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Twenty-seven monolingual and 27 bilingual children aged between 6 and 7 years were assessed using the core subtests of the NEPSY, a children's neuropsychological assessment. Bilingual children scored lower than monolingual children in the Language domain and their performance was comparable with the monolingual children in the domains of Attention/Executive Functioning, Sensorimotor, Visuospatial, and Memory. The NEPSY correlates well with measures of academic achievement. It is concluded that the NEPSY is relatively insensitive to cultural factors and appears to be insensitive to bilingualism in the neuropsychological assessment of bilingual children in the United Kingdom.

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BACKGROUND: Single and repeat concussions have a high prevalence in sport. However, there is limited research into longterm risks associated with single and repeat concussions. OBJECTIVES: To determine the effects of single and repeat historical concussions on the neuropsychological functioning and neurological reports of licensed jockeys. METHODS: Six hundred and ninety eight licensed jockeys in the UK were assessed for neurological and neuropsychological symptoms of concussion at least three months after potential episodes. RESULTS: Jockeys reporting multiple historical injuries versus a single injury showed reliable decrements on a measure of response inhibition and, to a less robust degree, on divided attention. Younger adults showed greater vulnerability. CONCLUSIONS: Repeated concussion is associated with reliable decrements in cognitive performance--even after a three month window for recent recovery.

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This paper describes an intervention aimed at empowering parents of child survivors of acquired brain injury (ABI) in their interaction with teachers and other professionals involved in their child's education. The particular characteristics of the late morbidity of child ABI led to the design of an intervention in the form of a video and informational booklet that is the property of the family. Early response to the intervention has been extremely positive, although formal evaluation has been unexpectedly challenging.

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A U.K. population of young offenders show the typical deficits in Verbal IQ reported in conduct disordered populations. Performance IQs are generally lower than those of previous studies from the 1970s, raising a question about decline in intellectual ability.

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Seventeen children aged 5-16 years old (M = 11.3, SD = 2.97, Range= 6.25-16.00) were assessed between 4-5 years post-severe closed head injury, using the Wide Range Assessment of Memory and Learning (WRAML). Compared to age and sex matched controls, this group demonstrated deficits in the ability to learn new information, particularly their rate of learning. Deficits were more apparent with verbal than visual material. There were no indications of differences in delayed recall as measured by the amount of information lost nor in recognition memory. Results indicate that retrieval deficits may be an important component of memory difficulties in severe closed head injury. Educational implications are considered.

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BACKGROUND: The UK Government's White Paper Saving Lives: Our Healthier Nation included among its targets a reduction in suicide. AIMS: To study causes of change in suicide rate over a 30-year period in Newcastle upon Tyne. METHOD: Suicide rates and methods, based on coroners' inquest records, were compared over two periods (1961-1965 and 1985-1994) and differences were related to changes in exposure to poisions and prescribed drugs, and to socio-demographic changes. RESULTS: Demographic and social changes had taken place which would adversely affect suicide rates. However, a dramatic fall was found in the rate for women, and a modest decline in that for men. Reduced exposure to carbon monoxide and to barbiturates coincided with the fall in rates. CONCLUSIONS: Reduced exposure to lethal methods was responsible for the fall in rate in both genders, while the gender difference in favour of women may be related to their preference for non-violent methods or to their being less affected by the social changes.

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BACKGROUND: Open verdicts are often included in with suicides for research purposes and for setting health targets. AIMS: To examine similarities and differences in cases defined by the coroner as suicide and open verdicts and the implications of open verdicts for suicide research. METHOD: All cases of open and suicide verdicts recorded in the Newcastle Coroner's Court in the period 1985-1994 were compared on demographic and medical parameters. RESULTS: Open and suicide verdicts had many similarities, differing only in some respects, of which logistic regression identified the most significant to be a suicide note, method used and age. CONCLUSIONS: Open verdicts should be included in all suicide research after excluding cases in which suicide was unlikely. Objective criteria are needed to facilitate comparison between different studies.

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AIM: To determine the incidence, presentation, aetiology, and outcome of non-traumatic coma in children aged between 1 month and 16 years. METHODS: In this prospective, population based, epidemiological study in the former Northern NHS region of the UK, cases were notified following any hospital admission or community death associated with non-traumatic coma. Coma was defined as a Glasgow Coma Score below 12 for more than six hours. RESULTS: The incidence of non-traumatic coma was 30.8 per 100 000 children under 16 per year (6.0 per 100 000 general population per year). The age specific incidence was notably higher in the first year of life (160 per 100 000 children per year). CNS specific presentations became commoner with increasing age. In infants, nearly two thirds of presentations were with non-specific, systemic signs. Infection was the commonest overall aetiology. Aetiology remained unknown in 14% despite extensive investigation and/or autopsy. Mortality was highly dependent on aetiology, with aetiology specific mortality rates varying from 3% to 84%. With follow up to approximately 12 months, overall series mortality was 46%.

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Cognitive and adaptive behavioural outcome were studied in the identified survivors of a population based study of non-traumatic coma (NTC) in childhood. Children were assessed early (six weeks) and late (12 months) after NTC. At least 7% of those children in whom no suspicions of prior neurodevelopmental morbidity existed showed moderate or severe disability following NTC. Children over 2 years of age at insult showed some improvement between early and late assessments; however, children below 2 years showed no improvement. Differing age at insult effects were observed between aetiological groups. A relation between early age at first insult and poor outcome was particularly evident among children experiencing NTC caused by epilepsy.

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100 children from the north-east of England, aged between 7 and 13 years of age, completed an assessment of intellectual ability and an attention battery based on the work of Mirsky, Anthony, Duncan, Ahearn, & Kellam (1991). Factor analysis was generally supportive of the Mirsky et al. (1991) model. Replication of the adult model produced the same four factors: sustain, encode, focus-execute and shift. Replication of the child model produced a three-factor model in which the encode and focus-execute factors combined. An extended model resulted in the introduction of a new factor labelled errors of processing. The scores on attention factors were found to have a reasonable level of independence from intellectual ability.

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Twenty-eight children (mean age= 10.9 years, SD= 1.9 years) who had experienced a severe closed head injury were assessed for outcome on tests of intelligence, attention and executive function at 1 year post-injury. The children with closed head injury were matched with children from a normative sample for age and intellectual ability. Specific deficits in attention and executive function were found in the closed head injury sample. The importance of including these outcome variables in child neuropsychological assessment is supported.

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BACKGROUND: The assumption that patients with bipolar disorder make a full inter-episode recovery has been challenged by limited evidence that suggests that neuropsychological dysfunction in bipolar disorder may persist beyond episodes of illness. AIMS: To test the hypothesis that patients with euthymic bipolar disorder show neuropsychological impairment. METHOD: A battery of neuropsychological tests (assessed attention, working memory, learning and executive function) was administered to three matched groups of subjects: good-outcome patients with bipolar disorder (n = 21); poor-outcome patients with bipolar disorder (n = 20); controls (n = 20). All patients were clinically euthymic, although some had low levels of depressive symptoms. RESULTS: Patients performed worse than controls on a number of neuropsychological tests. When age, premorbid IQ and depressive symptoms were controlled for, the results indicated impairment of executive function. CONCLUSIONS: These findings provide good evidence for the existence of neuropsychological impairment in patients with euthymic bipolar disorder, although the possible effect of medication should not be overlooked. This may be of clinical relevance and raises questions about the course and outcome of the illness.

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To make the Digit Symbol subtest of the Wechsler Intelligence Scale for Children-III more useful in neuropsychological assessment, the measurement and influence of motor speed and incidental learning on subjects' performance was examined. Analysis indicated that motor speed but not incidental learning were significant influences on scores. Statistically significant differences between 150 males (M age 12.3 yr., SD = 2.8) and 150 females (M age 12.1 yr., SD = 2.7) were obtained for both raw and scaled scores on the Digit Symbol subtest. The implications of these gender differences are discussed as a possible example of differences in executive function.

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The use of a bilateral Z-plasty with superiorly based myomucosal flaps of the posterior pharyngeal wall in the treatment of nasopharyngeal incontinence in 16 patients with rhinolalia is reported. The transposition of these flaps leads to the formation of a dynamic and physiologic velopharyngeal sphincter that produces a marked improvement in speech. The same procedure yielded satisfactory results in 3 cases of pharyngitis sicca. We have maintained a postoperative follow-up of these patients from 6 months to 16 years and have been very pleased with the sustained good results.

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A new bilobed cutaneous and myocutaneous flap providing ipsilateral reconstruction possibilities in the head and neck is described. The flap incorporates the pectoralis major myocutaneous flap and the medially based deltopectoral flap in a single bilobed flap. Both flaps come from the same side to provide bulk and cutaneous coverage in a single flap.

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