Validity and reliability of the infant behavioral summarized evaluation (IBSE): a rating scale for the assessment of young children with autism and developmental disorders

First Alarm and Time of Diagnosis in Autism Spectrum Disorders

Early diagnosis of autism spectrum disorder (ASD) is of paramount importance as it opens the road to early intervention, which is associated with better prognosis. However, early diagnosis is often delayed until preschool or school age. The purpose of the current retrospective study was to explore the age of recognition of first alarming symptoms in boys and girls as well as the age at diagnosis of different subtypes of ASD in a small sample. A total of 128 parents' of children with ASDs were participated in the survey by completing a self-report questionnaire about early signs and symptoms that raised their concern. Parents of children with autism voiced concerns earlier and obtained diagnosis significantly earlier compared to parents of children with Asperger syndrome (p value <0.000). No significant difference (p value<0.05) has been detected between males and females in early manifestation of first signs and symptoms of ASD. The mean age at diagnosis was 3.8 years for autistic disorder, 6.2 years for children with Asperger syndrome and 6.4 years for other, e.g., PDD-NOS. The most commonly reported symptoms were speech and language problems (p value = 0.001) for children who were later diagnosed with autism, while behavior problems (p value = 0.046) as well as difficulties in education at school (p value = 0.013) for children with Asperger syndrome. The gap between early identification and diagnosis pinpoints the urgent need for national systematic early screening, the development of reliable and sensitive diagnostic instruments for infants and toddlers and heightened awareness of early signs of ASD among parents, teachers, and healthcare professionals and providers as well.

A Brief Clinical Scale for the Early Evaluation of Imitation Disorders in Autism

Many authors have described a deficit of imitation of gestures and of symbolic and affective tasks in infants and young children with autism. This deficit is paradoxically associated with echolalia (atypical verbal imitation) and echopraxia (atypical gesture imitation) which in themselves appear to be excessive imitation. We have developed a brief clinical scale, the Imitation Disorders Evaluation scale (IDE scale), to evaluate these different early features of imitation disorders in autism. The present article reports (1) the validation study (inter- rater reliability, factor analysis) of the IDE scale carried out with a population of 30 infants and young children with autism aged from 10 to 46 months, and (2) the results of a follow-up study in which this scale was applied to a group of young children with autism (from 30 to 46 months) over 9 months’ treatment. Factor analysis provided two factors: factor 1, called ‘deficient imitation’, comprising six items describing a deficit of facial, gestural, vocal and affective imitation; and factor 2, called ‘atypical imitation’, including echolalia, echopraxia and variability of imitation. The descriptive results of the follow-up study emphasize the sensitivity of the IDE scale for assessment of improvement in imitation disorders of early autism.

Parental Concerns of Early Development in Children with Autism and Related Disorders

Parents of consecutively referred children with autism (39), Asperger syndrome (13), atypical autism (15), learning disability (20) and semantic-pragmatic disorder (14) completed a questionnaire on concerns regarding their child's development between 12 and 18 months. The early development questionnaire included scales of communication and language, social relationships and play behaviour. The autism and the learning disability groups differed significantly on most items. The diagnosis of autism was best predicted by play behaviour items and lack of referential gestures. Factor analysis within the autism group identified factors involving items from different scales, such as lack of physical contact, social communication and imitative skills. Children with the diagnosis of semantic-pragmatic disorders had relatively high rates of early difficulties in social development. Implications for the screening and detection of autism and related disorders in early life and for the training of professionals involved are discussed.

Systematic review of tools to measure outcomes for young children with autism spectrum disorder

BACKGROUND

The needs of children with autism spectrum disorder (ASD) are complex and this is reflected in the number and diversity of outcomes assessed and measurement tools used to collect evidence about children's progress. Relevant outcomes include improvement in core ASD impairments, such as communication, social awareness, sensory sensitivities and repetitiveness; skills such as social functioning and play; participation outcomes such as social inclusion; and parent and family impact.

OBJECTIVES

To examine the measurement properties of tools used to measure progress and outcomes in children with ASD up to the age of 6 years. To identify outcome areas regarded as important by people with ASD and parents.

METHODS

The MeASURe (Measurement in Autism Spectrum disorder Under Review) research collaboration included ASD experts and review methodologists. We undertook systematic review of tools used in ASD early intervention and observational studies from 1992 to 2013; systematic review, using the COSMIN checklist (Consensus-based Standards for the selection of health Measurement Instruments) of papers addressing the measurement properties of identified tools in children with ASD; and synthesis of evidence and gaps. The review design and process was informed throughout by consultation with stakeholders including parents, young people with ASD, clinicians and researchers.

RESULTS

The conceptual framework developed for the review was drawn from the International Classification of Functioning, Disability and Health, including the domains 'Impairments', 'Activity Level Indicators', 'Participation', and 'Family Measures'. In review 1, 10,154 papers were sifted - 3091 by full text - and data extracted from 184; in total, 131 tools were identified, excluding observational coding, study-specific measures and those not in English. In review 2, 2665 papers were sifted and data concerning measurement properties of 57 (43%) tools were extracted from 128 papers. Evidence for the measurement properties of the reviewed tools was combined with information about their accessibility and presentation. Twelve tools were identified as having the strongest supporting evidence, the majority measuring autism characteristics and problem behaviour. The patchy evidence and limited scope of outcomes measured mean these tools do not constitute a 'recommended battery' for use. In particular, there is little evidence that the identified tools would be good at detecting change in intervention studies. The obvious gaps in available outcome measurement include well-being and participation outcomes for children, and family quality-of-life outcomes, domains particularly valued by our informants (young people with ASD and parents).

CONCLUSIONS

This is the first systematic review of the quality and appropriateness of tools designed to monitor progress and outcomes of young children with ASD. Although it was not possible to recommend fully robust tools at this stage, the review consolidates what is known about the field and will act as a benchmark for future developments. With input from parents and other stakeholders, recommendations are made about priority targets for research.

FUTURE WORK

Priorities include development of a tool to measure child quality of life in ASD, and validation of a potential primary outcome tool for trials of early social communication intervention.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42012002223.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Reduced serotonin receptor subtypes in a limbic and a neocortical region in autism

Autism is a behaviorally defined, neurological disorder with symptom onset before the age of 3. Abnormalities in social-emotional behaviors are a core deficit in autism, and are characterized by impaired reciprocal-social interaction, lack of facial expressions, and the inability to recognize familiar faces. The posterior cingulate cortex (PCC) and fusiform gyrus (FG) are two regions within an extensive limbic-cortical network that contribute to social-emotional behaviors. Evidence indicates that changes in brains of individuals with autism begin prenatally. Serotonin (5-HT) is one of the earliest expressed neurotransmitters, and plays an important role in synaptogenesis, neurite outgrowth, and neuronal migration. Abnormalities in 5-HT systems have been implicated in several psychiatric disorders, including autism, as evidenced by immunology, imaging, genetics, pharmacotherapy, and neuropathology. Although information is known regarding peripheral 5-HT in autism, there is emerging evidence that 5-HT systems in the central nervous system, including various 5-HT receptor subtypes and transporters, are affected in autism. The present study demonstrated significant reductions in 5-HT1A receptor-binding density in superficial and deep layers of the PCC and FG, and in the density of 5-HT(2A) receptors in superficial layers of the PCC and FG. A significant reduction in the density of serotonin transporters (5-HTT) was also found in the deep layers of the FG, but normal levels were demonstrated in both layers of the PCC and superficial layers of the FG. This study provides potential substrates for decreased 5-HT modulation/innervation in the autism brain, and implicate two 5-HT receptor subtypes as potential neuromarkers for novel or existing pharmacotherapies.

Can questions about social interaction correctly identify preschool aged children with autism?

AIM

We developed a questionnaire to assess social development (SIQ) in preschool children. Social development is often not included in medical assessment, though it may assist in early identification of autism spectrum disorder (ASD).

METHODS

Parents of 108 children with ASD, speech and language disorders, or 'developmental concerns', recruited from a clinical developmental assessment and community child health service, completed the SIQ, and also a Childhood Autism Rating Scale (CARS) assessment. Receiver Operator Characteristic (ROC) curves were generated to assess the performance of different questionnaire score thresholds in correctly identifying children with a CARS score of 30 or more. Logistic regression models were used to identify the questions which had the most predictive value for a CARS score of 30 or more.

RESULTS

An SIQ score of 14 or more correctly identified children with a CARS ≥ 30 with a sensitivity of 85%, specificity 85%, positive likelihood ratio (LR) 8.3 and negative LR 0.2. Two questions were identified as most predictive of ASD.

CONCLUSIONS

The SIQ may assist clinicians in assessing social development and in making decisions about referral for autism assessment. Evaluation of the SIQ at the point of entry to a clinical service is needed.

Evidence of a distinct behavioral phenotype in young boys with fragile X syndrome and autism

OBJECTIVE

How does the behavioral expression of autism in fragile X syndrome (FXS + Aut) compare with idiopathic autism (iAut)? Although social impairments and restricted, repetitive behaviors are common to these variants of autism, closer examination of these symptom domains may reveal meaningful similarities and differences. To this end, the specific behaviors comprising the social and repetitive behavioral domains in young children with FXS + Aut and iAut were profiled.

METHOD

Twenty-three male subjects 3 to 5 years old with FXS + Aut were matched by age to a group of 38 boys with iAut. Repetitive behavior was assessed using the Repetitive Behavior Scales-Revised. Social behavior was evaluated using Autism Diagnostic Observation Schedule social item severity scores.

RESULTS

Rates of stereotypy, self-injury, and sameness behaviors did not differ between groups, whereas compulsive and ritual behavior scores were significantly lower for subjects with FXS + Aut compared with those with iAut. Those with FXS + Aut scored significantly lower (less severe) than the iAut group on five Autism Diagnostic Observation Schedule measurements of social behavior: gaze integration, quality of social overtures, social smile, facial expressions, and response to joint attention.

CONCLUSIONS

The behavioral phenotype of FXS + Aut and iAut are most similar with respect to lower-order (motoric) restricted, repetitive behaviors and social approach, but differ in more complex forms of restricted, repetitive behaviors and some social response behaviors. These findings highlight the phenotypic heterogeneity of autism overall and its unique presentation in an etiologically distinct condition.

Autism spectrum disorders in infancy and toddlerhood: a review of the evidence on early signs, early identification tools, and early diagnosis

To date, the biological basis of autism spectrum disorders (ASDs) remains unknown. Thus, identification and diagnosis are reliant on behavioral presentation and developmental history. There have been significant advances in our knowledge of the early signs of ASD through the use of retrospective videotape analysis, parental report, screening studies, and more recently, studies on high-risk infant siblings. Despite behavioral markers being identified within the first year of life, the current average age of diagnosis for ASD remains at approximately 3 years or older. Consequently, these children are not receiving intervention in their early years, which is increasingly recognized as an important time to begin intervention. There remains little research on the prospective identification of these children in a community-based sample before 18 months. It is recommended that future prospective studies monitor behavior repeatedly over time, thereby increasing the opportunity to identify early manifestations of ASD and facilitating the charting of subtle behavioral changes that occur in the development of infants and toddlers with ASD.

An exploration of symmetry in early autism spectrum disorders: analysis of lying

BACKGROUND

Early identification of children with autism spectrum disorders (ASD) is recognized as a critical aspect of their medical management and treatment. Movement disorders are considered one of the first signs which probably precede social or linguistic abnormalities.

OBJECTIVES

to verify, through observational methods, the possibility of distinguishing infants with ASD from infants with typical development or with mental retardation by movement.

METHODS

The Eshkol-Wachman movement analysis system, which analyses static symmetry (SS) and dynamic symmetry (DS) during lying, was applied to retrospective home videos regarding the first 5 months of life of children with ASD (n=18), typical development (n=18), or developmental delay (n=12).

RESULTS

Significant differences between ASD and the two control groups were found for both SS (p<.001) and DS (p<.01). Within ASD two groups of infants could be differentiated on the basis of the higher (HLS) or the lower (LLS) levels of symmetry. Early onset ASD are more likely to belong to the LLS group.

CONCLUSION

We suggest that motor functioning may define specific subgroups of early ASD which are related to different pathways to the syndrome. LLS could be used as an early indicator of potential autism since the first months of life.

The Autism Observation Scale for Infants: Scale Development and Reliability Data

The Autism Observation Scale for Infants (AOSI) was developed to detect and monitor early signs of autism as they emerge in high-risk infants (all with an older sibling with an autistic spectrum disorder). Here we describe the scale and its development, and provide preliminary data on its reliability. Inter-rater reliability both for total scores and total number of endorsed items is good to excellent at 6, 12 and 18 months; reliability is more modest for individual items, particularly in 6-month-olds. Test-retest reliability of the AOSI at 12 months of age is within acceptable limits. Evidence that the AOSI provides reliable data is the first critical step towards evaluating its efficacy in distinguishing high-risk infants who develop ASD.

Screening for autistic spectrum in children aged 14 to 15 months. I: the development of the Early Screening of Autistic Traits Questionnaire (ESAT)

This article describes the development of a screening instrument for young children. Screening items were tested first in a non-selected population of children aged 8-20 months (n = 478). Then, parents of children with clinically diagnosed ASD (n = 153, average age 87 months) or ADHD (n = 76, average age 112 months) were asked to score the items retrospectively for when their child was 14 months old. A 14-item screening instrument, Early Screening of Autistic Traits (ESAT) which had maximal sensitivity and specificity for ASD was developed. The sensitivity of the ESAT was checked in an independent sample of 34 children aged 16-48 months clinically diagnosed with ASD. A 4-item version appears to be a promising prescreening instrument.

Autism and developmental delay: a comparative clinical study in very young children using IBSE scale

OBJECTIVE

This study improves the knowledge of early autistic symptomatology and research concerning (i) the significant differences in the behaviors of children with autistic disorder (AD) and children with a developmental delay (DD), and (ii) the influence of the cognitive delay on symptomatology.

METHOD

Two groups of 20 young children (7-42 months) were compared: children with AD, and those with DD. The groups were paired by chronological and developmental age. The comparison was extended to four subgroups composed according to age (younger and older children--<24 months, >24 months) and to the global development quotient (GDQ) (the more and less delayed). Each child was evaluated with the Infant Behavior Summarized Evaluation scale (IBSE).

RESULTS

For the younger AD children, significant differences affected social communication and their adaptation to the environment (intolerance to frustration, resistance to change). For the older children (>24 months), this study showed the rapid progression of the number of distinctive signs between AD and DD children according to age and/or developmental level.

CONCLUSIONS

Cognitive delay has an important influence on the symptomatology at the moment of initial recognition of an autistic syndrome. This study is a complement for the fuller understanding of the nature and early diagnosis of disorders specific to autism at the earliest phases of development.

Screening for autism in pre-school children in primary care: Systematic review of English Language tools

OBJECTIVES

To review the accuracy of brief screening tools for autism in pre-school children.

DESIGN

Systematic review of diagnostic accuracy studies.

DATA SOURCES

Medline, Embase, Cinahl and Psychlit plus references of identified papers and contact with authors.

SUBJECTS

Children and infants aged 5 years or less without a prior diagnosis of autism or pervasive development delay.

INTERVENTIONS

Tools/checklists appropriate for use in screening for autism in primary care settings.

OUTCOME MEASURES

Sensitivity, specificity, positive and negative predictive value of screening tools and likelihood ratios relative to a diagnostic assessment made using either DSM-III/IV or ICD 10 diagnosis.

RESULTS

Three studies considering two tools were identified. The CHecklist for Autism in Toddlers (CHAT) was tested on an appropriate population sample with moderate long-term follow-up but demonstrated poor sensitivity and positive predictive value. Weaker evidence suggested that the Modified CHecklist for Autism in Toddlers (M-CHAT) had high sensitivity but follow-up was of shorter term and less comprehensive.

CONCLUSIONS

The CHAT demonstrated a level of sensitivity unlikely to be useful for population screening purposes, however, its high specificity suggests it has utility in secondary screening. The M-CHAT is a parent only report and might be more sensitive, and therefore appropriate for population screening. However, full conclusions regarding its accuracy cannot be drawn until follow-up data has been collected.

Early features of autism: Repetitive behaviours in young children

This study examined whether repetitive behaviours were a differentiating feature of autism in children aged less than 51 months. The study also examined the relationship between age (chronological and developmental) and repetitive behaviours in young children with autism. Standardised developmental and diagnostic assessments were conducted on 55 children aged between 22 and 51 months, consisting of 40 developmentally delayed children with DSM-IV-TR Autistic Disorder and 15 developmentally delayed children without Autistic Disorder. Results indicated that several measures of repetitive behaviour, particularly more complex high-level ones, were significantly positively associated with the probability of receiving a diagnosis of autism. No significant relationships were found between developmental age and the presence of repetitive behaviours in children with autism, but younger chronological age was associated more with simple or low-level repetitive behaviours.

Autismo infantil: despiste e prevenção

A detecção mais precoce possível do autismo infantil condiciona em grande parte a qualidade do prognóstico, sobretudo o prognóstico cognitivo. Essa detecção precoce coloca, no entanto, uma série de questões clínicas, teóricas e éticas extremamente importantes. O autismo infantil não pode ser reduzido a um déficit neurodesenvolvimental, e é preciso concebê-lo, de preferência, como o fruto de um processo autistisante progressivo e de origem multifatorial. Os sinais que permitem a detecção durante o segundo ano de vida são atualmente bem definidos, principalmente com a constituição do CHAT (Check list for autistic todlers). Durante o primeiro ano de vida são descritas atualmente perturbações interativas precoces, mas talvez seja necessário sobretudo detectar as crianças que necessitam de cuidados, sem confiná-las dentro de uma predição autística que incorre no risco de fixar as coisas, privando o futuro de uma abertura evolutiva ainda possível. A questão do estudo dos filmes familiares foi recentemente retomada de maneira renovada e muito fecunda.

Interaction and imitation deficits from infancy to 4 years of age in children with autism: a pilot study based on videotapes

The present study investigated the influence of developmental level on interaction and imitation in infants and young children with autism on the basis of family videos and filmed consultation. The sample comprised 18 children with autism divided into groups according to their developmental quotient (DQ>50 and DQ<50). A quantitative evaluation was performed on video observations at four periods (10-12 months, 16-18 months, 24-26 months, after 4 years) using scales appropriate for the evaluation of interaction and imitation impairments. The findings showed that, at a very early age, infants later diagnosed as having autistic disorder show different intensities of interaction and imitation deficits according to developmental level.

Screening for autism in infants and preschool children with developmental delay

OBJECTIVE

This study aimed to identify emotional and behavioural problems specific to young children with autism using the Developmental Behaviour Checklist (DBC-P) and thus evaluate the efficacy of this checklist as a screening tool for autism in children with developmental delay aged 18-48 months.

METHOD

Subjects were 60 children with autism and developmental delay and 60 children with developmental delay without autism.

RESULTS

Features were identified which differentiated the children with autism from those with developmental delay without autism. Analyses revealed that a 17-item version of the DBC-P performed well as a screening tool for autism, with an 'area under the curve' of 0.874, sensitivity of 0.8750, and specificity of 0.6909.

CONCLUSIONS

The DBC-P offers a potential simple and inexpensive method of screening at risk populations of preschool children with developmental delay for autism, thus facilitating timely referral to scarce specialist autism diagnostic services.

A retrospective journal-based case study of an infant with autism and his twin

This report describes the development of an infant who was later diagnosed with autism, and a direct comparison of his development to that of his twin, from a prenatal period through the age of 4 years, through the examination of personal journals and medical records kept by the mother of the twins. Examination of these journals revealed several differences in development between the twins, some as early as 6 months of age. In the first year of life, the infants already differed in language development, social development, sleep patterns, and sensitivity to pain. This rare opportunity to view early autistic development gives direction to developmental theories of autism and clinically useful cues to early signs of autism.

Course of autism signs in the first year of life

Autism spectrum disorders (ASD) are thought to be present right from birth, even if a minority of children displays a normal course during infancy followed by a regression during the second year of life. However, established criteria are not yet available to differentiate these different courses of ASD, and data coming from different sources have not yet been organized into a clear definition. The aim of this study was to elucidate the time of onset, as well as type, frequency and stability of symptoms during the first year of life in ASD. The behavioral summarized evaluation scale, applied to 40 home movies of children later diagnosed as having ASD, showed that most of the subjects (87.5%) display symptoms within the first year of life, when only a small group (12.5%) is completely symptom free. A group of more rated symptoms was found, constituting a typical pattern characterized by being withdrawn, and displaying poor social initiative, hypoactivity, and lack of emotional modulation. The importance of these findings is discussed in relation to early diagnosis and treatment.

Psychodiagnostische Verfahren zur Erfassung autistischer Störungen

Zusammenfassung: Fragestellung: Es wird eine Übersicht zu international gängigen und in deutscher Sprache erhältlichen Instrumenten zur Früherkennung und allgemeinen Diagnostik autistischer Störungen gegeben. Methodik: Alle bis Mai 2004 mittels Medline, PsychInfo, Psyndex und Google identifizierten Fragebogen, Beobachtungsskalen und diagnostischen Interviews zum Autismus und zu assoziierten Störungen werden zitiert und ferner für den deutschen Sprachraum adaptierte und entwickelte Verfahren genauer vorgestellt. Ergebnisse: Eine steigende Anzahl zuverlässiger Skalen zur Erfassung von Störungen des autistischen Spektrums ist international und national verfügbar. Derzeit gilt eine Kombination von Social Communication Questionnaire (SCQ), Autism Diagnostic Observation Schedule (ADOS) und Autism Diagnostic Interview-Revised (ADI-R) als Standard der psychometrisch basierten Autismusdiagnostik. Schlussfolgerungen: Für einige diagnostische Kategorien und Fragestellungen besteht weiterhin ein gewisser Bedarf an Verfahren in deutscher Sprache. Insbesondere Skalen zur Messung des breiteren Phänotyps des Autismus sowie stärker veränderungssensitive Instrumente zur Erfassung des Verlaufs und von Therapieeffekten sind wünschenswert. Schlüsselwörter: Autismus, Diagnostik, Früherkennung, Fragebogen, Ratingskalen, Interviews

Early Indicators of Autism Spectrum Disorders in the Second Year of Life

Three groups of 18 children were selected for this study, one group with autism spectrum disorders (ASD), one group with developmental delays in which ASD was ruled out (DD), and one group with typical development (TD), from a pool of 3026 children who were screened with the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP, Wetherby & Prizant. 2002) Infant-Toddler Checklist under 24 months of age. The CSBS DP Behavior Sample was videotaped on selected children as a second-level evaluation during the second year of life. The Infant-Toddler Checklist had a sensitivity and specificity of 88.9% for this sample of children. Significant group differences were found on the Infant-Toddler Checklist and the Behavior Sample, however, these differences did not distinguish children with ASD and DD with high accuracy. The videotapes of the Behavior Sample were reanalyzed to identify red flags of ASD. Nine red flags differentiated children in the ASD group from both the DD and TD groups and four red flags differentiated children in the ASD Group from the TD group but not the DD group. These 13 red flags were found to discriminate the three groups with a correct classification rate of 94.4%.

Analysis of intentional communication in severely handicapped children with Cornelia-de-Lange syndrome

Intentional communicative acts were assessed in 13 children with Cornelia-de-Lange syndrome (CdLS) with a severe mental disability and compared to a control group of Down and 5p (Cri-du-Chat (CdC)) syndrome children. The mean number of intentional communicative acts were significantly lower. Analysis of play behaviors revealed that the differences were specific for the communicative domain. They are part of a general behavioral characteristic of CdLS children with a severe mental disability which can be described as a lack of communication, emotional reactions and motility. A syndrome-specific low rate of communicative initiatives indicates a special problem for designing intervention programs which depend on opportunities for facilitating strategies.

LEARNING OUTCOMES

The reader will learn about the behavioral phenotype of CdLS, distinctive communication problems and qualities of play behavior which are relevant for planning educational interventions in children with this syndrome.

The Modified Checklist for Autism in Toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders

Autism, a severe disorder of development, is difficult to detect in very young children. However, children who receive early intervention have improved long-term prognoses. The Modified Checklist for Autism in Toddlers (M-CHAT), consisting of 23 yes/no items, was used to screen 1,293 children. Of the 58 children given a diagnostic/developmental evaluation, 39 were diagnosed with a disorder on the autism spectrum. Six items pertaining to social relatedness and communication were found to have the best discriminability between children diagnosed with and without autism/PDD. Cutoff scores were created for the best items and the total checklist. Results indicate that the M-CHAT is a promising instrument for the early detection of autism.

Towards a new functional assessment of autistic dysfunction in children with developmental disorders: the Behaviour Function Inventory

In order to assess particular disorders of psychological development and functioning in children with developmental disorders, we have developed a new tool, the Behaviour Function Inventory (BFI), based on 11 neurophysiological functions, disorders of which are considered to contribute to the core autistic syndrome. This article reports the reliability and validity study of this new scale. Factorial analysis computed on the 55 initial items identified six main dimensions which we characterized and labelled: interaction dysfunction, praxis dysfunction, auditory dysfunction, attention dysfunction, islet of ability and emotional dysfunction. Relationships between these six new variables and diagnostic subgroups, and chronological and developmental age, are discussed. The BFI offers precise information of the functional symptomatology of autism, showing clear evidence of some disordered areas of functioning. This new approach may provide valuable information in clinical research, especially for psychopathology and physiopathology studies.

The Modified Checklist for Autism in Toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders

Autism, a severe disorder of development, is difficult to detect in very young children. However, children who receive early intervention have improved long-term prognoses. The Modified Checklist for Autism in Toddlers (M-CHAT), consisting of 23 yes/no items, was used to screen 1,293 children. Of the 58 children given a diagnostic/developmental evaluation, 39 were diagnosed with a disorder on the autism spectrum. Six items pertaining to social relatedness and communication were found to have the best discriminability between children diagnosed with and without autism/PDD. Cutoff scores were created for the best items and the total checklist. Results indicate that the M-CHAT is a promising instrument for the early detection of autism.

Autism during infancy: a retrospective video analysis of sensory-motor and social behaviors at 9-12 months of age

This retrospective video study explored the usefulness of sensory-motor measures in addition to social behaviors as early predictors of autism during infancy. Three groups included 11 children with autism, 10 with developmental disabilities, and 11 typically developing children. Home videos were edited to obtain a 10-minute cross-section of situations at 9-12 months for each subjects. Using interval scoring, raters coded several behavioral categories (i.e., Looking, Affect, Response to Name, Anticipatory Postures, Motor/Object Stereotypies, Social Touch, Sensory Modulation). Nine items, in combination, were found to discriminate the three groups with a correct classification rate of 93.75%. These findings indicate that subtle symptoms of autism are present at 9-12 months, and suggest that early assessment procedures need to consider sensory processing/sensory-motor functions in addition to social responses during infancy. Furthermore, prior to a time that they reported autistic symptoms, caregivers used compensatory strategies to increase the saliency of stimuli in order to engage their children more successfully; these strategies may provide a window for earlier diagnosis.

Validation of the Revised Behavior Summarized Evaluation Scale

The Behavioral Summarized Evaluation scale (BSE), previously published and validated, was developed for the evaluation for the autistic behavior in developmentally disorder children. A revised version of this scale, the Revised Behavior Summarized Evaluation Scale (BSE-R) completed the 20-item BSE scale with the most relevant items extracted from a similar evaluation carried out with very young children. Thus 9 items were added to the original scale concerning nonverbal communication, emotional, and perception areas. This paper reports the reliability and validity studies of this new scale. In addition to confirming the previously published findings concerning the first version of the BSE, new items were extracted from the BSE-R content validity study. They involve fundamental functions such as intention and imitation which open new perspectives for a physiopathological approach to developmental disorders. The BSE-R is a useful tool for progressive recording of the evolution of patients both treated over long periods and included in short-term controlled therapeutic studies.

Early detection of autism. Diagnostic instruments for clinicians

Autism and Asperger syndrome are disorders with early childhood onset. They are believed to exist on the same spectrum of impairments of reciprocal communication and social interaction restriction of imagination and behaviour. A number of screening and diagnostic tools have been developed in the field, and several of these are briefly reviewed here. It is concluded that autism may be screened around age 18 months and a diagnosis reliably be made around age 30 months, whereas a diagnosis of Asperger syndrome is not usually suspected, screened or made until into the child's school age.

Disorders of regulation of cognitive activity in autistic children

Infantile autism is a pervasive developmental disorder characterized by disturbances concerning not only the areas of socialization and communication ("aloneness") but also the ability to modify and change behavior ("need for sameness"). In most recent studies, various abnormal and deviant cognitive activities, such as the ability to regulate one's behavior, were considered as accounting for these signs. In this report, we examined the regulation of cognitive activity, from a developmental perspective in comparing autistic with mentally retarded children matched in a pairwise manner by global, verbal, and nonverbal developmental ages. All children were tested with tasks adapted from the Object Permanence Test which corresponds to Piaget's sensorimotor development Stages IV to VI. Results showed that autistic children had a pervasive difficulty in maintenance set, made more perseverative errors when the abstraction degree of task was higher, and were more variable in their behavioral strategies. Discussion is focused on the interests and limits of these tasks for the examination of regulation activity from diagnostic and developmental perspectives. Finally, interpretations about recent neuropsychological and neurophysiological works, and additional interdisciplinary studies are suggested.

Quantified multidimensional assessment of autism and other pervasive developmental disorders. Application for bioclinical research

A large number of investigation techniques are used to establish the relationships between the clinical and biological data which are necessary for physiopathological analysis in the field of developmental disorders. It therefore seemed necessary to develop a quantified grouping system, based on developmental assessments, which could allow closer matching between clinical evaluations and biological numerical data. Two hundred and two subjects presenting developmental disorders (autistic disorder, pervasive developmental disorder not otherwise specified and mental retardation) were examined. For each child, a quantification of autistic behaviour, intellectual impairment, neurological signs and language and communication disorders was performed. A cluster analysis of these quantified data elicited four subgroups according to the scores obtained in these four different areas. We showed the value of this approach by applying it to one of the studies of monoamines routinely examined in childhood autism--dopamine and HVA, its main urinary derivative. Moreover, this method revealed a subgroup within the total population which was independent of nosographic classification and which had a particular clinical and biochemical profile. Other applications could follow, for example in the fields of neurophysiology, cerebral imaging, molecular biology and genetics.

Early detection of childhood autism: a review of screening instruments and rating scales

The detection and diagnosis of autism may be delayed until middle childhood, 3-4 years after its onset. This is more likely in high-functioning autism and in cases of co-morbidity with mental retardation. Such delays have serious effects on children and their families as well as on the provision of clinical and educational resources. In addition to greater awareness among professionals and to the development of comprehensive services, early detection could be facilitated by screening for early signs and symptoms of autism. The instruments that have been developed to rate autistic behaviours, particularly in pre-school children, are reviewed in this paper. Although the majority of these observational or informant-based measures were not initially designed for screening purposes, previous research findings from their application could be useful in the future development of such a screening instrument. Relevant research findings are discussed and suggestions are made for further evaluation in appropriate populations.

Blind ratings of early symptoms of autism based upon family home movies

Ratings of family home movies of 12 infants (0 to 2 years old) who were later diagnosed as autistic and 12 normal infants were performed by two diagnosis-blind psychiatrists with Infant Behavior Summarized Evaluation scale. The objective was to identify early symptoms of autism and their intensity and frequency before and after 1 year of age. Several pathological types of behavior related to socialization, communication, motility, and attention were noted during the first year of infant life and differentiated autistic and normal groups. These same differentiating behaviors, observed again in the second year, were more intense and associated with other pathological types of behavior, in particular, gaze avoidance, hypoactivity, and absence of emotional expressions. Analysis of the evolution of behavioral pathology in autistic children as a group during the 2 first years of life confirms the persistence of and the increase in some types of abnormality related to socialization, communication, motility, and attention functions. The limitations and values of this study concerning the early identification of autistic symptoms and functional impairments from home movies for diagnosis and establishing individualized treatment program are discussed.