Cortical visual impairment (CVI) is now the most common cause of visual impairment in children. Little is known about the long-term visual outcome. This study evaluates the outcome of children with congenital CVI. Using medical records, 423 children (225 males, 198 females) were identified with congenital CVI. Of these children, 259 had follow-up visual acuity assessments. The children's gestational age varied with 32 weeks or less representing 15.9%; 33 to 36 weeks representing 10.7%; 37 to 42 weeks representing 61.2%; and 43 weeks or greater representing 0.9% (11.3% of patients' gestational age was unrecorded). Clinical data were extracted and information regarding outcome was gathered. The majority of children showed improvement in their visual acuity levels after 2 or more years of follow-up. For the 194 children initially assessed before 3 years of age, 97 had improved, 75 were unchanged, 18 had deteriorated, and 4 had sub-optimal assessments. For the 74 children initially assessed at 3 or more years of age, 23 had improved, 44 remained unchanged, 3 had deteriorated, and 4 had sub-optimal testing. Children with better visual acuity levels at follow-up were more likely to have favourable cognitive outcomes (non-mental retardation) in 12.2% versus 2.8% (p<0.01). Similarly, favourable motor outcomes (independent ambulation) were present in 20.1% for those with better visual acuities versus 7.9% for those with poorer visual acuities (p<0.01). Our study demonstrates that the majority of children with CVI underwent improvement in visual acuity. Additional disabilities were common, but those children with better visual acuity outcomes faired better. Given the frequency of comorbid conditions, appropriate diagnostic assessment services are needed.

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Neurological lesions that cause dyskinetic cerebral palsy (CP) commonly involve ocular movements. This report describes a group of 14 children (nine males, five females) whose CP is associated with severe dyskinetic eye movements. Ages ranged from 4 months to 13 years (mean 6.9 years). Clinical features of this eye movement disorder are discussed and defined. The visual function of these children is slow, variable, and highly inefficient. They are often misdiagnosed as blind, due to cortical visual impairment. Early recognition of dyskinetic eye moment disorder and appropriate developmental and educational management are important.

To determine the effect of intravenous porcine secretin on autistic behaviours in children aged 2 to 7 years, the effects of secretin on (1) performance on a standardized language measure, and (2) autistic behaviours, as rated by parents and child development professionals was examined. Employing a randomized, double-blind, placebo-controlled design, 95 participants were assigned to one of two groups and administered a single dose of either secretin or placebo. A follow-up assessment was conducted 3 weeks after the injection. No significant differences in language or autistic behaviour measures were observed at the 3-week follow-up between the groups. Also, there was no significant difference in the proportion of individuals who improved by > or = 6 points on the language measure at follow-up. This study showed no significant effects of secretin on children with autism. Our results are consistent with a systematic review of randomized controlled trials evaluating the effect of secretin in children with autism.

AIM The aim of this study was to evaluate the interrater reliability and convergent validity of the American Academy for Cerebral Palsy and Developmental Medicine's (AACPDM) methodology for conducting systematic reviews (group design studies).METHOD Four clinicians independently rated 24 articles for the level of evidence and conduct using AACPDM methodology. Study conduct was also assessed using the Effective Public Health Practice Project scale. Raters were randomly assigned to one of two pairs to resolve discrepancies. The level of agreement between individual raters and pairs was calculated using kappa (a=0.05) and intraclass correlations (ICCs; a=0.05). Spearman's rank correlation coefficient was calculated to evaluate the relationship between raters' categorization of quality categories using the two tools.RESULTS There was acceptable agreement between raters (j=0.77; p<0.001; ICC=0.90) and between assigned pairs (j=0.83; p<0.001; ICC=0.96) for the level of evidence ratings. There was acceptable agreement between pairs for four of the seven conduct questions (j=0.53-0.87). ICCs (all raters) for conduct category ratings (weak, moderate, and strong) also indicated good agreement (ICC=0.76). Spearman's rho indicated a significant positive correlation for the overall quality category comparisons of the two tools (0.52; p<0.001).CONCLUSIONS The AACPDM rating system has acceptable interrater reliability. Evaluation of its study quality ratings demonstrated reasonable agreement when compared with a similar tool.The purpose of systematic reviews, meta-syntheses, and metaanalyses is to synthesize the best available research regarding specific intervention and diagnostic or prognostic procedures to assist clinicians and other stakeholders in evidence-based decision-making and to advance related science. Standardization of processes for creating reviews increases the degree to which consumers can depend upon synthesized literature. By definition, authors of systematic reviews must use processes designed to minimize bias by ensuring comprehensive and reproducible literature searches, and orderly selection and analyses of the individual articles reviewed. 1 Systematic reviews are based on specific questions and use 'systematic and explicit methods to identify, select, and critically appraise relevant research'. 2 Over the last two decades, systematic reviews have contributed to the creation of evidence-based health care practice guidelines and policies in addition to informing clinical practice and providing directions for research. 3,4 Many methods have been developed for grading the quality and strength of research evidence. 5,6 In 1999, the Treatment Outcomes Committee of the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) published a methodology for conducting systematic reviews of studies that report studies of treatment effectiveness. 7 At that time, the majority of rating scales used in systematic review methodologies were developed to assess the quality of randomized controlled trials. A...