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PubMed2004

Emotional attribution in high-functioning individuals with autistic spectrum disorder: a functional imaging study.

OBJECTIVE: To determine whether expertise in the attribution of emotion from basic facial expressions in high-functioning individuals with autistic spectrum disorder (ASD) is supported by the amygdala, fusiform, and prefrontal regions of interest (ROI) and is comparable to that of typically developing individuals. METHOD: Functional magnetic resonance imaging scans were acquired from 14 males with ASD and 10 matched adolescent controls while performing emotion match (EM) (perceptual), emotion label (EL) (linguistic), and control tasks. Accuracy, response time, and average activation were measured for each ROI. RESULTS: There was no significant difference in accuracy, response time, or ROI activation between groups performing the EL task. The ASD group was as accurate as the control group performing the EM task but had a significantly longer response time and lower average fusiform activation. CONCLUSIONS: Expertise in the attribution of emotion from basic facial expressions was task-dependent in the high-functioning ASD group. The hypothesis that the high-functioning ASD group would be less expert and would have reduced fusiform activation was supported in the perceptual task but not the linguistic task. The reduced fusiform activation in the perceptual task was not explained by reduced expertise; it is therefore concluded that reduced fusiform activation is associated with the diagnosis of ASD.

Adolescent↗
PubMed2007

Brief report: designing a playground for children with autistic spectrum disorders--effects on playful peer interactions.

This study investigated possible changes in social play and initiations in eight boys (5 to 7-years-old) with autistic spectrum disorders (ASD) who were moving from an old to a new school playground that was designed specifically to enhance playful peer interaction. Each boy was observed for half an hour over three occasions in the old, then the new setting. The playgrounds differed in design, spatial density and identity of potential play partners. As hypothesised, frequency of group play and overall social initiations increased significantly in the new setting. We discuss how playgrounds with appropriate levels of physical challenge and support for both structured, imaginative play and solitary observation may support peer interactions in children with ASD.

Autistic Disorder↗
PubMed2006

Communicating with the child who has autistic spectrum disorder: a practical introduction.

Many health professionals seem to lack the knowledge and skills required to understand and communicate with the child or young person with an autistic spectrum disorder. Educational materials about this subject for student nurses and healthcare professionals were developed as part of a nursing course and are presented in this article as an introductory reference for those seeking to improve their communication with these children. A short resource list is provided.

Attitude of Health Personnel↗
PubMed2000

Parents' constructions of professional knowledge, expertise and authority during assessment and diagnosis of their child for an autistic spectrum disorder.

This paper presents a discourse analysis of parents' talk about the knowledge, expertise and authority of professionals, during assessment and diagnosis of their child for an autistic spectrum disorder at a Child Development Centre. Focusing on the positional level of analysis, it was suggested that parents' constructions of professional expertise and authority were inherently ambivalent and at times contradictory. It was further argued that this ambivalence is also reflected in an ideological dilemma between equality and expertise, regarding the role and positioning of 'human relations experts'. Discourse analysis was found to be a particularly useful tool in investigating aspects of the parents' talk relating to authority, knowledge and expertise. It is suggested that acknowledging this ambivalence and scrutinizing one's assumptions and practice, rather than denying the authoritarian aspects of health care, would provide the basis for more ethical and respectful clinical practice.

Attitude↗
PubMed2005

The relationship between vocabulary, grammar, and false belief task performance in children with autistic spectrum disorders and children with moderate learning difficulties.

BACKGROUND: The aim of this study was to examine the relationship between language and theory of mind in children with autistic spectrum disorders (ASD) and children with moderate learning difficulties (MLD). Previous studies have found a strong association between language and theory of mind in a range of groups, but mostly have not included measures of both grammar and vocabulary; including these enables us to speculate about the causal direction of the relationship. METHODS: Fifty-eight children with ASD and 118 children with MLD were given standardised assessments of vocabulary and grammar, along with standard theory of mind tasks. RESULTS: The relationship between language and theory of mind was more evident in children with ASD than in those with MLD, and grammar was a particularly strong predictor of theory of mind performance in children with ASD. Children with MLD performed better on false belief (FB) tasks than did children with ASD, and their performance was more predictable across the different theory of mind tasks. CONCLUSIONS: Language, in particular grammar, and theory of mind appear to be more strongly related in children with ASD than in those with MLD. We speculate that this relationship may be causal, with some grammatical understanding being a precursor of theory of mind. The implications of these findings are discussed in relation to possible routes for compensatory strategies for mentalising in children with ASD.

Autistic Disorder↗
PubMed2006

Frequency of gastrointestinal symptoms in children with autistic spectrum disorders and association with family history of autoimmune disease.

This is a cross-sectional study that compares lifetime prevalence of gastrointestinal (GI) symptoms in children with autistic spectrum disorders (ASDs) and children with typical development and with other developmental disabilities (DDs) and examines the association of GI symptoms with a family history of autoimmune disease. A structured interview was performed in 50 children with ASD and 2 control groups matched for age, sex, and ethnicity-50 with typical development and 50 with other DDs. Seventy-four percent were boys with a mean age of 7.6 years (SD, +/-3.6). A history of GI symptoms was elicited in 70% of children with ASD compared with 28% of children with typical development (p <.001) and 42% of children with DD (p =.03). Abnormal stool pattern was more common in children with ASD (18%) than controls (typical development: 4%, p =.039; DD: 2%, p =.021). Food selectivity was also higher in children with ASD (60%) compared with those with typical development (22%, p =.001) and DD (36%, p =.023). Family history of autoimmune disease was reported in 38% of the ASD group and 34% of controls and was not associated with a differential rate of GI symptoms. In the multivariate analysis, autism (adjusted odds ratio (OR), 3.8; 95% confidence interval (CI), 1.7-11.2) and food selectivity (adjusted OR, 4.1; 95% CI, 1.8-9.1) were associated with GI symptoms. Children with ASD have a higher rate of GI symptoms than children with either typical development or other DDs. In this study, there was no association between a family history of autoimmune disease and GI symptoms in children with ASD.

Adolescent↗
PubMed1998

Clumsiness in autism and Asperger syndrome: a further report.

Clumsiness has been proposed as a diagnostic feature of Asperger syndrome (AS), a type of pervasive developmental disorder recently introduced in the ICD-10 and DSM-IV. However, the extent to which this symptom is specific to AS is not clear. To investigate this issue, we compared a sample of AS children with age- and sex-matched groups of children with autistic disorder and pervasive developmental disorder not otherwise specified (PDDNOS). Twelve subjects with AS (ICD-10/DSM-IV; 11 males; average age 11.4 years; mean full-scale IQ 104.9) were compared with 12 subjects with autistic disorder (DSM-III-R; II males; average age 10.3 years; mean full-scale IQ 78.4) and 12 subjects with PDDNOS (DSM-III-R; 10 males; average age 10.1 years; mean full-scale IQ 78.2). The BruininksOseretsky test, a standardized test of motor coordination, was administered blind by the same investigator to all the three groups. While coordination deficits were found in all three groups, children with AS were found to be less impaired than those with autistic disorder and PDDNOS. However, no significant relationship was found between coordination scores and diagnosis after adjusting for the level of intelligence. These findings suggest that some patients with AS may be less clumsy than those with autistic disorder and that this difference may be the result of their higher level of intelligence. Studies based on larger samples using multiple measures of coordination are needed to further clarify the role of clumsiness in the classification of pervasive developmental disorders.

Adolescent↗
PubMed1988

Autistic spectrum disorders: clinical presentation in preschool children.

It is well recognized that children with "autistic features" constitute a very heterogeneous population. There is a growing consensus that the core symptoms seen in autism include deficits in: (1) social/affective/behavioral functions, (2) developmental language disorders with concomitant deficits in interpersonal communication, and (3) play/preferred activities/preoccupations which have a repetitive or stereotypic quality. The definition of the boundaries of "autism" as opposed to other related pervasive developmental disorders is widely debated among clinicians and research investigators alike. In the present paper, it is argued that autism is a cover term for a spectrum disorder with similarities and differences in the clinical presentation of preschool children. A model for subtyping the autistic spectrum disorders is suggested.

Ammonia↗
PubMed2003

Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine: a systematic review of current epidemiological evidence.

OBJECTIVE: To systematically review the evidence for and against the existence of an association between autistic spectrum disorder (ASD) and the measles, mumps, and rubella (MMR) vaccine. STUDY DESIGN: We conducted a systematic review of the medical literature to identify all controlled epidemiological articles examining for an association between ASD and the MMR vaccine. We extracted data from the articles on the characteristics and objectives of the study as well as evidence of an association. RESULTS: Twelve articles met the inclusion criteria. One study found no difference in the rates of ASD and the MMR vaccine in children who were vaccinated and those who were not. Six studies examined for evidence of an increase in ASD associated with an increase in the MMR vaccine coverage, none of which showed evidence of an association. Four studies examined if a variant form of ASD was associated with the MMR vaccine, none of which showed evidence of an association. Eight studies attempted to determine if there was a temporal association between developing ASD and receiving the MMR vaccine. Of these, 1 study identified an increase in parental concern in the 6-month period following vaccination with MMR in one of its analyses. The results of all other studies showed no association between ASD and the MMR vaccine. CONCLUSIONS: The current literature does not suggest an association between ASD and the MMR vaccine; however, limited epidemiological evidence exists to rule out a link between a rare variant form of ASD and the MMR vaccine. Given the real risks of not vaccinating and that the risks and existence of variant ASD remain theoretical, current policies should continue to advocate the use of the MMR vaccine.

Autistic Disorder↗
PubMed2007

Short breaks services for children with autistic spectrum disorders: factors associated with service use and non-use.

Short break services in a UK county were studied using a postal survey of 256 families with a child with an autistic spectrum disorder (ASD). Results confirmed high degrees of stress and low levels of informal support for all families, but no significant difference in the informal support available to non-users as compared to users of short break services. Robinson & Stalker's (1990) 10-point dependency scale showed a significant difference in dependence and more difficult behaviors between children of users and non-users. However, a large number of non-users had children with high dependence (scoring >7 points). Access was denied by the age of the child (under 11) diagnosis (Asperger syndrome), educational placement (mainstream) and lack of social worker referral.

Autistic Disorder↗
PubMed2006

Department for Education and Skills/Department of Health Good Practice Guidance on the education of children with autistic spectrum disorder.

Currently, it is held by many that educational interventions are those most likely to make a significant difference to the prognosis and well-being of a child with an autistic spectrum disorder (ASD). Yet, decision making about educational interventions and provision in ASD is often based on beliefs, tradition and assumptions, rather than on empirical evidence. This can lead to inappropriate or ineffective provision and can cause confusion and conflict between and within professional groups and parents. Little rigorous research evidence exists to guide decisions for children with ASD. This is true for educational practice generally, and for children with other special educational needs. Practitioners and parents alike are keen for good information on how best to educate children with ASD. It was against this background that the Department for Education and Skills (DfES) and Department of Health (DoH) convened a working group of experienced practitioners and parents to produce the 'Good Practice Guidance on ASDs'. This paper explores the need for the DfES/DoH Guidance, describes its structure and content and then suggests why research evidence is sparse and how future research might be enhanced to inform practice.

Adult↗
PubMed2004

The use and understanding of virtual environments by adolescents with autistic spectrum disorders.

The potential of virtual environments for teaching people with autism has been positively promoted in recent years. The present study aimed to systematically investigate this potential with 12 participants with autistic spectrum disorders (ASDs), each individually matched with comparison participants according to either verbal IQ or performance IQ, as well as gender and chronological age. Participants practised using a desktop 'training' virtual environment, before completing a number of tasks in a virtual café. We examined time spent completing tasks, errors made, basic understanding of the representational quality of virtual environments and the social appropriateness of performance. The use of the environments by the participants with ASDs was on a par with their PIQ-matched counterparts, and the majority of the group seemed to have a basic understanding of the virtual environment as a representation of reality. However, some participants in the ASD group were significantly more likely to be judged as bumping into, or walking between, other people in the virtual scene, compared to their paired matches. This tendency could not be explained by executive dysfunction or a general motor difficulty. This might be a sign that understanding personal space is impaired in autism. Virtual environments might offer a useful tool for social skills training, and this would be a valuable topic for future research.

Adolescent↗
PubMed2005

The significance of ileo-colonic lymphoid nodular hyperplasia in children with autistic spectrum disorder.

BACKGROUND: Intestinal mucosal pathology, characterized by ileo-colonic lymphoid nodular hyperplasia (LNH) and mild acute and chronic inflammation of the colorectum, small bowel and stomach, has been reported in children with autistic spectrum disorder (ASD). AIM: To assess ileo-colonic LNH in ASD and control children and to test the hypothesis that there is an association between ileo-colonic LNH and ASD in children. PATIENTS AND METHODS: One hundred and forty-eight consecutive children with ASD (median age 6 years; range 2-16; 127 male) with gastrointestinal symptoms were investigated by ileo-colonoscopy. Macroscopic and histological features were scored and compared with 30 developmentally normal (non-inflammatory bowel disease, non-coeliac disease) controls (median age 7 years; range 1-11; 25 male) showing mild non-specific colitis in 16 cases (13 male) and normal colonic histology in 14 cases (12 male). Seventy-four ASD children and 23 controls also underwent upper gastrointestinal endoscopy. The influence on ileal LNH of dietary restriction, age at colonoscopy, and co-existent LNH elsewhere in the intestine, was examined. RESULTS: The prevalence of LNH was significantly greater in ASD children compared with controls in the ileum (129/144 (90%) vs. 8/27 (30%), P < 0.0001) and colon (88/148 (59%) vs. 7/30 (23%), P = 0.0003), whether or not controls had co-existent colonic inflammation. The severity of ileal LNH was significantly greater in ASD children compared with controls, with moderate to severe ileal LNH present in 98 of 144 (68%) ASD children versus 4 of 27 (15%) controls (P < 0.0001). Severe ileal LNH was associated with co-existent colonic LNH in ASD children (P = 0.01). The presence and severity of ileal LNH was not influenced by either diet or age at colonoscopy (P = 0.2). Isolated ileal LNH without evidence of pathology elsewhere in the intestine was a rare event, occurring in less than 3% of children overall. On histopathological examination, hyperplastic lymphoid follicles are significantly more prevalent in the ileum of ASD children (84/138; 61%) compared with controls (2/23; 9%, P = 0.0001). CONCLUSION: Ileo-colonic LNH is a characteristic pathological finding in children with ASD and gastrointestinal symptoms, and is associated with mucosal inflammation. Differences in age at colonoscopy and diet do not account for these changes. The data support the hypothesis that LNH is a significant pathological finding in ASD children.

Adolescent↗
PubMed2004

Autistic spectrum disorder associated with partial duplication of chromosome 15; three case reports.

Duplication of part or the entirety of chromosome 15 that involves the Prader-Willi/Angelman syndrome critical region (PWACR) is a genetic disorder which is associated with variable degrees of intellectual impairment, motor co-ordination problems and social and communication disorders. Published case reports indicate that phenotypic expression is dependent on parental origin of the duplication and implicate maternally derived duplications in the pathogenesis of autistic features. This article describes three individuals, two males and one female, aged between 5 and 8 years, all with partial duplication of chromosome 15. Autism (or autistic spectrum disorder) was present in all three instances with varying degrees of cognitive impairment. The aim of this paper is to describe the phenotypic characteristics of this genetic sequence and the possible associations between social and behavioural patterns on the one hand, and degree and nature of genetic impairment on the other.

Autistic Disorder↗
PubMed2005

Alterations of prolyl endopeptidase activity in the plasma of children with autistic spectrum disorders.

BACKGROUND: Prolyl Endopeptidase (PEP, EC 3.4.21.26), a cytosolic endopeptidase, hydrolyses peptide bonds on the carboxyl side of proline residue in proteins with a relatively small molecular weight. It has been shown that altered PEP activity is associated with various psychological diseases such as schizophrenia, mania and depression. Autistic Spectrum Disorders (ASD) are neuropsychiatric and behavioural syndromes affecting social behaviours and communication development. They are classified as developmental disorders. The aim of this study was to examine the hypothesis that PEP activity is also associated with ASDs. METHODS: Fluorometric assay was used to measure PEP activity in EDTA plasma in children with ASD (n = 18) aged 4-12 years (mean +/- SD: 7.9 +/- 2.5). These results were then compared to PEP activity in a control group of non-ASD children (n = 15) aged 2-10 years (mean +/- SD: 6.4 +/- 2.2). RESULTS: An alteration in PEP activity was found in the children with ASD compared to the control group. There was much greater variation of PEP activity in the group of ASD children when compared to the controls (SD= 39.9 and SD 9.6, respectively). This variation was significant (p < 0.0005), although the mean level of PEP activity in the group of ASD children was slightly higher than in the control group (124.4 and 134.1, respectively). CONCLUSION: Our preliminary finding suggests a role for PEP enzyme in the pathophysiology of autism but further research should be conducted to establish its role in the aetiology of psychiatric and neurological disorders, including autism and related spectrum disorders.

Autistic Disorder↗
PubMed2002

Double-blind, placebo-controlled study of L-carnosine supplementation in children with autistic spectrum disorders.

L-Carnosine, a dipeptide, can enhance frontal lobe function or be neuroprotective. It can also correlate with gamma-aminobutyric acid (GABA)-homocarnosine interaction, with possible anticonvulsive effects. We investigated 31 children with autistic spectrum disorders in an 8-week, double-blinded study to determine if 800 mg L-carnosine daily would result in observable changes versus placebo. Outcome measures were the Childhood Autism Rating Scale, the Gilliam Autism Rating Scale, the Expressive and Receptive One-Word Picture Vocabulary tests, and Clinical Global Impressions of Change. Children on placebo did not show statistically significant changes. After 8 weeks on L-carnosine, children showed statistically significant improvements on the Gilliam Autism Rating Scale (total score and the Behavior, Socialization, and Communication subscales) and the Receptive One-Word Picture Vocabulary test (all P < .05). Improved trends were noted on other outcome measures. Although the mechanism of action of L-carnosine is not well understood, it may enhance neurologic function, perhaps in the enterorhinal or temporal cortex.

Autistic Disorder↗