Effects of age on communication skill levels and prevalence of maladaptive behaviors in autistic and mentally retarded children

Anxiety in Autism Spectrum Disorder: Clinical Characteristics and the Role of the Family

BACKGROUND

Anxiety Disorder (AD) is among the most common psychiatric comorbidity in children and adolescents with Autism Spectrum Disorder (ASD). Likewise, parental psychological distress (PPD) was linked to anxiety symptoms in children and adolescents with ASD. The aim of this study was to characterise, in a sample of children and adolescents with ASD, anxiety symptoms, the functional impairment associated and the presence of PPD.

METHODS

Participants were divided into three groups based on their diagnosis: children and adolescents with a diagnosis of ASD + AD, others with a diagnosis of AD but without a diagnosis of ASD, and others with a diagnosis of ASD but without a diagnosis of AD.

RESULTS

Group ASD + AD showed lower global functioning than Group ASD and Group AD. Generalised Anxiety Disorder, Separation Anxiety Disorder and Specific Phobias were more frequent in Group ASD + AD. Our findings also showed higher depressive symptoms in Group ASD + AD, both in the child and parent reports. Finally, parents of the Group ASD + AD revealed higher levels of PPD.

CONCLUSIONS

Our findings suggest that early assessment of AD with functional impairment associated with the role of PPD could define individualised treatments and consequently mean a better prognosis in children and adolescents with ASD and AD.

Internet-of-Things Devices in Support of the Development of Echoic Skills among Children with Autism Spectrum Disorder

A significant therapeutic challenge for people with disabilities is the development of verbal and echoic skills. Digital voice assistants (DVAs), such as Amazon’s Alexa, provide networked intelligence to billions of Internet-of-Things devices and have the potential to offer opportunities to people, such as those diagnosed with autism spectrum disorder (ASD), to advance these necessary skills. Voice interfaces can enable children with ASD to practice such skills at home; however, it remains unclear whether DVAs can be as proficient as therapists in recognizing utterances by a developing speaker. We developed an Alexa-based skill called ASPECT to measure how well the DVA identified verbalization by autistic children. The participants, nine children diagnosed with ASD, each participated in 30 sessions focused on increasing vocalizations and echoic responses. Children interacted with ASPECT prompted by instructions from an Echo device. ASPECT was trained to recognize utterances and evaluate them as a therapist would—simultaneously, a therapist scored the child’s responses. The study identified no significant difference between how ASPECT and the therapists scored participants; this conclusion held even when subsetting participants by a pre-treatment echoic skill assessment score. This indicates considerable potential for providing a continuum of therapeutic opportunities and reinforcement outside of clinical settings.

A community survey establishing the prevalence rate of autistic disorder in adults with learning disability

AIMS AND METHOD

Most studies into autistic disorder have concentrated on children. This study aims to establish a prevalence rate of autistic disorders in an adult population with learning disabilities. Adults accessing learning disability services were diagnosed as having an autistic disorder by a two-stage process. The first stage was screening using the Pervasive Developmental Disorder – Mental Retardation Scale and then those identified by screening were diagnosed clinically.

RESULTS

An overall population rate of 7.7/10 000 for autistic disorder was obtained, which is a prevalence rate of 30% in those with learning disability. The prevalence rate was higher in intensive service settings.

CLINICAL IMPLICATIONS

Specific funding and interventions need to be targeted for the treatment of autistic disorders.

Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis

There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.

The EL mouse: a natural model of autism and epilepsy

PURPOSE

Autism is a multifactorial disorder that involves impairments in social interactions and communication, as well as restricted and repetitive behaviors. About 30% of individuals with autism develop epilepsy by adulthood. The EL mouse has long been studied as a natural model of multifactorial idiopathic generalized epilepsy with complex partial seizures. Because epilepsy is a comorbid trait of autism, we evaluated the EL mouse for behaviors associated with autism.

METHODS

We compared the behavior of EL mice to age-matched control DDY mice, a genetically related nonepileptic strain. The mice were compared in the open field and in the light-dark compartment tests to measure activity, exploratory behavior, and restricted and repetitive behaviors. The social transmission of food preference test was employed to evaluate social communication. Home-cage behavior was also evaluated in EL and DDY mice as a measure of repetitive activity.

KEY FINDINGS

We found that EL mice displayed several behavioral abnormalities characteristic of autism. Impairments in social interaction and restricted patterns of interest were evident in EL mice. Activity, exploratory behavior, and restricted behavior were significantly greater in EL mice than in DDY mice. EL mice exhibited impairment in the social transmission of food preference assay. In addition, a stereotypic myoclonic jumping behavior was observed in EL mice, but was not seen in DDY mice. It is of interest to note that seizure activity within 24 h of testing exacerbated the autistic behavioral abnormalities found in EL mice.

SIGNIFICANCE

These findings suggest that the EL mouse expresses behavioral abnormalities similar to those seen in persons with autism. We propose that the EL mouse can be utilized as a natural model of autism and epilepsy.

Factors associated with the risk of behaviour problems in adolescents with severe intellectual disabilities

BACKGROUND

Little is known about the factors affecting the risk of behavioural and emotional problems in young people with severe intellectual disability (ID), although such evidence as there is suggests that there may be differences between the pattern of risk factors in this group and those that operate in general population samples of the same age.

METHOD

From a sample of 111 children with severe ID who had been initially identified from the registers of six special schools at 4-11 years, 82 were traced and reassessed on average 5 years 4 months later. The relationships between potential risk factors and behaviour problems, reported here for 11:00-17:04 year olds, were assessed by means of parental interview conducted in the family home.

RESULTS

Behaviour problems were associated with the severity of ID and the severity of autistic symptomatology. Perhaps surprisingly, they were also more common in pre-pubertal than post-pubertal adolescents. Family factors such as a history of interrupted/disrupted maternal care, parental criticism of the child and aggressive parental disciplinary practices were also associated with behaviour problems, although the direction of causation was unclear. Several factors, including gender, social disadvantage and epilepsy, well established as risk factors in children without ID, were not significantly associated with behaviour problems in the present sample.

CONCLUSION

The findings suggest that the pattern of factors associated with behaviour problems in children with severe ID differs from that found both in the general population and in children with mild ID.

Atypical behaviors in children with autism and children with a history of language impairment

The frequency, course, and inter-relationships of atypical eating, sleeping, self-injurious behavior, aggression and temper tantrums in children with autism and children with a history of language impairment (HLI), was investigated using a parent interview that was created to examine these problem behaviors. The relationships between these behaviors and language, IQ, severity of autistic symptoms and depression were also assessed. Atypical eating behavior, abnormal sleep patterns, temper tantrums, and self-injurious behavior were significantly more common in the children with autism than those with HLI. Within the autism group, children who exhibited more atypical behaviors tended to have a lower nonverbal IQ, lower levels of expressive language, more severe social deficits and more repetitive behaviors. No relationship between the number of atypical behaviors and measures of cognitive or language ability was noted in the HLI group. However, having more atypical behaviors was related to increased restricted, repetitive behaviors in children with HLI. The atypical behaviors could be divided into two groups: abnormal eating and sleeping, which were independent and tended to begin early in life; and self-injury, tantrums and aggression, which began later and were inter-related. Sleep abnormalities were more common in children (groups combined) diagnosed with major depression.

ADHD symptom subtypes in children with pervasive developmental disorder

OBJECTIVE

Compares DSM-IV ADHD subtypes in large samples of 3-to-5 and 6-to-12 year old children with pervasive developmental disorder (PDD) vs. nonPDD clinic referrals.

METHOD

Parents and teachers completed a DSM-IV-referenced rating scale.

RESULTS

ADHD subtypes were clearly differentiated from the nonADHD group and showed a differential pattern of co-occurring psychiatric symptoms (more pronounced for teacher- than parent-defined subtypes and older than younger children) that was similar in both PDD and nonPDD samples. The Combined type had more severe oppositional, aggressive, and PDD symptoms than Inattentive type and were from less advantaged homes than other subtypes. Hyperactive-Impulsive type was least impaired.

CONCLUSION

Findings support the notion that ADHD may be a clinically meaningful syndrome in children with PDD.

Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders

The Kiddie Schedule for Affective Disorders and Schizophrenia was modified for use in children and adolescents with autism by developing additional screening questions and coding options that reflect the presentation of psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview-Present and Lifetime Version (ACI-PL), was piloted and frequently diagnosed disorders, depression, ADHD, and OCD, were tested for reliability and validity. The ACI-PL provides reliable DSM diagnoses that are valid based on clinical psychiatric diagnosis and treatment history. The sample demonstrated a high prevalence of specific phobia, obsessive compulsive disorder, and ADHD. The rates of psychiatric disorder in autism are high and are associated with functional impairment.

Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples

This study compares DSM-IV symptoms in children (ages 6 to 12 years) with pervasive developmental disorder (PDD), clinic controls, and community-based samples. Parents/teachers completed the Child Symptom Inventory-4 for four samples: PDD (N = 284/284) and non-PDD psychiatric clinic referrals (N = 189/181) and pupils in regular (N = 385/404) and special (N = 61/60) education classes. The PDD group received higher symptom severity ratings than the regular education group, but was similar to the non-PDD clinic sample. Screening prevalence rates were highest for ADHD, ODD, and generalized anxiety disorder. PDD subtypes exhibited differentially higher rates of psychiatric symptoms. The magnitude of rater and gender differences in symptom severity ratings was modest. Clinic-referred children with PDD exhibit a pattern of psychiatric symptoms highly similar to nonPDD clinic referrals. Although much additional research is needed on comorbidity, these symptoms have important treatment implications.

Psychiatric symptoms in preschool children with PDD and clinic and comparison samples

OBJECTIVE

This study describes and compares the severity of DSM-IV symptoms in preschool children with diagnosed pervasive developmental disorder (PDD), clinic controls, and two community-based samples.

METHOD

Parents (/and teachers) completed the early child inventory-4 (ECI-4), a DSM-IV-referenced rating scale for four samples: PDD (n = 172/160) and nonPDD psychiatric clinic referrals (n=135/101) and youngsters in regular (n=507/407) and special (n =64/140) early childhood programs. Children ranged in age from 3 to 5 years old.

RESULTS

With the exception of conduct problems, the PDD group generally received higher symptom severity ratings than the regular early childhood group, but the pattern of differences compared with the other two groups often varied by type of symptom and informant. Teachers rated the PDD and nonPDD clinic groups as having equally severe ADHD and oppositional defiant disorder symptoms. Teachers rated the PDD group as having more severe anxiety and depression symptoms than parents. The Asperger group was rated by both informants as more oppositional than the autism and PDDNOS subgroups. Teachers rated males in the regular early childhood sample as having more severe ADHD and aggressive symptoms than females, but this was not the case for the PDD sample.

CONCLUSION

Preschoolers with PDD exhibit more severe DSM-IV psychiatric symptoms than children in regular and special early childhood programs, and to some extent nonPDD psychiatric referrals. The concept of comorbidity warrants further exploration, as does informant-specific syndromes as validators of diagnostic constructs.

Assessment in multisite randomized clinical trials of patients with autistic disorder: the Autism RUPP Network. Research Units on Pediatric Psychopharmacology

Assessment of autistic disorder (autism) symptoms, primary and secondary, poses more challenging problems than ordinarily found in multisite randomized clinical trial (RCT) assessments. For example, subjects may be uncommunicative and extremely heterogeneous in problem presentation, and current pharmacological treatments are not likely to alter most core features of autism. The Autism Research Units on Pediatric Psychopharmacology (RUPP Autism Network) resolved some of these problems during the design of a risperidone RCT in children/adolescents. The inappropriateness of the usual anchors for a Clinical Global Impression of Severity (CGI-S) was resolved by defining uncomplicated autism without secondary symptoms as a CGI-S of 3, mildly ill. The communication problems, compromising use of the patient as an informant, were addressed by several strategies, including careful questioning of care providers, rating scales, laboratory tests, and physical exams. The broad subject heterogeneity requires outcome measures sensitive to individual change over a wide spectrum of treatment response and side effects. The problems of neuropsychologically testing nonverbal, lower functioning, sometimes noncompliant subjects requires careful instrument selection/adaptation and flexible administration techniques. The problems of assessing low-end IQs, neglected by most standardized test developers, was resolved by an algorithm of test hierarchy. Scarcity of other autism-adapted cognitive and neuropsychological tests and lack of standardization required development of a new, specially adapted battery. Reliability on the Autism Diagnostic Interview (currently the most valid diagnostic instrument) and other clinician instruments required extensive cross-site training (in-person, videotape, and teleconference sessions). Definition of a treatment responder required focus on individually relevant target symptoms, synthesis of possible modest improvements in many domains, and acceptance of attainable though imperfect goals. The assessment strategy developed is implemented in a RCT of risperidone (McDougle et al., 2000) for which the design and other methodological challenges are described elsewhere (Scahill et al., 2000). Some of these problems and solutions are partially shared with RCTs of other treatments and other disorders.

Anwendbarkeit der Child Behavior Checklist bei entwicklungsgestörten Kindern

Zusammenfassung: Frage: Die Child Behavior Checklist (CBCL) wird in großen, unausgelesenen Stichproben verwendet, um Verhaltensauffälligkeiten bei Kindern und Jugendlichen zu erfassen. In der hier vorgelegten Arbeit wird untersucht, inwieweit sich die CBCL eignet, um die bei einer Stichprobe entwicklungsgestörter Kinder typischerweise auftretenden Probleme zu erfassen. Methodik: Es wurden zwei Stichproben entwicklungsgestörter Kinder, bei denen Schwierigkeiten im Bereich der Sprache und der Kommunikation bestanden, untersucht. Es handelte sich um 34 Kinder mit einem frühkindlichen Autismus und 34 alters-, geschlechts- und intelligenzparallelisierte Kinder mit einer spezifischen Sprachentwicklungsstörung. Bei den zwei Stichproben wurde im Rahmen der routinemäßigen Abklärung der Symptomatik die CBCL ausgefüllt. Ergebnisse: Die Hälfte der sprachgestörten Kinder hatten im CBCL-Gesamtscore Werte im klinischen Bereich. Bei diesen Kindern sind die Probleme vor allem auf den Skalen «Aufmerksamkeitsstörungen», «Soziale Probleme» und «Zurückgezogenheit» anzutreffen. Etwa zwei Drittel der autistischen Kinder werden auf den oben genannten Syndromskalen als auffällig eingestuft. 32 der 34 autistischen Kinder erreichen auf der Skala V «Schizoid/Zwanghaft» auffällige Werte, während dies nur für ein sprachgestörtes Kind der Fall ist. Die Einzelitem-Analyse zeigt, daß in beiden Stichproben überdurchschnittlich häufig über entwicklungsbezogene Probleme (Sprechprobleme, Einnässen…) berichtet wird. Schlußfolgerungen: Die CBCL ist geeignet, um die bei entwicklungsgestörten Kindern charakteristischen Verhaltensauffälligkeiten zu erfassen. Diese Auffälligkeite n werden sowohl auf der Ebene der Syndromskalen wie auch durch Einzelitems erfaßt. Hohe Werte auf der Skala «Schizoid/Zwanghaft» sollten bei diesen Kindern Anlaß zu einer gezielten diagnostischen Abklärung eines frühkindlichen Autismus geben.

Clinical studies of pervasive developmental disorders in Japan

Articles on pervasive developmental disorders (PDD) published mainly by Japanese child psychiatrists in international journals for the last 20 years were reviewed for the purpose of clarifying the accomplishment and aims of Japanese PDD research. Although Japanese child psychiatrists investigated PDD in various specialties, their contributions to international archives were much fewer than those of Japanese professionals in other branches of medical sciences. This may be accounted for by the absence of an authorized education system of child psychiatrists and strong clinical orientation together with some reluctance of Japanese child psychiatrists to perform research. However, the epidemiology of PDD subtypes, the speech loss in PDD and the psychopathology of persons with high-functioning PDD seem to be providing promising research areas for Japanese child psychiatrists based on their clinical experiences.

The nature and extent of aggressive behaviour amongst people with learning difficulties (mental handicap) in a single health district

This paper describes the method and results of a survey of aggressive behaviour amongst people with learning difficulties. The study was confined to a single health district in the South Western Region of the UK with a general population of about 370,000. At the time of the survey, the Mental Handicap Register for the district recorded 1,362 people as having a learning difficulty. The overall prevalence of aggressive behaviour amongst people with learning difficulties for whom base population data was available was 17.6%. The lowest rate was identified amongst day facilities (9.7%) and the highest in hospitals within the district (38.2%). The prevalence rate amongst those attending schools for children with severe learning difficulties was 12.6%. Proportionately more males than females were reported to present problems of aggressive behaviour. The gender difference appeared to be largely accounted for by the disproportionate number of men identified within day facilities. There was no significant evidence of an association between the person's gender and the presence aggressive behaviour within schools or hospitals. The results indicated that, although physical and verbal aggression were the most frequently reported behaviours, many of the sample were also said to engage in other forms of challenging behaviour, particularly self-injurious, ritualistic, stereotypical and withdrawn behaviour. The risk of a serious or very serious injury to another person was very low; 0.7% or six people with learning difficulties from the district were reported to be currently presenting such a risk. Similarly, only 2% of the base population (n = 18) were reported to be extremely difficult to manage. The implications of the findings are discussed.

Behaviour problems of the mentally retarded

The behaviour profiles of 176 mentally retarded individuals from two reception centres and nine group homes were assessed. The correlations between behaviour and age, sex, degree of mental retardation, etiology of mental retardation and medical diagnosis were assessed using the Revised Child Behaviour Profile. The severity of behaviour disturbance did not vary with age or medical diagnosis. The moderately retarded subjects presented with more severe behaviour problems, such as aggression, than the severely mentally retarded subjects. The variable most predictive of behavioural problems was etiology of the disorder. Individuals with Down's syndrome had significantly fewer behaviour disturbances and those with autism and pervasive developmental disorder had significantly more behaviour disturbances than other subjects. A psychiatric disorder was found in 10.2% of the sample. The implications of these findings are discussed with respect to public policy.

Validity and reliability of the Childhood Autism Rating Scale with autistic adolescents

The validity and reliability of the Childhood Autism Rating Scale (CARS) for autistic adolescents was tested. In the first study, CARS scores for autistic children and adolescents (matched on nonverbal IQ, sex, and ethnicity) were compared. In the second study, a group of nonautistic, handicapped adolescents were administered the CARS and these scores were compared with those of a group of autistic adolescents (matched on age, nonverbal IQ, sex, and ethnicity). The CARS clearly discriminated the two adolescent groups, suggesting that the scale may be an adequate measure of autism in adolescence. Although the CARS total score did not discriminate the younger from older autistic subjects, some interesting age-related differences emerged for specific items. A recommendation is made for elimination of one of the items on the CARS that negatively correlates with the CARS total score for both autistic groups.

Effects of age on adaptive behavior levels and academic skill levels in autistic and mentally retarded children

This study investigated the effect of age on adaptive behavior and academic skill in autistic and mentally retarded children. Subjects were 47 autistic and 128 mentally retarded children from a special school. Cross-sectional comparisons were made between junior and senior groups using ratings obtained from teachers on adaptive behaviors and academic skills. We found that the levels of toilet training, eating skills, participation in group activities, and self-control in the autistic children improved significantly with age. The skills of number concepts in the autistic children also improved with age. However, these adaptive and academic levels were in general significantly lower than those of the mentally retarded children. The levels of initiative did not improve significantly in either the autistic or the mentally retarded children, and they were significantly lower in the autistic children. The implications of these findings in the context of our previous study on the changes of communication and maladaptive behaviors with age in the autistic children are discussed.

Speech skill levels and prevalence of maladaptive behaviors in autistic and mentally retarded children: a statistical study

Forty-seven autistic and 128 mentally retarded children, ages 6 to 14, from a special school were assessed in terms of nine maladaptive behaviors and speech skill levels. The results indicated that the group of the mentally retarded children with withdrawal had significantly lower speech skill levels than the group of those without withdrawal, and the group of the autistic children with self-injury had significantly lower speech skill levels than the group of those without self-injury.