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Isolated dihydroxyacetonephosphate acyltransferase deficiency presenting with developmental delay.

A boy aged 21 months who was being investigated for developmental delay and failure to thrive was found to have punctate epiphyseal calcification. He had no evidence of rhizomelic shortening of the limbs or cataracts. Investigation revealed defective plasmalogen synthesis due to isolated deficiency of dihydroxyacetonephosphate acyltransferase (DHAP-AT). The parents were consanguineous and a sister was similarly affected, suggesting autosomal recessive inheritance. Hitherto, recessively inherited isolated DHAP-AT deficiency has only been described in patients with a phenotype similar to that of rhizomelic chondrodysplasia punctata. This report indicates that the same biochemical disorder can be associated with a less severe phenotype.

Acyltransferases

Bilateral internal carotid artery agenesis in a child with psychomotor developmental delay.

In a 2-year-old boy with severe psychomotor developmental delay and a dysmorphic face, a chromosome study revealed a balanced translocation: 46XY,t-(1;3)(p31.2;p21). With magnetic resonance angiography, bilateral internal carotid artery agenesis was diagnosed. Periventricular high-intensity areas were evident on T2-weighted imaging, but no major cerebral malformation was observed.

Abnormalities, Multiple

Simultaneous, multilocus FISH analysis for detection of microdeletions in the diagnostic evaluation of developmental delay and mental retardation.

Many microdeletion and contiguous gene-deletion syndromes include mental retardation as a clinical feature. We have developed MultiFISH, a FISH assay using several probes to simultaneously screen for multiple microdeletion syndromes in patients who present with unexplained devleopmental delay and/or mental retardation. This screening tool can be used to determine whether a particular microdeletion syndrome is involved in the etiology of these clinical phenotypes. In this pilot study we combined probes for the commonly deleted regions of Prader-Willi, Angelman, Williams, Smith-Magenis, and DiGeorge/velocardiofacial syndromes in a single hybridization. The probes were differentially labeled, allowing multicolor detection, and 200 individual samples were screened in a blinded fashion. For all patients found by MultiFISH to have deletions, the deletions were originally identified and/or later confirmed by use of single-probe FISH analysis in our diagnostic cytogenetics laboratory. One patient, who was referred for developmental delay and was shown to have a normal G-banded karyotype, was identified by MultiFISH as having a micro-deletion at the DiGeorge/velocardiofacial commonly deleted region. Forty-six of the 200 total samples were tested for microdeletions by use of single FISH probes in the diagnostic laboratory. Ten of these cases were found to have deletions, and all deletions were subsequently detected by use of MultiFISH screen performed in a blinded fashion. Additionally, for all 200 patients tested by use of MultiFISH, no false-positive deletion results were observed. We demonstrate the ability of this technique to scan for and to identify microdeletions in a proportion of patients whose routine karyotype appears normal yet who are mentally retarded and/or developmentally delayed.

Child

Myelination patterns on magnetic resonance of children with developmental delay.

Magnetic resonance (MR) imaging was performed in 30 children with unexplained developmental delay who had associated neurological abnormalities such as seizures, spasticity, hypotonia, ataxia or poor vision. No child had a history of regression, preterm birth or neonatal cerebral injury. CT scans were performed before MR in all cases and were either normal or showed only mild atrophy. At least two MR sequences were obtained for all patients. Nine children had delayed or absent myelination on MR, one had patchy white-matter abnormalities, and in one patient myelination was topographically normal, but of inappropriately low signal intensity. MR was abnormal in six of seven children who had abnormal brainstem auditory evoked potentials (BAEP), and was normal in nine of 11 patients who had a normal BAEP. MR may have a useful rôle in demonstrating abnormal white-matter maturation in children with unexplained neurodevelopmental delay, particularly when abnormalities are found on BAEP studies.

Brain

Patterns of temperament variation in three groups of developmentally delayed preschool children: mother and father ratings.

Patterns of temperament variation in the developmentally delayed preschool population have not been adequately studied. The present paper reports temperament data for children 2 to 4 1/2 years old: 32 with Down's syndrome, 29 with neurological problems, and 35 with delays of unknown etiologies, as reported by their mothers and fathers. Results indicate that children in the total delayed sample are more approaching, less intense, less persistent, and have higher thresholds for stimulation than those in the normative sample. There were differences among the three groups in activity level, approach/withdrawal, and distractibility. Furthermore, on these three dimensions, mothers scored their children as more difficult than did fathers. These data highlight the need for adequate norms for subgroups of delayed children, and suggest that inclusion of temperament assessment can be a useful part of the clinical care of delayed children and their parents.

Child, Preschool

Improving the social-conversational skills of developmentally delayed children: an intervention study.

Twenty mothers and their preschool-aged, developmentally delayed children participated in this parent-focused intervention study. Nine mother-child dyads received an 11-week training program that espoused a social-conversational approach, while 11 dyads served as controls. Pre- and posttest videotapes were transcribed and coded to yield measures of turn taking, as well as indexes of responsiveness, topic control, and uninvolvement. Following treatment, the mothers in the experimental group were more responsive to and less controlling of their children's behavior than the mothers in the comparison group. The children initiated more topics, were more responsive to their mother's preceding turns, and used more verbal turns and a more diverse vocabulary than the control group children. No differences in language development, as measured by a standardized test, were found. Individual maternal responses to intervention as well as implications for modifying parent training programs are discussed.

Child, Preschool

Adaptive behavior of preschool children with developmental delays: parent versus teacher ratings.

Parents and teachers of 20 children with developmental delays, 24 through 38 months of age, from an early education program in Columbus, Ohio, were interviewed using the Adaptive Behavior Scale for Infants and Early Childhood. Significant differences were found between some of the ratings over the 23 domain and 11 subdomain scores, specifically in regard to sex of the child and length of time of the child's participation in the program. Parents provided higher ratings than did teachers on some domains. In general, parents and teachers tended to agree on the overall adaptive functional levels.

Activities of Daily Living

Age-related changes in stress experienced by families with a child who has developmental delays.

The hypothesis that stress in families increases as a child with developmental delays grows older was evaluated. Mothers with children ranging in age from 2 to 18 years were assigned to a preschool, middle childhood, or adolescent group and asked to complete the Parenting Stress Index (PSI). Results indicated that Child Domain scores were high for all groups, but Parent Domain scores were within normal limits. The middle childhood group was consistently higher in both domains than either the younger or older groups. Degree of handicap was not associated with mothers' stress in the preschool group, but was related to PSI scores for both other groups. Behavior problems were highly correlated with maternal stress for the middle childhood and adolescent groups (data not available for preschool group).

Activities of Daily Living

Identification of a small supernumerary ring chromosome 8 by fluorescent in situ hybridization in a child with developmental delay and minor anomalies.

We report a 15-month-old female with developmental delay, hypotonia, and minor anomalies whose karyotype is 47,XX,+r. Due to its small size, the origin of the ring chromosome was indeterminate by standard G-banded karyotyping. Fluorescent in situ hybridization was performed, which indicated that the ring chromosome was derived from the pericentric region of chromosome 8.

Abnormalities, Multiple

Autosomal recessive hypoparathyroidism with renal insufficiency and developmental delay.

Four children (two boys and two girls) with hypoparathyroidism, renal insufficiency, and developmental delay are described. They were the products of consanguineous marriages in three related Asian families presenting over a six year period. All the children died within the first 15 months of life despite treatment. Postmortem examination on one child showed absent parathyroid glands. We believe these children represent a previously undescribed syndrome that appears to be inherited in an autosomal recessive manner.

Child, Preschool

Delayed developmental sequences in rodent diabetic embryopathy.

Diabetes induced by alloxan at day 6 of gestation in Wistar rats produced decreased fetal growth, delayed skeletal ossification, decreased fetal kidney beta-glucuronidase, and an increased frequency of fetal birth defects which correlated with the degree of diabetic control. Offspring of severely diabetic mothers (mean blood glucose greater than 501 mg/dl) sacrificed at 20 days had a mean weight of 2.12 +/- 0.16 g, a mean of 1.8 +/- 0.46 caudal ossification centers, and a 28% incidence of birth defects as compared to 3.70 +/- 0.22 g, 5.9 +/- 0.42 caudal centers, and 1.1% defects for controls. Offspring of severely diabetic mothers sacrificed at 21 days had mean numbers of caudal and sternal ossification centers which did not significantly differ from controls, indicating that decreased ossification observed at 20 days of gestation is a delayed developmental sequence which is mostly corrected by 21 days. Offspring of moderately diabetic (mean blood glucose 300-500 mg/dl) and insulin-treated dams (mean blood glucose 152-168 mg/dl) had intermediate degrees of growth or ossification delay and birth defect frequency at both the 20- and 21-day sacrifices. Maternal diabetes also retards the developmental increase in fetal kidney beta-glucuronidase such than 20-day offspring of severely diabetic mothers had a mean specific activity of 1.1 nmol/min/mg compared to 3.0 nmol/min/mg for controls. The results support prior studies in rodents suggesting a progression of early growth delay, altered developmental sequences, and birth defects in diabetic pregnancy. This progression is suggested as a common teratogenic mechanism which has implications for evaluating analogous pregnancies in man.

Animals

Religion and families of children with developmental delays.

Parents in 102 families with a 3- to 5-year-old child with developmental delays of uncertain etiology were interviewed concerning religion and adaptations to their child with delays. Religious parents were somewhat more familistic than were nonreligious parents, emphasized parental nurturance, and said that their child was an opportunity rather than a burden. Religious and nonreligious families were similar on other measures of developmental beliefs and social support. Religious parents described the "purpose" of their children with delays in their lives in emotionally powerful and meaningful ways that clearly helped them, although direct measures of peace of mind and emotional adjustment did not differ between religious and nonreligious families.

Adaptation, Psychological

Ataxia, developmental delay and an extensive neuronal migration abnormality in 2 siblings.

Two siblings with developmental delay and a non-progressive cerebellar ataxia are described. The electroencephalograms in both children showed a rather unusual pattern of high amplitude 10-12/s rhythms maximal anteriorly, while extensive neuronal migration abnormalities were apparent on Magnetic Resonance scans. There were no dysmorphic features, metabolic abnormalities, chromosomal defects or evidence of prenatal environmental toxins. It is considered that these siblings have an autosomal recessive neuronal migration defect which has not previously been reported.

Brain

The frequency and distribution of spontaneous attention shifts between social and nonsocial stimuli in autistic, typically developing, and nonautistic developmentally delayed infants.

Spontaneous shifts of attention were observed in autistic, typically developing, and nonautistic developmentally delayed infants. Three types of attention shifting behaviour were observed; (1) between an object and another object, (2) between an object and a person, and (3) between a person and another person. The two control groups shifted attention more frequently between an object and a person than between an object and another object or between a person and another person. The infants with autism showed a different pattern, shifting attention between an object and another object more than any other type of shift. Furthermore, infants with autism showed fewer shifts of attention between an object and a person, and between person and person, than did the two control groups. They also spent less time overall looking at people and looked more briefly at people and for longer durations at objects, compared to the two control groups. These results indicate an abnormality in social orientation in autism even at the early age of 20 months.

Attention

Microphthalmia, marked short stature, hearing loss, and developmental delay: extension of the phenotype of GOMBO syndrome?

An adult male with microphthalmia, severe developmental delay, conductive hearing loss, marked short stature of prenatal onset, and radiographic skeletal changes is described. A review of the literature, focusing on his major findings, suggests that his manifestations might be an extension of the phenotype of GOMBO (growth retardation, ocular abnormalities, microcephaly, brachydactyly, oligophrenia) syndrome.

Abnormalities, Multiple

Oddity learning in developmentally delayed children: facilitation by means of familiar stimuli.

Four of 8 low-functioning, developmentally delayed children initially failed to demonstrate oddity responding under conditions in which ostensibly similar children did show oddity responding (e.g., Soraci et al., 1987). In the context of a multiple baseline across-subjects design, each of the 4 previously unsuccessful children demonstrated statistically significant increases in the percentage of correct oddity responses immediately upon introduction of familiar stimuli. These results indicate that perceptual differentiation enhances relational learning of the type required by the oddity task.

Attention

Ecocultural assessment in families of children with developmental delays: construct and concurrent validities.

Home interviews were conducted with 102 families of children with developmental delays to assess ecocultural family resources and constraints, values, and goals as well as proactive adaptive efforts to deal with their circumstances. Interview topics included (a) economic factors; (b) child safety, health, and education; (c) domestic and childcare workloads; (d) familial support networks; and (e) sociocultural influences. Factor analyses performed on the ecocultural measures revealed 12 salient factors. Results indicated that some of the ecocultural factors were unique and statistically independent of the traditional measures of home environment (e.g., child-rearing attitudes, cognitive stimulation of the child, and general psychosocial climate). Significant relations were found between certain ecocultural factors and child's developmental status. Both ecocultural factors and traditional family measures accounted for significant variation in child outcomes.

Adult