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EnAbstract Background Pediatric voice disorders have typically been blamed on vocal abuse. Changes in the pitch, loudness, and overall vocal quality tend to interfere with communicative abilities. Recently, research has focused on pediatric voice disorders and the effects of a voice disorder on a child’s life. It has been reported that children felt that their voice disorders resulted in negative attention and limited their participation in activities. Aim The aim of this study was to examine the relationship between the pediatric voice handicap index (p-VHI) and both the auditory perceptual assessment (APA) and acoustic analysis of voice in patients with hyperfunctional childhood dysphonia. Participants and methods This study included 32 children diagnosed with hyperfunctional childhood dysphonia within the age range of 4.7–11.8 years, with a mean of age of 8.4 years; 22 (68.75%) were boys and 10 (31.25%) were girls. All patients were subjected to an APA of their voice after a modified GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and the domains were graded on a scale of 0–3, in which 0 is normal and 3 is severe. Acoustic voice analysis was carried out using Kay Elemetrics’ Computerized Speech Laboratory to obtain the following perturbation measures: jitter (%), shimmer (%), and harmonic to noise ratio. All patients were examined by videolaryngoscopy using fiberoptic nasofibrolaryngoscopes. Parents of all patients were given an Arabic p-VHI form that consists of 23 items divided among three subscales: functional, physical, and emotional. Scoring of the Arabic p-VHI is on the basis of an ordinal scale: the parents rate each statement between ‘0’ and ‘4’, in which ‘0’ represents a response of ‘never’, ‘1’ represents ‘almost never’, ‘2’ represents ‘sometimes’, ‘3’ represents ‘almost always’, and ‘4’ represents ‘always’. From these responses, a total score was obtained by adding the values of all responses ranging from 0 to 92. Results The mean scores on the different domains of the Arabic p-VHI among the study groups were 18.6±3.75 in the functional domain (range 4–31), 20.91±8.36 in the physical domain (range 6–34), 13.11±4.86 in the emotional domain (range 3–28), and 52.77±18.15 (range 13–80) in the total score. Correlation between the domains of the APA and those of the Arabic p-VHI showed a significant correlation between both the functional and physical domains of the Arabic p-VHI, namely roughness, breathiness, and strain quality, and pitch, and overall severity, whereas the emotional domain was not correlated with any of the APA domains. The p-VHI total score showed a significant correlation with the overall severity of dysphonia and breathiness. Correlation between the Arabic p-VHI domains and perturbation measures showed a significant correlation between all the domains and all acoustic perturbation measures, namely jitter (r=0.83; P=0.42), shimmer (r=0.81; P=0.39), and harmonic to noise ratio (r=0.76; P=0.36). Conclusion and recommendations The Arabic p-VHI seems to be a useful tool in children with dysphonia. Although it could help in assessment of the degree of disability that a voice disorder is causing, it should not be used as a sole clinical tool. Other clinical evaluation procedures such as APA and acoustic analysis of voice are strongly recommended in the evaluation of voice disorders and defining the amount of voice handicap.

EnAbstract Background In recent times major advances have been made in the field of early detection of autism in infants, and validated screening tools now exist to facilitate the early and accurate screening of infants before further referral for specialized autism diagnostic testing. Objective The aim of this study was to screen low-birth-weight (LBW) toddlers for early autistic features compared with normal controls and identify the associated risk factors. Materials and methods This cross-sectional study included 100 toddlers (24–30 months old) with a history of LBW. They were screened for autism using the Modified Checklist for Autism in Toddlers (M-CHAT). Further assessment was made using the Childhood Autism Rating Scale (CARS), Vineland Social Maturity Scale, and Arabic Language Test. One hundred age-matched and sex-matched full-term toddlers with a history of average birth weight and uneventful natal, perinatal, and postnatal history were included as the control group. Results The toddlers with LBW had a significantly higher frequency of positive M-CHAT screening than did the controls (11% of LBW children vs. 2% of controls). Positively screened LBW toddlers had significantly higher parental age at conception, lower birth weight, higher frequency of small-for-gestational-age preterms as well as higher incidence of gestational bleeding when compared with negatively screened LBW. They also had lower language and social ages than the negatively screened LBW. M-CHAT scores of positively screened LBW children correlated positively with maternal age at conception and negatively with birth weight, social age, and language age. Five of the 11 positively screened LBW children and one of the two positively screened controls were confirmed to have autism on the basis of CARS. Conclusion LBW is probably an independent risk factor associated with the development of autism. Early screening for autism is recommended for the LBW population especially if associated with risk factor(s) or if showing early impairment of social and language abilities, to be followed by definitive autism testing in those with positive screening results.

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