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PubMed2003

The yield of the medical evaluation of children with pervasive developmental disorders.

Little information is available regarding the yield of the medical evaluation of children diagnosed with pervasive developmental disorder-not otherwise specified (PDD-NOS) compared to children diagnosed with autistic disorder. Medical records were reviewed for 182 patients less than 18 years of age with either PDD-NOS or autistic disorder evaluated between 1994 and 1998 at Mayo Clinic. A condition likely to be etiologically relevant was identified in 6/117 (5.1%) patients diagnosed with PDD-NOS and 2/65 (3.1%) patients diagnosed with autistic disorder. Genetic disorders, both chromosomal and single-gene, were the most commonly identified conditions. Seizure disorders, electroencephalogram abnormalities, and anomalies on brain imaging were common in both groups. The likelihood of uncovering an etiologically relevant condition in children diagnosed with either PDD-NOS or autistic disorder may be equivalent. The scope of the etiological search in an individual patient with an autistic spectrum disorder should not be limited by the specific diagnostic category.

Adolescent↗
PubMed2006

Music therapy in the assessment and treatment of autistic spectrum disorder: clinical application and research evidence.

BACKGROUND: Children and adolescents with autistic spectrum disorder (ASD) presenting with significant limitations in conventional forms of verbal and non-verbal communication are found to respond positively to music therapy intervention involving both active, improvizational methods and receptive music therapy approaches. Improvizational musical activity with therapeutic objectives and outcomes has been found to facilitate motivation, communication skills and social interaction, as well as sustaining and developing attention. The structure and predictability found in music assist in reciprocal interaction, from which tolerance, flexibility and social engagement to build relationships emerge, relying on a systematic approach to promote appropriate and meaningful interpersonal responses. RESULTS: Published reports of the value and effectiveness of music therapy as an intervention for children with ASD range from controlled studies to clinical case reports. Further documentation has emphasized the role music therapy plays in diagnostic and clinical assessment. Music therapy assessment can identify limitations and weaknesses in children, as well as strengths and potentials. Research evidence from a systematic review found two randomized controlled trials that examined short-term effects of structured music therapy intervention. Significant effects were found in these studies even with extremely small samples, and the findings are important because they demonstrate the potential of the medium of music for autistic children. Case series studies were identified that examined the effects of improvizational music therapy where communicative behaviour, language development, emotional responsiveness, attention span and behavioural control improved over the course of an intervention of improvizational music therapy.

Adolescent↗
PubMed2006

Intellectual ability, self-perceived social competence, and depressive symptomatology in children with high-functioning autistic spectrum disorders.

Although social competence deficits in children with high-functioning autistic spectrum disorders (HFASD) are well documented, there is little research investigating self-perceptions of social limitations. This study replicated research showing a negative association between self-perceived social competence and intellectual ability and investigated associations between self-perceived social competence and depressive symptomatology. Participants were 22 children with HFASD, aged 7-13 years with intelligence quotient (IQ) scores of 82-141. Parent- (N = 18) and teacher- (N = 17) rated social competence was lower for children with HFASD compared with a normative sample. Higher age and IQ predicted lower levels of self-perceived social competence, and low self-perceived social competence predicted higher levels of depressive symptomatology. Almost a third of children rated themselves for depression; parent ratings suggested even higher levels.

Adolescent↗
PubMed1992

The validity of autistic spectrum disorders: a literature review.

The objective of this literature review is to assess the validity of autistic spectrum disorders (ASD). Twenty papers were identified that adequately investigated the internal or external validity of various subtypes of ASD. At least three groups can be distinguished from autism on clinical grounds; an Asperger syndrome subtype, and two atypical subtypes characterized by low IQ and high IQ. However, the evidence that these clinical distinctions carry inferences with respect to etiology, clinical course, and treatment is only suggestive. Nevertheless, the specification of several ASD subtypes might promote further research and resolve many of the nosologic issues with respect to the classification of pervasive developmental disorders (PDDs).

Autistic Disorder↗
PubMed2005

Neural correlates of executive function in autistic spectrum disorders.

BACKGROUND: Some clinical characteristics of high-functioning individuals with autistic spectrum disorder (ASD) such as repetitive stereotyped behaviors, perseveration, and obsessionality have been related to executive function (EF) deficits, more specifically to deficits in inhibitory control and set shifting and mediating frontostriatal neural pathways. However, to date, no functional imaging study on ASD has investigated inhibition and cognitive flexibility and no one has related EF brain activation to brain structure. METHODS: We compared brain activation (using functional magnetic resonance imaging) in 10 normal intelligence adults with ASD and 12 healthy control subjects during three different EF tasks: 1) motor-inhibition (GO/NO-GO); 2) cognitive interference-inhibition (spatial STROOP); and 3) set shifting (SWITCH). Using voxel-based morphometry, we investigated if cortical areas which were functionally different in people with ASD were also anatomically abnormal. RESULTS: Compared with control subjects, ASD individuals showed significantly increased brain activation in 1) left inferior and orbital frontal gyrus (motor-inhibition); 2) left insula (interference-inhibition); and 3) parietal lobes (set shifting). Moreover, in individuals with ASD, increased frontal gray matter density and increased functional activation shared the same anatomical location. CONCLUSIONS: Our findings suggest an association between successful completion of EF tasks and increased brain activation in people with ASD, which partially may be explained by differences in brain anatomy.

Adolescent↗
PubMed1990

CSF beta-endorphins in childhood neuropsychiatric disorders.

Thirty-one children with autistic disorder, 8 with the Rett syndrome (RS), 2 with childhood disintegrative disorder and 5 with infantile spasms were compared with healthy adult controls with respect to cerebrospinal fluid (CSF) beta-endorphin levels. The autistic disorder and RS groups showed significantly lower values than the other groups. There were no age trends within the various groups. Further study of CSF beta-endorphins in these disorders and blindly examined age matched controls is warranted.

Adolescent↗
PubMed2004

Brief report: assessment of sensory abnormalities in people with autistic spectrum disorders.

Sensory functioning has long been considered crucial in the life of people with autistic spectrum disorders (ASD) (Gillberg, C., & Coleman, M. (1992). The Biology of Autistic Syndromes (2nd ed.). London: Mac Keith press.) However, much of the research is methodologically flawed and based on child populations and adults' retrospective accounts (O'Neill, M.C 1995). Sensory-perceptual abnormalities in autism. Psychological Perspectives in Autism-Conference Proceedings 1995 (pp. 55-61). Autism Research Unit, University of Sundarland). Such sensory dysfunction may contribute to poor person/environment fit and subsequent challenging behaviour. This paper presents an assessment tool developed to explore the sensory functioning of adults with ASD.

Adult↗
PubMedDate not supplied

Fragile X positivity in Chinese children with autistic spectrum disorder.

Chromosome analysis was performed in 105 Chinese children (96 boys, 9 girls) with autistic spectrum disorder to assess fragile X positivity. Seventy percent of these autistic children were mentally retarded. None of the children in the infantile autism group (N = 75) had fragile X positivity. Two boys in the autistic condition group (N = 30) had clinical features and chromosomal positivity for fragile X syndrome. The low (2%) prevalence rate of fragile X positivity in children with different degrees of expressivity of autistic features may be related to other factors rather than to pure autistic characteristics per se.

Autistic Disorder↗
PubMed2006

Randomized controlled trial of melatonin for children with autistic spectrum disorders and sleep problems.

BACKGROUND: Melatonin is often used for autistic children with sleep disorders, despite a lack of published evidence in this population. METHODS: A randomized, placebo-controlled double-blind crossover trial of melatonin was undertaken in 11 children with autistic spectrum disorder (ASD). RESULTS: Seven children completed the trial. Sleep latency was 2.6 h [95% confidence intervals (CI) 2.28-2.93] baseline, 1.91 h (95% CI 1.78-2.03) with placebo and 1.06 h (95% CI 0.98-1.13) with melatonin. Wakings per night were 0.35 (95% CI 0.18-0.53) baseline, 0.26 (95% CI 0.20-0.34) with placebo and 0.08 (95% CI 0.04-0.12) with melatonin. Total sleep duration was 8.05 h (95% CI 7.65-8.44) baseline, 8.75 h (95% CI 8.56-8.98) with placebo and 9.84 h (95% CI 9.68-9.99) with melatonin. CONCLUSIONS: Although the study was small owing to recruitment difficulties, it still provides evidence of effectiveness of melatonin in children with sleep difficulties and ASD, which we predict a larger study would confirm.

Adolescent↗
PubMed2006

Autistic spectrum disorders. 1: Presentation and assessment.

As many as six in every 1000 children may be affected by an autistic spectrum disorder. Characterised by a triad of social communication difficulties, these children exhibit impairment in communication and socialisation, and restricted and repetitive interests, movements and activities. This article will discuss the distinction between autism, Asperger's syndrome and pervasive developmental disorder. Assessment should include a history of the child's development, observation, school report and a profile of the child's strengths and weaknesses. However, it is important that potential differential diagnoses as well as conditions associated with autism are also considered. Differential diagnoses, management and possible causes of autistic spectrum disorders will be discussed in more detail in next month's Clinical Updates.

Asperger Syndrome↗
PubMed1993

Epilepsy in children with autistic spectrum disorder.

A prospective study looking at the prevalence of epilepsy in 246 children with autistic spectrum disorder revealed that 7.6% of children satisfying the criteria of infantile autism and 5% of those with an autistic condition had epilepsy. The majority had onset of seizures before the age of 1 year. Boys predominated in both groups. There was no correlation between the age of onset of seizures, type of seizure, sex, mentality, and the outcome of epilepsy. There is an increased risk of epilepsy in autistic children compared to those with developmental dysphasia or Down syndrome. There might be some underlying defect of the brain in autistic children that causes different degrees of autistic manifestation with which epilepsy is associated, as part of the spectrum complex.

Adolescent↗
PubMed2005

[Development of an interaction behaviors checklist for early detection of autistic children].

PURPOSE: This study was conducted to develop a behavioral checklist to predict an autistic disorder and to identify the earliest detecting time. METHOD: One hundred and fifty eight children including normal, autistic, institutionalized normal, and retarded were assessed using critical interaction behavioral markers from literature review. Data was collected by semi-structured mother-child interaction by videotape recording and analyzed by factor analysis, Cronbach alpha, Kappa, chi(2), and Duncan. RESULT: Ten behavioral markers were sorted into 2 factors; joint-attention and synchronized behavior. Autistic children were impaired in pretend play, prodeclarative pointing, proimperative pointing, gaze-monitoring, referential looking, showing, joint-attention, rhythmical vocal exchange, and synchronized laughing. The sychronized behavior was also a critical marker to predict the autistic disorder. However, it was difficult to differentiate autistic disorder from mental retardation. In addition, the appropriate detecting time was around 18 months after birth. CONCLUSION: This checklist should be behavior markers to predict autistic disorder and could be useful as educational material at children's clinics, parents class, and for caregivers in the health center. In addition, early detection should lead to treatment being started as soon after 18 months of age as possible.

Autistic Disorder↗
PubMed2006

Cost-impact of young adults with high-functioning autistic spectrum disorder.

There is a general lack of information about the economic impact of autistic spectrum disorder (ASD), particularly regarding adults and those with high-functioning ASD. In this study, the societal economic consequences of ASD were investigated using a sample of young high-functioning adults in need of employment support. A methodology for the collection of cost information was developed and information about how to avoid obstacles in the collection process was obtained. Today, many people with ASD who would be able to function in open employment do not get this opportunity. This study demonstrated that ASD results in high costs and indicates that a lack of supported employment programmes for people with ASD may have negative resource consequences for the economy. The study also contributes towards a methodology of economically evaluating supported employment programs as well as other interventions for people with high-functioning ASD.

Adult↗
PubMedDate not supplied

[Good practice guidelines for the treatment of autistic spectrum disorders].

INTRODUCTION: Due to the inexistence of an aetiology-based intervention for autistic spectrum disorders (ASD) families and professionals are exposed to diverse and sometimes conflictive recommendations when they have to decide the most adequate alternative for treatment. AIM: To elaborate treatment guidelines agreed by consensus at the ASD Study Group of the (National) Institute of Health Carlos III. DEVELOPMENT: Information about treatment of ASD was searched and gathered through available evidence based medical (EBM) databases. The data generated was complemented with practice parameters published elsewhere, reports from prestigious international institutions, focus oriented searches in PubMed and, finally, the opinion and experience of a multidisciplinary Study Group with extensive experience in treating ASD in Spain. Most popular treatment methods were reviewed as well as the common elements to be considered in successful support programs. CONCLUSION: No simple treatment algorithm can be produced at this time, and the level of available evidence based recommendations are in the weaker degrees of EBM classifications. Nevertheless, there is widespread agreement to stress that education, with special incidence in the development of communication and social competence, with the addition of community support are the main means of treatment. They can be complemented, depending on individual needs, with medication, behavioural approaches and cognitive-behavioural therapy for associated psychological problems in persons with higher cognitive level. Support to families and community empowerment are essential elements for the quality of life of persons with ASD.

Autistic Disorder↗
PubMed2000

Affective communication of infants with autistic spectrum disorder and internal representation of their mothers.

We have been examining the developmental process of affective communication in infants with autistic spectrum disorders from the viewpoint of relationship disturbance through our developmental and psychopathological studies on autism. In particular, the role of internal representation of the mother in the process of development of affective communication is discussed through the presentation of two cases diagnosed as autistic spectrum disorder in early infancy. In these cases, we postulate approach-avoidance motivational conflict 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, but affective communication with their mothers was not readily improved. Taking up the mothers' own internal representation in mother-infant psychotherapy, in particular, the mothers' problems in attachment behavior with their own mothers in infancy precipitated transition in the mothers' internal representation of their children, leading to active evolution in mother-child interaction and development in affective communication between mother and child. In this context, the basis and significance of internal representation of both parties being determinants in the quality of mother-child communication are discussed.

Affect↗