Growth Charting Used To Discover Neuro-Cognitive Abnormalities

Doctors, such as general practitioners and paediatricians, routinely use growth charts to measure children's height, weight and head circumferences in order to exclude any abnormalities. Researchers at the University of Michigan were wondering whether information from these growth charts could also help doctors to examine the maturation of function networks in the brain, to look for neuro-cognitive pathologies such as attention impairment.

The researchers wanted to study alterations in the intrinsic connectivity networks (ICN), which are important units of functional organization of the brain, and are associated with attention performance and which undergo substantial maturation during youth.

How the study was performed

The study was done by analyzing data that was publicly available from a sample of young patients who had certain assessments performed on them, including neuro-imaging. The sample group included 519 young people, with an average age of 16 and, of those, 25 of them completed the criteria for ADHD.

Some limitations were noted by the researchers such as that their findings needed to be replicated. The study itself introduced a novel brain network growth charting method for the prediction of attention impairment issues, but further research into the use of neuro-imaging to discover patterns of dysmaturation of the brain could provide early and objective findings of neuro-cognitive related disorders.

The clinical significance

For many years, growth charts were used to assess whether children and youths had any physical developmental issues. Now, a brain network charting methods exists where patients can be assessed for an increased risk in developing clinically relevant conditions such as impaired sustained attention disorders.

Executive dysfunction in clinical populations

A wide range of functions of the executive system of the brain relies on many neuro-cognitive processes. Any severe executive dysfunction, which is unrelated to any disorder or disease, is defined as dysexecutive syndrome and often occurs due to damage to the frontal lobes of the cerebrum.

Executive dysfunction is then associated with many psychiatric conditions, which often show similar symptoms to dysexecutive syndrome. This issue has been researched in relation to conditions such as psychotic disorders, cognitive developmental disorders, affective disorders, neuro-degenerative disorders, conduct disorders and acquired brain injury.

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These conditions could include the following:

• Schizophrenia - a mental disorder where patients are detached from reality due to their perceived ideas and thoughts becoming disrupted.
• Autism spectrum disorder (ASD) - this condition is characterized by abnormal or impaired development of communication and social interaction with others, as well as a decreased interest in activities.
• Bipolar mood disorder - a mood disorder which is characterized by fluctuations in mood from manic phases to depressive episodes which can alternate quickly (over days/weeks) or slowly (over weeks/months).
• Parkinson's disease - involves damage to the subcortical structures of the brain, and is associated with problems with thought and memory processes as well as difficulties with movement.
• ADHD - a disorder which is characterized by hyperactivity, inattention and impulsivity which can persist from childhood through to adulthood.

Attention Deficit/Hyperactivity Disorder In Children 

Subtypes

ADHD occurs more often in boys than in girls and the behaviours which they elicit are also different. An example would be that boys can be more hyperactive, whereas girls are more quietly inattentive.

To make the diagnosis of ADHD, symptoms need to be present for at least 6 months. These symptoms can negatively affect a child's schoolwork, relationships at school and/or at home as well as their home life. The behaviours of a child with ADHD aren't normal when compared to children who don't have this issue.

3 subtypes of ADHD exist and they are:

• Predominantly inattentive - where most of the symptoms are associated with inattention.
• Predominantly hyperactive-impulsive - most of the symptoms are associated with hyperactivity and impulsivity.
• Combined clinical picture - a mixture of inattentive symptoms and hyperactive-impulsive symptoms.

Symptoms  

A child demonstrating patterns of inattention can have the following issues:

• Doesn't pay close attention to details or they tend to make careless mistakes in their schoolwork.
• It appears they don't listen even when they are spoken to directly.
• They have trouble staying focused on tasks.
• There's trouble with organizing activities and tasks.
• They find it difficult to follow instructions.
• They fail to finish chores or their schoolwork.
• They tend to dislike or avoid tasks which require mental effort which needs to be focused.
• They are easily distracted.
• They tend to lose items which are needed for activities or tasks such as stationery.
• They seem forgetful regarding daily activities.

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Children showing patterns of hyperactivity and impulsivity often have the following picture:

• They are in constant motion.
• They have difficulty in staying seated in the classroom.
• They seem to fidget with objects or tap their hands and/or feet.
• They talk a lot and may be disruptive in the classroom.
• The climb and run around in inappropriate situations.
• There's difficulty experienced when they have to wait their turn.
• They may interrupt a teacher by blurting out answers.
• They may have trouble performing an activity quietly.
• They may intrude or interrupt other children's activities, conversations or games.

Risk factors

• Exposure to environmental toxins such as lead.
• A family history of a first-degree relative (mother, father or siblings) with ADHD or other mental health conditions.
• Smoking, alcohol use or drug use during pregnancy.
• Premature birth.

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Complications 

• These children tend to be involved in more injuries and accidents.
• They struggle in the classroom and this can result in being kept behind in their grade, as well as facing ridicule from their peers.
• They tend to develop a poor self-esteem.
• They struggle to interact with and be accepted by their peers and even by adults.
• This disorder can lead to an increased risk of drug and/or alcohol abuse as well as other delinquent behaviour.

Co-existing conditions 

Fortunately, ADHD doesn't cause other developmental issues or psychological disorders, but children with ADHD may be at an increased risk of developing conditions such as:

• Anxiety disorders.
• Disruptive mood regulation disorder.
• Learning disabilities.
• Oppositional defiant disorder (ODD).
• Bipolar mood disorder.
• Major depression.
• Conduct disorder.
• Tourette syndrome.