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PubMed2006

Do people with autistic spectrum disorder show normal selection for attention? Evidence from change blindness.

People in the general population are typically very poor at detecting changes in pictures of complex scenes. The degree of this 'change blindness', however, varies with the content of the scene: when an object is semantically important or contextually inappropriate, people may be more effective at detecting changes. Two experiments investigated change blindness in people with autism, who are known from previous research to be efficient in detecting features yet poor at processing stimuli for meaning and context. The first experiment measured the effect of semantic information while the second investigated the role of context in directing attention. In each task, participants detected the dissimilarity between pairs of images. Both groups showed a main effect of image type in both experimental tasks, showing that their attention was directed to semantically meaningful and contextually inappropriate items. However, the autistic group also showed a greater difficulty detecting changes to semantically marginal items in the first experiment. Conclusions point to a normal selection of items for attention in people with autism spectrum disorders, although this may be combined with difficulty switching or disengaging attention.

Adolescent↗

PubMed2001

Conversational characteristics of children with fragile X syndrome: tangential language.

The production of tangential language during conversations was studied with people who have fragile X syndrome, autistic disorder, or mental retardation not caused by fragile X. Tangential language was found to be more prevalent among those with fragile X, compared to the control groups, especially within unsolicited comments. These results support our hypothesis that the tangential language seen in fragile X is not the result of either general developmental delay or undiagnosed autistic disorder. We offer a possible interpretation of these results based upon such phenotypic characteristics as social anxiety, hypersensitivity to social and sensory stimuli, and inhibitory control deficits.

Adolescent↗

PubMed2002

Asperger's syndrome: implications for nursing practice.

The most common disorders within the category of Pervasive Developmental Disorders (PDD) are the Autistic Disorders. In the 1994 Diagnostic and Statistical Manual-IV, Asperger's Disorder became a distinct diagnosis within the Autistic category, as part of the disorders first diagnosed in childhood and adolescence. The terms Asperger's Disorder and Asperger's Syndrome are used interchangeably. Attention to and knowledge of Asperger's Syndrome (AS) are necessary to differentiate it from closely related disorders that have overlapping symptoms. There is much discussion about different definitions of Asperger's, different viewpoints of experts in the field, and the diagnostic dilemmas related thereto. Last, and most important, are the nursing implications. Nurses are in a position to identify children with Asperger's early. After identification, the necessary referrals, treatment options, support, and follow-up are essential for these children. Nurses need more knowledge about this disorder and need to be proactive in defining their role to help children with the disorder in the schools and the community.

Adolescent↗

PubMed2003

The platelet-poor plasma 5-HT response to carbohydrate rich meal administration in adult autistic patients compared with normal controls.

There are cumulative data indicating involvement of the 5-HT system in autistic disorder. Most studies examining 5-HT function have focused on whole blood 5-HT content. The carbohydrate-rich meal test (CRMT) is a dietary manipulation that could significantly influence platelet-poor plasma (PPP) 5-HT levels and reflect the responsiveness of the serotonergic system in 'free' plasma. In this study, CRMT was used as an indicator of 5-HT responsivity in drug-free adults with autistic disorder (n = 7), compared with normal controls (n = 10). The PPP 5-HT levels were measured at baseline and during 3 h after administration of the CRMT. A significant elevation in PPP 5-HT levels in adult autistic patients was reached 60 min after meal administration (p < 0.03 vs control and p = 0.05 vs baseline) and a significant decrease was noted after 120 min (p < 0.01 vs baseline). In contrast to the biphasic response of the autistic patients, normal controls exhibited a gradual linear increase of PPP 5-HT levels. Our results indicate that in adult autistic patients, the pattern of PPP 5-HT responsivity to a dietary challenge of CRMT is dysregulated compared with normal controls and provide further support for the role of 5-HT in autism.

Adult↗

PubMed2003

Prevalence of autism in a US metropolitan area.

CONTEXT: Concern has been raised about possible increases in the prevalence of autism. However, few population-based studies have been conducted in the United States. OBJECTIVES: To determine the prevalence of autism among children in a major US metropolitan area and to describe characteristics of the study population. DESIGN, SETTING, AND POPULATION: Study of the prevalence of autism among children aged 3 to 10 years in the 5 counties of metropolitan Atlanta, Ga, in 1996. Cases were identified through screening and abstracting records at multiple medical and educational sources, with case status determined by expert review. MAIN OUTCOME MEASURES: Autism prevalence by demographic factors, levels of cognitive functioning, previous autism diagnoses, special education eligibility categories, and sources of identification. RESULTS: A total of 987 children displayed behaviors consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for autistic disorder, pervasive developmental disorder-not otherwise specified, or Asperger disorder. The prevalence for autism was 3.4 per 1000 (95% confidence interval [CI], 3.2-3.6) (male-female ratio, 4:1). Overall, the prevalence was comparable for black and white children (black, 3.4 per 1000 [95% CI, 3.0-3.7] and white, 3.4 per 1000 [95% CI, 3.2-3.7]). Sixty-eight percent of children with IQ or developmental test results (N = 880) had cognitive impairment. As severity of cognitive impairment increased from mild to profound, the male-female ratio decreased from 4.4 to 1.3. Forty percent of children with autism were identified only at educational sources. Schools were the most important source for information on black children, children of younger mothers, and children of mothers with less than 12 years of education. CONCLUSION: The rate of autism found in this study was higher than the rates from studies conducted in the United States during the 1980s and early 1990s, but it was consistent with those of more recent studies.

Black or African American↗

PubMed2005

Multi-site study of the Childhood Autism Rating Scale (CARS) in five clinical groups of young children.

This study examined several questions pertaining to the Childhood Autism Rating Scale (CARS) in a sample of 274 preschool children (aged 2-6 years) clinically diagnosed as falling in one of five groups: Autistic Disorder, PDD-NOS, MR, Delayed, and Other. In addition to diagnosis and the CARS, all children were given standardized cognitive and adaptive behavior measures. Results indicated high concordance between the CARS and clinical diagnosis using DSM-IV (including excellent sensitivity and specificity). There was a moderate negative correlation of CARS scores and developmental level (both cognitive and adaptive), indicating significant shared variance. There were significant and sensible differences in mean CARS score for different diagnostic groups, including a substantial difference between the Autistic Disorder and PDD-NOS groups.

Autistic Disorder↗

PubMed2006

Two terms--one meaning: the conundrum of contemporary nomenclature in autism.

TOPIC: Autism as a diagnostic construct in the last decade has undergone a process of rapid evolution in the way that it is operationalized. A by-product of the important conceptual shift is that we have been left with two terms, autistic disorder and Asperger's disorder, that point to the same thing. The existence of two terms that cannot be clearly delineated results in confusion and an added element in an already anxiety-laden mix for all those trying to come to terms with the concept of autism. PURPOSE: This paper moves beyond contemporary arguments of whether autistic disorder and Asperger's disorder are different entities and uses a case study to consider the mechanism of the confusion caused, and highlight the importance of referent clarity. SOURCES: A review of sources in journals and texts related to the topic is included to complement the progressive review of the case study as the clients move through a 1-hour initial consult. CONCLUSION: The current diagnostic criteria are ambiguous posing the risk of confusion to parents, clinicians, and researchers. Nurses have an important role in assisting parents' construction of a unified concept of autism clinically, and through research. This paper moves beyond merely acknowledging the confusion that exists by considering the nature of the confusion, and through sharing the experience of one possible way of navigating it.

Adaptation, Psychological↗

PubMed1989

Autistic behaviour in Moebius syndrome.

Seventeen children and young adults with Moebius syndrome were examined with a view to finding symptoms of autism. Some 40% of the group showed all or many of the symptoms typical of autistic disorder. The high frequency of autistic symptoms in Moebius syndrome might be a marked overrepresentation and could be suggestive of a common underlying neurobiological deficit at the brainstem level.

Adolescent↗

PubMed2002

Risperidone in the treatment of autistic Thai children under 4 years of age.

The authors report five cases of very young children with autistic disorder, aged 2.1-3.7 years, treated with risperidone, as part of the comprehensive intervention. Treatment with risperidone 0.25-0.5 mg per day was associated with clinically meaningful decreases in problem behaviors including hyperactivity, irritability, and aggressiveness. There were also improvements in social relatedness and cooperation with developmental treatment. All of the children tolerated the medication well and experienced no untoward effects. The efficacy of risperidone in the treatment of very young children with autistic disorder reported here is consistent with findings in the limited number of cases previously reported in the literature. Controlled studies are needed to confirm the efficacy and safety of risperidone in the treatment of these children.

Autistic Disorder↗

PubMed1996

Autism in Angelman syndrome: a population-based study.

The aim of this study was to examine the prevalence of angelman syndrome in prepubertal school-aged children and analyze its comorbidity with autistic disorder. A clinical/psychiatric evaluation of a population-based sample of 6- to 13-year-old mentally retarded children with active epilepsy was performed. Four individuals in a total population of almost 49,000 children conformed to the clinical diagnosis of Angelman syndrome. Two of these had a typical microdeletion at chromosome 15q11-13. The minimum prevalence of Angelman syndrome was estimated at 0.008% (1: 12,000) in the examined age group. All 4 children with Angelman syndrome met full behavioral criteria for the diagnosis of autistic disorder/childhood autism. It is concluded that Angelman syndrome is uncommon, but more frequent than previously estimated. The diagnosis should be considered in all patients with combined autistic disorder, severe mental retardation, and epilepsy. The implications of the possible association of Angelman syndrome and autism are discussed.

Adolescent↗

PubMed2001

Behavior phenotype in the RSH/Smith-Lemli-Opitz syndrome.

The behavior phenotype of Smith-Lemli-Opitz syndrome (SLOS) was studied by assessing behavior, social, and communication abilities, sensory hyperreactivity, and the deficits associated with autistic disorder. Fifty-six SLOS subjects, age 0.3 to 32.3 years, were evaluated by multiple age-dependent questionnaires and telephone interviews. Of the 56 subjects, 50 (89%) had a history of repeated self-injury: 30 (54%) bit themselves; 27 (48%) head-banged; and 30 (54%) threw themselves backward in a highly characteristic upper body movement ("opisthokinesis"). Forty-seven of these subjects were also evaluated by direct observation and by direct interview of the parent or caregiver. Of 11 subjects 10 years or older, three (27%) had a stereotypic stretching motion of the upper body accompanied by hand flicking. Additional measures showed sensory hyperreactivity, temperament dysregulation, sleep disturbance, and social and communication deficits. Nine of 17 subjects (53%) met the diagnostic criteria for autistic disorder by the Autism Diagnostic Interview-Revised (ADI-R) algorithm questions [Lord et al., 1993, 1994]. Thus, SLOS is a metabolic disorder that can be associated with autism and other behavioral characteristics that define a distinctive and diagnostically important behavioral disorder.

Adolescent↗

PubMed1993

Disintegrative psychosis of childhood. An appraisal and case study.

This study reports on five cases seen in a child psychiatry service in Northern India who met the criteria for disintegrative psychoses of childhood. Their clinical features were different from the described for autistic disorders of childhood supporting the validity of this disorder. The issues of diagnostic criteria and classification of disintegrative psychoses as distinct from autistic disorders is highlighted.

Child↗

PubMedDate not supplied

[Evaluation of q11-q13 locus of chromosome 15 aberrations and polymorphisms in the B3 subunit of the GABA-A receptor gene (GABRB3) in autistic patients].

The aim of the study was the evaluation of chromosomal aberrations, especially locus q11-q13 of chromosome 15 and polymorphisms in the g-aminobutyric acid receptor subunit B3 gene (GABRB3) and genetic aetiology of autistic disorder. We studied 20 probands (aged 4-27 years old) and their parents and siblings (73 persons). Following cytogenetic methods were used: conventional GTG-banding analysis, study of fra(X), fluorescence in situ hybridisation, with two specific probes: SNRPN and UBE3A/D15S10. Dinucletide (CA)n repeat polymorphism at the GABRB3 gene was analysed using PCR-STR method. Chromosomal analysis revealed paracentomere inversion--46, XX, inv(9)(p11q13) in 1 patient, but this is frequently found in population chromosomal variation. FISH didn't reveal abnormalities in 15q11-q13 region. ETDT analysis didn't reveal connection between autistic disorder and studied marker. Lack of anomalies in 15q11-q13 region may be related to small number of probands, heterogenity of studied group and small number of studied locus and markers. So conclusions should be related only to this studied group, and not to all autistic patients.

Adolescent↗

PubMed1993

Demonstration of abnormal cyclic AMP production in platelets from patients with fragile X syndrome.

Cyclic AMP production was studied in platelets from 31 patients with fragile X syndrome, 16 patients with mental retardation, 4 patients with autistic disorder, and 57 control individuals. 1-isobutyl-3-methylxanthine (IBMX) was used to inhibit phosphodiesterase; prostaglandin E1 (PGE1), to stimulate cAMP production via a receptor-dependent mechanism, and forskolin (FSK), to directly activate the catalytic subunit. Cyclic AMP production in IBMX, PGE1 + IBMX, and FSK + IBMX was 50% (P < 0.05), 65% (P = 0.001), and 53% (P = 0.001), respectively, in fragile X platelets relative to controls. Cyclic AMP production was not statistically different from controls in patients with mental retardation or autistic disorder. There was no effect of age or sex on cAMP production. Dose response curves suggested that abnormal cAMP production was due to diminished maximal response rather than altered potency of stimulating agents. The data presented here demonstrate that diminished cAMP production exists in platelets from patients with fragile X syndrome. Thus, defective functioning of cAMP-mediated regulatory signalling pathways in fragile X brain may contribute to the mental deficiency in these patients.

Adolescent↗

PubMed2002

Auditory brainstem response in two children with autism.

Autism develops before 30 months of age. Autistic disorder is characterized by a qualitative impairment in verbal and non verbal communication, in imaginative activity, and in reciprocal social interactions. Communication in autism is so strikingly impaired that the function of the hearing system has been under study over the past 30 years, namely after the advent of physiological assessment of hearing with the auditory brainstem response (ABR). Many research studies were developed to study ABR in autism as they constitute a direct test of both hearing status and integrity of brainstem pathways, but the results obtained are contradictory. The authors present case reports of two children with autistic disorder, 2 and 4 years of age, in which the ABR findings document a prevalent Peak I in the four ears tested. This characteristic configuration in ABR has not been previously reported and future work is needed to establish the importance of this finding and its implications in the awareness of the auditory status in these children.

Audiometry↗

PubMed2003

Evidence of brain overgrowth in the first year of life in autism.

CONTEXT: Autism most commonly appears by 2 to 3 years of life, at which time the brain is already abnormally large. This raises the possibility that brain overgrowth begins much earlier, perhaps before the first clinically noticeable behavioral symptoms. OBJECTIVES: To determine whether pathological brain overgrowth precedes the first clinical signs of autism spectrum disorder (ASD) and whether the rate of overgrowth during the first year is related to neuroanatomical and clinical outcome in early childhood. DESIGN, SETTING, AND PARTICIPANTS: Head circumference (HC), body length, and body weight measurements during the first year were obtained from the medical records of 48 children with ASD aged 2 to 5 years who had participated in magnetic resonance imaging studies. Of these children, 15 (longitudinal group) had measurements at 4 periods during infancy: birth, 1 to 2 months, 3 to 5 months, and 6 to 14 months; and 33 (partial HC data group) had measurements at birth and 6 to 14 months (n = 7), and at birth only (n = 28). MAIN OUTCOME MEASURES: Age-related changes in infants with ASD who had multiple-age measurements, and the relationship of these changes to brain anatomy and clinical and diagnostic outcome at 2 to 5 years were evaluated by using 2 nationally recognized normative databases: cross-sectional normative data from a national survey and longitudinal data of individual growth. RESULTS: Compared with normative data of healthy infants, birth HC in infants with ASD was significantly smaller (z = -0.66, P<.001); after birth, HC increased 1.67 SDs and mean HC was at the 84th percentile by 6 to 14 months. Birth HC was related to cerebellar gray matter volume at 2 to 5 years, although the excessive increase in HC between birth and 6 to 14 months was related to greater cerebral cortex volume at 2 to 5 years. Within the ASD group, every child with autistic disorder had a greater increase in HC between birth and 6 to 14 months (mean [SD], 2.19 [0.98]) than infants with pervasive developmental disorder-not otherwise specified (0.58 [0.35]). Only 6% of the individual healthy infants in the longitudinal data showed accelerated HC growth trajectories (>2.0 SDs) from birth to 6 to 14 months; 59% of infants with autistic disorder showed these accelerated growth trajectories. CONCLUSIONS: The clinical onset of autism appears to be preceded by 2 phases of brain growth abnormality: a reduced head size at birth and a sudden and excessive increase in head size between 1 to 2 months and 6 to 14 months. Abnormally accelerated rate of growth may serve as an early warning signal of risk for autism.

Anthropometry↗

PubMed2000

Age and IQ at intake as predictors of placement for young children with autism: a four- to six-year follow-up.

The predictive power of age and IQ at time of admission to an intensive treatment program using applied behavior analysis were examined in a 4- to 6-year follow-up of educational placement. Twenty-seven children with autistic disorder who were between the ages of 31 and 65 months and had IQs on the Stanford Binet between 35 and 109 at time of admission to the Douglass Developmental Disabilities Center were followed up 4 to 6 years after they left the preschool. The results showed that having a higher IQ at intake (M = 78) and being of younger age (M = 42 months) were both predictive of being in a regular education class after discharge, whereas having a lower IQ (M = 46) and being older at intake (M = 54 months) were closely related to placement in a special education classroom. The results are interpreted as pointing to the need for very early intervention for children with Autistic Disorder. It is also emphasized that older children and those with lower IQs in the present study showed measurable gains in IQ from treatment. The data should not be taken to suggest that children older than 4 years of age do not merit high quality treatment.

Age Factors↗

PubMed2003

Autism and auditory brain stem responses.

OBJECTIVE: To study a controversy that has been discussed for more than two decades: whether or not children with autism have abnormalities affecting the cochlear nerve or the auditory pathway in the brain stem and, if so, to describe these abnormalities. DESIGN: A group of 153 children and adolescents with autistic disorder were included in an investigation of auditory brain stem responses (ABR). Two thirds of this group, 101 individuals (75 boys, 26 girls), had normal hearing and they were selected for an in-depth ABR study. The results from the study group were compared with those of an age-matched comparison group. RESULTS: The III-V interpeak latency (IPL) was significantly prolonged in both boys and girls with autism, compared with the controls. The latencies of ABR waves I and V were also significantly lengthened in the study groups. The individual test results showed that more than half of this normal-hearing autistic disorder group (58%) had abnormalities of one or more of eight ABR parameters studied. The most common abnormalities were prolongation of wave V (38%), and of I-V IPL (28%). A lengthening of the I-V IPL was also recorded in 27% of 49 children who were difficult to test or who had hearing loss. Abnormal left-right differences of ABR latencies were found in 18% of autism cases with normal hearing. CONCLUSIONS: Possible causes of the reported ABR abnormalities, observed here as well as in other studies, are discussed. Brain stem lesion, occult cochlear dysfunction, and involvement of the cochlear efferent system are probable factors that can explain the ABR findings

Adolescent↗