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In general, developmental course of newborns is hard to predict. Risk factors, such as brain lesions or atypical movements, assist prediction of neurodevelopmental disorders, including cerebral palsy (CP). CP is the most common physical disability in paediatrics, causing limited mobility, often due to spasticity. In the present PhD-thesis, effects of early intervention in infants at very high risk of CP are studied. Typical infant physiotherapy (TIP) has been compared with a new developed intervention method: COPing with and CAring for infants with special needs - a family centred programme. Interventions have been studied in two different projects: the VIP-project (2003-2005) and the LEARN2MOVE 0-2-project (2008-2015). After applying one of the two mentioned intervention methods, child and family outcome in the two groups was similar. Detailed analysis of the contents of the interventions, indicated several positive associations between specific COPCA-elements and outcome: with child outcome in the VIP-project and with family outcome in the LEARN2MOVE 0-2-project. Analyses of the contents of intervention showed increasing family involvement over the years in the TIP-intervention. To be able to study outcome of intervention studies adequately, appropriate measurements are needed. Therefore, some suggestions have been provided for specific motor measurements for infants at high risk of CP. With the results of this thesis, we hope to improve care for infants at very high risk of CP and their families.

Child psychiatric diagnoses are generally based on a clinical examination and not on standardized questionnaires. The present study assessed whether symptom diagnostics based on clinical records facilitates the use of non-standardized clinical material for research. Six hundred and eighty-five children, referred to a third level child psychiatric centre in the Netherlands, were, after extensive multidisciplinary examination, classified according to the multi-axial classification scheme for psychiatric disorders in childhood and adolescence (MAC-ICD-9). By two raters 44 behavioural symptoms were scored based on the clinical records of these children. Interrater agreement on symptoms in 50 records was performed. Principal components analysis on symptom scores of all children was performed; factor scores were related with MAC-ICD-9 classifications. Interrater reliability for behavioural symptoms was excellent (kappa = 0.88). Many children with psychiatric problems suffer from a large number of behavioural symptoms. Factor scores of the symptoms revealed recognizable and well interpretable entities and indicated overlap in symptomatology and comorbidity. A symptom-based diagnostic approach based on extensive clinical patient files may provide a special dimension to improve the reliability of psychiatric classification.

AIM The aim of this study was to examine the effects of intervention in infants at risk of developmental disorders onmotor outcome, as measured by the InfantMotor Profile (IMP) and using the combined approach of a randomized controlled trial and process evaluation. METHOD At a corrected age of 3 months, 46 infants (20 males, 26 females) recruited from the neonatal intensive care unit at the University Medical Centre Groningen (median birthweight 1210g, range 585-4750g; median gestational age 30wks, range 25-40wks) were included on the basis of definitely abnormal general movements. Exclusion criteria were severe congenital disorders and insufficient understanding of the Dutch language. The infants were assigned to either the family-centred COPing with and CAring for Infants with Special Needs (COPCA) intervention group (n=21; 9 males, 12 females) or the traditional infant physiotherapy (TIP) intervention group (n=25; 11 males, 14 females) for a period of 3 months. Three infants assigned to the TIP group (one male, two females) did not receive physiotherapy. IMP scores were measured by blinded assessors at 3, 4, 5, 6, and 18 months. At each age, the infants were neurologically examined. Physiotherapeutic sessions at 4 and 6 months were videotaped. Quantified physiotherapeutic actions were correlated with IMP scores at 6 and 18 months. RESULTS The IMP scores of both the COPCA and TIP groups before, during, and after the intervention did not differ. Some physiotherapeutic actions were associated with IMP outcomes; the associations differed for infants who developed cerebral palsy (n=10) and those who did not (n=33). INTERPRETATION At randomized controlled trial level, the scores of both the TIP and COPCA groups did not differ in effect on motor outcome, as measured with the IMP. The analysis of physiotherapeutic actions revealed associations between these actions and IMP outcomes. However, the small sample size of this study precludes pertinent conclusions.

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