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Biomedical subjects

E Fombonne

Publications and source records attributed to E Fombonne.

At least 55 records · Page 3Linked to original sources
PubMed1997

Autism and associated medical disorders in a French epidemiological survey.

OBJECTIVE: To estimate the prevalence of autism, to assess the strength of its association with specific medical disorders, and to test for a secular increase in its incidence. METHOD: An epidemiological survey was conducted among 325,347 French children born between 1976 and 1985 and living in three different French départements. Diagnosis, educational level, and associated medical conditions were abstracted from the records of children known to local educational authorities. Data were also pooled with those from another similar survey. RESULTS: One hundred seventy-four children (mean age: 11.6 years) with autism were identified. The prevalence rate was 5.35/10,000 (16.3/10,000 if other pervasive developmental disorders are included), with no difference according to geographical area or social class. Rates of medical conditions were as follows: 1.1% for tuberous sclerosis, 2.9% for chromosomal abnormalities including fragile X, 2.9% for cerebral palsy, 4.6% for sensory impairments, 0.6% for neurofibromatosis, 0.6% for congenital rubella, and 1.7% for Down syndrome. In the combined sample of 328 children with autism, the level and pattern of medical correlates were comparable, with tuberous sclerosis having a consistently strong association with autism. Prevalence rates were similar in successive birth cohorts. CONCLUSION: Medical disorders (excluding epilepsy and sensory impairments) accounted for fewer than 10% of the cases of autism. No secular increase in the prevalence of autism was found.

Adolescent↗
PubMed1997

Diagnosing autism: analyses of data from the Autism Diagnostic Interview.

Results from ROC curves of items from two scales, the Autism Diagnostic Interview (ADI) and Autism Diagnostic Interview-Revised (ADI-R), operationalizing DSM-IV criteria for autism are presented for 319 autistic and 113 other subjects from 8 international autism centers. Analyses indicate that multiple items were necessary to attain adequate sensitivity and specificity if samples with varying levels of language were considered separately. Although considering only current behavior was generally sufficient when a combination cutoff and additive model was employed, predictive power was highest when history was taken into account. A single set of criteria, as operationalized by individually structured questions in the ADI/ADI-R, was effective in differentiating autism from mental handicap and language impairment in subjects with a range of chronological ages and developmental levels.

Adolescent↗
PubMed1997

A family study of autism: cognitive patterns and levels in parents and siblings.

First-degree relatives of 99 autism probands and of 36 Down's syndrome controls were assessed with standardised tests of intellectual functioning, reading, and spelling. Higher mean verbal IQ scores, and discrepancies in favour of verbal scores, were characteristic of autism relatives. No consistent differences were found on performance scales, reading, and spelling tests. Among autism relatives, siblings affected with the broad phenotype of autism had significantly lower IQ scores and poorer reading and spelling performances than unaffected siblings. However, the small size of the cognitive difference and the lack of a distinctive cognitive profile indicates that standardised cognitive measures used in this study are unlikely to improve the operationalised definition of the broad phenotype of autism. The slightly superior verbal performance of relatives in the autism group might represent some form of heterozygote advantage.

Adolescent↗
PubMed1997

[Children of the GAZEL Cohort: I--Prevalence of contacts with the medico-educational system for psychological reasons, and associated factors].

An epidemiological survey of French children aged 4 to 16 was conducted in order to estimate the 12-months rates of service utilization for psychological reasons and to assess the factors associated with service use in this community sample. A large sample of 2582 children and adolescents was recruited from the families whose one parent was employed by the national electricity and gaz company (EDF-GDF). Of these employees, 20,000 have volunteered for a long-term prospective cohort study of their health and, since 1989, they have participated to annual surveys and additional ad hoc research programmes. Families with a child aged 4 to 16 in 1991 were selected. Only one child was selected in each family, and the sample was stratified by socio-economic status and family size according to census data. A survey questionnaire comprising a valid measure of child psychopathology (Child Behavior Checklist: CBCL) and an additional questionnaire including questions related to service use was used as a means of data collection. The response rate was 62.2% and factors associated with participation in the survey were analysed. The 12-months prevalence rate of contact for psychological motives were: 42.3% for general practitioners and family doctors, 7.8% for speech and language therapists, 9.5% for educational specialists, and 6.0% for mental health professionals. With the exception of general practitioners, rates of service contact were significantly higher for boys. Logistic regression analysis was used to identify separately factors associated with recent contact for each category of professionals. Results showed that, for all professionals, high scores on the CBCL measure was significantly associated with service use, the strongest association being found for mental health professionals. Family structure was also predictive of the latter, with higher rates of contacts for those children living in families whose parents are divorced, separated or widowed. Some differences for contacts with doctors were found according to the region; otherwise, no effects of socio-economic status, educational level of the parent, or other socio-economic indicators were found to predict service utilization. The implications for services are discussed.

Adolescent↗
PubMed1997

[Children from the GAZEL cohort: II--motive for contact with the medical-educational system by age and sex].

An epidemiological survey of 2582 French children aged 4 to 16 has been conducted to assess patterns of service use in relation to psychological disturbances. Details on the design, sample, survey instruments, response rate, and 12-months prevalence rates of contacts with a range of different professionals were presented in a previous article. In this second article, the psychological motives leading to contact with family doctors, school-based professionals, speech and language therapists, and mental health specialists are analyzed. The age and gender effects are assessed for each motives. On the whole, consistent sex differences were found for the types of complaints presented by service users, with emotional symptoms being more frequent amongst girls, and behavioural, developmental and learning difficulties being more frequent amongst boys. Mental health specialists were attended for a variety of reasons. Family doctors were contacted for minor emotional difficulties. Because family doctors were consulted by a high proportion of children and adolescents of our sample, the role of this professionals in the detection and management of minor psychological morbidity is emphasized.

Adolescent↗
PubMed1996

Is bulimia nervosa increasing in frequency?

OBJECTIVE: To assess whether or not claims of an increase in the incidence of bulimic disorders are empirically justified. METHOD: Review of the epidemiological data informative to gauge time trends: Studies based on hospital records or registers, community surveys of bulimic disorders, questionnaire-based investigations. RESULTS: Epidemiological studies conducted since 1980 do not show an upward trend in rates. Reports of increased rates among recent birth cohorts were unreliable and did not control for confounding comorbid disorders. Changes in diagnostic and referral practices are likely to account for higher numbers of patients seen in specialized treatment centers. DISCUSSION: Although based on a limited number of studies, the empirical evidence does not support secular changes in the incidence of bulimic disorders. In keeping with this conservative conclusion, it is noted that high rates of dieting and body dissatisfaction were already reported 30 years ago among adolescent girls.

Adolescent↗
PubMed1996

Ethnicity and adolescent deliberate self-harm

The characteristics of all adolescents referred to the psychiatric service of a tertiary hospital following an episode of deliberate self-harm (DSH) were studied. Of 100 adolescents selected over a 3-year period, 64 White and 28 Black adolescents were compared to identify factors associated with DSH in Black adolescents. The main findings were: (1) the referral rate for Black adolescents was in proportion to the community composition; (2) the characteristics of Black and White adolescents referred following DSH were similar for background socio-demographic variables, psychiatric symptoms, circumstances of the attempt and outcome. However, more social stress was reported in the Black group.

Journal Article↗
PubMed1995

Anorexia nervosa. No evidence of an increase.

BACKGROUND: This paper examines the evidence that rates of anorexia nervosa have increased over time. METHOD: Epidemiological studies that have provided time trends in incidence rates in specific countries or psychiatric registers and prevalence surveys were reviewed to assess whether or not prevalence estimates are higher in the most recent studies. RESULTS: Estimated trends in incidence rates showed an increase but no study ruled out plausible alternative explanations. Studies showing no upward trend were as numerous and were generally based on larger samples. Analysis of 29 cross-sectional surveys conducted over the last 25 years indicated that the median prevalence rate was 1.3 per 1000 females. There was no indication that more recent surveys yielded higher prevalence rates. CONCLUSION: Anorexia nervosa remains a rare disorder and there is no evidence of a secular increase in its incidence.

Adolescent↗
PubMed1994

Increased rates of depression: update of epidemiological findings and analytical problems.

The evidence for an increased incidence of rates of depressive conditions, defined as depressed mood, depressive syndromes or depressive disorders, is reviewed. Findings from prospective studies, family genetic studies, community surveys, repeated cross-sectional surveys, admission data and suicide statistics are summarized. Methodological problems and difficulties in the analysis and interpretation of these results are then summarized. Because converging results from studies conducted with various designs, sampling and measurement strategies are convergent, it is concluded that the increase over time of depressive phenomena is a plausible finding. However, its magnitude remains unknown and is probably smaller than sometimes claimed. Furthermore, studies have failed to demonstrate that the increase in rates was specific to depressive conditions. Finally, it is noted that these epidemiological enquiries have failed to provide cues on the possible mechanisms underlying these secular changes.

Adolescent↗
PubMed1994

The Chartres Study: I. Prevalence of psychiatric disorders among French school-age children.

A survey of child psychiatric disorders was conducted in a community sample of 2441 French school-aged children selected from 18 public and private schools; children attending special classes were oversampled. A two-stage survey design was used to identify disorders. Measures were the Child Behavior Checklist and the Rutter teacher scale for screening. The Isle of Wight parental interview was used in the second phase for 217 home interviews, along with the Children Global Assessment Scale as an index of impaired functioning. Response rates were excellent, and non-respondents in the screening phase were shown to have higher levels of psychopathology as gauged by their teacher scale scores. Several weights were used in the analysis to adjust for differential probabilities of selection and participation in each survey phase. The overall prevalence rate among 8-11-year-olds was estimated to be 12.4% (5.9% for more severe disorders), with roughly equal rates of disruptive and emotional disorders (6.5% and 5.9%). Prevalence was higher in boys (15.0%) than in girls (9.5%), owing to a threefold increase in their frequency of conduct disturbances. Rates of disturbance were twice as high among children with special educational needs, while no difference was found between private and public schools. The frequency of behavioural problems appeared to be similar in the urban and semi-rural subsamples.

Anxiety Disorders↗
PubMed1993

The Vineland Adaptive Behavior Scale in a sample of normal French Children: a research note.

The Vineland Adaptive Behavior scale (survey form) was used in a sample of 151 normal children under age 18. Standardized mean scores of French children were comparable to those of the American normative sample. From the age of 6 onwards, French children scored consistently lower in the Daily Living Skills domain though the magnitude of this difference remained moderate. While the overall findings support the cross-cultural stability of the psychometric properties of this instrument, attention is drawn to potential problems in the use of the Vineland scales, with special reference to autistic samples.

Activities of Daily Living↗
PubMed1993

[Contribution of epidemiology to etiological research in psychiatry: from risk factors to risk mechanisms].

Over the last 25 years, the burgeoning of psychiatric epidemiology has generated a considerable knowledge base on the prevalence and incidence of psychiatric disorders. For most disorders, risk factor research has also led to the identification of vulnerability factors in the genetic, biological, psychological and social arenas. However, the delineation of psychopathological mechanisms requires a better understanding of the developmental connexions and sequences of intervention of the postulated risk factors. Similarly, psychopathological models should benefit from the study of protective influences and processes. The importance of longitudinal approaches to the study of causation in psychopathology is emphasized. While future research endeavors need to be theory-driven and to rely on more sophisticated measurement strategies, etiological research in psychiatry will continue to benefit from the range of research methods provided by epidemiology.

Adolescent↗
PubMed1992

Prevalence of infantile autism in four French regions.

A survey conducted in four French regions identified a sample of 154 autistic children born in the birth cohorts 1972 and 1976. Their mean ages were respectively 6.9 and 5.5 years when their handicaps were registered to local administrative services. The overall prevalence estimate is 4.9/10,000, with little difference between the two cohorts. The boy/girl sex ratio is 2.1:1, and more than two thirds are mentally retarded. The SES distribution does not deviate from census data. An elevated incidence of epilepsy is found (22%), with higher rates among the most retarded subjects and those with perinatal antecedents. Otherwise, relatively few autistic subjects were reported to have a clearcut medical disorder known for its association with autism.

Autistic Disorder↗
PubMed1992

Diagnostic assessment in a sample of autistic and developmentally impaired adolescents.

A sample of 43 autistic and developmentally impaired adolescents were assessed with the Autism Diagnostic Interview (ADI), DSM-III-R criteria, and the clinician's diagnosis. DSM-III-R criteria for autism have low specificity and agree poorly with the other two definitions. Detailed results of the ADI are provided that confirm the usefulness and discriminant validity of this semi-structured diagnostic interview in a sample of very retarded autistic subjects.

Activities of Daily Living↗
PubMed1991

The use of questionnaires in child psychiatry research: measuring their performance and choosing an optimal cut-off.

This paper introduces the basic principles of Receiver Operating Characteristics (ROC) analysis, a technique to evaluate and compare the discriminant power of questionnaires employed in psychiatric research. ROC curves may assist in the selection of an optimal cut-off point, which has been shown to depend upon the prevalence rate, the consequences of correct and incorrect classifications, and the distributions of scale scores among normal individuals and cases. Then, ROC analysis is applied to the Child Behavior Checklist on a sample of 564 6-11-year old French children. The performances of the social competence scales of this instrument are poorer than those of the behavior problem scales. The findings suggest also that the cut-offs should be varied within this same age group and be higher for screening in community surveys. Further applications of ROC analysis are discussed.

Affective Symptoms↗
PubMed1989

The Child Behaviour Checklist and the Rutter Parental Questionnaire: a comparison between two screening instruments.

In order to carry out an epidemiological survey of child psychiatric disorders in a community sample, the Child Behaviour Checklist was chosen as a parental questionnaire for screening in the first stage of the study. A French version of this instrument was developed and a pilot study of the scale was completed on a clinical sample (N = 127). As a criterion to gauge its validity, the Rutter scale was used as a concurrent measure. The correlation coefficient between the total scores of the two scales is 0.79, and ranges between 0.22 and 0.96 for individual items. A linear regression analysis, using the total score of the Rutter scale as an independent variable, predicts a value of 41 as the optimal cut-off to be used for the Child Behaviour Checklist. Comparative properties (reliability and time of completion) of the two scales are presented and discussed.

Child↗
PubMed1989

Season of birth and childhood psychosis.

This paper reports a test of the hypothesis that winter birth is a risk factor for childhood psychosis. All psychotic children (n = 208) admitted to a day-treatment facility in Paris from 1960 through to 1986 were compared with 1040 controls matched by sex and year of birth. Risk ratio estimates were computed for each month, and a significant increase was observed for boys born in December. This association was stronger in some years than in others. The fact that there were no excesses in contiguous months detracts from the persuasiveness of this association.

Age Factors↗