnosis was made according to the Diagnostic and Statistical Manual-5. Nineteen were diagnosed with ASD. Results: Of the 8451 children screened between the age group of one and a half to 10 yr, 19 (10 boys and 9 girls) were diagnosed as ASD, thus the prevalence of ASD was found to be 2.25 per 1000 (0.69-5.19, 95% confidence interval) children in Chandigarh. No child below the cut-off on the screening instrument was diagnosed as ASD. Interpretation & conclusions: The results suggest that the prevalence of ASD in Chandigarh was in tandem with other reports from across India and was lower than western countries.

Autism assessment: the Melton Health model.

AIM: The following paper describes the Autism Spectrum Assessment Clinic which operates at Melton Health, a publically funded health service in Melbourne's west. METHODS: A retrospective audit of 234 children assessed between 2007 and 2012 in the Autism Spectrum Assessment Clinic was undertaken. Characteristics of the children assessed (age, sex, locality, referral source) were examined along with characteristics of the clinic (clinicians, assessment outcome). RESULTS: A detailed description of the model is provided, including evident changes since the clinic began. Data were split between the 2007 to 2009 and 2010 to 2012 time periods to reflect changes in the operation of the clinic. Overall, 48 girls and 186 boys were assessed with a mean age of 71 months; the average waiting time between referral and assessment was 136.6 days. Across the two time periods, the proportion of children receiving a diagnosis of autism spectrum disorder increased from 43.1% to 66.3%. Changes are evident in the referral sources between the two time periods, and in the disciplines of clinicians involved in the assessment. CONCLUSIONS: The research illustrates an assessment model, within the Victorian public health context, which currently operates effectively according to best-practice guidelines. This research begins to fill a gap between localised clinical practice and the dissemination of this information to a wider audience, allowing for comparison for other assessment providers. It is hoped that we can contribute more broadly to future assessment processes becoming more consistent, reproducible and equitable for children suspected of having autism spectrum disorders.

Temporal and Geographical Variability of Prevalence and Incidence of Autism Spectrum Disorder Diagnoses in Children in Catalonia, Spain.

This study aims to estimate the prevalence of autism spectrum disorders (ASD) in 2017 and the ASD diagnosis incidence between 2009 and 2017 in children living in Catalonia region in Spain, and their temporal and geographical variability. We used administrative data for all children aged 2-17 years who were insured in the public Catalan Health System between 2009 and 2017. We identified all ASD cases diagnosed between 2009 and 2017 (ICD-9 codes 299.0, 299.1, 299.8, and 299.9). We estimated the ASD prevalence in 2017 and the overall annual incidence between 2009 and 2017, then stratified by sex, age group, and healthcare area. We used Poisson regression models to assess temporal trends in the incidence and mixed-effects Poisson regression models to assess geographical variability. We observed an ASD prevalence of 1.23% (95% confidence interval [CI] 1.21-1.25) in 2017, with 1.95% (95% CI 1.92-1.99) for boys and 0.46% (95% CI 0.44-0.48) for girls, the highest prevalence being in 11- to 17-year-olds (1.80%, 95% CI 1.76-1.83). The ASD diagnosis incidence increased from 0.07% (95% CI 0.06-0.09) in 2009 to 0.23% (95% CI 0.21-0.24) in 2017, with a higher increase in girls, and in children aged 2-5 years at the time of diagnosis. We only observed geographical differences in prevalence in the 2017 data. We also detected a threefold increase in the diagnosis incidence overall, which was even more pronounced in girls and at early ages. In conclusion, the ASD prevalence observed in this study was 1.23% in 2017, with a sex ratio of 4.5 in favor of boys, which is consistent with previous studies. Autism Res2019. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Autism spectrum disorders (ASD) are currently well known in our society as one of the most common neurodevelopmental disorders during childhood. The results of our study showed that, in 2017 in Catalonia, slightly more than one in a 100 children had an ASD diagnosis, it was more common in boys than in girls, and also in older children. In addition, between 2009 and 2017, we observed an increase in the number of new cases diagnosed each year. The data presented in this study will assist in planning and evaluating the needs of health services in this geographical region.

Multidisciplinary Approaches in Developing Guideline for Mediating Behavioral Problems in Children and Adolescents with Neurodevelopmental Disorders / 신경정신의학

OBJECTIVES: To initiate and develop a treatment guideline in multidisciplinary approaches for related professions who are either working and/or living with children and adolescents with neurodevelopmental disorders who show behavioral problems. METHODS: To collect and reflect opinions from multiple professions who assumedly have different interventions or mediations on behavioral problems, a self-report survey and Focus Group Interview (FGI) were conducted for a group of child and adolescent psychiatrists, behavioral therapists, special education teachers, social welfare workers, and caregivers. RESULTS: According to a self-report survey and FGI results from multiple professional groups, aggressive behavior is the mostly common behavioral problem necessitating urgent interventions. However, both mainly used intervention strategies and effective treatment methods were different depending on professional backgrounds, such as pharmacological treatment, parent training, and behavior therapy, even though they shared an importance of improving communication skills. In addition, there was a common understanding of necessity to include parent training in a guideline. Lastly the data suggested lack of proper treatment facilities, qualified behavior therapists, and lack of standardized treatment guideline in the field needed to be improved for a quality of current therapeutic services. CONCLUSION: It is supported that several subjects should be included in the guidelines, such as how to deal with aggressive behavior, parent training, and biological aspects of neurodevelopmental disorders. Also, it is expected that publishing the guideline would be helpful to above multiple professions as it is investigated that there are lack of treatment facility and qualified behavioral therapists compared to need at the moment.

Assessment of Neurologic Problems in Autism Spectrum Disorder and ADHD / 대한소아신경학회지

PURPOSE: Autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are neurodevelopmental disorders. previous report have examined the neurologic problems both in ASD and ADHD. METHODS: We studied 49 children with ASD and 51 with ADHD who had visited our hospital's neuropsychiatric clinic from January 1999 to December 2008. We examined age, EEG abnormalities, developmental delays, and seizures in both groups. RESULTS: 1) The mean age of children diagnosed with ASD was 4 years while that for ADHD was 9 years (P=0.000). 2) The percentage of abnormal EEG in children with ASD was 54.5% and that for those with ADHD was 25.4% (P=0.027). 3) The percentage of developmental delays in children with ASD was 89.8% and that for those with ADHD was 39.2% (P=0.000). 4) The mean age of first seizure in children with ASD was 13 years and that for those with ADHD was 6 years (P=0.005). CONCLUSION: The percentage of abnormal EEG and developmental delay in children with ASD was more than in those with ADHD. The mean age of diagnosis in children with ASD was younger than in those with ADHD and the mean age of first seizure in children with ASD was older than in those with ADHD. The percentage children with ASD who exhibited normalized EEGs upon follow-up was greater than that for children with ADHD.