Adolescent with Autistic Spectrum Disorder and some Obsessive-Compulsive Disorder behavior.
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Adolescent↗
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Famotidine treatment of children with autistic spectrum disorders: pilot research using single subject research design.
Using single subject research design, we performed pilot research to evaluate the safety and efficacy of famotidine for the treatment of children with autistic spectrum disorders. We studied 9 Caucasian boys, 3.8-8.1 years old, with a DSM-IV diagnosis of a pervasive developmental disorder, living with their families, receiving no chronic medications, and without significant gastrointestinal symptoms. The dose of oral famotidine was 2 mg/kg/day (given in two divided doses); the maximum total daily dose was 100 mg. Using single-subject research analysis and medication given in a randomized, double-blind, placebo-controlled, cross-over design, 4 of 9 children randomized (44%) had evidence of behavioral improvement. Primary efficacy was based on data kept by primary caregivers, including a daily diary; daily visual analogue scales of affection, reciting, or aspects of social interaction; Aberrant Behavior Checklists (ABC, Aman); and Clinical Global Improvement scales. Children with marked stereotypy (meaningless, repetitive behaviors) did not respond. Our subjects did not have prominent gastrointestinal symptoms and endoscopy was not part of our protocol; thus, we cannot exclude the possibility that our subjects improved due to the effective treatment of asymptomatic esophagitis. The use of famotidine for the treatment of children with autistic spectrum disorders warrants further investigation.
Autistic Disorder↗
Characteristics of children with autistic spectrum disorders served in comprehensive community-based mental health settings.
This study describes the characteristics of children with autistic spectrum disorders (ASD) receiving treatment in community mental health settings. Data from a national community mental health initiative was used to identify children who had received a primary diagnosis of ASD. These children were compared with children with other diagnoses on socio-demographic and psychosocial characteristics, presenting problems and service histories. Regardless of diagnosis, children were most often referred to service because of disruptive behaviors. Children with ASD were less likely to be referred for drug use, truancy or running away, but were more likely to be referred for social interaction difficulties and strange behavior. Many children had family histories of mental illness, substance abuse and domestic violence. Implications of these findings are discussed in detail.
Asperger Syndrome↗
The disclosure of a diagnosis of an autistic spectrum disorder: determinants of satisfaction in a sample of Scottish parents.
Satisfaction with disclosure of the diagnosis of an autistic spectrum disorder was investigated using a self-report questionnaire completed by 126 parents. On a rating of satisfaction, 55 percent indicated that they were satisfied or very satisfied with the disclosure. Parents were more likely to be satisfied if they gave positive ratings to the manner of the professional and the quality of the information provided; if they had been given written information and the opportunity to ask questions; and if their early suspicions had been accepted by professionals. These factors were combined into a global index of satisfaction; those gaining higher scores were more likely to have been given the diagnosis of Asperger syndrome (as opposed to autism), to have had a definite diagnosis, and to have children who were not currently in an educational placement. These results underline the importance of the interaction between parent and professional during the disclosure interview.
Adult↗
The prevalence of autistic spectrum disorder in children surveyed in a tertiary care epilepsy clinic.
UNLABELLED: It is well documented that children with autistic spectrum disorder (ASD) have an increased prevalence of seizures; however, studies have not been done to evaluate the prevalence of ASD in children with epilepsy. This comorbidity is important to define as early diagnosis and intervention in some children with ASD has been shown to improve outcome. METHOD: Children with epilepsy seen in a tertiary care epilepsy clinic were evaluated using validated autism screening questionnaires (ASQ). In addition, questions about sleep-related disorders, behavior, seizure characteristics, antiepileptic agents, and body mass index (BMI) were requested. An attempt was then made to determine if there was a correlation between the factors identified and ASD. RESULTS: Of the 107 questionnaires returned, 97 ASQ's were properly completed and used in this study. Approximately 32% of children fit the ASQ criteria for having ASD. Most children had not been previously diagnosed. Worst behavior and daytime sleepiness was seen in those at greater risk (p < 0.01). Seizures also occurred earlier (approximately 2 years) in children at risk of having ASD. CONCLUSION: Though confirmatory diagnostic evaluations are needed, this questionnaire-based study suggests that children with epilepsy are at greater risk of having ASD, and illustrates the need for more clinical vigilance. Behavioral difficulties and daytime sleepiness identified in these children could potentially affect their ability to learn. It is of interest that the age of seizure onset identified in those at greater risk corresponds with the approximate age of regression identified in some children with ASD.
Adolescent↗
[MMR vaccination and autism--a population-based follow-up study].
INTRODUCTION: It has been suggested that the measles-mumps-rubella (MMR) vaccination causes autism. MATERIAL AND METHODS: We conducted a retrospective cohort study of all children born in Denmark from January 1991 through December 1998. The cohort was established based on data from the Danish Civil Registration System. A unique person identifiable number given to all subjects enabled linkage with other national registries. MMR vaccination status was obtained from the Danish National Board of Health. Information on the children's autism status was obtained from the Danish Psychiatric Central Register which contains information on all diagnoses received from psychiatric hospitals, psychiatric wards, and outpatient clinics in Denmark. We obtained information on potential confounders from the Danish Medical Birth Registry, the National Hospital Registry, and Statistics Denmark. RESULTS: In the cohort of 537,303 children (2,129,864 person-years), 440,655 children had been MMR vaccinated. We identified 316 children with a diagnosis of autistic disorder and 442 with a diagnosis of other spectrum disorders. After adjusting for potential confounders, the risk for autistic disorder and other spectrum disorders was not increased in vaccinated compared with unvaccinated children (relative risk 0.92; 95 percent confidence interval, 0.68 to 1.24 and relative risk 0.83; 95 percent confidence interval, 0.65 to 1.07). There was no association between age at vaccination, time since vaccination or calendar period at time of vaccination and development of autistic disorder. DISCUSSION: This study provides strong evidence against the hypothesis that MMR vaccination causes autism.
Autistic Disorder↗
Reduced plasma apelin levels in patients with autistic spectrum disorder.
BACKGROUND: Dysregulation of the vasopressin (AVP) system has been implicated in the pathogenesis of autistic spectrum disorder (ASD). Apelin is a recently discovered neuropeptide that could counteract AVP actions and whose receptors are colocalized with vasopressin in hypothalamic magnocellular neurons. Aims of the present study were to investigate circulating levels of apelin in patients with ASD and to assess their correlation with plasma AVP concentrations. METHODS: Plasma levels of apelin and AVP were measured in a total of 18 patients with ASD and 21 age- and gender-matched healthy comparison subjects. The Childhood Autism Rating Scale (CARS) was used to assess the severity of autistic symptoms. RESULTS: Significantly reduced levels of apelin (p < 0.001) and elevated concentrations of AVP (p = 0.02) were found in ASD patients as compared to controls. Additionally, a significant inverse correlation between apelin and AVP levels was found within the ASD group (r = -0.61; p = 0.007), but not in healthy participants (r = -0.26; p = 0.25). Multivariate linear regression analysis showed that only AVP concentrations independently predicted apelin values in ASD individuals (beta = -0.42, t = 2.63, p = 0.014). No correlation was seen between apelin levels and CARS scores (r = -0.10; p = 0.68). CONCLUSIONS: Our findings of a significantly reduced peripheral level of apelin coupled with elevated AVP point to a subtle but definite vasopressinergic dysfunction in autism that could play a role in the etiopathophysiology of this disorder in humans.
Adolescent↗
Mercury exposure in children with autistic spectrum disorder: case-control study.
Although mercury has been proven to be a neurotoxicant, there is a lack of data to evaluate the causal relationship between mercury and autism. We aim to see if there is increased mercury exposure in children with autistic spectrum disorder. We performed a cross-sectional cohort study over a 5-month period in 2000 to compare the hair and blood mercury levels of children with autistic spectrum disorder (n = 82; mean age 7.2 years) and a control group of normal children (n = 55; mean age 7.8 years). There was no difference in the mean mercury levels. The mean blood mercury levels of the autistic and control groups were 19.53 and 17.68 nmol/L, respectively (P = .15), and the mean hair mercury levels of the autistic and control groups were 2.26 and 2.07 ppm, respectively (P = .79). Thus, the results from our cohort study with similar environmental mercury exposure indicate that there is no causal relationship between mercury as an environmental neurotoxin and autism.
Autistic Disorder↗
Barking up the wrong tree? Lexical ambiguity resolution in children with language impairments and autistic spectrum disorders.
Lexical ambiguity resolution was investigated in 9- to 17-year-olds with language impairment (LI, n=20), autistic spectrum disorder (ASD) plus language impairment (ALI, n=28), ASD and verbal abilities within the normal range (ASO, n=20), and typically developing children (TD, n=28). Experiment 1 investigated knowledge of dominant and subordinate meanings of ambiguous words. The LI and ALI groups knew fewer subordinate meanings than did the ASO and TD groups. Experiment 2 used a modified version of the paradigm to investigate contextual facilitation and suppression of irrelevant meanings. All groups demonstrated contextual facilitation, responding quickly and more accurately to words following a biased context. However, children with ALI and LI did not use context as efficiently as did their peers without language deficit. Furthermore, for the LI and ALI groups, errors in the suppression condition reflected poor contextual processing. These findings challenge the assumptions of weak central coherence theory and demonstrate the need for stringent language controls in the study of autistic cognition.
Adolescent↗
Community introduction of practice parameters for autistic spectrum disorders: Advancing early recognition.
OBJECTIVES: Within a strong interdisciplinary framework, improvement in the quality of care for children with autistic spectrum disorders through a 2 year implementation program of Practice Parameters, aimed principally at improving early detection and intervention. METHOD: We developed Practice Parameters (PPs) for Pervasive Developmental Disorders and circulated the PPs to all child and adolescent psychiatrists practicing in the region. RESULTS: PP development and parallel information strategies resulted in a significant decrease of 1.5 years in the mean-age-at-diagnosis. However, further analysis indicated that improvement was only transient. CONCLUSION: Despite the encouraging improvement in mean-age-at-diagnosis 2 years after PP implementation, other indicators showed a failure to maintain the improvements. A systematic screening program would be the most reliable method to reinforce the PPs.
Asperger Syndrome↗
Changes in the incidence of childhood autism and other autistic spectrum disorders in preschool children from two areas of the West Midlands, UK.
The incidence of childhood autism and other autistic spectrum disorders (ASDs) in preschool children was determined for two areas of the West Midlands between 1991 and 1996. Children diagnosed before the age of 5 years and residing within the study areas at diagnosis were detected from the records of four child development centres. The incidence rate per 10,000 children per year for the combined areas was 8.3 for all children with ASDs, 3.5 for classical childhood autism (CA), and 4.8 for other ASDs. Rates were similar in both areas, despite differences in social deprivation and proportions of ethnic minorities. While rates for classical CA increased by 18% per year, a much larger increase (55% per year) was seen for 'other ASDs', suggesting that clinicians are becoming increasingly able and/or willing to diagnose ASDs in preschool children.
Autistic Disorder↗
Ring chromosome 22 and autism: report and review.
Ring chromosome 22 has been described in over 50 cases. A characteristic phenotype has not been fully delineated; however, long face, thick eyebrows, 2-3 toe syndactyly, mental retardation, adequate somatic growth and the absence of major malformations are noted in many cases. An 11-year-old boy with ring chromosome 22 and 46,XY,r(22)(p11.31-q13.31 approximately q13.33) karyotype presented with global developmental delay, autistic disorder, and dolichocephaly, apparently low-set and large ears, midface hypoplasia, and 2-3 toe syndactyly. This is the second report of a ring chromosome 22 with autistic disorder. There appears to be an association between abnormalities of chromosome 22, including r(22), and autistic disorder; however, this occurrence may be a result of the association of autistic disorder with mental retardation rather than specifically due to r(22). The physical findings in this case also suggest that ring chromosome 22 causes a subtle but distinct phenotype which has previously been proposed.
Abnormalities, Multiple↗
Treating autistic spectrum disorders in children: utility of the cholinesterase inhibitor rivastigmine tartrate.
Rivastigmine tartrate is a dual-action cholinesterase inhibitor shown to improve language, cognition, and global functioning in patients with Alzheimer's disease, likely via increased availability of cerebral acetylcholine. Because cholinergic receptor abnormalities can contribute to the neuropathology of autistic spectrum disorders, rivastigmine tartrate could prove to be an effective therapy for affected children. Observations of improved behavior and language output from prior open-label and double-blind treatment of autistic children with donepezil, another cholinesterase inhibitor, prompted this 12-week open-label study with rivastigmine tartrate of 32 autistic patients. Therapeutic indices were the Childhood Autistic Rating Scale, Gardner's Expressive and Receptive One-Word Picture Vocabulary tests, and the Conners' Parent Rating Scale. Testing administered at baseline, 6 weeks, and 12 weeks showed gains in both expressive speech and overall autistic behavior over baseline. These improvements were statistically significant and supported the hypothesis that treatment with cholinergic enhancing drugs in autistic spectrum disorders yields positive therapeutic effects.
Acetylcholine↗
Top-down attentional modulation in autistic spectrum disorders is stimulus-specific.
This study investigated top-down modulation of bottom-up attentional capture in children with autistic spectrum disorders (ASDs) and in a typically developing (TD) comparison group using a spatial-cuing task (Experiment 1) and a series of visual search tasks (Experiment 2) employing task-irrelevant distractors. The effect of color and onset singleton distractors was investigated. The TD group showed similar top-down modulation of color and onset stimuli. The ASD group showed typical top-down modulation of color stimuli, but impaired top-down modulation of onset stimuli. The results suggest that children with ASDs may be impaired at prioritizing dynamic stimuli; this has implications for social processing impairments in ASDs.
Attention↗
Parents and teachers reports of DSM-IV psychopathological symptoms in preschool children: differences between urban-rural Spanish areas.
BACKGROUND: This study used DSM-IV criteria to analyse reports from teachers and parents and to compare behavioural and emotional symptoms in Spanish preschool children from both urban and rural populations. METHOD: The field survey was conducted in two geographical areas in Catalonia (Spain). A sample of 1104 children (56.67% boys and 43.32% girls) aged 3-6 years participated in this study: 697 were from urban areas and 408 from rural ones. The Early Childhood Inventory-teachers' and parents' versions (ECI-4) [Gadow KD, Sprafkin J (1997)-was used as the screening instrument. RESULTS: The teachers' and parents' reports assigned 32.7 and 46.7%, respectively, to one or more ECI-4 categories. Significant differences between sexes were found in teachers' reports. The whole disorders were significantly more prevalent in the urban sample than in the rural one (30.6 vs. 20.3%). The most prevalent disorders in both areas were Anxiety Disorders and Behavioural Problems, and the least prevalent were Mood Disorders and Autistic Disorders. CONCLUSIONS: The findings indicate that there are some differences in the prevalence rates of preschool psychopathological disorders between rural and urban Spanish areas.
Child, Preschool↗
[Homicide by mentally ill: clinical and criminological analysis].
The present study analysed the characteristics of homicide in internees according to the Social Defence system in Belgium. The Social Defence system was inaugurated in 1930, following the ideas of Adolphe Prins, a Belgian specialist in the criminal law. The Social Defence system concerns those offenders who are considered as mentally ill at large. The concept of mental illness encompasses the classical notion of "dementia" but also those people with mental unbalance as personality disordered offenders and mentally retarded persons. In the present study, we considered all those internees who committed a homicide or a homicide attempt and whose cases were examined by the review board between September 1998 and June 2000. We collected 99 cases and studied the age at the time of the offence (mean: 32.2 years), their diagnoses, the status of victims. These 99 murderers committed 111 "facts", a fact being a murder or murder attempt on one or several person(s) without arrest between the different phases of the commitment. These facts provoked 132 victims (72 men and 60 women); 61.36 % deceased. There was no significant difference in the characteristics of homicide versus homicide attempt. The results showed that, in our population, 59.6 % of the patients endorsed a diagnosis of psychosis (37 cases of paranoid schizophrenia, 2 schizophrenias of other types, 7 schizo-affective disorders, 1 autistic disorder, and 12 delusional disorders). Other axis I disorders were 3 intermittent explosive disorders, 2 major depressive disorders, 2 paraphilias and 1 bipolar disorder. The 32 offenders with no axis I major mental diseases presented such diagnoses, alone or comorbid, as antisocial personality disorder (n = 17), borderline personality disorder (n = 8), paranoid personality disorder (n = 4), and schizoid personality disorder (n = 2), 14 were mentally retarded and 5 presented a cerebral damage or an epilepsy. The age of the offender at the first homicide was not significantly different between the different diagnoses: group 1 : schizophrenia-type group (29.63 years) ; group 2 : comorbid diagnoses of schizophrenia and cluster B personality disorder (31.64 years) ; group 3 : cluster B personality disordered people (without psychosis) (27.90 years) ; and group 4 : the mixed group of residual diagnoses (32.63 years). Only the persons with a delusional disorder (group 5) significantly committed their homicide at an older age (47,06 year). We found no significant differences between group 2 (54.55 %), 3 (69.23 %), and 4 (50 %) in the proportion of offenders having substance problems. The group 1 (schizophrenia-type without comorbid personality disorder) presented significantly less problems with substances (13.83 %) than the three former groups. The group 5 (20.0 % prevalence) exhibited only a significant difference with group 3. We distinguished instrumental and emotional violence. Instrumental violence was more represented in the facts committed by group 2, 3 and 4 versus group 5. Group 1 differed also significantly from groups 2 and 3. The status of the victim(s) was divided in: 1) members of the family; 2) specifically known persons (outside the family); 3) specifically chosen victims (chosen, searched or followed because of their status, gender, profession, social role); 4) opportunity victims (victims present at the time and having sufficient characteristics to be attacked, e.g. being a woman, suspected to have some money); and 5) accidental victims. We demonstrated in our sample that victims of murderers in their family or specifically known were more frequently victims of pure psychotic offenders (groups 1 + 5) than of offenders of the mixed group (groups 2, 3 and 4) (21.97% vs 10.61%; 16,67% vs 13.64 %, respectively). On the contrary, specifically chosen (2.27 % vs 8.33 %) and opportunity victims (3.03 % vs 11.36 %) were more frequently attacked by the "mixed group". Accidental murders were almost only committed by psychotics (10.61 % vs 0.76 %), often in the context of a spree murder. In conclusion, we discuss that, from such a biased sample, the interest resides in the study of the comparison of the homicidal behaviour between psychotics (schizophrenia-type or delusional disordered), "mixed" and non-psychotics in terms of age at murder (older in delusional disorder), substance problems (more problems in non-psychotics), motivation (more emotional offences in psychotics) and statutes of victims (more family and known victims in psychotics). We are encouraged to precise our data on a larger sample and a longer period in future studies.
Adult↗
Psychopathology in children with epilepsy before and after temporal lobe resection.
The aim of this study was to establish the rate and spectrum of psychiatric disorder among children before and after temporal lobe surgery for epilepsy. Data were examined for associations between psychopathology and seizure outcome following surgery, or association between psychopathology and other variables, such as laterality of lesion, sex, cognitive level, and underlying pathology. Participants were 60 children (35 males, 25 females) who had focal seizures of temporal lobe origin and who had undergone temporal lobe resection between 1992 and 1998; mean age at time of operation 10 y 7 mo, (SD 4 y 11 mo) range 7 mo to 17 y 11 mo. Mean length of follow-up was 5.1 years (SD 2.3, range 2 to 10 y). Twenty-eight (47%) children had undergone right temporal lobectomy. Diagnosis of a psychiatric disorder was present in 50/60 (83%) children at some point, with high rates of psychiatric comorbidity. Common childhood psychiatric disorders of attention-deficit-hyperactivity disorder, oppositional defiant disorder/conduct disorder, and emotional disorders were present in about 25% of children. Disorders rarely seen in the general child population were over-represented: disruptive behaviour disorder--not otherwise specified (30/60 [50%]), and pervasive developmental disorder (autistic spectrum disorder; 23/60 [38%]). there was no significant relationship between pathology, sex, seizure frequency, or postoperative seizure outcome and psychiatric disorder, other than for pervasive developmental disorder. The same proportion of children had psychiatric diagnoses pre- and postoperatively (43/60 [72%] and 41/57 [72%] respectively). Although mental health problems are common in children undergoing temporal lobe resection, there are few predictors of psychiatric outcome following epilepsy surgery. Parents require counselling on these issues in the preoperative work-up.
Adolescent↗
Children with disruptive behaviours I: service utilization.
OBJECTIVE: To describe the demographic characteristics and patterns of service utilization in the Hunter region (NSW, Australia) of families caring for a child manifesting disruptive behaviour. METHODOLOGY: Families were eligible to participate in the survey if they had at least one child known to have one of the DSM-IV disruptive behaviour disorders, autistic spectrum disorders, behaviour problems associated with rarer forms of brain disease, brain injury or mild intellectual disability, or identified by school personnel as having significant behaviour problems. Families were recruited to the survey via schools, early education centres and clinical services. Parents completed a mail survey about demographic details and service utilization. RESULTS: In total, 1412 families responded to the survey, a participation rate of approximately 65%. The demographic characteristics of respondent families were similar to those of the regional population. A high proportion (85%) of children from respondent families were receiving treatment. Nearly half those children attending clinical services were attending two or more services. Approximately one-third each of the sample was attending public clinics, private clinics or a combination of both. Children were more likely to be treated by a paediatrician (64%) than a child psychiatrist (39%) or a psychologist (23%). Compared with a normative Australian sample, parents of children manifesting disruptive behaviour reported a high level of family stress. CONCLUSIONS: Families of children manifesting disruptive behaviour are a highly stressed group who often access several clinical services. Paediatricians make a significant contribution to the management of children with disruptive behaviours and need to be considered in service planning.
Adolescent↗