The association between neurological soft signs, measured by the pediatric examination described by Pine et al [1], and externalizing and internalizing psychopathology was examined in 56 boys, 8.5 (+/-1.5) years old, from a high-risk sample treated at the New York State Psychiatric Institute, NY. Soft sign measurements, based on 64 observations of 11 motor tasks performed in 20 minutes, included motor slowness, accuracy, abnormal movements, and smoothness. The results of this soft sign exam and correlations with psychiatric symptoms were stable over a 1-year period. Symptoms of externalizing disorders (ODD and CD) and internalizing disorders (anxiety, phobias, depression or dysthymia) correlated with impaired performance on the soft sign examination. An association between soft signs and ADHD was nonsignificant. [2]

COMMENT. Childhood subtle impairments in motor performance, involving motor speed, accuracy, and fluency, may be exhibited by children with ODD/CD or anxiety and depression disorders, in the absence of specific abnormal neurological signs. The authors and others attribute these soft neurological signs and associated psychiatric symptoms to basal ganglia dysfunction. The lack of significant association between ADHD and soft signs, as measured by the Pine method, is surprising. The demonstration of soft signs in a neurological examination may be a risk factor for childhood onset psychiatric symptoms, and for ADHD. [3]