The use of mood stabilizers and atypical antipsychotics in children and adolescents with bipolar disorders

The clinical use of mood stabilizers and antipsychotics in children and adolescents with bipolar disorders has increased significantly over the past few years. These agents have multiple effects and interactions. This articles reviews the studies that support the use of mood stabilizers and atypical antipsychotics in children and adolescents with bipolar disorders and presents information on these agent's pharmacokinetics, dosing, and drug interactions.     

Smooth pursuit eye movements are associated with phonological awareness in preschool children

Phonological awareness is strongly related to reading ability, but reports are more conflicting concerning the association of high level oculomotor skills with reading. Here, we show that phonological awareness is specifically associated with the ability to perform smooth pursuit eye movements in preschool children. Two large independent samples of preschool children (n=838 and n=732) aged 5-6.4 years, without history of neurological disorder, were examined by school medical doctors for visual and oculomotor problems. Nineteen percent of the children in the first sample and 14% in the second failed at the clinical evaluation of smooth pursuit eye movements, and 17 and 15%, respectively, presented another visual or oculomotor problem. Ten short cognitive tests were performed by the same children. Visual and oculomotor problems other than a failure on smooth pursuit were not consistently related to the cognitive tasks, with one exception, the visual recognition of letters. Children who failed at smooth pursuit obtained lower scores at a number of cognitive tasks, and especially phonological awareness tasks and copy of visually presented trajectories. Poor working memory and/or failure of anticipation during the tracking of a visual or auditory stimulus related to frontal cortex immaturity may explain these associations in preschool children.     

Biographic and behavioral factors are associated with music-related motor skills in children pianists

This study aimed to identify biographical and behavioral factors associated with children pianists’ motor skills using an objective assessment of a music-relevant motor task. Motor skills at the piano were assessed in 30 children pianists by measuring temporal unevenness in standardized scale playing using musical instrument digital interface (MIDI)-based scale analysis. Questionnaires were used to collect detailed information about the amount of time playing the piano, practice characteristics, attitudes toward music and practice, and the environment of music and practice. Associations between performance values and variables from the questionnaire were investigated using multivariable linear regression. A higher number of years playing the piano, more frequent parental involvement in the child’s practice, more frequent practice of technical exercises, and greater enjoyment of practice and of the visual arts were associated with better motor performance. In addition to cumulative experience and aspects of practice, extrinsic motivational factors (e.g., parental interest) and intrinsic motivational factors (e.g., an artistic disposition) were associated with better performance on a musically-relevant motor task in children pianists.     

The influence of developmental coordination disorder and attention deficits on associated movements in children

The relationship between associated movements (AMs) and level of motor performance is not well understood. In this study we investigated whether children with developmental coordination disorder (DCD), with (n = 10) and without (n = 10) attention deficit hyperactivity disorder (ADHD), and a control group (n = 10), differed in the severity of AMs. A total AM severity score was obtained for each child by rating their performance on AM tasks. Both groups with motor difficulties had significantly more severe AMs than the control group. A significant correlation was found between level of motor performance and total AM scores (r = -.62). Our results suggest that level of motor performance should be considered in future research attempting to understand individual differences in severity of AMs as a function of motor, learning, and behavioural disorders.     

Criterion movements in motor short-term memory experiments

Analysis of both the criterion and reproduction movements from a motor short-term memory experiment using preselected movement is presented. The movement cues under imvestigation, location and distance, were found to interact significantly with amplitude for both the criterion and reproduction movements. It seems that movement cue affects the amplitude of criterion as well as reproduction movements. Thus previous findings by Gundry (1975) are replicated and extended. An increase in a central tendency effect over trials was found which indicated that the criterion movements were effected by proceding movements. The theoretical and methodological implications of these findings are discussed.     

Serotonin syndrome in elderly patients treated for psychotic depression with atypical antipsychotics and antidepressants: two case reports

We report two cases of serotonin syndrome in elderly patients during treatment of psychotic depression with atypical antipsychotics and antidepressants. The first case is a 69-year-old man who was admitted for depression with psychosis and treated with trazodone, risperidone, and sertraline. Subsequently, he developed myoclonus, tremor, cogwheel rigidity, and diaphoresis. The second case is a 72-year-old female initially admitted to a medical inpatient unit for a change in mental status that presented as increased confusion, lethargy, slurred speech, and a fever of 101.5 degrees. She had been on phenelzine and quetiapine. In both cases, all symptoms resolved within 24 hours of the psychotropics being stopped. In both cases, we believe that serotonin syndrome was produced by a combination of an antidepressant and an atypical antipsychotic. There have been several case reports of serotonin syndrome from similar combinations of antidepressant and atypical antipsychotic treatment. Clinicians treating elderly patients with a combination of serotonergic antidepressants and atypical antipsychotics for psychotic depression should be aware of the potential for serotonin syndrome.     

Therapy of treatment resistant depression: focus on the management of TRD with atypical antipsychotics

Treatment-resistant depression (TRD) represents a significant challenge for physicians. About one third of patients with major depressive disorder fail to experience sufficient symptom improvement despite adequate treatment. Despite this high occurrence of TRD there was no general consensus on diagnosis criteria for TRD until 1997 when researchers proposed a model of defining and staging TRD. In 1999, others defined operational criteria for the definition of TRD. Treatment of TRD is commonly separated into pharmacologic and nonpharmacologic methods. This review gives a short overview of these two methods. The nonpharmacologic methods include psychotherapy, electroconvulsive therapy, and vagus nerve stimulation. Pharmacologic methods include switching to another antidepressant monotherapy, and augmentation or combination with two or more antidepressants or other agents. This review especially focuses on the augmentation of the antidepressant therapy with atypical antipsychotics.     

Schizotypal personality traits and atypical lateralization in motor and language functions

Atypical cerebral lateralization in motor and language functions in regard to schizotypal personality traits in healthy populations, as well as among schizophrenic patients, has attracted attention because these traits may represent a risk factor for schizophrenia. Although the relationship between handedness and schizotypal personality has been widely examined, few studies have adopted an experimental approach. This study consisted of three experiments focusing on motor and language functional lateralization in regard to schizotypal personality in the absence of mental illness: line-drawing, finger tapping, and a semantic go/no-go task. The results suggested that positive schizotypal personality might be related to functional non-lateralization in regard to at least some functions (e.g., spatial motor control and semantic processing in the present study). Subjects with high schizotypal personality traits performed equally with their right and left-hands in the line-drawing task and they reacted equally with their right and left-hands in a semantic go/no-go task involving semantic auditory stimuli presented in both ears. However, those low in schizotypal personality traits showed typical lateralization in response to these tasks. We discuss the implications of these findings for schizotypal atypical lateralization.     

The preparation of reach-to-grasp movements in adults, children, and children with movement problems

This study explored the use of advance information in the control of reach-to-grasp movements. The paradigm required participants to reach and grasp illuminated blocks with their right hand. Four target blocks were positioned on a table surface, two each side of the mid-saggital plane. In the complete precue condition, advance information precisely specified target location. In the partial precue condition, advance information indicated target location relative to the midsaggital plane (left or right). In the null condition, the advance information was entirely ambiguous. Participants produced fastest responses in the complete precue condition, intermediate response times in the partial condition, and the slowest responses in the null condition. This result was observed in adults and four groups of children including a group aged 4-6 years. In contrast, children with Developmental Coordination Disorder (DCD, n = 11, aged 7-13 years) showed no advantage of partial precueing. Movement duration was determined by target location but was unaffected by precue condition. Movement duration was a clear function of age apart from children in the DCD group who showed equivalent movement times to those of the youngest children. These findings provide important insights into the control of reach-to-grasp movements and highlight that partial cues are exploited by children as young as 4 years but are not used in situations of abnormal development.     

The role of eye movements in motor sequence learning

An experiment that utilized a 16-element movement sequence was designed to determine the impact of eye movements on sequence learning. The participants were randomly assigned to two experimental groups: a group that was permitted to use eye movements (FREE) and a second group (FIX) that was instructed to fixate on a marker during acquisition (ACQ). A retention test (RET) was designed to provide a measure of learning, and two transfer tests were designed to determine the extent to which eye movements influenced sequence learning. The results demonstrated that both groups decreased the response time to produce the sequence, but the participants in the FREE group performed the sequence more quickly than participants of the FIX group during the ACQ, RET and the two transfer tests. Furthermore, continuous visual control of response execution was reduced over the course of learning. The results of the transfer tests indicated that oculomotor information regarding the sequence can be stored in memory and enhances response production.     

Abnormalities of motor and praxis imagery in children with DCD

In an earlier study using the visually guided pointing task (VGPT) the authors showed that the timing of imagined movement sequences in children with developmental coordination disorder (DCD) does not conform to the conventional speed-for-accuracy trade-off (or Fitts' law [P.M. Fitts, Journal of Experimental Psychology 47 (1954) 381-391]) that occurs when the distance and accuracy requirements of movements are varied [P. Maruff, P.H. Wilson, M. Trebilcock, J. Currie, Neuropsychologia 37 (1999b) 1317-1324]. The present study sought to replicate this earlier finding and to examine (using a weight manipulation) whether this deficit was also attributable to inaccurate programming of relative force. The chronometry of real and imagined movements was investigated in a group of 20 children with DCD aged between 8 and 12 years and a group of controls matched on age and verbal IQ (VIQ). Movement duration was tested for real and imagined movements using the preferred hand, with the VGPT performed under two load conditions: with and without the addition of a weight attached to a pen. Group means of each subjects' mean movement duration were calculated and plotted against target width for each of the four conditions [Movement type (2) x Load (2)] and a logarithmic curve was fitted to the data points. In the control group, the speed-for-accuracy trade-off for both real and imagined performance conformed to Fitts' law under each load condition. In the DCD group only real movements conformed to Fitts' law. Moreover, the effect of load differed between groups--for real movements, movement duration did not differ between load and no-load conditions for either group, while for imagined movements, movement duration increased under the load condition for the control group only. These results replicate and extend the results of our earlier study. This pattern of performance suggests that children with DCD have an impairment in the ability to generate internal representations of volitional movements which may reflect an impaired ability to process efference copy signals. The ability to programme both relative force and timing appears to underly this difficulty. Results have implications for the use of (guided) motor imagery training in order to facilitate the development of motor skill in children with DCD.     

Analogue functional analysis of movements associated with tardive dyskinesia

We studied whether movements associated with tardive dyskinesia (TD) served operant functions in 2 men with developmental disabilities. We found that TD-related movements occurred more frequently in the alone and attention conditions and less frequently in control and demand conditions. Our findings suggest that TD-related movements may not be maintained by social reinforcers and that decreases in TD movements are possibly a result of engagement in activities that are incompatible with TD movements.     

Observational studies of retarded children with multiple stereotyped movements

Stereotyped movements, such as body rocking and hand gesturing, are common among developmentally delayed children. However, very little is known concerning the naturally occurring circumstances that produce variability in this type of responding. Three relatively long-term observational studies, involving seven preschool children, each of whom exhibited multiple stereotypies, were conducted to determine the extent to which the type of activity or setting had any effect upon the rates of these responses. Repeated observations were made of each child during a variety of school activities. In two studies, adult-child interactions were also recorded. The results showed that, in general, the particular activity greatly affected rates of stereotyped behavior, although there were some marked individual differences. Moreover, in two studies variability was apparent across sessions within a particular setting. For some of the children, there was evidence that their multiple stereotypies were functionally interrelated. Adult interactions, as recorded in one study, appear to be both quantitatively and qualitatively different for stereotyping as contrasted with nonstereotyping children. An environmental analysis employing a sequential model indicated that there were teacher behaviors that affected the frequency and/or conditional probability of the child's aberrant behavior.This research was supported by P.H.S. Grant No. HD-00973.     

A device to record gross motor movements in human subjects

A P. R. Mallory Crime Alert CA-2 was used to detect gross motor movements in human Ss, The device was sensitive enough to detect hard eye blinking, rapid movements of a single finger, or more general movements of arms and legs while the S rested in a recliner chair. Noxious audio feedback was effective in inhibiting gross motor movements.     

The micro-structure of tapping movements in children

In order to investigate the development of movement speed in relation to movement organization, children of 5, 6, 7, 8 and 9 years of age and adults carried out a reciprocal tapping task, in which time pressure and distance were manipulated. The duration, velocity, acceleration and accuracy of the movements were compared between age groups. Age differences appeared mainly in the homing time, not in the duration of the distance covering movement phase. Accuracy and velocity of the distance covering movement phase differed with age. Time pressure affected the homing time, but not the duration of the distance covering phase. Distance manipulation affected mainly the velocity and duration of the distance covering movement phase and the homing time. In the discussion it is contended that age differences in homing time may be related to both the accuracy of the distance covering movement phase and the rate of information processing of the subject.     

Imitation of body postures and hand movements in children with specific language impairment

Within the domain-general theory of language impairment, this study examined body posture and hand movement imitation in children with specific language impairment (SLI) and in their age-matched peers. Participants included 40 children with SLI (5 years 3 months to 6 years 10 months of age) and 40 children with typical language development (5 years 3 months to 6 years 7 months of age). Five tests were used to examine imitation and its underlying cognitive and motor skills such as kinesthesia, working memory, and gross motor coordination. It was hypothesized that children with SLI show a weakness in imitation of body postures and that this deficit is not equally influenced by the underlying cognitive and motor skills. There was a group effect in each cognitive and motor task, but only gross motor coordination proved to be a strong predictor of imitation in children with SLI. In contrast, hand movement imitation was strongly predicted by performance in the Kinesthesia task in typically developing children. Thus, the findings show not only that children with SLI performed more poorly on the imitation tasks than their typically developing peers but also that the groups’ performances showed qualitative differences. The results of the current study provide additional support to the view that the weaknesses in children with SLI are not limited to the verbal domain.     

The link between motor impairment level and motor imagery ability in children with developmental coordination disorder

The present study examined motor imagery ability in children with developmental coordination disorder (DCD). Specifically, it explored whether children with varying degrees of motor impairment differed in their ability to perform motor imagery tasks. Fourty-two children scoring below the 15th percentile on the Movement ABC were split into two groups--DCD severe (DCD-S), scoring on or below the 5th percentile, and DCD mild (DCD-M), scoring from the 6th to 15th percentiles--and compared to 21 age matched controls. Participants performed two motor imagery tasks--hand (performed without and with specific imagery instructions) and whole-body rotation. The results demonstrated that children in the DCD-S group had a generalized motor imagery deficit in that they were less accurate across tasks than controls (and the DCD-M group on the hand task) and showed little benefit when given specific imagery instructions. The DCD-M group appeared capable of performing simpler motor imagery transformations, but were less successful as task complexity increased. Unlike the DCD-S group, the DCD-M group did show some benefit from specific imagery instructions with increases in accuracy on the hand task. These results suggest that a motor imagery deficit does exist in many children with DCD but that its presentation can vary--factors such as the individual child's level of motor impairment and task complexity appear to be linked to the profile of deficits observed, which could explain the inconsistent findings of previous studies. Although this study lends support to the theory that a deficit in internal modeling is an underlying problem for children with DCD, still more research is required to develop the theory further.     

Differential changes in the development of motor coordination and executive functions in children with motor coordination impairments

Cognitive and motor coordination skills of children with and without motor coordination impairments were examined with a one-year follow-up investigation. Initially, children were between 4 and 6 years old. Age-appropriate tests of executive functions (updating, switching, inhibition, interference control), motor coordination (the Movement Assessment Battery for Children-2) and fitness (the Körperkoordinations-Test für Kinder) were administered in two consecutive years. Several background variables (age, socioeconomic status, medical support, clinical interventions, leisure activities) and potential moderators (nonverbal intelligence, reaction time, visual perception) were controlled. The matched sample consisted of 48 control children and 48 children with motor coordination impairments. The children’s executive functions dramatically improved during the one-year period. With regard to motor coordination performance, half of the impaired children caught up to the control children’s level (“remission group”), while the remaining half showed no improvement (“persisting group”). Compared to the persisting group, the children in the remission group showed markedly better interference control at both measurement points. The correlation between executive functions and motor coordination is significant in the persisting group, but not in the remission group. The results of the study are discussed in the light of the role of executive functions, especially inhibition processes, for the automatization of motor coordination tasks.     

Cognitive and motor development in children with vertically transmitted HIV infection

This study was designed to examine mental and motor development in infants with vertically transmitted human immunodeficiency virus (HIV) infection. Early neurodevelopment was examined in 25 young children with HIV infection acquired through vertical transmission. Compared with 25 children born to HIV-positive mothers but not infected with the virus, and after controlling for developmental risk factors, the HIV-infected group showed impairments in mental and motor development. Mental and motor development were assessed using the Bayley Scales of Infant Development. On the mental scale (MDI), the HIV-infected infants obtained significantly lower scores than the uninfected infants. On the performace scale (PDI), the HIV-infected infants obtained significantly lower standard scores than the uninfected infants. CT scan results were available for 20 of the HIV-infected children. CT abnormalities were associated with developmental delays, particularly for motor development. The results point to the importance of early abnormalities in myelination and of subcortical lesions of cognitive and motor development.