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PubMed2005

Neural mechanisms of imitation and 'mirror neuron' functioning in autistic spectrum disorder.

An association between autistic spectrum disorder and imitative impairment might result from dysfunction in mirror neurons (MNs) that serve to relate observed actions to motor codings. To explore this hypothesis, we employed a functional magnetic resonance imaging (fMRI) protocol previously used to identify the neural substrate of imitation, and human MN function, to compare 16 adolescent males of normal intelligence with autistic spectrum disorder (ASD) and age, sex and IQ matched controls. In the control group, in accord with previous findings, we identified activity attributable to MNs in areas of the right parietal lobe. Activity in this area was less extensive in the ASD group and was absent during non-imitative action execution. Broca's area was minimally active during imitation in controls. Differential patterns of activity during imitation and action observation in ASD and controls were most evident in an area at the right temporo-parietal junction also associated with a 'theory of mind' (ToM) function. ASD participants also failed to show modulation of left amygdala activity during imitation that was evident in the controls. This may have implications for understanding the imitation of emotional stimuli in ASD. Overall, we suggest that ASD is associated with altered patterns of brain activity during imitation, which could stem from poor integration between areas serving visual, motor, proprioceptive and emotional functions. Such poor integration is likely to adversely affect the development of ToM through imitation as well as other aspects of social cognitive function in ASD.

Adolescent↗
PubMed2005

Clinical experience with Topiramate to counteract neuroleptic induced weight gain in 10 individuals with autistic spectrum disorders.

Children and adolescents with autistic spectrum disorders are treated with neuroleptics to limit behavioral disturbances such as aggression, hyperactivity and self-injury. They may experience substantial weight gain when undergoing treatment with atypical antipsychotics actually employed. Topiramate (TPM) is an antiepileptic medication that is being progressively demonstrating a wider spectrum of action, mainly as an agent for weight control and as a mood stabilizer. It was administered to a group of children and adolescents with autistic spectrum disorders with the aim of reversing weight gain. This is an open study over an observation period of 18 months of 10 children and adolescents, eight males and two females, mean age 13 years, SD+/-3.6, range 8-19 years with a diagnosis of autistic disorder or pervasive developmental disorder not otherwise specified according to DSM-IV. Starting dosage of TPM was 0.5 mg/kg followed by titration of 0.5 mg/kg on a weekly basis, up to 1-3 mg/kg/day as the maintenance dosage. Eight subjects were undergoing long-term treatment with risperidone, one with pimozide and one was temporarily not on antipsychotics. Six patients took TPM on a regular basis and four dropped out. Variable degrees of weight reduction were observed in four patients, two subjects showed weight increase. Behavioral adverse effects were observed in three patients causing rapid withdrawal of the medication. TPM should be used with caution in autistic spectrum disorders because this population has a high risk of behavioral disruption.

Adolescent↗
PubMed2002

The Diagnostic Interview for Social and Communication Disorders: algorithms for ICD-10 childhood autism and Wing and Gould autistic spectrum disorder.

BACKGROUND: The Diagnostic Interview for Social and Communication Disorders (DISCO) is an interviewer-based schedule for use with parents and carers. In addition to its primary clinical purpose of helping the clinician to obtain a developmental history and description of the child or adult concerned, it can also be used to assist in providing a formal diagnostic category. METHOD: In this study we compared two algorithms based on the ninth revision of the schedule (DISCO 9). The algorithm for ICD-10 childhood autism comprised 91 individual, operationally defined items covering the behaviour outlined in the ICD-10 research criteria. The algorithm for the autistic spectrum disorder, as defined by Wing and Gould (1979), was based on 5 DISCO items that represented overarching categories of behaviour crucial for the diagnosis of autistic disorders. The aim of the study was to examine the implications for clinical diagnosis of these two different approaches. Parents of 36 children with clinical diagnoses of autistic disorder, 17 children with learning disability and 14 children with language disorders were interviewed by two interviewers. Algorithm diagnoses were applied to interview items in order to analyse the relationship between clinical and algorithm diagnoses and the inter-rater reliability between interviewers. RESULTS: Clinical diagnosis was significantly related to the diagnostic outputs for both algorithms. Inter-rater reliability was also high for both algorithms. The ICD childhood disorder algorithm produced more discrepant diagnoses than the Wing and Gould autistic spectrum algorithm. Analysis of the ICD-10 algorithm items and combination of items helped to explain the reason for these discrepancies. CONCLUSIONS: The results indicate that the DISCO is a reliable instrument for diagnosis when sources of information are used from the whole interview. It is particularly effective for diagnosing disorders of the broader autistic spectrum.

Adolescent↗
PubMed2000

Catatonia in autistic spectrum disorders.

BACKGROUND: The clinical pictures of autistic spectrum disorders include features described in catatonia. AIMS: To examine the severe exacerbation of the catatonic features of autistic disorders in adolescence or early adult life, which occurs in some individuals. METHOD: A semi-structured interview schedule was used to collect information from parents or other care-givers concerning 506 referrals to a specialist clinic for autistic spectrum disorders. Individuals with severe exacerbation of catatonic features were compared with a same-age group of referrals without this type of deterioration in skills and behaviour. RESULTS: Seventeen per cent of referrals aged 15 or over had severe exacerbation of catatonic features. They were significantly more likely than the comparison group to have had, before the onset of the change in behaviour, impaired language and passivity in social interaction. CONCLUSIONS: Catatonia is a later complication of autistic spectrum disorders, which adds considerably to the burden of caring. More research is needed to identify causes, neuropathology, and early signs of vulnerability.

Activities of Daily Living↗
PubMed2006

Antibrain antibodies in children with autism and their unaffected siblings.

Serum autoantibodies to human brain, identified by ELISA and Western immunoblotting, were evaluated in 29 children with autism spectrum disorder (22 with autistic disorder), 9 non-autistic siblings and 13 controls. More autistic subjects than controls had bands at 100 kDa in caudate, putamen and prefrontal cortex (p<0.01) as well as larger peak heights of bands at 73 kDa in the cerebellum and cingulate gyrus. Both autistic disorder subjects and their matched non-autistic siblings had denser bands (peak height and/or area under the curve) at 73 kDa in the cerebellum and cingulate gyrus than did controls (p<0.01). Results suggest that children with autistic disorder and their siblings exhibit differences compared to controls in autoimmune reactivity to specific epitopes located in distinct brain regions.

Autistic Disorder↗
PubMed1993

Receptor inhibition by immunoglobulins: specific inhibition by autistic children, their relatives, and control subjects.

Forty-two parents of children with autistic disorder, 15 children with autistic disorder, 17 siblings of children with autistic disorder, and 12 unrelated normal adult controls were studied to determine if immunoglobulins isolated from their plasma would inhibit binding of the 5HT1A agonist, [3H]-8-hydroxy-N,N-dipropyl-2-aminotetralin (DPAT) to 5HT1A receptors in human hippocampal membranes. There were no significant differences among the means of percentage inhibition of DPAT binding of parents, children with autistic disorder, siblings, or unrelated controls. In addition, there were no differences in the proportion of subjects with > 15% DPAT inhibition among autistic children, their parents, their siblings, or unrelated controls. Immunoglobulin inhibition was not specific for the 5HT1A receptor binding site, since immunoglobulins inhibited binding to 5HT2, D1, D2, and alpha 2-adrenergic binding sites. The immunoglobulins isolated from normal controls inhibited [3H]-rauwolscine binding at alpha 2-adrenergic sites less than immunoglobulins of children with autistic disorder and their parents and siblings. This study did not support the hypothesis that autoantibodies to 5HT1A or 5HT2 receptors are characteristic of autistic disorder.

Adolescent↗
PubMed2005

The potential importance of steroids in the treatment of autistic spectrum disorders and other disorders involving mercury toxicity.

Autism is a neurodevelopmental disorder that according to the Centers for Disease Control and Prevention (CDC) affects 1 in 150 children in the United States. Autism is characterized by impairments in social relatedness and communication, repetitive behaviors, abnormal movements, and sensory dysfunction. Recently emerging evidence suggests that mercury, especially from childhood vaccines, appears to be a factor in the development of the autistic disorders, and that autistic children have higher than normal body-burdens of mercury. In considering mercury toxicity, it has previously been shown that testosterone significantly potentates mercury toxicity, whereas estrogen is protective. Examination of autistic children has shown that the severity of autistic disorders correlates with the amount of testosterone present in the amniotic fluid, and an examination of a case-series of autistic children has shown that some have plasma testosterone levels that were significantly elevated in comparison neurotypical control children. A review of some of the current biomedical therapies for autistics, such as glutathione and cysteine, chelation, secretin, and growth hormone, suggests that they may in fact lower testosterone levels. We put forward the medical hypothesis that autistic disorders, in fact, represents a form of testosterone mercury toxicity, and based upon this observation, one can design novel treatments for autistics directed towards higher testosterone levels in autistic children. We suggest a series of experiments that need to be conducted in order to evaluate the exact mechanisms for mercury-testosterone toxicity, and various types of clinical manipulations that may be employed to control testosterone levels. It is hoped by devising therapies that address the steroid hormone pathways, in addition to the current treatments that successful lower heavy metal body-burdens of mercury, will work synergistically to improve clinical outcomes. In light of the fact that there are a number of other diseases that may have a chronic mercury toxicity component, such as Alzheimer's disease, heart disease, obesity, ALS, asthma, and other various forms of autoimmune disorders, it is imperative that further research should be conducted to understand mercury-testosterone toxicity.

Autistic Disorder↗
PubMed2007

Using virtual environments for teaching social understanding to 6 adolescents with autistic spectrum disorders.

Six teenagers with Autistic Spectrum Disorders (ASDs) experienced a Virtual Environment (VE) of a café. They also watched three sets of videos of real cafés and buses and judged where they would sit and explained why. Half of the participants received their VE experience between the first and second sets of videos, and half experienced it between the second and third. Ten naïve raters independently coded participants' judgments and reasoning. In direct relation to the timing of VE use, there were several instances of significant improvement in judgments and explanations about where to sit, both in a video of a café and a bus. The results demonstrate the potential of Virtual Reality for teaching social skills.

Adolescent↗
PubMedDate not supplied

Asperger's disorder: a review of its diagnosis and treatment.

Asperger's disorder is a pervasive developmental disorder that shares similar features of social impairment disorder, restricted interests, and repetitive behaviors with autistic disorder. Although both Asperger's disorder and autistic disorder persist into adulthood, autistic disorder is usually apparent before the age of 3, while Asperger's disorder usually manifests itself at preschool age. Asperger's disorder in the majority of cases is not associated with delay in language development and there is an increased likelihood to seek social interactions and to engage in activities and friendship with others. In contrast to autistic disorder, most Asperger's disorder patients have normal intellectual functioning and some have motor clumsiness. Although the etiology of Asperger's disorder is still undetermined, this article will review the assessment and treatment interventions that could improve the prognosis of this illness. The historical background, epidemiology, diagnostic features, differential diagnosis, and course and overall management/treatment of Asperger's disorder will be discussed. Despite the absence of a cure for Asperger's disorder, the awareness of its distinctive clinical features that differentiate it from autistic disorder could improve its prognosis and differentiate response to treatment and comorbid conditions.

Asperger Syndrome↗
PubMed1998

Relation between blindness due to retinopathy of prematurity and autistic spectrum disorders: a population-based study.

Children with blindness due to retinopathy of prematurity (ROP)--who are at greatly increased risk of cerebral damage--have been noted to have a high rate of autistic symptoms, but systematic controlled studies have been lacking. A controlled population-based study was performed; one group was blind due to ROP (N=27) and the other was congenitally blind due to hereditary retinal disease (N=14). Fifteen of the 27 children with ROP had autistic disorder. All these children were mentally retarded and about one-third of them had cerebral palsy. In the comparison group, two of the 14 children had autistic disorder. It is concluded that there is a strong association between ROP and autistic disorder. The association is most probably mediated by brain damage and is largely independent of the blindness per se.

Adolescent↗
PubMed1992

[Demonstration of cerebral lateralisation disorder in autistic children: study of auditory reactivity by transcranial pulsed Doppler].

Transcranial Doppler Ultrasonographic recordings of the middle cerebral arteries were performed on children with autistic behavior (AUT), compared to retarded children without autistic behavior (NON-AUT) and normal children (NOR). Blood flow measurements (resistance index) were performed at rest and during auditory stimulations. Compared to NOR and NON-AUT, significant differences of the resistance index were found in AUT on the left side, thus suggesting differences in metabolic mechanisms evoked by auditory stimulations. This result confirms the hypothesis of abnormal development of cerebral lateralization in autism.

Autistic Disorder↗
PubMed2001

Autistic spectrum disorders in Möbius sequence: a comprehensive study of 25 individuals.

The prevalence of autistic disorder was analysed in 25 individuals with Möbius sequence, a disorder with brain-stem dysfunction. The sample consisted of 18 males and seven females (20 participants were aged 2 to 22 years, and five were aged 1, 19 and 23 months, and 55 years old). Participants were recruited after a nationwide call and were part of a multidisciplinary study of individuals with Möbius sequence. They were given a meticulous neuropsychiatric examination including standardized autism diagnostic interviews. Ten individuals had an autistic spectrum disorder. Six of these met all diagnostic criteria for autism. In 23 individuals cognitive development could be assessed. Eight of those 23 patients had clear learning disability and six individuals were functioning in the normal but subaverage range. Autistic spectrum disorder and learning disability occurred in more than a third of the examined patients. Considering the hospital-based nature of the sample, these findings may be overestimates. Nevertheless, awareness of this coexistence is important in the diagnosis and habilitation care of children with Möbius sequence. Moreover, the results provide further support for the notion of a subgroup of autistic spectrum disorders being caused by first trimester brain-stem damage.

Adolescent↗
PubMed2000

Counseling parents regarding prognosis in autistic spectrum disorder.

A triaxial model for autistic spectrum disorder (ASD) is presented, incorporating age, degree of intelligence, and severity of autistic features. As the name implies, ASD can vary in degree of expression from minimal to profound. Furthermore, the symptoms of ASD change in predictable ways with the passage of time. For example, echolalia during early childhood may be replaced by verbal literalism and difficulty with verbal humor during later childhood or adolescence. The prognosis for children with ASD is governed by the joint impact of the degree of expression of ASD and the degree of developmental delay, if any. All combinations of ASD and intellect are possible (ie, severe ASD plus severe mental retardation, severe ASD plus normal general intelligence, and so forth). The relationship among these 3 parameters-severity of ASD, level of general intelligence, and change in symptom expression over time, is represented schematically as a 3-dimensional graph. The utility of this graph as a counseling tool, and as the basis for future research on the prognosis of ASD are discussed.

Age Factors↗
PubMed1987

[Reproduction of picture stories by autistic, learning disordered and normal children].

Autistic, learning disabled and young normal children (9 each) matched for mental age were shown 6 sets of picture cards and asked to answer questions about the pictures, arrange the cards in the correct sequence and tell the story. The picture descriptions and the stories the children told were analyzed with reference to the concept of story schemes to identify the comprehension deficits peculiar to the autistic group. The autistic children had great difficulty in making the correct associations between the different elements of the action sequences and in recognizing the motives of the interacting persons.

Adolescent↗
PubMed2005

Autoextraction in a child with autistic spectrum disorder.

Many children with mild/moderate autistic spectrum disorder (ASD) receive care in general dental practice. We report a seven year old boy with ASD presenting with dental pain who auto-extracted one of his deciduous canines. Children with ASD may have hyposensitivity to pain and can exhibit unusual forms of self-injurious behaviour.

Autistic Disorder↗
PubMed2005

Autistic-spectrum disorders: lessons from neuroimaging.

Autistic-spectrum disorder is approximately half as common as schizophrenia but its cause remains unknown. Recent studies have begun to clarify the underlying neuroanatomical abnormalities and brain-behaviour relationships in autism. In the past decade, great advances have been made in our understanding of the neurobiological basis of autism.

Autistic Disorder↗