Search

During the past two decades, awareness of the role of the family in the child's life has increased and the term "family-centred services" (FCS) has been introduced to facilitate care for children with special needs and their families. It is, however, unclear how various early intervention programmes incorporate family involvement in service delivery. The present study systematically analyses the nature of family involvement in six frequently used early intervention programmes for infants at high risk of developmental disorders: neurodevelopmental treatment, treatment according to Vojta, Conductive Education, Infant Health and Development Program, Infant Behaviour Assessment and Intervention Program, and Coping with and Caring for infants with special needs--a family-centred programme (COPCA). The analysis shows that the role of the family is diverse: it varies from parent training to be a therapist without attention to family function (in Vojta) to the autonomous family that receives coaching (COPCA). The data suggest two trends over time: (1) from child-focused to family-focused orientation; and (2) from professionally directed guidance to coaching based on equal partnership. (Contains 1 table and 1 figure.)

Research over the past three decades has shown that early intervention in infants biologically at risk of developmental disorders, irrespective of the presence of a brain lesion, is associated with improved cognitive development in early childhood without affecting motor development. However, at present it is unknown whether early intervention is also able to improve developmental outcome in infants with a serious lesion of the brain. This paper discusses factors that might play a role in the effect of early intervention. The following picture emerged from the limited evidence available: (1) coaching of parents seems an effective means of intervention; (2) our understanding of the plasticity of the developing human brain is currently too limited to allow a direct practical implementation in early intervention; (3) intervention before term age should primarily focus on stress reduction, intervention after term age on stimulation of infant development; and (4) our knowledge of the best ways to stimulate infant development is scant. Nevertheless, preliminary data suggest that offering the infant ample opportunities to explore by self-produced motor activities the borders of their own abilities might be a good strategy for promoting developmental outcome, including functional mobility.

Aim: Abnormal general movements at around 3 months corrected age indicate a high risk of cerebral palsy (CP). We aimed to determine whether specific movement characteristics can improve the predictive power of definitely abnormal general movements. Method: Video recordings of 46 infants with definitely abnormal general movements at 9 to 13 weeks corrected age (20 males; 26 females; median gestational age 30wks; median birthweight 1200g) were analysed for the following characteristics: presence of fidgety, cramped synchronized, stiff, or jerky movements and asymmetrical tonic neck reflex pattern. Neurological condition (presence or absence of CP), gross motor development (Alberta Infant Motor Scales), quality of motor behaviour (Infant Motor Profile), functional mobility (Pediatric Evaluation of Disability Inventory), and Mental Developmental Index (Bayley Scales) were assessed at 18 months corrected age. Infants were excluded from participating in the study if they had severe congenital anomalies or if their caregivers had an insufficient knowledge of the Dutch language. Results: Of the 46 assessed infants, 10 developed spastic CP (Gross Motor Function Classification System levels I to V; eight bilateral spastic CP, two unilateral spastic CP). The absence of fidgety movements and the presence of predominantly stiff movements were associated with CP (Fisher's exact test, p = 0.018 and p = 0.007 respectively) and lower Infant Motor Profile scores (Mann-Whitney "U" test, p = 0.015 and p = 0.022 respectively); stiff and predominantly stiff movements were associated with lower Alberta Infant Motor Scales scores (Mann-Whitney "U" test, p = 0.01 and p = 0.004 respectively). Cramped synchronized movements and the asymmetrical tonic neck reflex pattern were not related to outcome. None of the movement characteristics were associated with Pediatric Evaluation of Disability Inventory scores or the Mental Developmental Index. Interpretation: The assessment of fidgety movements and movement stiffness may improve the predictive power of definitely abnormal general movements for developmental outcome. However, the presence of fidgety movements does not preclude the development of CP.

Aim: The aim of this study was to improve the understanding of brain function in children with autism spectrum disorder (ASD) in relation to minor neurological dysfunctions (MNDs). Method: We studied MNDs in 122 children (93 males, 29 females; mean age 8y 1mo, SD 2y 6mo) who, among a total cohort of 705 children (513 males, 192 females; mean age 9y, SD 2y 0.5mo) referred to a regional outpatient non-academic psychiatric centre in the Netherlands, were diagnosed with ASD after an extensive multidisciplinary psychiatric assessment. Children with clear neurological abnormalities (e.g. cerebral palsy or spina bifida) were excluded from the study. MNDs were assessed in all 705 children using the Touwen examination method. Special attention was paid to the severity and type of MND. Data of the children with ASD were compared with neurological morbidity data of children with other psychiatric disorders and with children in the general population, who were born at Groningen University Hospital between 1975 and 1978. Results: Seventy-four percent of the children with ASD showed complex MNDs compared with 52% of the children with other psychiatric disorders and 6% of the reference group (chi[superscript 2] = 18.0, p less than 0.001; chi[superscript 2] = 937.5, p less than 0.001 respectively). Specific dysfunctions frequently encountered in ASD were dysfunctional posture and muscle tone, fine manipulative disability, dyscoordination, and excessive associated movements. Conclusion: These findings suggest a contribution of dysfunctional supraspinal networks involving multiple parts of the brain in the pathogenesis of ASD. This is consistent with findings from neuroimaging studies, and highlights the importance of neurological examinations in paediatric psychiatric assessments.

Aim: Little is known of minor neurological dysfunction (MND) in infancy. This study aimed to evaluate the inter-assessor reliability of the assessment of MND with the Touwen Infant Neurological Examination (TINE) and the construct and predictive validity of MND in infancy. Method: Inter-assessor agreement was determined in a sample of 40 infants (24 males, 16 females) aged 3 to 12 months (25 born at term: gestational age 37-41wks, median 39; and 15 born preterm, gestational age 24-35wks, median 32). Thirty typically developing term infants (18 males, 12 females; gestational age 37-42wks, median 40) and 59 preterm infants (34 males, 25 females) born at less than 35 weeks' gestation (gestational age 25-34wks, median 29) participated in the validity study. They were neurologically assessed with the TINE at the corrected ages of 4, 6, 10, and 12 months and with the Hempel assessment at 18 months. Results: The findings indicated that MND can be assessed reliably (inter-assessor agreement: kappa=0.83). MND during infancy was related to prenatal, perinatal, and social factors, and in particular to preterm birth. Neurological condition during infancy was prone to change, but was related to neurological condition at 18 months at all ages tested. Interpretation: We conclude that MND can be determined reliably in infancy. Important considerations in the construct of MND in infancy are its relation to prenatal and perinatal factors, its limited stability, and its moderate predictive value. (Contains 5 tables.)

A reliable and valid instrument to assess neuromotor condition in infancy is a prerequisite for early detection of developmental motor disorders. We developed a video-based assessment of motor behaviour, the Infant Motor Profile (IMP), to evaluate motor abilities, movement variability, ability to select motor strategies, movement symmetry, and fluency. The IMP consists of 80 items and is applicable in children from 3 to 18 months. The present study aimed to test intra- and interobserver reliability and concurrent validity of the IMP with the Alberta Infant Motor Scale (AIMS) and Touwen neurological examination. The study group consisted of 40 low-risk term (median gestational age [GA] 40wks, range 38-42wks) and 40 high-risk preterm infants (median GA 29.6wks, range 26-33wks) with corrected ages 4 to 18 months (31 females, 49 males). Intra- and interobserver agreement of the IMP were satisfactory (Spearman's "rho"=0.9). Concurrent validity of IMP and AIMS was good (Spearman's "rho"=0.8, p less than 0.005). The IMP was able to differentiate between infants with normal neurological condition, simple minor neurological dysfunction (MND), complex MND, and abnormal neurological condition (p less than 0.005). This means that the IMP may be a promising tool to evaluate neurological integrity during infancy, a suggestion that needs confirmation by means of assessment of larger groups of infants with heterogeneous neurological conditions.

Aim: To evaluate whether infants with complex congenital heart disease (CCHD) have an increased risk of impaired quality of motor behavior and delayed motor milestones. Method: A cohort of 69 infants with CCHD (43 males, 26 females) were assessed with the Infant Motor Profile (IMP) at three time periods between 6 to 18 months, mean ages in months (SD): 6.4 (0.7); 12.7 (1.0); 18.5 (0.7) IMP data were available from a reference sample of 300 Dutch infants. Analyses included multivariable logistic regression analysis to estimate differences in IMP scores below the 15th centile between children with CCHD and the reference group, and linear mixed‐effects models to assess the effect of ventricular physiology and systemic oxygen saturation (SpO2) of less than 90% on IMP outcomes. Results: Infants with CCHD had increased risks of total IMP scores below the 15th centile (lowest odds ratio [OR] at 18mo: 6.82 [95% confidence interval {CI} 2.87–16.19]), especially because of lower scores in the domains of variation, adaptability, and performance. Children with single ventricle CCHD scored consistently 3.03% (95% CI 1.00–5.07) lower than those with two ventricle physiology, mainly from contributions of the variation and performance domains. SpO2 of less than 90% was associated with 2.52% (95% CI 0.49–4.54) lower IMP scores. Interpretation: CCHD, especially single ventricle physiology, increases risk of impaired motor development. What this paper adds: Complex congenital heart disease (CCHD) substantially increases risk of impaired motor development.CCHD is associated with motor delay and reduced motor variation and adaptability.Single ventricle physiology increases the risk of impaired motor behavior. [ABSTRACT FROM AUTHOR]

Spanish, Portuguese & French translation of this Invited Editorial is available in the online issue. [ABSTRACT FROM AUTHOR]

Aim: (1) To systematically review the literature on developmental outcomes from infancy to adolescence of children with complex congenital heart disease (CHD) who underwent early surgery; (2) to run a meta-regression analysis on the Bayley Scales of Infant Development, Second Edition Mental Developmental Index and Psychomotor Developmental Index (PDI) of infants up to 24 months and IQs of preschool-aged children to adolescents; (3) to assess associations between perioperative risk factors and outcomes.Method: We searched pertinent literature (January 1990 to January 2019) in PubMed, Embase, CINAHL, and PsycINFO. Selection criteria included infants with complex CHD who had primary surgery within the first 9 weeks of life. Methodological quality, including risk of bias and internal validity, were assessed.Results: In total, 185 papers met the inclusion criteria; the 100 with high to moderate methodological quality were analysed in detail. Substantial heterogeneity in the group with CHD and in methodology existed. The outcome of infants with single-ventricle CHD was inferior to those with two-ventricle CHD (respectively: average scores for PDI 77 and 88; intelligence scores 92 and 98). Perioperative risk factors were inconsistently associated with developmental outcomes.Interpretation: The literature on children undergoing surgery in early infancy suggests that infants with a single ventricle are at highest risk of adverse developmental outcomes. [ABSTRACT FROM AUTHOR]