Journal of Pediatric Neurology 3 (2005) 123–125 123 IOS Press Editorial Neurological “soft signs” in children and adolescents Paola Iannetti * , Mario Mastrangelo and Sara Di Netta Pediatric Neurology Unit, Department of Pediatrics, University of Rome “La Sapienza”, Italy Received 15 April 2005 Accepted 17 April 2005 1. Introduction Neurological “soft signs” (NSS) are defined as mi- nor abnormalities in the neurological examination in subjects with no other features of fixed or transient neu- rologic disorders [1]. These clinical disabilities are of- ten associated with behavior, coordination and learn- ing difficulties. The prevalence of motor examination abnormalities among a normal pediatric population is unknown; about this aspect, studies performed have given different results in children examined at seven and seventeen years [2]. In this issue of JPN, Wu et al. [3] investigated the frequency of motor abnormali- ties in a random sample of healthy 5-year-old children, and then they examined the relationship between these motor abnormalities and standardized measures of cog- nition and motor performance. Based on their findings they have concluded that motor examination abnormal- ities in otherwise healthy 5-year-old children may be more common than previously thought. However, the proportion of children with motor examination abnor- malities who have an unrecognized neurologic disorder remains unknown [3]. The main factors that may determine the appearance of NSS are: * Correspondence: Prof. Dr. Paola Iannetti, La Sapienza Uni- versity, Division of Pediatric Neurology, Viale Regina Elena 324, 00161 Roma, Italy. Fax: +39 6 49979312; E-mail: paola.iannetti@ uniroma1.it. – Genetic predisposition to hereditary neurological diseases. These congenital conditions are very numerous and not always severe and manifest in early ages; – Neonatal and perinatal diseases as prenatal Cy- tomegalovirus and Toxoplasma infections, perina- tal ischemia and/or asphyxia. Moreover, a high incidence of minor neurological signs, perceptual motor difficulties and fine motor skills abnormal- ities have been observed in prematurely born ba- bies, low-birth weight infants and in malnutrition. There is a high rate of preterm children who shows minor neurological signs and/or perceptual motor difficulties in the absence of major neurological impairment [4]. It appears that NSS may emerge as a result of general developmental disability as- sociated with the complications of pregnancy and failure to grow at expected rates [5]. The involve- ment of early malnutrition in the manifestation of NSS is, instead, mainly due to moderate or severe protein-energy uptake deficiency [6]; – Environmental causes including social and eco- nomic situations; – Psychological aspects: mainly learning disabili- ties and Attention Deficit Hyperactivity Disorder (ADHD). The principal NSS in “normal” pediatric population are: – The inability to recognize the familiar objects with tactile manipulation: astereognosis; 1304-2580/05/$17.00  2005 – IOS Press and the authors. All rights reserved