Interface between research and clinical practice in child psychiatry--some personal reflections: discussion paper.
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Child↗
Biomedical subjects
M Rutter
Publications and source records attributed to M Rutter.
Autism diagnostic observation schedule: a standardized observation of communicative and social behavior.
The Autism Diagnostic Observation Schedule (ADOS), a standardized protocol for observation of social and communicative behavior associated with autism, is described. The instrument consists of a series of structured and semistructured presses for interaction, accompanied by coding of specific target behaviors associated with particular tasks and by general ratings of the quality of behaviors. Interrater reliability for five raters exceeded weighted kappas of .55 for each item and each pair of raters for matched samples of 15 to 40 autistic and nonautistic, mildly mentally handicapped children (M IQ = 59) between the ages of 6 and 18 years. Test-retest reliability was adequate. Further analyses compared these groups to two additional samples of autistic and nonautistic subjects with normal intelligence (M IQ = 95), matched for sex and chronological age. Analyses yielded clear diagnostic differences in general ratings of social behavior, specific aspects of communication, and restricted or stereotypic behaviors and interests. Clinical guidelines for the diagnosis of autism in the draft version of ICD-10 were operationalized in terms of abnormalities on specific ADOS items. An algorithm based on these items was shown to have high reliability and discriminant validity.
Adolescent↗
Infantile autism and developmental receptive dysphasia: a comparative follow-up into middle childhood.
An interim follow-up study of a group of "higher functioning" boys with infantile autism and control group of boys with severe (receptive) developmental language disorder (or dysphasia) is reported. The boys were compared both initially and at follow-up for overall functioning in the areas of language, peer relationships, stereotyped behaviors, and disruptive public behaviors, as well as for the presence of a number of specific symptoms. In some respects, the behaviors that differentiated the groups initially did so also at follow-up, although there were important differences. Very few of the autistic boys had good language skills at follow-up, whereas nearly half of the dysphasic group were communicating well, a difference that is striking in view of the initial general similarity between the groups in terms of poor language functioning. However, some of the dysphasic children had developed greater difficulties in peer relationships. The implications for concepts of the nature of the deficit in severe receptive developmental language disorders are considered.
Autistic Disorder↗
Autism diagnostic interview: a standardized investigator-based instrument.
The development of a new standardized investigator-based interview for use in the differential diagnosis of pervasive developmental disorders is described, together with a diagnostic algorithm (using ICD-10 criteria) based on its use. Good interrater reliability for algorithm items was shown between four raters, two in Canada and two in the UK, who rated 32 videotaped interviews. The items also significantly discriminated between 16 autistic and 16 nonautistic mentally handicapped subjects. The algorithm based on ICD-10 identified all 16 autistic individuals and none of the 16 nonautistic subjects.
Adolescent↗
Females with autism and the fragile X.
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Adult↗
Isle of Wight revisited: twenty-five years of child psychiatric epidemiology.
Child psychiatric epidemiology over the last 25 years is reviewed in terms of conceptual and methodological issues arising out of substantive findings. The Isle of Wight surveys undertaken in the mid-1960s are briefly described to establish a starting point, and progress since then is reviewed in terms of topics not originally covered--especially problems in preschool children and specific psychiatric disorders. The use of epidemiology to study causal hypotheses is considered, methodological advances are noted, and challenges for the future are discussed.
Child↗
Child psychiatric disorders in ICD-10.
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Adolescent↗
Mothers' speech to autistic children: a preliminary causal analysis.
Changes over time in the language patterns of autistic children and their parents were examined during the course of a home-based intervention programme. Although the language used by parents to their autistic children was not deficient, language modification procedures were found to lead to rapid changes in the verbal interaction between parents and children. Parents in the non-intervention, control group showed little change in their communication style. In the experimental group, but not in the control group, a close relationship was found between increases in the use of language-eliciting utterances by their mothers and improvements in children's socialized language. The pattern of association between parent and child language suggested that the main effect was of the parent on the child but that the extent of the child's language handicap constrained what could be achieved by treatment.
Autistic Disorder↗
Recognition and expression of emotional cues by autistic and normal adults.
High-functioning autistic adults were compared with normal adults using a battery of tests devised to assess the recognition and expression of emotional cues in both facial and vocal modalities. The autistic subjects were relatively impaired in both the appreciation and production of emotional expressions. Although no one test provided a clear-cut separation of the groups at the individual level, composite scores did separate the groups quite well. It is suggested that this battery of tasks may have some value in family genetic studies of autism that need to identify subclinical deficits that might be aetiologically linked with autism.
Adult↗
Pathways from childhood to adult life.
Principles and concepts of development are reviewed in relation to life-span issues noting the need to consider: development in its social context; timing of experiences; intrinsic and experiential factors; continuities and discontinuities; parallels and differences between normal and abnormal development; heterotypic and homotypic continuities; key life transitions; risk and protective factors; indirect chain affects; mediating mechanisms; age as an index of maturational and experiential factors. Developmental findings from childhood to adult longitudinal studies are reviewed for possible mediating factors. These include: genetic mechanisms; the (non-genetic) biological substrate; shaping of the environment; cognitive and social skills; self-esteem and self-efficacy; habits, cognitive sets and coping styles; links between experiences.
Adolescent↗
Adult personality functioning assessment (APFA). An investigator-based standardised interview.
The development of an investigator-based standardised interview to assess patterns of specific and general social dysfunction is described. It covers six domains of functioning: work; love relationships; friendships; non-intimate social contacts; negotiations; and everyday coping. Inter-rater reliability was tested by three investigators rating 21 audiotaped interviews, and was shown to be high, with an intraclass correlation of 0.87 for the total score. The pattern of associations between specific and general social dysfunction was examined through determination of sensitivities and specificities and through LISREL modelling. The findings varied across social domains but it was concluded that the total APFA score provided a reasonable measure of general social dysfunction.
Adaptation, Psychological↗
Epidemiological approaches to developmental psychopathology.
Developmental psychopathology as a research approach draws on both developmental and psychopathologic perspectives to tackle questions about causal mechanisms. Developmental perspectives are discussed in terms of the implications that flow from age differences in prevalence, age trends in remission of disorders, developmental appropriateness of psychiatric conditions, continuities and discontinuities in psychopathology between childhood and adult life, and age differences in the effects of psychiatric risk factors. Psychopathologic perspectives are considered in terms of continuities and discontinuities between normality and pathology and the contrasts between pervasive and situation-specific disorders, and by the differences between single variables and behavioral composites. The use of epidemiological data to examine causal processes is discussed, with attention to the need to consider development in its social context and to examine indirect, as well as direct, causal chains of connection.
Aging↗
Infantile autism and urinary excretion of peptides and protein-associated peptide complexes.
Sixty-nine early morning urine samples obtained from three groups of young adult males (autistic, mentally handicapped, and a group of men of normal intelligence) were analyzed using the methods described by Trygstad et al. (1980). No consistent patterns of urinary chromatographic profiles were identified. A number of possible contributing factors are discussed in relation to this failure to replicate the results of previous studies.
Adult↗
Fragile X in female autistic twins.
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Adult↗
Selective subcortical abnormalities in autism.
Nine physically healthy, adult autistic men, with normal or near normal intelligence, and 13 healthy male controls were examined in a CT brain scan study. CT scans were analysed with a fully automated computer-assisted program, and regional brain radiodensities were measured with careful attention to artefacts. Autistic patients revealed significantly larger third, but not lateral, ventricular size and significantly lower mean caudate, but equivalent mean frontal and thalamic, radiodensities compared to controls. The sizes of the Sylvian fissures and interhemispheric fissure were equivalent between groups. The findings are consistent with selective subcortical abnormalities in autism.
Adult↗
The assessment of lifetime psychopathology: a comparison of two interviewing styles.
A structured respondent-based version of the SADS-L interview was compared with a semi-structured investigator-based version of the same interview in terms of efficiency in assessing lifetime psychopathology. There was substantial agreement across most Research Diagnostic Criteria (RDC) categories, but there was less agreement on the rating of symptoms. The implications of these similarities and differences between the techniques are discussed.
Adult↗
Cerebral blood flow and metabolism of oxygen and glucose in young autistic adults.
Regional cerebral blood flow, oxygen consumption and glucose consumption were measured by positron emission tomography in six young autistic men. No significant differences were found between patients and normal controls for any of the physiological variables. The results do not substantiate the previous finding of glucose hypermetabolism in autism; the likely reasons for the variance in findings are discussed.
Adult↗
Psychiatric interviewing techniques. A second experimental study: eliciting feelings.
The effects of two experimental interview styles, designed to differ in the extent of their use of active feeling-oriented techniques but similar in their use of active fact-oriented techniques, were compared in initial diagnostic interviews with the mothers of children referred to a psychiatric clinic. The style that employed a higher level of actively responsive feeling-oriented techniques elicited more emotional expression and more often obtained certain feelings of potential diagnostic significance. The actively responsive style was more effective in increasing the amount of feeling expressed if mothers' spontaneous rate of expression was relatively low.
Adolescent↗