![]() ![]() Moreover, these behaviors can be elevated to pathological levels and are the hallmarks of the neuropsychiatric diagnosis of attention-deficit hyperactivity disorder (ADHD) however, they also occur at elevated levels (though often below diagnostic criteria for ADHD) in a multitude of developmental disorders. The behavioral traits of hyperactivity/motor impulsivity, impulsivity/non-planning, and inattentiveness form a core dimension of personality that is heritable, emerges early in the course of development, and persists across developmental stages (McKay and Halperin 2001 Kochanska and Knaack 2003). 2007) however, the externalizing behaviors were not subdivided to isolate or characterize specific types. found that parent ratings of children with ICLP showed a significant increase in both internalizing and externalizing behaviors compared to children without ICLP (Hunt et al. 2003) however, very few studies have evaluated externalizing behaviors such as aggression, opposition, hyperactivity, impulsivity or inattention. Subjects with ICLP have been consistently shown to have increased internalizing behavior problems (social inhibition or shyness, depressed mood) (Endriga et al. In regard to behavior, an estimated 30% to 50% of children with ICLP experience at least some periods of behavioral abnormality (Richman and Millard 1997). These deficits are severe enough that reading disabilities have been reported to be as common as 35% of children with ICLP (Richman et al. The cognitive deficits associated with ICLP are well documented and characterized with a lowering of overall intelligence quotient (IQ) (though not to mental retardation level) and specific deficits in language function (Richman and Eliason 2009 Richman and Eliason 2001). In addition to the facial cleft, persons affected with isolated clefts of the lip and/or palate (ICLP) suffer from a constellation of other problems including persistent problems with speech (even after cleft repair), as well as cognitive and behavioral abnormalities. Isolated oral clefts are further divided anatomically into clefts of the lip and/or palate (CLP) and clefts of the palate only (CPO). As a group, 70% of clefting disorders are comprised of those that are isolated to facial clefts only (non-syndromic), and 30% are those in which the facial cleft is part of a well-defined syndrome of additional anomalies (Jones 1988). ![]() These oral clefts are developmental craniofacial abnormalities that result, at least in part, from a failure of neural crest cells to migrate properly. Orofacial clefts are the most common major birth defect in America, affecting over 6,800 births annually (Canfield et al. Enlargement of this region of the brain is therefore considered to be pathological in the ICLP group and supports the notion that abnormal brain structure (from abnormal brain development) is the underlying etiology for the abnormal behaviors seen in this population. In boys with ICLP, there are higher levels of HII compared to the controls and this is directly related to a significantly enlarged volume of the right vmPFC. The vmPFC is a region of the brain that governs behaviors of hyperactivity, impulsivity and inattention (HII). There was a direct relationship between HII score and vmPFC volume in both the ICLP group and control group, but the relationship was in the opposite direction: in ICLP, the higher the vmPFC volume, the higher the HII score for the comparison group, the lower the vmPFC volume, the greater the HII score. Boys with ICLP had significantly higher ratings of hyperactivity/impulsivity/inattention (HII) and significantly increased volume of the right vmPFC relative to the comparison group. Parents and teachers provided quantitative measures of hyperactivity, impulsivity, and inattentiveness using the Pediatric Behavior Scale. Magnetic resonance imaging brain scans were used to evaluate vmPFC structure. A total of 50 boys with ICLP were compared to 60 healthy boys without clefts. The purpose of this study is to evaluate quantitative structural measures of the ventromedial prefrontal cortex (vmPFC) in boys with isolated clefts of the lip and/or palate (ICLP) relative to a comparison group and to associate measures of brain structure with quantitative measures of hyperactivity, impulsivity, and inattentiveness.
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