Correlation between Pre- and Post-Surgical Findings for Long-Term Neurocognitive and Behaviour Development Due to Posterior Fossa Pilocytic Astrocytomas: The Trend after 10 Years

Objective: The objective of the present study was to selectively evaluate the long-term impact of posterior fossa pilocytic astrocytomas, which are known to be among the most benign forms of paediatric brain tumours on neurocognitive and behavioural functions. Methods: Children that were operated on for a posterior fossa pilocytic astrocytoma in the Pediatric Neurosurgery Department of the Catholic University Medical School were selected according to the following criteria: (a) age > 5 years (in order to have a complete set of neurocognitive evaluations data), (b) ability to perform a complete set of tests before and after surgery, and (c) children that had a regular follow-up up to 10 years from the surgical treatment. Results: Forty-three percent of the children selected for the present study showed a borderline IQ before surgery, which is a result corresponding to those previously reported in the literature for children affected by posterior fossa pilocytic astrocytomas; praxis and visual perception were the selective functions that were more frequently affected. Language performance tests scores were below average in 40% of the cases but tended to improve in terms of expressive and receptive skills even at the 1-year follow-up; the improvements became significant at the 5-year and 10-year follow-ups. Conclusions: Recognising and measuring the short- and long-term effects of cerebellar tumours in children and their treatment are the first step towards improving their clinical course and quality of life. Early interventions should be offered to all of them, with specific attention bestowed on visual-spatial stimulation, speech and occupational therapies in order to act on praxic and visuo-perceptive skills, as well as on emotion and behaviour tracts of the neurocognitive profile, which more commonly tend to persist in the long term.

ADHD WITH NON-ORGANIC ENURESIS AND BORDERLINE INTELLIGENT QUOTIENT

Symptoms of Attention Deficit Hyperacitivity Disorder (ADHD) can be associated with nocturnal enuresis. Nocturnal enuresis cases are common occur in children with Mental Retardation. There are several hypotheses underlying this comorbidity, such as genetic, neurophysiological, environmental and psychosocial factors. We report the case of a 7 year old boy with symptoms such as inability to concentrate, active movement, talk a lot, unable to wait his turn, unable to delay desires, easy fighting and behaving and speaking harshly. Patients still wet the bed at night at least 3-4 times a week The Abbreviated Conners Score rating scale assessed by the mother at the start of treatment was 21. The IQ test score was 71 and the Strength and Difficulty Questionnaire (SDQ) score was 35. The patient's symptoms were reduced after 4-month therapy with 2x5mg of methylphenidate administration, psychoeducation of parents to implement toilet training and behavior therapy for patients, apply reward and punishment with the principle of token economy. In the development process of children and adolescents, parenting is an important factor. Many studies shows that parenting can impact the resilience and vulnerability of a child to behavioral disorders. In children with ADHD with borderline IQ and enuresis, parenting with a high parental control component can cause psychological symptoms to worsen without being balanced with the attitude of parents who are responsive to the psychological needs of the child.

ADHD WITH NON-ORGANIC ENURESIS AND BORDERLINE INTELLIGENT QUOTIENT

Symptoms of Attention Deficit Hyperacitivity Disorder (ADHD) can be associated with nocturnal enuresis. Nocturnal enuresis cases are common occur in children with Mental Retardation. There are several hypotheses underlying this comorbidity, such as genetic, neurophysiological, environmental and psychosocial factors. We report the case of a 7 year old boy with symptoms such as inability to concentrate, active movement, talk a lot, unable to wait his turn, unable to delay desires, easy fighting and behaving and speaking harshly. Patients still wet the bed at night at least 3-4 times a week The Abbreviated Conners Score rating scale assessed by the mother at the start of treatment was 21. The IQ test score was 71 and the Strength and Difficulty Questionnaire (SDQ) score was 35. The patient's symptoms were reduced after 4-month therapy with 2x5mg of methylphenidate administration, psychoeducation of parents to implement toilet training and behavior therapy for patients, apply reward and punishment with the principle of token economy. In the development process of children and adolescents, parenting is an important factor. Many studies shows that parenting can impact the resilience and vulnerability of a child to behavioral disorders. In children with ADHD with borderline IQ and enuresis, parenting with a high parental control component can cause psychological symptoms to worsen without being balanced with the attitude of parents who are responsive to the psychological needs of the child.

Efficacy of Shankhapushpi Choorna on Borderline IQ in School Going Children - A Randomized Placebo Controlled Clinical Study

Objective: To study the concepts regarding Medha, Medhya and IQ. Detailed assessment of IQ level of school going children with 6-8 years of age group. To study the efficacy of Shankhapushpi Choorna in the enhancement of IQ of school going children with Borderline IQ. Design: Open randomized placebo controlled clinical study with pre and post-test design. Setting: O.P.D. of Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Udupi and also nearby schools of Udupi. Interventions: A minimum of 40 children under borderline IQ were selected based on the inclusion and exclusion criteria. The selected children were randomly divided into 2 groups of 20 each. Group A (Trial Group) were treated with Shankhapushpi Choorna with dose of 5grams daily at night, after food with lukewarm milk for a duration of 60 days and Group B was administered with Placebo. The follow up period was 30 days after the intervention. Main outcome measures: The subjective criteria were based on the parameters of Grasping power, Memory power, Courage & Activity. The values obtained using Malin’s Intelligence Scale for Indian Children (MISIC) were considered for objective assessment. Results: Over the duration of the study, the trial drug Shankhapushpi Choorna was seen to have a positive effect on all the subjective and objective parameters with statistically highly significant results. Conclusion: Shankhapushpi Choorna with the proper dosage according to the age definitely improves the Medha of children with borderline IQ. The drug can be used as both promotive as well as curative aspects in accordance with intelligence.

Socio-demographic differentials of cognitive development and nutrition among school children: evidence from the tribal areas of Jharkhand, India

BackgroundThis study attempts to assess the differentials of cognitive development and nutrition of school children in tribal areas of Jharkhand, India.MethodologyA cross-sectional study was carried out in 16 schools of Jharkhand amongst 962 children during the period of November to December 2017. Anthropometry, hemoglobin and IQ tests were assessed along-with their socio-demographic characteristics using standard procedures after obtaining their guardian’s consent. Various tests of significance were used such as an independent sample t-test and Fisher’s exact test along with multinomial logistic regression for determination of predictors for low-normal to borderline IQ among school children.ResultsStunting and thinness were noted in 38% and 35% children, respectively, whereas anemia and low IQ were observed in more than 4/5th of the total children assessed. Anemia was more common in children >12 years of age and IQ was lower in tribal ethnic children (p < 0.05) amongst socio-demographic characteristics. Among the predictors, only tribal ethnicity appeared to be associated with low IQ [odds ratio (OR)-1.85; 95% confidence interval (CI) – 1.25, 2.75].ConclusionDespite various nutrition-related programs being run in government schools, the malnutrition and hemoglobin status of the children presents a poor picture. Cognitive development of children particularly tribal children is unsatisfactory and needs to be worked upon by government agencies.

Prisoners with intellectual disability: How to adapt interventions and the environment

There is an increasing interest in the Spanish prison to give the appropriate care when they are in prison. This situation has a special meaning in inmates with learning disabilities, as they are a vulnerable group inside prison. They are vulnerable in different areas as they have a high prevalence dual diagnosis (both with mental illness and drug misuse), they could suffer from abuse from other inmates, difficulties to understand prison regulations, etc. The prevalence of intellectual disability (ID) in the prison setting has been poorly evaluated. In Spain, despite various approximations or estimates regarding people with intellectual disabilities no reliable data is available.In our presentation, we will give an overview of the care of this group of patients, presenting some data from an epidemiological study in Spain. The rate of learning disabilities was of 3.77% of the study population has an IQ below 70, and 7, 3% has borderline IQ rate. We also describe a new setting in one of wards of a prison of Barcelona where has a model of therapeutic community for treating offenders with intellectual disabilities. This resource open two years ago and is run between prison services and an organization “Accepta” (specialized in people with learning disability and penal law problems). This is an effort from the prison services to adapt to the needs of inmates and deliver a better service with a good post-release follow-up.And finally, we present some data about learning disability in penitentiary psychiatric settings (the prevalence as a main diagnose is around 10%).Disclosure of interestThe author has not supplied his declaration of competing interest.

Association between type of cerebral palsy and the cognitive levels

Background Cerebral palsy is the main cause of physical disabilityduring childhood. Assessment is necessary to acknowledge thelevel of intelligence of the patients and to prevent impairmentsin order to plan the prompt intervention.Objectives To evaluate the cognitive levels of cerebral palsy andassociation between cognitive levels and its types.Methods We conducted a cross-sectional study on subjectsfrom Sekolah Luar Biasa Negeri 3 Yogyakarta. Intelligence wasmeasured using the Stanford-Binet intelligence scales, whereasdiagnosis of cerebral palsy was based on criteria of the AmericanAcademy for Cerebral Palsy (AACP). Data were analyzed usingchi-square test.Results There were 35 subjects, comprising of 21 boys and 14girls aged 5-18 years. The results show that in general, childrenwith cerebral palsy had mental retardation in several cognitivelevels. Children with hemiplegia type (1 subject) had IQ level that equals to mental retardation. Children with spastic diplegia type (6 subjects) showed borderline IQ (1) and mental retardation (5). Children with quadriplegia type ( 15 subjects) had superior IQ (1), borderline (7) and mental retardation (7). Out of 13 subjects with athetoid type 2, had borderline IQ (2), and mental retardation (11). The statistical analysis with chi-square test resulted in P = 0.114 (P < 0.05).Conclusion Our data showed that most patients with cerebral palsy had mental retardation of several cognitive level but there was no significant association between each type of cerebral palsy with cognitive levels.

Intellectual functioning and outcome of patients with severe psychotic illness randomised to intensive case management

BackgroundLittle research has been carried out on the benefits of intensive case management (ICM) for people with borderline IQ and severe mental illness.AimsTo compare outcome and costs of care of patients with severe psychotic illness with borderline IQ to patients of normal IQ and to assess whether ICM is more beneficial for the former than for the latter.MethodThe study utilises data from the UK700 multi-centre randomised controlled trial of case management. The main outcome measure was the number of days spent in hospital for psychiatric reasons. Secondary outcomes were costs of care and clinical outcome.ResultsICM was significantly more beneficial for borderline-IQ patients than those of normal IQ in terms of reductions in days spent in hospital, hospital admissions, total costs and needs and increased satisfaction.ConclusionsICM appears to be a cost-effective strategy for a subgroup of patients with severe psychosis with cognitive deficits.