To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the classification system until consensus among 48 experts (physical therapists, occupational therapists, and developmental pediatricians with expertise in cerebral palsy) was achieved. Interrater reliability (kappa) was 0.55 for children less than 2 years of age and 0.75 for children 2 to 12 years of age. The classification system has application for clinical practice, research, teaching, and administration.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-8749.1997.tb07414.x

Development and reliability of a system to classify gross motor function in children with cerebral palsy

How we raise young children is one of today's most highly personalized and sharply politicized issues, in part because each of us can claim some level of "expertise." The debate has intensified as discoveries about our development-in the womb and in the first months and years-have reached the popular media. How can we use our burgeoning knowledge to assure the well-being of all young children, for their own sake as well as for the sake of our nation? Drawing from new findings, this book presents important conclusions about nature-versus-nurture, the impact of being born into a working family, the effect of politics on programs for children, the costs and benefits of intervention, and other issues. The committee issues a series of challenges to decision makers regarding the quality of child care, issues of racial and ethnic diversity, the integration of children's cognitive and emotional development, and more. Authoritative yet accessible, From Neurons to Neighborhoods presents the evidence about "brain wiring" and how kids learn to speak, think, and regulate their behavior. It examines the effect of the climate-family, child care, community-within which the child grows.

/pdf/from-neurons-to-neighborhoods-the-science-of-early-childhood-3bfl5g72ow.pdf

From Neurons to Neighborhoods: The Science of Early Childhood Development

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Modern Applied Statistics With S

ContextThe cognitive and behavioral outcomes of school-aged children who were
born preterm have been reported extensively. Many of these studies have methodological
flaws that preclude an accurate estimate of the long-term outcomes of prematurity.ObjectiveTo estimate the effect of preterm birth on cognition and behavior in
school-aged children.Data SourcesMEDLINE search (1980 to November 2001) for English-language articles,
supplemented by a manual search of personal files maintained by 2 of the authors.Study SelectionWe included case-control studies reporting cognitive and/or behavioral
data of children who were born preterm and who were evaluated after their
fifth birthday if the attrition rate was less than 30%. From the 227 reviewed
studies, cognitive data from 15 studies and behavioral data from 16 studies
were selected.Data ExtractionData on population demographics, study characteristics, and cognitive
and behavioral outcomes were extracted from each study, entered in a customized
database, and reviewed twice to minimize error. Differences between the mean
cognitive scores of cases and controls were pooled. Homogeneity across studies
was formally tested using a general variance-based method and graphically
using Galbraith plots. Linear meta-analysis regression models were fitted
to explore the impact of birth weight and gestational age on cognitive outcomes.
Study-specific relative risks (RRs) were calculated for the incidence of attention-deficit/hyperactivity
disorder (ADHD) and pooled. Quality assessment of the studies was performed
based on a 10-point scale. Publication bias was examined using Begg modified
funnel plots and formally tested using the Egger weighted-linear regression
method.Data SynthesisAmong 1556 cases and 1720 controls, controls had significantly higher
cognitive scores compared with children who were born preterm (weighted mean
difference, 10.9; 95% confidence interval [CI], 9.2-12.5). The mean cognitive
scores of preterm-born cases and term-born controls were directly proportional
to their birth weight (R2 = 0.51; P<.001) and gestational age (R2 = 0.49; P<.001). Age at evaluation had
no significant correlation with mean difference in cognitive scores (R2 = 0.12; P = .20).
Preterm-born children showed increases in externalizing and internalizing
behaviors in 81% of studies and had more than twice the RR for developing
ADHD (pooled RR, 2.64; 95% CI, 1.85-3.78). No differences were noted in cognition
and behaviors based on the quality of the study.ConclusionsChildren who were born preterm are at risk for reduced cognitive test
scores and their immaturity at birth is directly proportional to the mean
cognitive scores at school age. Preterm-born children also show an increased
incidence of ADHD and other behaviors.

https://jamanetwork.com/journals/jama/articlepdf/195181/JMA10039.pdf

Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis.

New Ballard Score, expanded to include extremely premature infants.

Stimulant medication for the child with attention-deficit/hyperactivity disorder.

A questionnaire assessing current clinical approach to the problem of childhood hyperactivity was mailed to 910 primary care physicians in the state of Washington. A response of 462 (50.8%) was obtained. Pediatricians assess and manage hyperactivity in a manner significantly different from that of family physicians or general practitioners. Age of physician also accounted for significant differences, although to a lesser degree than type of training. Few differences were determined by size of community. An overall high prevalence of the problem of hyperactivity was apparent. Combined use of stimulant medications, behavioral programs, and special diets was common.

Management of childhood "hyperactivity" by primary care physicians.

The claim that large, nonspecific doses of vitamins and minerals improve the performance of mentally retarded children has recently reappeared in both the scientific literature and the public media. This hypothesis was examined in a double-blind, case-control study involving 20 home-reared children with Down9s syndrome between 5 and 13 years of age. Children were randomly assigned by matched pairs to either a vitamin/mineral group or placebo group for an 8-month study period. No significant group differences or suggestive trends were found in any tested area of development or behavior, including intelligence (IQ), school achievement, speech and language, and neuromotor function. No group differences in appearance, growth, or health were seen. No support was found for the orthomolecular hypothesis in school-aged children with Down9s syndrome.

Vitamin and Mineral Supplementation in Down's Syndrome

• To investigate the etiology of spastic diplegia (SD) of prematurity, we compared the prenatal, perinatal, and neonatal course of 18 preterm infants with SD to that of a control group of preterm infants without SD. No significant differences between the group with SD and the control group were found in most of the perinatal and neonatal factors analyzed. Significant differences were found in birth weight, birth head circumference, and the one-minute Apgar score. Controlling for gestational age, infants with SD weighed less at birth, had smaller heads, and were more often briefly neurologically depressed. Intracranial hemorrhage and neonatal seizures occurred significantly more often in infants with SD. Fifteen infants with SD were believed to be neurologically normal at the time of nursery discharge. These findings suggest the importance of prenatal factors in optimally treated preterm infants in whom SD develops. (Am J Dis Child1981;135:732-737)

Spastic Diplegia in Premature Infants: Etiologic and Diagnostic Considerations

Early identification of neuromotor deficits, cerebral palsy or other neurological handicaps, is a focus of concern for neurologists, pediatricians, and developmental therapists. Among infants at risk for developing these handicaps are those with low birthweight, idiopathic respiratory distress syndrome, and early central nervous system insults. The Movement Assessment of infants (MAI), a neuromotor assessment tool, was developed for the purpose of evaluating high-risk infants participating in the University of Washington's Neonatal Intensive Care Unit Followup Clinic. The predictive validity of the MAI was evaluated for 246 infants for whom assessments had been completed at four months and for whom at least one set of followup data was available at either one or two years of age. Correlations between the MAI total risk score and all five of the outcome measures at one and two years were highly significant. The clinical relevance of this study in the use of the MAI as an evaluation tool for identifying infants with neuromotor dysfunction is discussed.

Forrest C. Bennett

Papers

Stimulant medication for the child with attention-deficit/hyperactivity disorder.

Management of childhood "hyperactivity" by primary care physicians.

Vitamin and Mineral Supplementation in Down's Syndrome

Spastic Diplegia in Premature Infants: Etiologic and Diagnostic Considerations

Predictive validity of the "Movement Assessment of Infants".