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Biomedical subjects

D Skuse

Publications and source records attributed to D Skuse.

At least 37 records · Page 2Linked to original sources
PubMed1996

Prevalence of feeding problems and oral motor dysfunction in children with cerebral palsy: a community survey.

OBJECTIVE: To determine the prevalence and nature of feeding difficulties and oral motor dysfunction among a representative sample of 49 children with cerebral palsy (12 to 72 months of age). STUDY DESIGN: A population survey was undertaken by means of a combination of interview and home observational measures. RESULTS: Sucking (57%) and swallowing (38%) problems in the first 12 months of life were common, and 80% had been fed nonorally on at least one occasion. More than 90% had clinically significant oral motor dysfunction. One in three (36.2%) was severely impaired and therefore at high risk of chronic undernourishment. There was a substantial discrepancy between the lengthy duration of mealtimes reported by mothers and those actually observed in the home (mean, 19 minutes 21 seconds; range, 5 minutes 21 seconds to 41 minutes 39 seconds). In 60% of the children, severe feeding problems preceded the diagnosis of cerebral palsy. CONCLUSIONS: Using a standardized assessment of oral motor function, we found the majority of children to have clinically significant oral motor dysfunction. Contrary to maternal report, mealtimes were relatively brief, and this, combined with the severity of oral motor dysfunction, made it difficult for some children to achieve a satisfactory nutritional intake. The study illustrates the importance of observing feeding, preferably in the home.

Cerebral Palsy↗
PubMed1996

Short stature--the role of intelligence in psychosocial adjustment.

Short children are often described as having psychosocial problems. These reports may be inaccurate as former studies have relied largely on parental report. Psychosocial functioning of short children was assessed with the aim of using them and their peers as informants. Twenty two short (mean (SD) height -2.53 (0.28) SD score) prepubertal children aged between 6 and 11 years were recruited from growth clinics. Comparison children were recruited from each case child's class at school. Cognitive and psychosocial functioning was assessed. Peer relationships were measured using sociometry. There were no significant group differences in terms of peer acceptance, self perception, and social competence. Although cases described themselves as receiving less social support from teachers, no differences were evident in other areas of social support. Little evidence was found to suggest clinic referred prepubertal short children are psychosocially maladjusted. Further analysis revealed cognitive ability was a better predictor than height for most aspects of behavioural and emotional adjustment.

Anthropometry↗
PubMed1995

The objective rating of oral-motor functions during feeding.

The Schedule for Oral Motor Assessment (SOMA) was developed to record oral-motor skills objectively in infants between ages 8 and 24 months postnatal. Its aim is to identify areas of dysfunction that could contribute to feeding difficulties. The procedure takes approximately 20 min to administer, and is intended to be rated largely from a videorecording of a structured feeding session. A series of foodstuffs of varying textures, including liquids, is presented to the child in a standardized manner. Oral-motor skills are evaluated in terms of discrete oral-motor movements. The schedule distinguishes these from skills at more aggregated levels of functioning such as jaw, lip, and tongue control. A total of 127 children have been studied with the instrument, including normal healthy infants and samples with nonorganic failure to thrive, and cerebral palsy. Interrater and test-retest reliabilities were determined on a subset of 10 infants who each took part in three trials rated by 2 therapists. Excellent levels of interrater reliability (kappa > 0.75) were obtained for the presence/absence of 69% of discrete oral-motor behaviors. Test-retest reliability was similarly excellent for 85% of ratable behaviors. For the first time an assessment of oral-motor functioning has been shown to have adequate reliability for children aged 8-24 months. The validation of the SOMA on a large sample of normally developing infants and its application to clinical groups is presented in an accompanying paper [1].

Bottle Feeding↗
PubMed1995

Schedule for oral-motor assessment (SOMA): methods of validation.

The Schedule for Oral Motor Assessment (SOMA) was developed for the purpose of objectively rating the oral-motor skills of preverbal children, with a view to identifying areas of deficient abilities that could have clinical significance. The instrument can be administered without special equipment, by a trained observer. Oral-motor function is assessed across a range of food textures and fluids. Ratings of oral-motor skills are largely made post hoc by analysis of a videorecording of the test administration. The test-retest and interrater reliability of the instrument have been shown to be excellent. Criterion validity was investigated by means of a novel 'seeded cluster analysis' procedure in which 127 young children were assessed, most of whom were between 8 and 24 months of age. Ten percent of the sample had known abnormal oral-motor function in association with cerebral palsy (ages between 12 and 42 months). Not only was criterion validity satisfactorily established by the analysis but an abbreviated version of the SOMA--suitable for screening purposes--was developed. This has been shown to have a positive predictive validity greater than 90% and sensitivity greater than 85% for the detection of infants with clinically significant oral-motor dysfunction.

Cerebral Palsy↗
PubMed1995

Mother-child interaction and the cognitive and behavioural development of four-year-old children with poor growth.

A whole population inner-city survey identified 23 stunted, otherwise healthy, children with persistently poor growth from infancy to 4 years. Their cognitive development was significantly retarded relative to a matched comparison group. Unstructured home observations were used to create transcripts of verbal and nonverbal mother-child interactions. In both groups child behavioural adjustment was linked to maternal negativity, and cognitive performance was correlated with quality of stimulation. The developmental delay associated with chronic failure to thrive appeared more likely to arise from other influences, perhaps a previous biological insult, than to contemporaneous parenting practices.

Adult↗
PubMed1995

Psychosocial and clinical burden of thalassaemia intermedia and its implications for prenatal diagnosis.

Twenty eight patients with thalassaemia intermedia and their parents were interviewed using specifically designed questionnaires to evaluate psychosocial burden. Hospital notes were analysed for clinical burden. A wide variation was found for both patients and parents, ranging from virtually unaffected to severely affected. Normal sexual function and setting up a family were mentioned by patients and parents as being particularly important for quality of life. Over half (58%) of the patients had problems with sexual maturation and functioning, and continuous monitoring of all patients with thalassaemia intermedia by a paediatric endocrinologist is therefore strongly indicated. Most parents said, in light of their experiences, that they would opt for prenatal diagnosis and termination of affected pregnancies even if a genotype predicting the mild form of disorder were discovered.

Abortion, Legal↗
PubMed1994

Reversibility of physiological growth hormone secretion in children with psychosocial dwarfism.

OBJECTIVE: Reversibility of GH insufficiency with a change of environment is characteristic of psychosocial dwarfism, and excludes an organic endocrinopathy. However, the change in GH pulsatility has not previously been described. We therefore wished to study spontaneous GH secretion before and after change to a more favourable environment in 11 children with psychosocial deprivation and short stature in order to evaluate if separation from the families can modify their patterns of GH secretion. PATIENTS AND DESIGN: We describe 11 prepubertal children (6 M and 5 F; 2.2-13.5 years of age) who had growth failure and psychosocial deprivation. They were diagnosed by a multidisciplinary team as having environmental growth failure after admission to hospital for 3 weeks. Six of them were discovered to have been sexually abused. During the uninterrupted hospital admission parental access was restricted. Three sets of 18-hour GH profiles were performed on each child, except one child who had only two, during the 3-week admission. MEASUREMENTS: Pulse analysis of GH profiles was by Fourier transformation. RESULTS: On the first day of admission spontaneous GH secretion demonstrated a spectrum of abnormalities in the pattern of basal values, pulse frequency and pulse amplitude. Such GH insufficiency showed reversibility during the 3 weeks in hospital. Indeed, there was a significant increase in GH secretion which was amplitude modulated without any significant modification in pulse frequency. CONCLUSION: Our data indicate that there is abnormal physiological GH secretion in children with psychosocial deprivation, which is associated with growth failure. Despite a pathological situation, each child retained his own characteristic pattern of GH pulsatility. The pattern of reversibility of abnormal GH pulsatility provides information for the mechanism of the control of GH secretion.

Adolescent↗
PubMed1994

Postnatal growth and mental development: evidence for a "sensitive period".

For many years it has been suspected that severely impaired somatic growth during early postnatal life can be associated with the subsequent impairment of mental abilities. This study aimed to test that hypothesis on the basis of data gathered from a prospective whole population survey of infant development in south London. A year's birth cohort of 1558 full-term singletons was monitored; 47 otherwise healthy cases with serious growth faltering in the first year were recruited. Mental and psychomotor abilities were assessed at 15 months. Potentially confounding psychosocial variables, including cognitive stimulation received at home, were measured contemporaneously. A statistical model was constructed that enabled the timing, duration and severity of growth faltering to be used as predictors of mental functioning. Up to 37% of the variance in cognitive and psychomotor outcome at 15 months can be explained by the model. The first few postnatal months appear to constitute a "sensitive period" for the relationship between growth and mental development.

Anemia↗
PubMed1994

Psychosocial assessment of children with short stature: a preliminary report.

Previous studies that have examined the psychosocial adjustment of children with short stature have often been flawed, for two main reasons: first, a lack of sample homogeneity and, secondly, the measures of adjustment used have been limited in terms of their sensitivity. This paper examines psychological functioning in the following four broad areas: cognition, social behaviour, emotional adjustment and self-concept. A sample of children referred to growth clinics (mean height below -2 SDS) and a comparison group, recruited from the referred childrens' classes at school, were assessed. Children were prepubertal (age range, 6-11 years) and had no organic cause for their short stature. Parent, teacher and peer reports were used in the assessment, which included sociometric measures in the classroom. The children with short stature described themselves as equally well supported as the comparison children in terms of social support by parents, teachers, peers and friends. Peers reported the short children to be well accepted within their class. Compared with control children, there was a trend for short children to be described by their peers as socially better adjusted than average. Teacher and parental accounts revealed significant group differences in terms of reported behaviour, with poorer attention and more thought problems among the children with short stature. Further analysis suggested, however, that their slightly lower IQ than children of normal height (95.8 +/- 18.7 (mean +/- SD) compared with 105 +/- 15.4) accounted for a greater proportion of the variance in these findings than short stature per se. There is little evidence to indicate that short prepubertal children are psychosocially maladjusted.(ABSTRACT TRUNCATED AT 250 WORDS)

Affective Symptoms↗
PubMed1994

Cognitive abilities associated with the Silver-Russell syndrome.

There is no consensus opinion on whether or not cognitive impairments are found in the Silver-Russell syndrome. An investigation of a substantial sample was undertaken, using standardised assessments, in 20 boys and five girls aged 6.0 years to 11.8 years. Mean (SD) birth weights were -2.65 (0.95) SD scores, corrected for gestation. At evaluation the children had a mean (SD) age of 8.8 (1.8) years and a mean height of -2.26 (1.5) SD scores. Tests of cognitive abilities included assessments of general intelligence, reading and arithmetic attainments, and a cognitive processing task. Most had some degree of developmental delay: mean (SD) full scale IQ was 86 (24); 32% scored within the learning disability range (that is, IQ < 70); 40% were reading at least 24 months below their chronological age. Current head circumference correlated highly with full scale IQ. Assessments of special educational needs had been completed on 36%; 48% were receiving speech therapy. Approximately half of children with the Silver-Russell syndrome have significant impairment of their cognitive abilities.

Birth Weight↗
PubMed1993

Parenting provided by adults with mental retardation.

Studies assessing the quality of parenting provided by adults with mental retardation present conflicting conclusions. Some consider the majority to be doing reasonably well, whilst others report frequently unsatisfactory caretaking. There are a number of reasons for such different views. First, inconsistent selection criteria make it hard to compare across studies. In particular, sample composition will be influenced by the recruitment source. For example, if parents have been chosen from voluntary educational programmes a rather different picture is likely to be found than if they have been selected from individuals known to, or referred by, statutory agencies. On the whole, authors working with subjects from the former source have been rather more optimistic than those working with parents referred because there were already serious concerns about parenting difficulties or about delayed child development. Secondly, the majority of studies have used poorly defined global measures of parenting, with variable criteria of what constitutes adequate care. Some have concentrated on physical care and hygiene, whilst others have looked for the presence of affection and warmth. A child's reception into care as the sole measure of the quality of parenting is an unsatisfactory criterion because parental retardation has itself occasionally been used as the basis for removal of a child into care, even in the absence of other evidence of neglect or abuse. Thirdly, methodological flaws are found in studies that have used observational assessments of parenting. Such studies have suggested mothers with mental retardation tend to lack interactive skills (such as high levels of praise and imitation, and low restrictiveness) which are known to be associated with optimal child development. Control groups have often not been matched on social and other variables which might be expected to exert a significant influence upon parenting practices. In addition, the generalisability of these observational studies is open to question as parenting style has been adduced from brief play sessions, lasting at the most 10 minutes. The extent to which mothers with mental retardation play spontaneously with their children at home in a stimulating and age-appropriate fashion has not been measured. With regard to the evidence on abuse and neglect, questions have been raised about whether the children of parents with mental retardation are at increased risk. This problem has rarely been addressed in a methodologically satisfactory way. First, most studies have drawn their samples from referrals to medical or psychiatric departments. Secondly, as indicated earlier, reception into care cannot by itself be taken to be an indicator of child abuse.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1992

A longitudinal study of general practitioner consultations for psychiatric disorders in adolescence.

Patterns of psychiatric diagnoses given during adolescence to a group of individuals continuously registered with a single general practitioner in South London over 20 years were analysed first during 'early adolescence' and secondly during 'early adulthood'. Psychiatric diagnoses were found to be relatively common. Of the young adolescents who received a psychiatric diagnosis (almost one in ten of the group), 38% received a psychiatric diagnosis as young adults compared with only 16% of the remainder. Comorbidity was found to be very common--over 50% of young adults with a diagnosis of depression also had a diagnosis of anxiety and phobic neuroses. Young people with problems of a psychological nature therefore deserve more attention, particularly from the primary care team.

Adolescent↗
PubMed1992

Characteristics and management of feeding problems of young children with cerebral palsy.

The nature and extent of feeding difficulties associated with cerebral palsy was assessed in 12 infants with moderate to severe oral-motor dysfunction, compared with a control group. Data were gathered at the infants' homes by interview and by direct observation of mealtimes. The results revealed a range of long-standing problems, for which little management advice had been given. Most case infants were poorly positioned; specially designed seats were not used. The mean duration of mealtimes for case and comparison infants did not differ significantly. Case infants ate and were offered less food than the control infants. Feeding problems usually had persisted since birth and were associated with marked failure to thrive. Multidisciplinary assessments of the severe feeding difficulties of these children are indicated.

Cerebral Palsy↗
PubMed1992

Oral-motor dysfunction and feeding disorders of infants with Turner syndrome.

The oral-motor function of 10 infants with Turner syndrome and their age- and sex-matched controls were assessed during feeding. In addition to well-recognised dysmorphic features, including oral anomalies and high-arched palates, index infants had marked hypotonia of the cheeks and lips, dysfunctional tongue movements and poorly developed chewing skills. Their meal-times were significantly shorter than those of the controls and they weighed significantly less at six, 12 and 15 months. All mothers of infants with Turner syndrome complained of difficulties feeding their children and these problems often had been present since birth.

Child, Preschool↗
PubMed1990

Behavioral style in failure-to-thrive infants: a preliminary communication.

In a pilot inner-city survey, nine 1-year-old infants with nonorganic failure to thrive (NOFT) and pairwise matched controls from the same deprived inner-city area were studied at home. A multimethod approach to the study of infant behavioral style was adopted. A consistent pattern of NOFT infants' behaviors in mothers' descriptions, in observation of play behavior, and in interaction with the examiner during standard testing emerged. NOFT infants were found to be more fussy, demanding, and unsociable. They were also less task-oriented and persistent, and their mothers expressed more negative emotions during play interaction. Mental development was significantly delayed in NOFT infants. The findings emphasize the importance of behavioral contributions from both infant and mother to the relationship problems characteristic of NOFT.

Arousal↗