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Background: Separation anxiety (SA) can be defined as the fear reaction and protest manifested by children when the main caregivers move away from him/her or in front of unfamiliar person. SA near eight months may be considered as an important and normal phase of the correct and typical social neurodevelopment. Aims of the present pilot study is assessing the prevalence of separation anxiety in a population of patients with migraine without aura (MwA). Materials and methods: 119 children (69 males) suffering from MwA (mean age 1.78 ± 7:59) were consecutively recruited. The control population consisted of 231 (114 males) healthy subjects similar for age (7.64 ± 1:34; p = 0.768) and gender (p=0.987) The Screen for child anxiety related emotional disorders (SCARED) test was used to assess the prevalence of separation anxiety among MwA children. Results: Healthy individuals are on average less affected (mean 4.72 ± 0:32) of the Separation Anxiety Disorder respect of MwA children (mean 6.83 ± 0.97; p < 0.001) (Figure 1). Conclusion. MwA presents many psychiatric comorbidities and among ones separation anxiety may be considered in the clinical and therapeutic management of pediatric primary headache.

Introduction: Autism spectrum disorders (ASD) are a complex set of neurological dysfunction and development characterized by deficits in social and non-verbal interaction. Few studies have explored the executive functioning in ASD preschoolers. The aim of this pilot study is the assessment of executive functioning in preschool children with ASD. Material and methods: 8 ASD children (7 males, 1 female) mean age 3.09 (SD ± 0.83 years) were enrolled in the study and compared with a control group of 15 typically developing children (12 males, 3 females) (mean age 24.3 ± 0.61). All subjects underwent assessment of executive functioning with the BRIEF-P test. Results: The two groups were matched for age (p = 0.625) and gender (p = 0.900). Table 1 shows the comparison between the two groups at the BRIEF-P, with significantly higher scores on all subscales of ASD children compared with controls. Conclusions: Despite the small sample examined the results of this study agree with what is already known in the literature confirm the presence of a significant deficit in executive functions of subjects with ASD emphasizing for the first time the emergence of such problems at an early stage of development, but demanding further studies to confirm this.

Introduction: The sinactive developmental model provides suggests a different way for the brain study by observing the children behavior. In all neurodevelopmental disorders, we can observe autonomic alteration comprising sleep disorders, meal behaviour alteration and self-regulatory impairment. These alterations/impairment are very frequent in autism spectrum disorders (ASD) (1-12). Aim of the present preliminary study is the assessment of metabolic rate in children affected by ASD. Material s and methods. 5 males affected by ASD aged 7-10 years (mean age 6.73±3:39), were recruited. The average score at the ADOS scale was 12.24 (SD± 3.29). The control group consisted of 5 males typically developing children (TDC) aged 7 to 11 years (mean age 7.92 ± 3.23). Autonomic/Metabolic evaluation: Free-living daily physical activity was measured using either the SenseWear Armband in order to calculate the total energy expenditure (TEE), baseline (REE) and the metabolic physical activity for prolonged periods of time. In general, the SenseWear Armband allows objective monitoring of the lifestyle including duration and sleep efficiency. Results: ASD subjects show values of total energy expenditure (p = 0.0047) and active energy expenditure (p = 0.044) significantly higher compared to control subjects (Table 1). In addition, ASD children have a metabolic intermediate significantly higher than healthy subjects (p=0.015). (Table 1). Finally, the ASD children show a significant reduction of sleep time (p = 0.027) (Table 1). Conclusion: ASD can represents a very significant risk factor for developing sleep disorders and to high energy expenditure, although further studies are needed in this respect.

Introduction: Migraine is a common disorder in children and adolescents, associated with various disorders such as emotions, behavioral problems, and sleep disturbances. Aim of the study is to verify the relationship between psychological problems of cephalalgic patients and sleep disturbances. Materials and methods: 64 subjects (27 females), aged 8-12 years (mean 9.4 years, SD ± 1.03) with primary headache were enrolled. CBCL 6-18 scale and the SDSC scale were used for behavioral screening and for assessing sleep habits. Results: According to the ICHD-III criteria, the distribution of the headache subtype was as follows: headaches without aura (71.87%), headache episodes typical of tension (7.81%) and chronic headache (7.81%) (Figure 1). CBCL assessment (total problem element) showed an interesting relationship with sleep disorders such as DIMS, DA and SWTD (respectively r = .37, p = 0.019; r = .39, p = 0.015; r = 37, p = 0.019). Discussion: MwA children revealed a specific behavioral phenotype characterized by internalization problems. Among migraine subjects, prevalent sleep disorders include difficulty falling asleep, increased night-time awakening, decreased sleep duration, and excessive daytime sleepiness.

Nonverbal learning disability (NVLD) can be defined as a specific learning disorder peculiar for deficits in non-verbal area, such as visuospatial and visuo-constructive difficulties, fine motor coordination impairments, and poor mathematics achievement, associated with well-developed language skills. aim of the present work is suggesting rehabilitative proposal for management treatment of NVLD in pediatric age tailored on children and based on EBM.

Introduction: Autism spectrum disorder (ASD) is a behavioral syndrome caused by a developmental disorder, biologically determined, with onset in the first three years of life. The areas concerned are mainly those related to social communication, social interaction and mutual functional and symbolic play. In the last decades, different conceptions of autism have taken, also emphasizing different sensory-perceptual abnormalities as the basis of the central features of disorder. This pilot study intends to address the issue of sensory perception in preschool children affected by ASD. Material and methods: 11 ASD children were enrolled (7 males, 4 female) aged between 2.3 years and 4.6 years, (mean age 3.29 ± 0.72). The control group consisted of 24 typical developing children (15 males, 9 females) (mean age 3.08 ± 0.87). All subjects underwent assessment of sensory perceptual abilities according to the Bogdashina's Sensory Profile Checklist Revised (SPCR) evaluation (43). Results: The two groups are comparable for age (p = 0.491) and sex distribution (p = 0.755). Table 1 shows the comparison between the two groups results in the SPCR, specifically, individuals with ASD, showed significantly higher scores on near all perception areas evaluated than healthy controls, suggesting a clear perceptual impairment in ASD subjects. Only for olfactory perception two groups were comparable. Conclusions: no significant differences in behavioral reaction to smell stimulation between ASD and typical developing children, and this result could be explained according to the early age of our sample that could cause high reactivity to smell stimulation also in typical developing examined children.

Introduction: Anxiety is the psychological process by which the individual reacts to dangerous external stimuli, triggering responses (mediated by norepinephrine, GABA and serotonin) involving physiological reactions and cognitive strategies. Anxiety can be differentiated in state anxiety and trait anxiety. Fragile X Syndrome (FXS) is a disorder most commonly caused by a triplet repeat expansion of > 200 cytosine-guanine-guanine (CGG) repeats in the 50 untranslated region of the Fragile X mental retardation 1 (FMR1) gene. Aim of the present study is investigating the state or trait anxiety in a sample of mothers of children affected by X-fragile. Materials and methods: 84 mothers (mean age 48.36 ± 7.11) of children affected by FXS were recruited and compared with mother of 171 typical developing children (mean age 46.18 ± 9.53). The Scale State-Trait Anxiety Inventory for Adults (STAI) was used in order to assess the anxiety levels. Results: All mothers of children affected by FXS showed high score of anxiety levels at the STAI evaluation (Table 1), with no differences were found between mothers of males and females children affected. Conclusions: Mothers of children with FXS appear to be in a state of anxiety effects and suddenly even higher than those found later in mothers of children with other chronic diseases.

Introduction: Obstructive sleep apnea syndrome (OSAS) affects up to 4% of pediatric population, with many co-morbidities in the medium-long term. Functional alterations in prefrontal cortex (PFC) may explain why OSAS impacts aspects such as: executive functions, memory, motor control, attention, visual-spatial skills, learning and mood regulation. Emotional intelligence (EI) is a complex neuropsychological function that could be impaired in many clinical conditions. Aim of the study is to evaluate the difference in emotional intelligence skills among children with OSAS and healthy subjects Materials and methods: 29 children (16 males) mean age 9.5 ± 1.54 years, affected by OSAS were compared with 60 typical developing children similar for gender (p = 0,871), age (p = 0,934) and socio-economic status (p = 0.714). Bar-On emotional quotient inventory, youth version (EQ-i: YV) was used in order to assess the Emotional Quotient. Results: Apnea/hypopnea index (AHI) results to be 8.76 ±3.45 with medium desaturation index (ODI) amounting to 2:52 ± 21.5, average saturation 92.7±4.8 %, average desaturation 4.9 %. OSAS children have significant differences in Interpersonal scales (84.95 ± 07.03 vs. 99.61 ± 8.96; p

In 1921 Wilder defined classical cholesterol diet providing the patient with a daily calorie intake of less than 20% compared to age-related requirements. The main macronutrient is represented by saturated and long chain unsaturated fatty acids, in the ratio of 4: 1 to carbohydrates and proteins (4 grams of lipids per gram of carbohydrates and proteins). One of the first therapeutic protocols proposed is that of John Hopkins that the onset of the diet should take place in a hospital environment to assess the patient's response in a controlled situation.

Background: Cerebral palsy (CP) is the most common pediatric disability causing long-term functional limitations. CP remarkably influences the life of those affected and their families. For this reason it is important and necessary to direct attention not only type of the CP, but also the impact the disorder has on the child, parents, siblings and the entire family as a whole. The aim of this study was to assess the impact of CP on the child’s quality of life, considering parents’ perceptions about their child's illness, in order to underline the impact the illness has not only on the child but also his/her family. Methods: The study included both parents of the 36 subjects enrolled (19 males and 17 females), with established CP diagnosis. The effect of CP on the families was assessed using the Impact of Childhood Illness Scale. This questionnaire assesses the quality of life in children with epilepsy and other chronic pathologies and in their families. All questions refer to effect to the illness family. The scale comprises 30 questions divided into four sections: impact of illness and its treatment ; impact on development and child s adjustment; impact on parents and impact on the family. Descriptive analyses were used for data analysis and it is also calculated the rank correlation coefficient Spearman’s rho. Results and conclusion: The mothers’ group presents little higher average scores than the group of fathers in two four subscales or in the basement “Impact on the child” and “Family impact on the organization”. This could be due to the fact that mothers are concerned most of the child's caregiver, living most of all the difficulties that entails; mothers show greater concerns than fathers. In subscale “Impact on parents” the average score of the answers of the group of mothers coincide with that of the fathers; the experience and the experience of his son's illness is analogous for both parents. No significant differences were found from the correlational analysis between the individual items of the subscales and the different forms of CP. In families of children with CP, strategies for optimizing caregiver physical and psychological health include supports for behavioral management and daily functional activities as well as stress management and self-efficacy techniques.

The Femoral hypoplasia - unusual facies syndrome (FHUF) or Femoral - facial syndrome (FFS) was at first described in 1975. Up to now about 60 cases have been reported. According to our knowledge only 4 cases have had congenital central nervous system's malformations, furthermore the main stages of psychomotor development are almost always reported as normal or slightly altered in early childhood. We describe the first case of autism spectrum disorders (ASD) in a patient with FFS, emphasizing that this rare association could be one of many unrecognized underlying features.

The moments that follow the diagnosis of celiac disease and the early stages of the gluten-free diet are extremely difficult and complex for parents and child, because they face an important change punctuated by self-denial and deprivation. The main objective of this research is to assess the impact of celiac disease on quality of life in subjects in developmental age, taking into account the perceptions of parents about the child's illness, with the aim to highlight the effect of disease on the child and the entire family.The study included both parents of 45 children aged between 2 and 10 years, with established celiac disease. To evaluate the effect of celiac disease on the lifestyle of affected children and their families has been used, after having adapted to the Italian context, the Impact Scale of Childhood Diseases of Hoare and Russell (1995). This study shows that celiac disease is a condition that has a significant impact on both the child and his family.The results obtained by administration of Impact Scale of Childhood Diseases to parents showed that subjects in developmental age with celiac disease could have difficulty on emotional level that affect child development and the whole family context. Acceptance of the illness by the child depends mainly by how much and how this has been accepted by parents.

Introduction: The association between primary monosymptomatic nocturnal enuresis (PMNE) and behavioral disorders was highlighted frequently, suggesting psychiatric origin. On the other hand, there is no difference between the incidence of mental disorders in children with PMNE and controls, although the psychological genesis could provide additional secondary forms, in which the child might react to stressful events with the resumption of involuntary urination at night, with a possible alteration of bowel control due to a high vulnerability to stressors. The purpose of this study is assessing the stressful events of life in a sample of children with PMNE. Materials and methods: 56 subjects with PMNE, (37 males and 19 females) (mean 10.87 years; SD ± 1.68) were recruited consecutively. All subjects were evaluated for the presence of stressful events (ICU) with test Coddington Life Events Scales (CLES). The control group consists of 98 typically developing children (65 males, 33 females) (p = 0.855) (mean 11.3 years; SD ± 1.85; p = 0.594). Results: Individuals with enuresis do not show a significant difference in the prevalence of stressful events than the control group (42.85% vs 41.83%; Chi-square = 0.002; p = 0,963) (table 1). Conclusions: These results for the first time show that PMNE can be regarded as an independent state by stress factors, suggesting that it itself represents a stress factor that can affect the proper psychological and neuropsychological development in children.

Objectives: Primary monosymptomatic nocturnal enuresis (PMNE) is a common problem in childhood and studies about the sleep habits of affected children are not conclusive. Work-family conflict (WFC) results from the incompatibility between family demands and business/workplace needs. WFC can impact parental quality with many consequences on children health. Aim of study is assessing the prevalence of sleep disturbances in enuretic children, sons of work-shifters. Materials and methods: 80 children (67 males) aged 5-13 years (mean 10,43; SD ± 1,99), were consecutively referred for PMNE. Sleep habits were investigated with Sleep Disturbances Scale for Children (SDSC) and the results were compared with a control group of 255 (190 males) typical developing children (TDC) sons of no shift-workers, matched for age (mean 10.57 SD ± 1,89; p = 0.569) and sex distribution (Chi-square= 2.416; p = 0.120). Results: To evaluate statically differences among mean values of two samples, the Chi-square test was performed. Logistic regression was assessed to verify the role of paternal shift-working as risk factor for sleep disorders. p=0.05. All sleep disturbances categories were more prevalent in PMNE children sons of shift-workers than control group (Chi-square= 43.926; p

The Ketogenic diet (KD) presents many effects on neurostrasmitters pathways. KD may act on potassium channels sensitive to ATP (KATP), inhibiting rapamycin pathway in mammalians or glutamatergic synaptic transmission or mediated by peptide hormones.

Introduction: The core of autism spectrum disorders (ASD) consists of alterations of neurological functions that affect the typical developmental trajectory leading to deficits in social interaction and non-verbal behaviors. In general, ASD is diagnosed at age three and many other frequent neurological signs may be present, such as sleep disorders. The aim of study is evaluating sleep habits in a sample of ASD children. Material and methods: The study population consists of 65 ASD children (43 males and 22 females), aged between 2 and 11 years (mean 5.73 ± 2.39 years). The control group consists of 114 children with typical development (68 males and 46 females), aged between 3 and 10 years (mean 5.91 ± 2.23 years). The diagnosis of ASD was confirmed by the evaluation ADOS -2, while the evaluation of sleep habits with the SDSC tests. Results: The two groups were matched for age (p = 0.633) and sex distribution (p = 0.483). The ASD subjects show a significantly higher rate of sleep disorders in all categories explored by SDSC tests (Table 1). Discussion: The sleep of people with ASD is compromised at any age and regardless of the severity of social impairment and communication, but not the level of development. Still, ASD is a very important risk factor for the development of sleep disorders, although the report could also be interpreted in the opposite manner.

Ketogenic diet (KD) is a high-lipid diet, adequate for protein content but low in carbohydrates content. Caloric intake is calculated on the basis of the ideal patient's needs, reduced by about 20%, and is about 90% of lipids present in 3: 1 or 4: 1 ratio with proteins and carbohydrates. KD is considered the most ancient antiepileptic therapy, actually proposed also for migraine therapy.

Angelman's Syndrome (AS) was described for the first time by Harry Angelman in the 1960s, based on obervation of three child patients with similar physical and behavioral features such as severe intellectual impairment, lack of language, motor disorders and happy behaviour. Many years later the typical patients' features were identified as linked to genetic abnormalities mainly characterized by neurological symptoms. Life expectancy is good although the symptoms tend to be stable and severe.

Cornelia de Lange syndrome (CdLS) is a congenital disorder characterized by distinctive facial features, growth retardation, limb abnormalities, intellectual disability, and behavioral problems. Cornelia de Lange syndrome is associated with abnormalities on chromosomes 5, 10 and X. Heterozygous point mutations in three genes (NIPBL, SMC3 and SMC1A), are responsible for approximately 50-60% of CdLS cases. CdLS is characterized by autistic features, notably excessive repetitive behaviors and expressive language deficits. The prevalence of autism spectrum disorder (ASD) symptomatology is comparatively high in CdLS. However, the profile and developmental trajectories of these ASD characteristics are potentially different to those observed in individuals with idiopathic ASD. A significantly higher prevalence of self-injury are evident in CdLS. Self-injury was associated with repetitive and impulsive behavior. This study describes the behavioral phenotype of four children with Cornelia de Lange syndrome and ASDs and rehabilitative intervention that must be implemented.

Kabuki syndrome (KS) (Kabuki make-up syndrome, Niikawa-Kuroki syndrome) is a rare genetic disorder first diagnosed in 1981. Kabuki make-up syndrome (KMS) is a multiple malformation/intellectual disability syndrome that was first described in Japan but is now reported in many other ethnic groups. KMS is characterized by multiple congenital abnormalities: craniofacial, skeletal, and dermatoglyphic abnormalities; intellectual disability; and short stature. Other findings may include: congenital heart defects, genitourinary anomalies, cleft lip and/or palate, gastrointestinal anomalies including anal atresia, ptosis and strabismus, and widely spaced teeth and hypodontia. The KS is associated with mutations in the MLL2 gene in some cases were also observed deletions of KDM6A. This study describes three children with autism spectrum disorders (ASDs) and KS and rehabilitative intervention that must be implemented.

Introduction: The Autism Spectrum Disorders (ASDs) have onset in the first years of life and are characterized clinically by qualitative impairments in social interaction, communication and a restricted repertoire, stereotyped and repetitive interests and activities. Currently there is a medical consensus on the causes of autism: they should not be psychosocial but should be based in biology, especially in the central nervous system abnormalities caused by both inherited and environmental causes. The aim of this study was to study a sample of subjects with Autism Spectrum Disorders (ASDs) with a wide protocol, including neurophysiological and radiological investigations as well as laboratory investigations in order to investigate the neurobiologic basis of the syndrome. Methods: The patients group included 34 subjects diagnosed as having ASDs. All were examined with a protocol of investigations (brain MRI; EEG; VEP, ABR; karyotype; evaluation of brain metabolites; antibodies against neurotrophic agents). In order to evaluate and identify the presence and intensity of autistic symptoms have been used the CARS (Childhood Autism Rating Scale) and ADOS (Autism Diagnostic Observation Schedule) tools. Results and Conclusion. Ninety percent of the subjects had at least one parameter neurobiological disease, the fifty-nine percent have a specific genetic syndrome. This study highlights the different noxae involved in the etiopathogenesis of AD and the percentage that every biological factor has in the development of the autistic phenotype. This study confirms the hypothesis that autism spectrum disorders (ASDs) are a severe neuropsychiatric diseases with strong genetic basis.

Sturge-Weber-Krabe syndrome (SWS), also known as encephalotrigeminalangiomatosis and named the forthfacomatosis, recall the names of the authors who first describedit in its basic clinical, radiological andanatomopathological aspects. We report here 14 cases of Sturge-Weber disease. In 6 of these, despite what had been previously described in literature, an extension of the angioma has been noted in other parts of the body. The study of these subjects stresses not only the need for a pharmacological/neuropsychomotor intervention, but alsothe need of a psychotherapeutic approach, for the emotional and affective implications thatcould derive from this syndrome. The reported cases are similar to those presented in literature for their main features. In particular, two elements are interesting: i) the exceptional diffusion of the red nevousto the whole hemicorpo; and ii) the evaluation of the way the patients live the disease, which has not beenpreviously considered in literature. We can conclude that SWS is a multisystem disorder that requires the neurologist to be aware of the possible endocrine, psychiatric, ophthalmological, and other medical issues that can arise and impact on the neurological status of the patients. and neuropsychomotor therapies, but also a psychotherapeutic support to patients. It should be noted that the literature does not take psychotherapeutic support into consideration.

Impairment of intelligence in Duchenne muscular dystrophy (DMD) patients was described by Duchenne de Boulogne himself in 1868. Further studies report intelligence disorders with mayor impairment of memory. The aim of the present study was to assess the presence of affective and personality disorders in a group of children affected by DMD. Twenty six male DMD patients, mean age eleven and four months years old, were assessed for their affective and personality disorder. Only eight subjects had a total IQ below average with major difficulties in verbal and visual-spatial memory, comprehension, arithmetic and vocabulary. All the subjects presented some disorders: tendency to marginalization and isolation, self-depreciation, sense of insecurity, hypochondriac thoughts and marked state of anxiety. These disorders are often a dynamic prolongation of a psychological process which starts when the diagnosis is made and continues, in a slow and latent fashion, throughout the evolution of the disease.

AIM: Since the 1950s, the problem of how to evaluate creativity has been addressed in studies on the definition of measurement criteria and on the relationship between intelligence and creative thinking. Many revealed cognitive and relational disorders in preterm infants, particularly in preterm very low birth weight infants (birth weight 2500 g. The test battery included: Torrance Test of Creative Thinking (TCTT); WISC-R intelligence test; Goodenough Human Figure Drawing Test. RESULTS: Statistical analysis (Mann-Whitney U test) showed a statistically significant difference (P>0.05) between the 2 groups; scores for figure originality, figure fluidity and figure elaboration were consistently higher in the control group. Within the low birth weight group, there was a significant correlation (Spearman r) between verbal IQ and verbal fluidity and verbal flexibility subscale scores and between IQ performance and figure elaboration. Scores on the figure drawing tests showed higher creative ability in the control group. CONCLUSIONS: In children born preterm with low birth weight, emotive dynamics and flow of affection may influence the channels of communication between child and family. The low figure originality subscale scores support the hypothesis that psychodynamic and relational factors (worry about the preterm condition, overprotective behaviour by parents and others) could lead to diminished autonomy, flexibility and manipulatory interest in the child.

Several studies on intelligence of children suffering from Duchenne muscular dystrophy (DMD) found impairments in linguistic functions and memory. Memory deficit mainly involves long-term memory; short-term memory impairment was also present, even if less frequently. Some studies tried to establish a correlation between the distal deletion of the dystrophin gene and low intelligence levels. The present study investigated the neuropsychological performance in a group of DMD children (26 subjects); neuropsychological tests included: Wechsler intelligence scale for children-revised; Raven’s progressive matrices test; Rey’s complex figure test; memory and digit span tests; Benton’s visual retention form D.

AIM: Risk behaviours--as they are defined by specialist literature for the damage these behaviours cause to young people's health and/or life--are getting more and more frequent among young people. They range from self-injuring behaviours to the consequences of a precocious, high-risk and/or promiscuous sexual activity, from abnormal eating behaviours to the deaths from fun. METHODS: The inquiry concerned a group of university students (100 males and 100 females), selected at random from the Faculties of Medicine and Surgery, Psychology, Economy and Jurisprudence of the University of Palermo, who were asked to answer a questionnaire composed of 91 questions and structured in 4 sections. The first section regards associate-identifying information; the second one inquires on experiences and requirements concerning sexuality; the third section explores the state of health and the use of drugs and alcohol; the fourth section looks into relations with others. RESULTS: The analysis of our data revealed that young people have different high-risk behaviours (use of drugs and alcohol, non protected sexual intercourse, carelessness for one's and one's partner's serological state); this is associated to poor information, as complained by the people interviewed, on the prevention of sexually transmissible diseases, use of drugs and alcohol. CONCLUSIONS: The conclusion is drawn that the new modalities of the assumption of risk by young people would correspond to the climate of vagueness, lack of limits, meanings and values which characterize the present society.