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PubMed2002

Family system and coping behaviors: a comparison between parents of children with autistic spectrum disorders and parents with non-autistic children.

The study deals with strain on the family system, as well as the level of coping and types of coping behavior of the parents, in families with a child diagnosed as having an autistic spectrum disorder (ASD) as compared to families in a control group. Thirty-seven families and 66 parents were involved in each case, and four psychological tests were used. It was found that lower levels of coping were associated with higher levels of strain on the family system, that the level of strain on the family system was greater in the families with a child with an ASD, and that the two groups differed in their pattern of coping behavior. It is argued that limited contact between the child with an ASD and its parents, claimed earlier to be a cause of autism, can be explained in terms of strain on the family system and the resulting pattern of coping.

Adaptation, Psychological↗

PubMed2006

Long-term outcome of social skills intervention based on interactive LEGO play.

LEGO building materials have been adapted as a therapeutic modality for increasing motivation to participate in social skills intervention, and providing a medium through which children with social and communication handicaps can effectively interact. A 3 year retrospective study of long-term outcome for autistic spectrum children participating in LEGO therapy (N = 60) compared Vineland Adaptive Behavior Scale socialization domain (VABS-SD) and Gilliam Autism Rating Scale social interaction subscale (GARS-SI) scores preand post-treatment with a matched comparison sample (N = 57) who received comparable non-LEGO therapy. Although both groups made significant gains on the two outcome measures, LEGO participants improved significantly more than the comparison subjects. Diagnosis and pre-treatment full-scale IQ scores did not predict outcome scores; however, Vineland adaptive behavior composite, Vineland communication domain, and verbal IQ all predicted outcome on the VABS-SD, especially for the LEGO therapy group. Results are discussed in terms of implications for methods of social skills intervention for autistic spectrum disorders.

Antipsychotic Agents↗

PubMed2007

Brief report: social and communication abilities and disabilities in higher functioning individuals with autism and Asperger syndrome.

Individuals with higher functioning autism (HFA) fail to translate their cognitive potential into real-life adaptation, and the severity of their symptoms is considerable despite their intellectual ability. This paper reports on a subsample from a larger study (A. Klin et al., in press) analyzed here by autism spectrum subtypes. It focuses on the nature of ability and disability in HFA and Asperger syndrome (AS) in relation to age and IQ. Participants included 32 individuals with autism and 35 with AS. Individuals with AS had significantly higher Verbal IQ scores and less symptomatology than individuals with autism, but their Vineland scores were equally impaired, highlighting the adaptive deficits in ASD regardless of classification. No relationship was found between adaptive functioning and symptom severity.

Adolescent↗

PubMed2005

The effect of concurrent task load on stimulus over-selectivity.

Stimulus over-selectivity is a phenomenon displayed by individuals with autism, and has been implicated as a basis for many autistic-spectrum symptoms. In four experiments, non-autistic adult participants were required to learn a simple discrimination using picture cards, and then were tested for the emergence of stimulus over-selectivity, both with and without a concurrent task. Greater stimulus over-selectivity was noted when participants completed the concurrent task. The results are discussed in relation to the implications for the development of a model of memory deficits in autism.

Adult↗

PubMed2000

Linguistic processing in high-functioning adults with autism or Asperger's syndrome. Is global coherence impaired?

BACKGROUND: Linguistic processing was explored in normally intelligent adults with either autism or Asperger's syndrome, to test if global coherence was impaired. Global coherence is the ability to establish causal connections and interrelate local chunks into higher-order chunks so that most linguistic elements are linked together thematically. Since individuals with autism are hypothesized to have weak central coherence then one would predict that the clinical groups would have difficulty integrating information globally so as to derive full meaning. METHODS: Two experiments were designed to test global coherence. Experiment 1 investigated whether individuals on the autism spectrum condition could arrange sentences coherently. Experiment 2 investigated whether they were less able to use context to make a global inference. RESULTS: The clinical groups were less able to arrange sentences coherently and use context to make a global inference. CONCLUSIONS: The results suggest that individuals on the autism spectrum have impaired global coherence. Arranging sentences and making global inferences correlated highly, suggesting that central coherence may be a unitary force in these different tasks. Of the two clinical groups, the autism group had the greater deficit. The effect that such a deficit would have on one's daily life is discussed, along with possible explanations for the clinical groups' greater difficulty, and suggestions for future research.

Adolescent↗

PubMed1997

When to investigate for purine and pyrimidine disorders. Introduction and review of clinical and laboratory indications.

When to suspect and thus investigate for inborn errors of purine and pyrimidine metabolism is a dilemma for even the most observant investigator. Often parents of affected children, or a history involving siblings, can provide valuable clues. The recognition of new purine and pyrimidine disorders requires skill and serendipity. But even identifying known disorders can prove difficult, since they cover a broad spectrum of illnesses, can have more than one symptom, or lead to early death. This problem is compounded by the fact that they are relatively recently described and therefore often little known, either in the clinic or laboratory. The considerable heterogeneity in clinical expression within families as well as between families means that asymptomatic homozygotes may not be recognized or can present at any time from early childhood through adolescence up to their eighth decade. Consequently, all siblings should be screened. These disorders should be suspected in any case of unexplained anaemia, failure to thrive, susceptibility to recurrent infection, or neurological deficits with no current diagnosis, including autism, cerebral palsy, delayed development, deafness, epilepsy, self-mutilation, muscle weakness, the inability to walk or talk, and-unusual in children and adolescents-gout, sometimes with renal disease. Some disorders present with radiolucent kidney stones, in acute or chronic renal failure, alone or with any of the above, or as an intolerance/sensitivity to therapy (e.g. 5-fluorouracil in malignancies or azathioprine immunosuppression in organ transplantation), often with life-threatening consequences. Several parameters need to be evaluated to ensure correct diagnosis. Pitfalls which can mask diagnosis using only a single test are renal failure, blood transfusion, diet or drugs.

Biomarkers↗

PubMed2000

Occurrence of tics in Asperger's syndrome and autistic disorder.

Asperger's syndrome is a condition in the autistic spectrum in which language development is normal. Patients with Asperger's syndrome frequently exhibit repetitive movements (stereotypies), and can have motor and phonic tics in addition to other behavioral abnormalities. We present 12 patients with autistic spectrum disorders who were referred to our Movement Disorders Clinic for evaluation of tics. Eight of the 12 had normal language development and therefore met criteria for Asperger's syndrome. All patients exhibited stereotypic movements; in addition, seven had tics and six of these met diagnostic criteria for Tourette syndrome. Of the six patients with clinical features of both Asperger's syndrome and Tourette syndrome, three had severe congenital sensory deficits. The autistic patients in our series were clinically heterogeneous and though tics were clearly present, other aberrant movements demonstrated by them were harder to classify. Our series confirms the wide range of clinical manifestations in Asperger's syndrome and autism, including tics and other features of Tourette syndrome. Furthermore, it suggests that sensory deprivation contributes to the development of adventitious movements in this population.

Adolescent↗

PubMed2003

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↗

PubMed2006

Androgens and autistic traits: A study of individuals with congenital adrenal hyperplasia.

Testosterone promotes male-typical neural and behavioral development in non-human mammals. There is growing evidence that testosterone exerts similar influences on human development, although the range of behaviors affected is not completely known. This study examined the hypothesis that autistic traits are increased following prenatal exposure to abnormally high levels of testosterone caused by congenital adrenal hyperplasia (CAH). Sixty individuals with CAH (34 female, 26 male) and 49 unaffected relatives (24 female, 25 male) completed the Autism Spectrum Quotient (AQ). Females with CAH scored significantly higher than unaffected females on total AQ score, largely due to enhanced scores on subscales measuring social skills and imagination. These results suggest that prenatal exposure to high levels of testosterone influences some autistic traits and that hormonal factors may be involved in vulnerability to autism.

Adolescent↗

PubMed1999

Do children with PDDNOS have a theory of mind?

This study sought to differentiate PDDNOS from a similar nonautistic disorder (i.e., language impairment) on the basis of a cognitive deficit, theory-of-mind (ToM). ToM is an ability to infer mental states in others and has been found to be highly prevalent in autism, a disorder that shares many characteristics with PDDNOS (Baron-Cohen, 1985; Volkmar & Cohen, 1988). A sample of 28 children with either PDDNOS or a language impairment formed two groups (n = 14), matched on gender and verbal mental age. Participants were administered the brain function task (Baron-Cohen, 1989) and the false belief task (Perner, Frith, Leslie, & Leekam, 1989) to assess ToM. Results suggest that children with PDDNOS are deficient in a ToM ability, however, this relationship is not as strong as in previous studies with autistic samples, suggesting that children with PDDNOS may have a greater ToM ability. The existence of PDDNOS on the higher end of a spectrum of the Pervasive Developmental disorders as well as the construct of ToM itself existing on a continuum are discussed.

Brain↗

PubMed2005

Modeling clinical outcome of children with autistic spectrum disorders.

OBJECTIVES: Autistic spectrum disorders (ASD) have variable developmental outcomes, for reasons that are not entirely clear. The objective of this study was to test the clinical observation that initial developmental parameters (degree of atypicality and level of intelligence) are a major predictor of outcome in children with ASD and to develop a statistical method for modeling outcome on the basis of these parameters. METHODS: A retrospective chart review was conducted of a child development program at a tertiary center for the evaluation of children with developmental disabilities. All children who had ASD, were seen by J.C. between July 1997 and December 2002, met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for autism or pervasive developmental disorder (referred to hereafter as ASD), had undergone at least 1 administration of the Childhood Autism Rating Scale (CARS), and had at least 1 determination of developmental quotient (DQ) or IQ (N = 91) were studied. The sample was 92.3% male and 80.2% white. METHODS: The DSM-IV was used to confirm that each patient met criteria for a diagnosis of autism or pervasive developmental disorder. The CARS was used to quantify the severity of expression of ASD. Age at evaluation, CARS score, and DQ or IQ at each visit were extracted from the medical record. The 2 independent sample t test or the Mann-Whitney test was used for comparing CARS and age between 2 groups: first recorded DQ or IQ <0.70 (n = 58) versus first recorded DQ or IQ >or=0.70 (n = 33). Associations among CARS score, IQ or DQ, and age were examined using Pearson or Spearman correlation. A mixed-effect model was used for expressing the multivariate model. Length of follow-up (period) was calculated by subtracting age in months at initial evaluation from age in months at each follow-up evaluation. Therefore, at first evaluation, period = 0. Period was considered as a random effect because collection of repeated information from patients was not uniform. The predictive relationships among CARS, age at first evaluation, period, and DQ or IQ group (<0.70 and >or=0.70) were examined using a mixed-effects model. Variables that were expressed as percentage change between first and last measurements were analyzed using the t test or the Mann-Whitney test. Socioeconomic status was assessed using Hollingshead criteria. RESULTS: All patients met DSM-IV criteria for ASD. Mean age at initial evaluation was 46.2 months (SD: 23.7; range: 20.0-167.3 months). Mean CARS score at initial evaluation was 36.1 (SD: 6.3; range: 21.5-48). Mean DQ or IQ at initial evaluation was 0.65 (SD: 0.20; range: 0.16-1.10). There was no significant difference in socioeconomic status between DQ/IQ groups. CARS scores among children with an initial DQ or IQ <0.70 showed no significant decrement with time. In contrast, CARS scores among children with an initial DQ or IQ >or=0.70 showed a significant decrement with time, which could be modeled by the formula CARS = 37.93 - [(0.12 x age in months at first visit) + (0.23 x period)]. The predicted CARS scores generated by this model correlated with the observed values (r = 0.71) and explained 50% of the variability in the CARS scores for this group. CONCLUSIONS: These data provide preliminary validation of a statistical model for clinical outcome of ASD on the basis of 3 parameters: age, degree of atypicality, and level of intelligence. This model, if replicated in a prospective, population-based sample that is controlled for treatment modalities, will enhance our ability to offer a prognosis for the child with ASD and will provide a benchmark against which to judge the putative benefits of various treatments for ASD. Our model may also be useful in etiologic and epidemiologic studies of ASD, because different causes of ASD are likely to follow different developmental trajectories along these 3 parameters.

Adolescent↗

PubMed2006

Empathizing and systemizing in adults with and without autism spectrum conditions: cross-cultural stability.

UNLABELLED: This study tests the empathizing-systemizing (E-S) theory of sex differences and the extreme male brain (EMB) theory of autism. Three groups of participants took part: n = 48 people with autism spectrum, n = 137 general population controls, and n = 1,250 university student controls. Each participant completed the Empathy Quotient (EQ) and the Systemizing Quotient (SQ). RESULTS: The autism spectrum condition (ASC) group scored significantly lower than controls on the EQ, and significantly higher on the SQ. Among both control groups, females scored significantly higher than males on the EQ, whilst males scored significantly higher than females on the SQ. The distribution of 'brain types', based on the difference between EQ and SQ scores, showed distinct profiles for people with ASC, control males and control females.

Adolescent↗

PubMed2004

The very early identification of autism: outcome to age 4 1/2-5.

Forty-nine 2 years olds with social and language characteristics suggestive of autism were identified by community professionals and screening tools, then given a diagnostic assessment and reexamined at age 4 1/2. Agreement between autism clinic and screenings was high, with 88% receiving a diagnosis on the autism spectrum. The children were lower functioning relative to the autism population, thus more likely to be identified early. Reliability of diagnoses from 2 1/2 to 4 1/2 was high with 79% staying in the same diagnostic category, but more so for clear autism than for PDDNOS. About a third improved over 20 IQ points and similar number similarly declined. Changes were not related to amount or type of intervention but were related to the children's characteristics. Higher functioning children with milder autism were the most improved.

Adaptation, Psychological↗

PubMed1996

The role of the specialist for families with autistic children.

This research article looks at the present and future needs of a group of children within one particular London borough, who were diagnosed as having autism or being on the autistic spectrum. A nurse was employed by a voluntary organisation as a family services worker, to provide support to these families and also to identify areas of unmet need for the children and their families. Of the 70 children identified as autistic, 42 of the families indicated that they wanted to make contact with the specialist worker. The author concludes that the specialist nurse has a pivotal role to play in reducing the stress experienced by these families.

Adolescent↗

PubMed2001

Intra-monocyte pathogens delineate autism subgroups.

Immune panels of many autism-spectrum children reveal signs of atypical infections and shifted cell counts. In conjunction with trait-related cerebral hypometabolism and hypoperfusion, these findings suggest a hypothesis: Several autism-spectrum subgroups derive from intra-monocyte pathogens such as measles virus, cytomegalovirus, human herpesvirus 6, and Yersinia enterocolitica. Furthermore, with much inter-child variation, their effects manifest as diminished hematopoiesis, impaired peripheral immunity, and altered blood-brain barrier function often accompanied by demyelination. In some such children, one or more of these pathogens persists as a chronic-active, seemingly subclinical infection etiologically significant to the child's autistic traits. Within these subgroups, immune impairments and atypical infections may be treatable.

Autistic Disorder↗

PubMed2003

Prospective preliminary analysis of the development of autism and epilepsy in children with infantile spasms.

The objective of this study was to compare the efficacy of corticotropin (ACTH) versus vigabatrin in treating infantile spasms and to determine which medication has a more favorable long-term outcome in terms of cognitive function, evolution of epilepsy, and incidence of autism. Patients with infantile spasms were included in the study if they were 3 to 16 months old, had hypsarrhythmia, and had no previous treatment with vigabatrin or corticosteroids. Patient evaluation included electroencephalographic and psychometric measures before and after treatment. Patients were stratified based on etiology (idiopathic or symptomatic) and sex and then randomized between the ACTH and vigabatrin treatment groups. Each of the treatment groups received either ACTH or vigabatrin for 2 weeks. At the end of 2 weeks of treatment, patients were considered responders if spasms and hypsarrhythmia resolved. Nonresponders were crossed over and treated with the alternate drug. Nine patients were included in the study. Three patients received ACTH, one of whom was a responder. Six patients received vigabatrin, three of whom were responders. The five nonresponders received both therapies. All patients had some degree of developmental plateau or regression before the initiation of treatment. Four patients with idiopathic infantile spasms showed improved cognitive function following treatment. The remaining five patients remained significantly delayed. Five patients with symptomatic infantile spasms had epilepsy following treatment; three of them were in the autistic spectrum. The small number of infants in this pilot study is insufficient to determine which of the two drugs is more effective. However, the following trends were identified: vigabatrin may be more effective for patients with symptomatic infantile spasms; patients with idiopathic infantile spasms tend to have a better cognitive outcome; and patients with symptomatic infantile spasms tend to develop both epilepsy and autism.

Adrenocorticotropic Hormone↗

PubMed1999

A test of central coherence theory: linguistic processing in high-functioning adults with autism or Asperger syndrome: is local coherence impaired?

Central coherence theory (Frith, U., 1989. Autism: Explaining the Enigma. Blackwell, Oxford.) is addressed by exploring linguistic processing in normally intelligent adults with either autism or Asperger syndrome, to test whether local coherence is impaired. Local coherence is the ability to make contextually meaningful connections between linguistic information in short-term or working memory. Experiment 1 demonstrated that individuals with an autism spectrum condition were less likely to use the sentence context spontaneously to provide the context-appropriate pronunciation of a homograph. Experiment 2 presented scenarios which had a situation and outcome which only cohered if a bridging inference was drawn. The clinical groups were less likely to select the most coherent (bridging) inference from competing alternatives. Experiment 3 demonstrated that individuals with an autism spectrum condition were less able to use context to interpret an auditorily presented ambiguous sentence. The findings from Experiments 2 and 3 suggest that individuals with autism or Asperger syndrome have a difficulty in achieving local coherence, while the evidence from Experiment 1 suggests a preference not to strive for coherence. Taken together, these results suggest that individuals with an autism spectrum condition are impaired in achieving local coherence, and they have a preference not to strive for coherence unless instructed to do so, or unless they make a conscious decision to do so. Moreover, the three experiments correlate with one another, which suggests that central coherence may be a unitary force in these different tasks. Of the two clinical groups, the autism group had the greater difficulty in achieving coherence. Possible explanations for the clinical groups' difficulty are explored.

Adolescent↗

PubMed2005

Chronomics of autism and suicide.

We examine whether autism may be influenced by non-photic environmental factors, among others, in a California database consisting of the number of cases added quarterly to the system between 1993 and 2004. Instead of a precise calendar (1.0)-year-long spectral component, we detect unseen primarily helio- and geomagnetic signatures, including a newly discovered near-transyear of 1.09-year length. In this case, it overrides any undetected seasonal effects, the topic of much previous unrewarding research, also analyzed herein without overcoming the limitation by stacking. Since we could not get additional data on autism, data on suicides, the final "detachment" and failure to bond, were also analyzed, again revealing a spectrum of non-photic signatures. What we do not see and do not anticipate can exist and can override the seasons, as resolved time-microscopically by chronomics, the study of chronomes (time structures). Just as spatial microscopy and electron microscopy resolved infectious agents, so does microscopy in time resolve the signature of environmental agents in human behavior in health and disease.

Autistic Disorder↗