Neurological soft signs in mainstream pupils. (Community child health, public health and epidemiology)

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Date: Nov. 2001
From: Archives of Disease in Childhood(Vol. 85, Issue 5)
Publisher: BMJ Publishing Group Ltd.
Document Type: Article
Length: 2,792 words

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Aims--(1) To examine the relation between neurological soft signs and measures of cognition, coordination, and behaviour in mainstream schoolchildren. (2) To determine whether high soft sign scores may predict children with significant problems in other areas.

Methods--A total of 169 children aged between 8 and 13 years from mainstream schools were assessed. They form part of a larger study into the outcome of meningococcal disease in childhood. Half had previous meningococcal disease and half were controls. Assessment involved measurement of six soft signs followed by assessment of motor skills (movement ABC), cognitive function (WISC-III), and behaviour (Conners' Rating Scales).

Results--Children having an age corrected soft sign score above the 90th centile were considered to have an excess of soft signs. When compared to the other children they had significantly worse scores on the other three measures. Median movement ABC score was 15.3 v 7. Mean total IQ scores were lower by 10.3 points. Median behaviour scores were significantly higher on both parental and teacher questionnaires. A soft sign score above the 90th centile had a sensitivity of 38% for detecting cognitive impairment, 42% for detecting coordination problems, and 25% for detecting possible attention deficit hyperactivity disorder.

Conclusion--In this group of children higher scores on the soft sign battery were related to significantly worse performance on measures of cognition, coordination, and behaviour. However, although soft sign assessment may be of interest it cannot accurately predict which children are likely to have impairment in other areas. (Arch Dis Child 2001;85:371-374)

Keywords: neurological soft signs; ADHD; learning difficulties; developmental coordination disorder

Paediatricians in the UK are increasingly being asked to assess children in mainstream school who are not performing as well as their peers. Differential diagnoses include developmental coordination disorder, specific or general learning difficulties, and behaviour problems such as attention deficit hyperactivity disorder (ADHD). Frequently children may have problems in all three areas. Neurological examination is usually normal and subsequent assessment is time consuming and may involve multiple agencies such as education, occupational therapy, and child and adolescent psychiatry. Are there any tests that a paediatrician may use to predict which children have significant problems?

Neurological soft signs (NSS) may be defined as minor abnormalities in the neurological examination in the absence of other features of fixed or transient neurological disorder. (1) They have been associated with behaviour, (1 2) coordination,3 and learning difficulties. (4) Other authors believe they represent a developmental lag rather than a fixed abnormality. (5) Studies have found a high incidence of soft signs in children following premature (6) or low birthweight (7) birth, meningitis, (8) and malnutrition. (9 10)

There are a number of soft sign batteries published that include tests of sensory function, coordination, motor speed, and abnormal or associated movements. (11 12) Some have been validated and tested longitudinally. (12-14) Tests may be performed quickly in the clinic situation and do not require special equipment.

We aim firstly to examine the associations between NSS and measures of cognitive ability, motor performance, and behaviour in...

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Gale Document Number: GALE|A80446243