Is the search for a unitary explanation of autistic spectrum disorders justified?
Explore the source record for details and available documents.
Autistic Disorder↗
SEARCH · PubMed Health
Results for “Autistic Disorder”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Autistic spectrum disorders.
Explore the source record for details and available documents.
Adolescent↗
Screening for autistic spectrum disorder in children aged 14-15 months. II: population screening with the Early Screening of Autistic Traits Questionnaire (ESAT). Design and general findings.
A two-stage protocol for screening for autistic spectrum disorders (ASD) was evaluated in a random population of 31,724 children aged 14-15 months. Children were first pre-screened by physicians at well-baby clinics using a 4-item screening instrument. Infants that screened positive were then evaluated during a 1.5-h home visit by a trained psychologist using a recently developed screening instrument, the 14-item Early Screening of Autistic Traits Questionnaire (ESAT). Children with 3 or more negative scores were considered to be at high-risk of developing ASD and were invited for further systematic psychiatric examination. Eighteen children with ASD were identified. The group of children with false positive results had related disorders, such as Language Disorder (N = 18) and Mental Retardation (N = 13).
Autistic Disorder↗
Pilot study of a moderate dose multivitamin/mineral supplement for children with autistic spectrum disorder.
OBJECTIVE: Determine the effect of a moderate dose multivitamin/mineral supplement on children with autistic spectrum disorder. DESIGN: Randomized, double-blind, placebo-controlled 3-month study. SUBJECTS: Twenty (20) children with autistic spectrum disorder, ages 3-8 years. RESULTS: A Global Impressions parental questionnaire found that the supplement group reported statistically significant improvements in sleep and gastrointestinal problems compared to the placebo group. An evaluation of vitamin B(6) levels prior to the study found that the autistic children had substantially elevated levels of B6 compared to a control group of typical children (75% higher, p < 0.0000001). Vitamin C levels were measured at the end of the study, and the placebo group had levels that were significantly below average for typical children, whereas the supplement group had near-average levels. DISCUSSION: The finding of high vitamin B(6) levels is consistent with recent reports of low levels of pyridoxal-5-phosphate and low activity of pyridoxal kinase (i.e., pyridoxal is only poorly converted to pyridoxal-5-phosphate, the enzymatically active form). This may explain the functional need for high-dose vitamin B(6) supplementation in many children and adults with autism.
Adult↗
Autistic spectrum disorders in preschool children.
OBJECTIVE: To review existing data on early signs of autistic spectrum disorders (ASD) and on how these disorders can be distinguished from other atypical patterns of development, and to describe a developmental surveillance approach that family physicians can use to ensure that children with these diagnoses are detected as early as possible. QUALITY OF EVIDENCE: MEDLINE was searched from January 1966 to July 2000 using the MeSH terms autistic disorder/diagnosis AND diagnosis, differential AND (infant OR child, preschool). Articles were selected based on relevance to developmental surveillance in primary care and on experimental design, with emphasis on prospective studies with systematic measurement procedures using up-to-date diagnostic criteria. MAIN MESSAGE: Autistic spectrum disorders are characterized by impairments in social interaction and verbal and nonverbal communication, and by preferences for repetitive interests and behaviours. Early signs that distinguish ASD from other atypical patterns of development include poor use of eye gaze, lack of gestures to direct other people's attention (particularly to show things of interest), diminished social responsiveness, and lack of age-appropriate play with toys (especially imaginative use of toys). Careful attention to parents' concerns and specific inquiry into and observation of how children interact, communicate, and play will help ensure that early signs are detected during regular health maintenance visits. CONCLUSION: Family physicians have an important role in early identification of children with ASD. Early diagnosis of these disorders is essential to ensure timely access to interventions known to improve outcomes for these children.
Autistic Disorder↗
Psychiatric family history and neurological disease in autistic spectrum disorders.
The authors obtained neurological assessments and psychiatric family history data for 40 children with autistic spectrum disorders (autism, Asperger syndrome and pervasive developmental disorder). Neurological evaluation included EEG, MRI, karyotyping and positron emission tomography as indicated. Family history data were obtained from family members during long-term follow-up. 20 probands had positive neurological findings, 18 with negative family history. 14 had no neurological findings and positive family histories; they tended to have higher function. Six had neither, and two had both. The segregation of neurological findings and familial affective disorder was highly significant. These findings suggest that an important subgroup of autistic spectrum disorders may be related etiologically to familial major affective disorders, and may represent the early-life onset of a severe phenotype of major affective, particularly bipolar, disease.
Adolescent↗
Measles-mumps-rubella vaccine and autistic spectrum disorder: report from the New Challenges in Childhood Immunizations Conference convened in Oak Brook, Illinois, June 12-13, 2000.
BACKGROUND: Parents and physicians are understandably concerned about the causes and treatment of autism, a devastating disease that affects the entire family. Although much has been learned about autism, there are many gaps in our knowledge about what causes the disorder and how it can be prevented. Autistic symptoms occur along a spectrum, often referred to as autistic spectrum disorder (ASD). Concern has been raised about a possible association between measles-mumps-rubella (MMR) vaccine and inflammatory bowel disease (IBD) and ASD, especially autism with regression. Also, increased requests for educational services related to ASD have raised concerns about possible increases in the incidence of ASD. METHODS: On June 12-13, 2000, the American Academy of Pediatrics (AAP) convened a conference titled "New Challenges in Childhood Immunizations" in Oak Brook, Illinois. At this conference, parents, practitioners, and scientists presented information and research on MMR vaccine and ASD. Attendees included representatives from select AAP committees and sections as well as federal and other organizations that address related issues. The multidisciplinary panel of experts reviewed data on what is known about the pathogenesis, epidemiology, and genetics of ASD and the available data on hypothesized associations with IBD, measles, and MMR vaccine. Supplemental information was requested from authors who have proposed the hypotheses and other experts in relevant areas. RESULTS: Autism is a complex disorder of uncertain and probably multiple etiologies. Genetic predisposition to ASD may involve as many as 10 genes. Many experts believe that the abnormal brain development in autism occurs before 30 weeks' gestation in most instances. In utero rubella is a known cause of autism. Animal model data support the biologic plausibility that exposure to yet unrecognized infectious or other environmental agents could cause ASD. Several factors may contribute to apparent increases in incidence of ASD in recent years. Most data indicate increased recognition and reporting as primary factors, but the epidemiologic data are insufficient to determine if there has been a true increase in the incidence of ASD. Increased reporting of ASD in recent years has occurred long after the introduction of MMR vaccine in the United States in 1971 and widespread use of this vaccine in the 1970s for routine immunization of children at 12 to 15 months of age. Appropriate detailed studies are needed to define the true incidence and prevalence of ASD. Epidemiologic studies in Europe indicate no association between MMR vaccine and ASD. Some children with ASD have gastrointestinal symptoms, but an increased rate of any specific gastrointestinal disorder in children with ASD has not been established. Studies to detect evidence of measles virus in intestinal tissue specimens from patients with IBD or autism with gastrointestinal symptoms have not used uniform techniques. Several laboratories have found no evidence of measles viruses in tissue specimens from patients with IBD, but 2 groups have found evidence of measles virus using different techniques. A group that found evidence of measles virus in affected tissue specimens from patients with IBD has also reported detecting portions of measles virus in peripheral blood lymphocytes and intestinal tissue specimens from patients with autism and gastrointestinal disorders. Finding a portion of a virus using molecular techniques does not constitute evidence for a causal relationship, because some viruses persist in unaffected hosts. Additional controlled studies in several laboratories are needed to determine if portions of measles virus persist in intestinal and other tissues of people with and without gastrointestinal disease and/or ASD. CONCLUSIONS: Although the possible association with MMR vaccine has received much public and political attention and there are many who have derived their own conclusions based on personal experiences, the available evidence does not support the hypothesis that MMR vaccine causes autism or associated disorders or IBD. Separate administration of measles, mumps, and rubella vaccines to children provides no benefit over administration of the combination MMR vaccine and would result in delayed or missed immunizations. Pediatricians need to work with families to ensure that children are protected early in the second year of life from these preventable diseases. Continued scientific efforts need to be directed to the identification of the causes of ASD.
Autistic Disorder↗
Play preferences and behavior of preschool children with autistic spectrum disorder in the clinical environment.
The play of children with autistic spectrum disorder (ASD) is a valuable medium for assessment and intervention, and its analysis has the potential to aid diagnosis. This study investigated spontaneous play behavior and play object preferences for 24 preschool children with ASD in a typical occupational therapy clinical environment. Play behavior was rated and choice of play object noted at 10-second intervals from a 15-minute video recording of unstructured play. Statistical analyses indicated that play behavior was consistent with descriptions in the literature. In addition, the children demonstrated clear preferences for play objects in the form of popular characters (e.g., Thomas the Tank Engine) and those with sensorimotor properties. We propose that the inclusion of preferred play objects in a clinical environment may increase intrinsic motivation to play, and thereby enhance assessment and intervention.
Autistic Disorder↗
Autistic children on followup: change of diagnosis.
The present study compared baseline assessments of 30 autistic children studied at ages 2.8 to 6.3 years (mean = 4.5; median = 4.5) with assessments at followup 0.38 to 14.3 years later (mean = 5.05; median = 4.33). The assessments included diagnosis, Severity of illness, and intellectual functioning. At the time of followup, when they participated in the American Psychiatric Association's DSM-IV Field Trial, the subjects' ages ranged from 5.5 to 19.25 years (mean = 9.60). At followup, a clinical diagnosis of autistic disorder was made in 22 of the 30 children; autistic disorder, residual state was diagnosed in 6 children, and pervasive developmental disorder not otherwise specified (PDDNOS) was diagnosed in 2 children. The group of children who, on followup, no longer met the diagnosis of autistic disorder had lower severity of illness ratings and higher intellectual functioning at baseline and at followup than those children who remained diagnosed as autistic disorder; they also showed a rise in intellectual functioning over time whereas those children who remained diagnosed as autistic did not. Both groups showed decreases in severity of illness over time.
Adolescent↗
[Motivational conflict, attachment "amae" and emotional communication between infants with autistic spectrum disorders and their caregivers].
To date, many researchers in Japan have been working on the assumption that the cause of autistic spectrum disorders is attributable to some disorder in the ability of the child. We have been working on the premise that the autistic spectrum disorders are brought about by some form of relationship disturbances in early infancy, and have been attempting to validate this hypothesis through early intervention. We have been examining the developmental process of affective communication in infants with autistic spectrum disorders. We postulated approach-avoidance motivational conflict (Richer, 1993) as the primary factor impeding development of affective communication, focusing therapeutic intervention on this perspective. As a result, attachment behavior was remarkably improved in the children. Through a clinical course of an example, the problem pertaining to the process of acquiring the function of language cognition is discussed. Starting with the concept that the meaning of any given object is not stipulated as a unique existence, but by context, it is pointed out that in order to relate the meaning of some object to a child, sharing with the child "which" attributes of the object the child should focus upon and "how" it should be dealt with are indispensable. This is then followed by discussion of how this cannot be accomplished without deepening of affective communication upon the basis of attachment formation.
Adult↗
Private Speech and executive functioning among high-functioning children with autistic spectrum disorders.
Private speech used by high-functioning children with autistic spectrum disorders (ASD) (n = 33) during two executive functioning tasks was compared to that of typically developing children (n = 28), and children with ADHD (n = 21). Children with ASD were as likely as others to talk to themselves and their speech was similarly relevant and likely to appear in moments of task difficulty. Unlike others, children with ASD were more likely to get items correct when they were talking than when they were silent. Group differences in performance were observed when children were silent but not when children were talking. Findings suggest that autistic children talk to themselves in relevant ways during problem-solving and that such speech is helpful in normalizing their executive performance relative to controls.
Adolescent↗
Prevalence of autism in a United States population: the Brick Township, New Jersey, investigation.
OBJECTIVE: This study determined the prevalence of autism for a defined community, Brick Township, New Jersey, using current diagnostic and epidemiologic methods. METHODS: The target population was children who were 3 to 10 years of age in 1998, who were residents of Brick Township at any point during that year, and who had an autism spectrum disorder. Autism spectrum disorder was defined as autistic disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger disorder. The study used 4 sources for active case finding: special education records, records from local clinicians providing diagnosis or treatment for developmental or behavioral disabilities, lists of children from community parent groups, and families who volunteered for participation in the study in response to media attention. The autism diagnosis was verified (or ruled out) for 71% of the children through clinical assessment. The assessment included medical and developmental history, physical and neurologic evaluation, assessment of intellectual and behavioral functioning, and administration of the Autism Diagnostic Observation Schedule-Generic. RESULTS: The prevalence of all autism spectrum disorders combined was 6.7 cases per 1000 children. The prevalence for children whose condition met full diagnostic criteria for autistic disorder was 4.0 cases per 1000 children, and the prevalence for PDD-NOS and Asperger disorder was 2.7 cases per 1000 children. Characteristics of children with autism in this study were similar to those in previous studies of autism. CONCLUSIONS: The prevalence of autism in Brick Township seems to be higher than that in other studies, particularly studies conducted in the United States, but within the range of a few recent studies in smaller populations that used more thorough case-finding methods.
Anthropometry↗
The pharmacological treatment of autistic spectrum disorders.
What role do medications play in the overall treatment of autistic spectrum disorders? In this review, the decision-making process involving identifying symptoms, initiating a pharmacological intervention, and monitoring that process is discussed. A review of the literature with an emphasis on controlled trials in autistic spectrum disorders is also undertaken.
Journal Article↗
Clomipramine in autism: preliminary evidence of efficacy.
This report provides preliminary evidence for the efficacy of clomipramine in the treatment of young adults with autistic disorder. Four of five outpatients with autistic disorder showed significant improvement in social relatedness, obsessive compulsive symptoms, and aggressive and impulsive behavior with clomipramine treatment. These findings are consistent with previous evidence, suggesting that serotonin neurotransmission may be relevant to the treatment, and possibly the pathophysiology, of some symptoms of autistic disorder.
Adolescent↗
Autism and other pervasive developmental disorders: exploring the dimensional view.
OBJECTIVE: To examine empirical data on children with autistic disorder (AD), Asperger's disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) for continuities or distinguishing features between disorder and to see to what extent the Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) diagnostic criteria-reflect observed data. METHOD: Studies were identified in 4 ways. 1)A Medline search from 1976 to the present of articles with the key words autism, pervasive developmental disorder, autistic spectrum disorder, and Asperger; of these articles, those with mesh headings or textwords "cluster," which identified cluster analyses deriving pervasive developmental disorder (PDD) subtypes, were retained 2) The Journal of Autistic and Developmental Disorder from 1990 to the present was hand-searched to identify other empirically derived studies on diagnosis, prevalence, classification, and validity of PDD subtypes. 3) Key review articles were searched for their references. 4) The references of all identified articles were searched. RESULTS: Eight cluster studies were retained for their relevance to diagnostic issues, as were 7 empirically derived studies delineating clinic characteristics of children will AD, Asperger's syndrome, or PDD-NOS. Data suggests that children with PDD may fit into 1 of 2 overlapping groups, including a lower-functioning group with greater developmental compromise, social aloofness, and a greater number of autistic symptoms and a higher-functioning group with higher IQ, fewer autistic symptoms, and more prosocial behavior. The PDD subtype resemble each other and can be seen as existing o a continuum, differing only by degree of impairment. CONCLUSION: Children exhibiting the triad of autistic impairments can be seen as suffering from disorders on a PDD continuum. While the DSM-IV does identify a lower-functioning autistic group (AD), the higher-functioning group is less well served. Asperger's disorder as defined in the DSM-IV is not clearly distinguishable from AD and PDD-NOS, and the PDD-NOS subcategory is not operationalized. Further research is required to elaborate criteria for the higher-functioning PDD group, and measures related to etiology, outcome, and treatment response may help determine which diagnostic criteria can meaningfully separate one disorder from another.
Autistic Disorder↗
Children with autistic spectrum disorder and a family history of affective disorder.
This paper compiles the clinical behavioral phenomenology of individuals with autistic spectrum disorder (ASD) with a family history of bipolar affective disorder (BPAD) or major depression and no identified neurological disorder, based on repeated clinical interviews during extended follow-up (ranging from six months to 21 (mean 3.9) years. Their pattern of affective and cognitive symptoms showed notable similarities across the entire group, despite wide variations in severity; was congruent with standard definitions of ASD; showed many features of childhood BPAD, including affective extremes, cyclicity, obsessive traits, special abilities, and regression after initial normal development; and differed from that of autistic children with neurological etiologies. These observations support the concept that ASD in some cases may be etiologically related to BPAD.
Adolescent↗
Etiologic yield of autistic spectrum disorders: a prospective study.
At present, the etiologic yield in community-derived samples of young children with an autistic spectrum disorder is not known. To address this question, all young children (under 5 years of age) referred for an initial assessment to ambulatory pediatric neurology or developmental pediatric clinics at a tertiary university center over an 18-month period for a suspected developmental delay were prospectively identified. Specific diagnostic testing was left to the discretion of the evaluating physician. In all, 50 children with an autistic spectrum disorder were assessed. Detailed history or physical examination was informative with respect to suggesting the possibility of an underlying etiology in a minority (10/50,20%). Genetic studies (FMR-1, karyotype), electroencephalography (EEG), and neuroimaging were carried out in a majority (42/50, 34/50, and 33/50, respectively) of the children, for the most part on a screening rather than an indicated basis (31/42, 34/34, and 28/33, respectively). Etiologic yield was low (1/50, 2%), with only a single child identified with a possible Landau-Kleffner variant on sleep EEG tracing. The results suggest an evaluation paradigm with reference to etiologic determination for young children with autistic spectrum disorder that does not presently justify metabolic or neuroimaging on a screening basis. Recurrence risk and treatment implications, however, suggest that strong consideration be given to genetic (FMR-1, karyotype) testing and EEG study despite a relatively low yield.
Autistic Disorder↗
Gangliosides in cerebrospinal fluid in children with autism spectrum disorders.
Gangliosides are sialic acid-containing glycolipids found in all cells, especially abundant in nerve cells and mainly situated on outer-membrane surfaces. The aim of this study was to provide data on the concentration of gangliosides in the CSF of children and adolescents with autism spectrum disorders (ASD) - 66 with autistic disorder, and 19 with other autism spectrum disorders. The comparison group consisted of 29 children and adolescents, whose CSF had been sampled to exclude acute infectious CNS disorder. The concentrations of the gangliosides GM1, GD1a, GD1b, and GT1b were determined using a microimmunoaffinity technique. The ASD group had a significantly higher concentration of ganglioside GM1 compared with the comparison group. The GM1 increase could not be explained as secondary to other clinical factors. Mean ganglioside levels did not differentiate subgroups with autistic disorder and those with a more atypical clinical picture, nor subgroups with known medical disorders and those with idiopathic autism. Altered patterns of gangliosides in the CNS might reflect important correlates of pathogenesis in autism.
Adolescent↗