Patterns of intellectual functioning in non-retarded autistic and schizophrenic children

Different levels of visuospatial abilities linked to differential brain correlates underlying visual mental segmentation processes in autism

The neural underpinnings of enhanced locally oriented visual processing that are specific to autistics with a Wechsler's Block Design (BD) peak are largely unknown. Here, we investigated the brain correlates underlying visual segmentation associated with the well-established autistic superior visuospatial abilities in distinct subgroups using functional magnetic resonance imaging. This study included 31 male autistic adults (15 with (AUTp) and 16 without (AUTnp) a BD peak) and 28 male adults with typical development (TYP). Participants completed a computerized adapted BD task with models having low and high perceptual cohesiveness (PC). Despite similar behavioral performances, AUTp and AUTnp showed generally higher occipital activation compared with TYP participants. Compared with both AUTnp and TYP participants, the AUTp group showed enhanced task-related functional connectivity within posterior visuoperceptual regions and decreased functional connectivity between frontal and occipital-temporal regions. A diminished modulation in frontal and parietal regions in response to increased PC was also found in AUTp participants, suggesting heavier reliance on low-level processing of global figures. This study demonstrates that enhanced visual functioning is specific to a cognitive phenotypic subgroup of autistics with superior visuospatial abilities and reinforces the need to address autistic heterogeneity by good cognitive characterization of samples in future studies.

Differential neural correlates underlying mental rotation processes in two distinct cognitive profiles in autism

Enhanced visuospatial abilities characterize the cognitive profile of a subgroup of autistics. However, the neural correlates underlying such cognitive strengths are largely unknown. Using functional magnetic resonance imaging (fMRI), we investigated the neural underpinnings of superior visuospatial functioning in different autistic subgroups. Twenty-seven autistic adults, including 13 with a Wechsler's Block Design peak (AUTp) and 14 without (AUTnp), and 23 typically developed adults (TYP) performed a classic mental rotation task. As expected, AUTp participants were faster at the task compared to TYP. At the neural level, AUTp participants showed enhanced bilateral parietal and occipital activation, stronger occipito-parietal and fronto-occipital connectivity, and diminished fronto-parietal connectivity compared to TYP. On the other hand, AUTnp participants presented greater activation in right and anterior regions compared to AUTp. In addition, reduced connectivity between occipital and parietal regions was observed in AUTnp compared to AUTp and TYP participants. A greater reliance on posterior regions is typically reported in the autism literature. Our results suggest that this commonly reported finding may be specific to a subgroup of autistic individuals with enhanced visuospatial functioning. Moreover, this study demonstrated that increased occipito-frontal synchronization was associated with superior visuospatial abilities in autism. This finding contradicts the long-range under-connectivity hypothesis in autism. Finally, given the relationship between distinct cognitive profiles in autism and our observed differences in brain functioning, future studies should provide an adequate characterization of the autistic subgroups in their research. The main limitations are small sample sizes and the inclusion of male-only participants.

Review of Cognitive Characteristics of Autism Spectrum Disorder Using Performance on Six Subtests on Four Versions of the Wechsler Intelligence Scale for Children

This study was a systematic review of research using the Wechsler Intelligence Scale for Children (WISC) with Autism Spectrum Disorder (ASD) to examine cognitive characteristics of children with ASD beyond the impact of revisions based on WISC and diagnostic criteria changes. The classic "islets of ability" was found in individuals with full-scale IQs < 100. The "right-descending profiles" were observed among high IQ score individuals. High levels on the Block Design and low Coding levels were consistently found regardless of the variation in intellectual functioning or diagnosis. This review identified patterns of cognitive characteristics in ASD individuals using empirical data that researchers may have previously been aware of, based on their experiences, owing to the increased prevalence of ASD.

Similar impairments shown on a neuropsychological test battery in adolescents with high-functioning autism and early onset schizophrenia: a two-year follow-up study

Introduction: Cognitive impairments are common in both Autism Spectrum Disorders (ASD) and schizophrenia, but it is unclear whether the pattern of difficulties is similar or different in the two disorders. This cross-sectional and longitudinal study compared the neuropsychological functioning in adolescents with ASD with adolescents with Early Onset Schizophrenia (EOS).Methods: At baseline and at two-year follow-up, participants were assessed with a brief neuropsychological test battery measuring executive functions, visual and verbal learning, delayed recall and recognition and psychomotor speed.Results: We found similar levels of neuropsychological impairment across groups and over time in the adolescents with ASD or EOS. Adolescents in both groups did not improve significantly on verbal learning, verbal delayed recall, visual learning, visual delayed recall or visual delayed recognition, and both groups performed poorer on verbal recognition. Both groups improved on measures of psychomotor processing and executive functions.Conclusion: The findings suggest that it may be difficult to differentiate adolescents with EOS and ASD based on neuropsychological task performance. An implication of the results is that adolescents with either disorder may benefit from a similar approach to the treatment of cognitive impairment in the disorders.

Students with Higher Functioning Autistic Disorder

This study focused on identifying the characteristics of children and youth identified as having higher functioning autistic disorder (H-F AD). Teachers of 29 children and youth previously identified as having H-F AD completed a common autism assessment measure on their students, the Autism Behavior Checklist. Review of teachers' ratings of the 29 subjects failed to reveal a common set of characteristics of students with H-F AD. Thus, even though the evaluators identified a variety of exceptional characteristics, including a number that are common to other students with mild disabilities, there was not a consistent image of students with H-F AD. These results are discussed relative to their implications for educational and clinical planning and practice.

The Utility of the WISC-III Freedom from Distractibility in the Diagnosis of Youth with Attention Deficit Hyperactivity Disorder in a Psychiatric Sample

The “Freedom from Distractibility” (FD) or the Third Factor of the Wechsler Intelligence Scales for Children—Revised (WISC-R), has been used to discern attention deficit hyperactivity disorder (ADHD) from other childhood disorders. This study expands the current research by examining the utility of the Third Factor of the Wechsler Intelligence Scales for Children-III (WISC-III) to differentiate between youth with and without ADHD who are hospitalized at an acute-care psychiatric hospital. There were no significant differences between subjects with and without ADHD on the Third Factor solutions of the WISC-III. The WISC-III FD was not a valid discriminator of psychiatric disorder (affective versus disruptive disorders) or ADHD diagnosis. While these findings question the utility of the Third Factor in the diagnosis of ADHD, the WISC-III FD may be, as described by Kaufman (1994) “a land mine that explodes on a diversity of abnormal populations” (p. 213).

Neuropsychological Profiles of Children with Asperger Syndrome and Autism

This study examined the possibility that diagnostic differentiation between children with autism and Asperger syndrome may be enhanced through the use of neuropsychological profiles. Two groups of children, clinically diagnosed as having Asperger syndrome ( n35) or autism ( n21), were tested with a neuropsychological battery to assess the propositions that these groups might differ in terms of Wechsler IQ profiles, brain hemispheric strengths and weaknesses, and executive functioning. Clinically diagnosed children with Asperger syndrome and autism were not differentiated on the basis of their neuropsychological profiles. The major difference between them was the overall higher IQ in Asperger syndrome, which was largely due to superior verbal abilities. Differences were also examined using DSM-IV/ICD-10 criteria: children were grouped according to the early history of presence or absence of language delay. No differences between the groups on any neurocognitive measure were found and there was no support for current neuropsychological theories purporting to support differential diagnostic status. It appears that current diagnostic differentiation in clinical practice may be primarily influenced by the child’s estimated verbal IQ level.

Neuroimaging findings from childhood onset schizophrenia patients and their non-psychotic siblings

Childhood onset schizophrenia (COS), with onset of psychosis before age 13, is a rare form of schizophrenia that represents a more severe and chronic form of the adult onset illness. In this review we examine structural and functional magnetic resonance imaging (MRI) studies of COS and non-psychotic siblings of COS patients in the context of studies of schizophrenia as a whole. Studies of COS to date reveal progressive loss of gray matter volume and cortical thinning, ventricular enlargement, progressive decline in cerebellar volume and a significant but fixed deficit in hippocampal volume. COS is also associated with a slower rate of white matter growth and disrupted local connectivity strength. Sibling studies indicate that non-psychotic siblings of COS patients share many of these brain abnormalities, including decreased cortical thickness and disrupted white matter growth, yet these abnormalities normalize with age. Cross-sectional and longitudinal neuroimaging studies remain some of the few methods for assessing human brain function and play a pivotal role in the quest for understanding the neurobiology of schizophrenia as well as other psychiatric disorders. Parallel studies in non-psychotic siblings provide a unique opportunity to understand both risk and resilience in schizophrenia.

Cross-sectional evidence for a decrease in cognitive function with age in children with autism spectrum disorders?

Autism spectrum disorders (ASD) are associated with early disturbances in brain maturation processes and these interferences presumably have their consequences for the progressive emergence of cognitive deficits later in life, as expressed in intelligence profiles. In this study, we addressed the impact of age on cognitive functioning of 6- to 15-year-old children and adolescents with ASD. Intelligence profiles were measured by the Wechsler Intelligence Scale for Children and compared among four consecutive age cohorts (children aged 6.17-8.03 years, 8.04-9.61 years, and 9.68-11.50 years and adolescents aged 11.54-15.85 years) of 237 high-functioning boys with ASD. The results clearly demonstrated that the global intelligence level was lower in children aged 8 years and older, when compared with 6- and 7-year-old children with ASD. This is mostly due to the Freedom From Distractibility factor, suggesting that older children were less able to sustain their attention, they were more distractible, or had more graph motor difficulties. Moreover, an effect of age was also found with respect to the relatively poor performance on the subtest Comprehension when compared with other verbal comprehension subtests, indicating that specifically the impairments in verbal comprehension and social reasoning abilities were more profound in older children when compared with 6- and 7-year-old children with ASD. Findings of this cross-sectional study showed that it is relevant to take age into account when evaluating the impact of cognitive impairments on intelligence in children with ASD, because the impact of these developmental disorders might be different at different ages.

Cognitive abilities in siblings of children with autism spectrum disorders

The aim of the present study was to assess the cognitive profiles of children with autistic spectrum disorder and of their healthy siblings (Siblings). With the term cognitive profile, we indicate the relationship extant among the values of verbal and performance subtests of the Wechsler Intelligence Scale. The conducted statistical analyses indicated that, although siblings showed a normal intelligent quotient and did not differ in this aspect from typically developing group, their cognitive profile was amazingly similar to that of their relatives affected by autism. A k-means clustering analysis on the values of single subtests further confirmed this result, showing a clear separation between typically developing children on the one side, and autistics and their siblings on the other. We suggest that the common cognitive profile observed in autistic children and their siblings could represent a marker of liability to autism and, thus, a possible intermediate phenotype of this syndrome.

Abstract spatial reasoning as an autistic strength

Autistic individuals typically excel on spatial tests that measure abstract reasoning, such as the Block Design subtest on intelligence test batteries and the Raven’s Progressive Matrices nonverbal test of intelligence. Such well-replicated findings suggest that abstract spatial processing is a relative and perhaps absolute strength of autistic individuals. However, previous studies have not systematically varied reasoning level – concrete vs. abstract – and test domain – spatial vs. numerical vs. verbal, which the current study did. Autistic participants (N = 72) and non-autistic participants (N = 72) completed a battery of 12 tests that varied by reasoning level (concrete vs. abstract) and domain (spatial vs. numerical vs. verbal). Autistic participants outperformed non-autistic participants on abstract spatial tests. Non-autistic participants did not outperform autistic participants on any of the three domains (spatial, numerical, and verbal) or at either of the two reasoning levels (concrete and abstract), suggesting similarity in abilities between autistic and non-autistic individuals, with abstract spatial reasoning as an autistic strength.

Wechsler Intelligence Scale for Children 4th edition-Chinese version index scores in Taiwanese children with attention-deficit/hyperactivity disorder

AIM

The Wechsler Intelligence Scale for Children 4th edition-Chinese version (WISC-IV-Chinese) has been in clinical use in Taiwan since 2007. Research is needed to determine how the WISC-IV, modified from its earlier version, will affect its interpretation in clinical practice in a Mandarin-speaking context.

METHODS

We attempted to use WISC-IV-Chinese scores to identify the cognitive strengths and weaknesses in 334 Taiwanese children with attention-deficit/hyperactivity disorder (ADHD). Comparison of cognitive profiles of WISC-IV-Chinese scores between subtypes of ADHD was also performed.

RESULTS

The results indicated that the four-factor model of the WISC-IV-Chinese fitted well for Taiwanese children with ADHD. The profiles showed that performance in the index score of the Processing Speed Index was the weakness domain for the Taiwanese children with ADHD, as confirmed by two different kinds of analytic methods. Cognitive profile analysis of ADHD subtypes revealed children with inattentive subtypes to have a greater weakness in processing speed performance.

CONCLUSION

The implications of the profiles of the index scores on the WISC-IV-Chinese version for Taiwanese children with ADHD were explored.

WISC-IV profile in high-functioning autism spectrum disorders: impaired processing speed is associated with increased autism communication symptoms and decreased adaptive communication abilities

Changes in the Wechsler Intelligence Scales for Children-IV (WISC-IV) may affect the IQ profile characteristic of autism spectrum disorders (ASD). Moreover, the association of particular component cognitive abilities (unlike overall IQ) with symptomatology and adaptive functioning in ASD remains unclear. This archival study characterizes the WISC-IV IQ profile among 56 high-functioning (IQ > 70) children with ASD and correlates WISC-IV performance with ASD and ADHD symptomatology and adaptive functioning. The ASD WISC-IV profile included strengths on Matrix Reasoning and Similarities, weaknesses on Comprehension (which correlated negatively with social symptoms) and the subtests comprising the Processing Speed Index (Coding, Symbol Search). Processing speed task performance correlated negatively with communication symptoms and positively with communication abilities, indicating its importance to functional outcomes in ASD.

A novel syndrome with psychiatric features and review of malformation syndromes with psychiatric disorders

Psychiatric disease occurs with increased frequency in a number of malformation syndromes. We hypothesize that the study of these disorders is helpful for understanding the pathophysiology of psychiatric disease. With this objective, we have been screening for individuals with malformations and prominent psychiatric disease. We report on a man with visual and auditory hallucinations and behavioral problems who was the product of an incestuous relationship and had anomalies primarily of his face, hands and feet. His distinctive features define an undescribed acro-auricular malformation syndrome with a psychiatric component. The study of Mendelian syndromes such as the one presented will likely be helpful for isolating novel genes involved in psychiatric illness.

Cognitive profile difference between normally intelligent children with Asperger's disorder and those with pervasive developmental disorder not otherwise specified

AIM

Asperger's disorder (Asperger syndrome, AS) and pervasive developmental disorder not otherwise specified (PDD-NOS) are different subtypes of mild pervasive developmental disorders (PDD).

METHODS

Using the Japanese version of the Wechsler Intelligence Scale for Children-Third Edition (WISC-III), 28 AS children (mean age, 9.3 years, 24 male) were compared with 78 PDD-NOS children (mean age, 7.6 years, 64 male) with normal intelligence (IQ > or = 85), using analysis of covariance (ancova) with the chronological age of a child as a covariate.

RESULTS

Verbal IQ tended to be higher in the AS children than in the PDD-NOS children (mean raw scores, AS vs PDD-NOS: 103.9 vs 99.6; P < 0.10), although full-scale and performance IQ did not differ significantly. Compared with the PDD-NOS children, the AS children scored significantly higher on Freedom from Distractibility index (110.1 vs 104.5; P < 0.05) consisting of Arithmetic (11.0 vs 9.9, P = 0.04) and Digit Span (12.4 vs 11.6, P = 0.051), but tended to score lower on Coding (8.5 vs 9.8, P = 0.08).

CONCLUSION

The typical cognitive profile of PDD (i.e. low score on Comprehension and high score on Block Design) was shared by both groups, which may support the validity of the current diagnostic classification of PDD. Relatively better verbal ability in AS children seems to reflect their normal language acquisition in infancy, and strong numeric interest may produce the AS children's mathematical excellence over PDD-NOS children. A low score on Coding in AS children might reflect their extreme slowness, circumstantiality and/or drive for perfection.

Conservation and formal thought disorder in schizophrenic and schizotypal children

We studied the conservation scores of 21 schizophrenic and schizotypal children (aged 6;7–12;5 years) and 21 yoked normal mental age matches and their relationship to the Kiddie Formal Thought Disorder Scale measures. Like the normal children, the schizophrenic/schizotypal subjects were able to recognize the invariance of two dimensional space, number, and substance, but not of weight. Unlike the normal children, the schizophrenic/schizotypal children were poor conservers of continuous and discontinuous matter, and this was related to their illogical thinking scores. Age and IQ accounted for the conservation competence of the normal children. The conservation skills of the patients, however, were associated with the severity of their formal thought disorder scores, not with their age or IQ. The developmental approach employed in this study enabled further clarification of the cognitive parameters of formal thought disorder in middle childhood. We discuss the developmental, clinical, and possible information processing implications of these findings.

Sex differences in WISC-III profiles of children with high-functioning pervasive developmental disorders

Using the Japanese version of the Wechsler Intelligence Scale for Children-Third Edition (WISC-III), 26 girls with high-functioning (IQ > or = 70) pervasive developmental disorders (HFPDD) (mean age, 8.2 years) were compared with 116 boys with HFPDD (mean age, 9.0 years). Compared with the boys, the girls scored significantly higher on the Processing Speed index, Coding, and Symbol Search, but scored significantly lower on Block Design. Although both groups showed weakness on Comprehension in the verbal domain, the girls' subtest profile in the performance domain was relatively even and significantly different from the boys', which was characterized by a peak on Block Design. Such differences should be replicated, and possible behavioral, neurological, and genetic links to these sex differences should be clarified.

Neuropsychological functioning of siblings of children with autism, siblings of children with developmental language delay, and siblings of children with mental retardation of unknown genetic etiology

Neuropsychological functioning of 30 siblings of children with autism (AU-S), 28 siblings of children with mental retardation of (MR-S), and 30 siblings of children with developmental language delay (DLD-S) was compared. Two siblings, both AU-S, received diagnoses of pervasive developmental disorder (PDD). More siblings with cognitive disabilities were found in DLD-S than in AU-S. However, these differences disappeared after excluding diagnosed siblings or after accounting for family membership. In sum, despite the elevated incidence of PDD among AU-S, the neuropsychological functioning of the remaining siblings did not convey specific characteristics related to the genetic risk associated with autism, in contrast to the cognitive functioning of the DLD-S, which did reflect a genetic risk.

WISC-IV and WIAT-II Profiles in Children With High-Functioning Autism

Children with high-functioning autism earned above normal scores on the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Perceptual Reasoning and Verbal Comprehension Indexes and below normal scores on the Working Memory and Processing Speed Indexes and Wechsler Individual Achievement Test-Second Edition (WIAT-II) Written Expression. Full Scale IQ (FSIQ) and reading and math scores were similar to the norm. Profiles were consistent with previous WISC-III research, except that the new WISC-IV motor-free visual reasoning subtests (Matrix Reasoning and Picture Concepts) were the highest of the nonverbal subtests. The WISC-IV may be an improvement over the WISC-III for children with high-functioning autism because it captures their visual reasoning strength, while identifying their attention, graphomotor, and processing speed weaknesses. FSIQ was the best single predictor of academic achievement.

Childhood onset schizophrenia: cortical brain abnormalities as young adults

BACKGROUND

Childhood onset schizophrenia (COS) is a rare but severe form of the adult onset disorder. While structural brain imaging studies show robust, widespread, and progressive gray matter loss in COS during adolescence, there have been no longitudinal studies of sufficient duration to examine comparability with the more common adult onset illness.

METHODS

Neuro-anatomic magnetic resonance scans were obtained prospectively from ages 7 through 26 in 70 children diagnosed with COS and age and sex matched healthy controls. Cortical thickness was measured at 40,962 points across the cerebral hemispheres using a novel, fully automated, validated method. Patterns of patient-control differences in cortical development were compared over a 19-year period.

RESULTS

Throughout the age range, the COS group had significantly smaller mean cortical thickness compared to controls. However, the COS brain developmental trajectory appeared to normalize in posterior (parietal) regions, and remained divergent in the anterior regions (frontal and temporal) regions, and the pattern of loss became more like that seen in adults.

CONCLUSIONS

Cortical thickness loss in COS appears to localize with age to prefrontal and temporal regions that are seen for both medication naïve and medicated adult onset patients.

Cognitive and Symptom Profiles in High-Functioning Pervasive Developmental Disorder Not Otherwise Specified and Attention-Deficit/Hyperactivity Disorder

Age- and IQ-balanced 27 children with high-functioning (IQ>or=70) pervasive developmental disorder not otherwise specified (HPDDNOS) and 27 children with attention-deficit/hyperactivity disorder (ADHD) were compared on the Japanese version of Wechsler Intelligence Scale for Children Third Edition (WISC-III) and the Childhood Autism Rating Scale-Tokyo Version (CARS-TV). Compared with the ADHD children, the HPDDNOS children scored significantly lower on verbal comprehension, vocabulary, and comprehension, but significantly higher on block design. After controlling for the total CARS-TV score, the HPDDNOS children were significantly more abnormal on "relationships with people," "nonverbal communication," and "general impressions," but less abnormal on "near receptor responsiveness" and "activity level." These differences in cognitive and autistic symptom profiles may help professionals to distinguish clinically between both conditions.

WISC-IV and WISC-III profiles in children with ADHD

Wechsler Intelligence Scale for Children, 3rd and 4th editions (WISC-III n = 586 and WISC-IV n = 118), profiles were compared for children with ADHD and normal intelligence. Mean Verbal Comprehension Index (VCI) and Perceptual Organization/Perceptual Reasoning Index (POI/PRI) scores were significantly higher than Freedom From Distractibility/Working Memory Index (FDI/WMI) and Processing Speed Index (PSI), and Symbol Search was higher than Coding. FDI/WMI and PSI scores were similar on both tests, but VCI and POI/PRI were higher on the WISC-IV than on the WISC-III. Therefore, index discrepancies were greater for the WISC-IV, suggesting that the WISC-IV might be better than the WISC-III in delineating the strengths and weaknesses of children with ADHD. All children in the WISC-IV sample scored lowest on WMI or PSI, whereas only 88% of the WISC-III children scored lowest on FDI or PSI. Thus, the WISC-IV may be more helpful in diagnosing ADHD than the WISC-III.

IQ stabilization in childhood-onset schizophrenia

OBJECTIVE

To examine the long term IQ trajectory for childhood-onset schizophrenia (COS) in an expanded, prospective longitudinal study.

METHODS

Seventy children meeting DSM criteria for schizophrenia were tested at 2 year intervals with age appropriate Wechsler intelligence tests and repeated administration of information and comprehension WISC subtests even after age 18. For a subgroup with 31 patients, pre-NIH IQ test administrations were available including 18 pre-psychotic and 13 post-psychotic subjects. The pattern of IQ performance over time was determined using mixed model regression analysis.

RESULTS

No progressive cognitive decline was seen up to 13+ years post psychosis onset. For the subgroup of subjects with pre-illness scores, there had been an initial steep decline in IQ, from about 2 years prior to 1.7 years after onset of psychotic symptoms, as reported for adult patients.

CONCLUSIONS

The level long-term trajectory of IQ measures in COS appears stable, similar to that reported for adult onset patients. For COS, level cognitive functioning extends up to 13+ years post psychosis onset, in spite of chronic illness and concomitant, progressive loss of cortical gray matter.

Similarities and differences in Wechsler Intelligence Scale for Children--Third Edition (WISC-III) profiles: support for subtest analysis in clinical referrals

Our study supports the reliability and validity of profile analysis in children with neurobiological disorders. Three mutually exclusive WISC-III profiles were identified that characterized the majority of children with autism (low coding or Freedom from Distractibility Index with low Comprehension), attention deficit hyperactivity disorder and learning disability (low Coding or FDI without low comprehension), and brain injury (low Performance without low Coding or FDI). The profiles suggest attention, writing, and performance speed deficits in autism, ADHD, and LD; global visual-motor problems in brain injury; and specific difficulty with language comprehension and social reasoning in autism. Children with anxiety, depression, and behavior disorders did not exhibit distinct profiles. Our profile analysis is based on the simple rank ordering of standard scores. The profiles are clinically useful because they may alert clinicians to certain diagnostic possibilities, they reveal characteristic strengths and weaknesses that have implications for educational intervention, and they are consistent with preliminary WISC-IV data.

The Maudsley early onset schizophrenia study: cognitive function in adolescents with recent onset schizophrenia

Neuropsychological function has been little studied early in the course of adolescent onset schizophrenia. The present study investigated cognitive function in adolescents with recent onset schizophrenia (n=20) and healthy controls (n=21), employing a comprehensive battery of intelligence, memory and executive function paradigms. Relative to the control group, the patients showed significant or near-significant deficits in more than half of the cognitive variables we examined. A substantial proportion of this broadly based neuropsychological deficit could be accounted for, at least in part, by a mild decrement in general intellectual ability. However, deficits in general and verbal memory remained highly significant after co-varying for IQ.

Analysis of WISC-III, Stanford-Binet:IV, and academic achievement test scores in children with autism

Nonverbal IQs were greater than verbal IQs for young children (3-7 years of age) on the Stanford-Binet:IV (n = 53). However, WISC-III verbal and nonverbal IQs were similar for older children, 6-15 years of age (n = 63). Stanford-Binet:IV profiles were generally consistent for the low-IQ (< 80) and high-IQ (> or = 80) groups, with high scores on visual matching tests (Bead Memory and Quantitative Reasoning). The low- and high-WISC-III IQ groups both performed well relative to IQ on tests of lexical knowledge (Similarities, Information, and Vocabulary), but not on language comprehension and social reasoning (Comprehension). The low-IQ group did best on visuo-motor subtests (Object Assembly and Block Design), but the high-IQ group did not. The high-IQ group had significantly low scores on the Digit Span, Arithmetic, Coding, VMI, and WIAT Written Expression tests, suggesting attention and writing weaknesses.

Ability profiles in children with autism: influence of age and IQ

To understand the effect of IQ and age on ability in children with autism, psychological data were analyzed for 164 3- to 15-year-olds with autism (IQs 14-143). As age increased, so did IQ, which probably reflects both an actual increase in IQ over time and the likelihood that brighter children are diagnosed later. Early in life, 67 percent had normal motor and delayed speech milestones. Verbal IQ continued to lag behind non-verbal IQ during the preschool years. By school age, the gap between verbal and non-verbal IQs had closed. Visual reasoning exceeded graphomotor scores for all children, and surpassed IQ for most. Graphomotor scores were significantly below IQ for both high-IQ groups. For school-age children with low IQs, math, spelling, and writing scores were consistent with IQ and reading was above IQ. School-age children with high IQs had average reading, math, and spelling scores and a weakness in writing.

Neurocognitive impairments in schizophrenia: a piece of the epigenetic puzzle

This paper is a review of studies examining the neurobehavioral antecedents of schizophrenia which flesh out neurodevelopmental models of schizophrenia by detailing the time course of the ontogeney of neurobehavioral impairments in schizophrenia. A follow back design was used to identify precursors of psychotic symptoms in children with a schizophrenic disorder. The vast majority of children with a schizophrenic disorder had significant developmental delays beginning early in life. For example, gross deficits in early language development were found in almost 80% of the schizophrenic children. Somewhat later in development impairments in fine motor and bi-manual coordination are noted. Some of these early developmental delays are transitory. For example, basic language skills are among the best preserved neurocognitive functions in children and adults with schizophrenia. The results of our cross-sectional neurocognitive studies suggest that children with schizophrenia suffer from limitations in the ability to engage in effortful cognitive processing or impairments in working memory. The links between these elementary neurocognitive impairments and the development of formal thought disorder as well as discourse deficits in children with a schizophrenic disorder will be discussed.

Intelligence patterns among children with high-functioning autism, phenylketonuria, and childhood head injury

High-functioning children with autistic-spectrum disorder show the typical pattern of lower Comprehension relative to their own scores on Block Design. This profile is shared, almost exactly, by age- and IQ-matched children with poorer control PKU. Quite distinct profiles are shown by children with better control PKU, who show no difference between Block Design and Comprehension, and by children with head injury involving frontal lobe contusion, who show slightly better Comprehension that Block Design. The data bear on several questions: the relation between Comprehension deficits and language functions measured by Vocabulary; the limits of the advantages conveyed by higher IQ to autistic individuals; whether impaired Comprehension in autism indexes persisting symptoms and/or impairments on theory of mind tasks; the possibility that dopamine deficiency is common to autism and poorer control PKU; and the need for future research aimed at understanding the relations among neurodevelopmental disorders.

"Multidimensionally impaired disorder": is it a variant of very early-onset schizophrenia?

OBJECTIVE

To examine the validity of diagnostic criteria for a subgroup of children with atypical psychosis (n = 19), designated here as "multidimensionally impaired." These children are characterized by poor attention and impulse control, psychotic symptoms, and poor affective control.

METHOD

Children and adolescents (n = 19) meeting our criteria for multidimensionally impaired syndrome with onset of psychotic symptoms at or before age 12 years were identified from a total of 150 in-person screenings for very early-onset schizophrenia between 1990 and 1996. We compared the premorbid adjustment, family history, follow-up status, and laboratory measures for a subgroup of these children with those of (1) a rigorously defined group of 29 children with DSM-III-R schizophrenia and (2) 19 children with attention-deficit hyperactivity disorder.

RESULTS

Patients with multidimensionally impaired syndrome and patients with very early-onset schizophrenia shared a similar pattern of early transient autistic features, postpsychotic cognitive decline, and an elevated risk of schizophrenic-spectrum disorders among their first-degree relatives. This pattern was not seen in the attention-deficit hyperactivity disorder group. In contrast to very early-onset schizophrenia, the multidimensionally impaired group had significantly poorer scores on the Freedom From Distractibility factor on the WISC-R, a less deviant pattern of autonomic reactivity, and no progression to schizophrenia.

CONCLUSIONS

The findings support the distinction of the multidimensionally impaired cases as separate from those with other psychiatric disorders, and there is somewhat greater evidence to suggest that this disorder belongs in the schizophrenia spectrum.

Practice parameters for the assessment and treatment of children and adolescents with schizophrenia. American Academy of Child and Adolescent Psychiatry

These practice parameters review the literature on children and adolescents with schizophrenia. Because this literature is sparse, information is also drawn from research with adults. Clinical features in youth with schizophrenia include predominance in males, high rate of premorbid abnormalities, increased family history of schizophrenia, and often poor outcome. Diagnostic issues include the overlap, and therefore potential for misdiagnosis, between the first presenting symptoms of schizophrenia and those of psychotic mood disorders, developmental disorders, organic conditions, and other nonpsychotic emotional/behavioral disorders. Treatment should include using antipsychotic medications in conjunction with psychoeducational, psychotherapeutic, and social and educational support programs. These parameters were previously published in J. Am. Acad. Child Adolesc. Psychiatry, 1994, 33:616-635.

Are people with autism and Asperger syndrome faster than normal on the Embedded Figures Test?

Previous work suggests children with autism show superior performance (in relation to their general mental age) on the Embedded Figures Test (EFT). Frith interprets this as showing that they have "weak central coherence". In Experiment 1, using an adult level version of this task, we aimed to replicate and extend this finding, first, by collecting response time (RT) data; second, by testing adults with autism of normal intelligence; and third, by testing a group of adults with Asperger syndrome, in order to test for differences between autism and Asperger syndrome. Both clinical groups were significantly faster on the EFT. In Experiment 2, we investigated if this difference was due to a preference for local over global processing, using a novel drawing task based on the classical Rey Figure. The clinical groups did not differ significantly on this test, but there was a trend towards such a difference. Alternative explanations for the EFT superiority in autism and Asperger syndrome are considered.

Wechsler IQ profiles in diagnosis of high-functioning autism

A Wechsler Intelligence Scale profile characterized by VIQ < PIQ with lowest subtest score on Comprehension and highest on Block Design has been associated with autism. Recently, this profile has been applied to assess the accuracy of diagnosis in research samples and for differentiating autism from similar disorders in high-functioning individuals. Universality of this profile, however, has not been sufficiently demonstrated. We therefore examined WISC-R and WAIS-R profile characteristics in 81 rigorously diagnosed high-functioning (VIQ and FSIQ > 70) children (n = 45) and adults (n = 36) with autism. Analysis of the profiles in these groups did not reveal the presumed typical VIQ < PIQ pattern. The typical subtest pattern was found, but the magnitude of profile variability was small. We concluded that individuals with autism can demonstrate a wide range of ability levels and patterns on the Wechsler scales, without a single characteristic prototype. Use of IQ score profiles in the diagnosis and differential diagnosis of autism in high-functioning individuals is not considered valid.

Contextual strategy instruction: socially/emotionally maladjusted adolescents with language impairments

Ten socially/emotionally maladjusted adolescents with language impairments (SEM/LI) and ten non-impaired adolescents received four treatment sessions in the use of a "context clues strategy" for facilitating comprehension of unfamiliar words in four sentence types. Both groups improved their ability to use a context clues strategy following direct instruction. The SEM/LI subjects exhibited greater difficulty with the appositive sentence type than did the non-impaired subjects. The results indicated that SEM/LI adolescents probably would benefit from receiving direct instruction involving any of the three other sentence types (i.e., cause/effect, example, grouping), prior to instruction involving the appositive sentence type

Children with a schizophrenic disorder: neurobehavioral studies

This paper summarizes retrospective and cross-sectional neurobehavioral studies of schizophrenic children. Retrospective studies of schizophrenic children reveal that during early childhood, prior to the first onset of schizophrenic symptoms, most schizophrenic children showed delays in language acquisition and/or impairments and delays in visual-motor coordination. These impairments appear to be developmental delays rather than fixed neurobehavioral impairments, because cross-sectional studies conducted when the children are at least 10 years of age, after the first onset of psychosis, fail to detect the same deficits. The results of behavioral, cognitive/neuropsychological studies as well as the study of event-related potentials measured during performance of cognitive tasks suggests that schizophrenic children suffer from limitations in processing resources. It is argued that the developmental delays observed in schizophrenic children represent the greater time it takes them to automate certain skills. The delay in automation may reflect their limited information-processing capacity.

Wechsler IQ profile and theory of mind in autism: a research note

The unusually uneven intelligence test profile found in autism has been consistently replicated. However, few psychological theories of autism give prominence to this feature. Nor is it clear how currently influential theories, such as the theory of mind account or the executive function hypothesis, can explain the marked peaks and troughs found in the performance of both high- and low-functioning individuals with autism. The present study reports the pattern of Wechsler subtest results for subjects with autism who do or do not pass standard theory of mind tasks. The results suggest that while difficulty with the Comprehension subtest may reflect poor theory of mind, relative skill on the Block Design subtest is characteristic of subjects with autism regardless of theory of mind performance. Implications of this finding for the central coherence hypothesis are considered.

Practice parameters for the assessment and treatment of children and adolescents with schizophrenia. American Academy of Child and Adolescent Psychiatry

These practice parameters review the literature on children and adolescents with schizophrenia. Because this literature is sparse, information is also drawn from research with adults. Clinical features in youth with schizophrenia include predominance in males, high rate of premorbid abnormalities, increased family history of schizophrenia, and often poor outcome. Diagnostic issues include the overlap, and therefore potential for misdiagnosis, between the first presenting symptoms of schizophrenia and those of psychotic mood disorders, developmental disorders, organic conditions, and other nonpsychotic emotional/behavioral disorders. Treatment should include using antipsychotic medications in conjunction with psychoeducational, psychotherapeutic, and social and educational support programs.

Academic achievement in high functioning autistic individuals

Academic achievement levels in 54 high functioning (IQ > 70) autistic subjects were compared with those of 41 normal controls, who did not differ significantly in age, IQ, gender, race, or SES from the autistic subjects. The measures of academic achievement used included portions of the Detroit Tests of Learning Aptitude-2, the Woodcock Reading Mastery Test, and the Kaufman Test of Educational Achievement. Based on prior neuropsychological findings, it was hypothesized that autistic subjects would not differ from controls on subtests assessing mechanical and procedural skills, but would differ on subtests measuring comprehension and interpretive skills. As predicted, the autistic subjects performed significantly less well than controls on comprehension tasks, but not on mechanical reading, spelling, and computational tasks. This pattern is at variance with the typical academic profile of individuals with disabilities in reading or spelling, but shares some features with the nonverbal learning disabilities.

Performance of autistic and control subjects on three cognitive perspective-taking tasks

One explanation for the persistent social disabilities of individuals with autism is based on the nature of social stimuli, being transient, complex and very difficult to predict. It was suggested that autistic people's performance on cognitive perspective-taking tasks (a measure of understanding of other people) would be enhanced with increased predictability and reduced transience of stimulus materials. Thus autistic and control subjects were tested on Baron-Cohen, Leslie, and Frith's (1985) "Sally/Anne" task and on two other perspective-taking tasks that involved more predictable interactions and nontransient cues. Autistic subjects differed significantly from the control subjects in their ability to perform Baron-Cohen's task but not the other tasks. As well the autistic subjects performed significantly differently on the two types of tasks. Failure of the autistic subjects on the Sally/Anne task with their concurrent success on the other tasks can best be attributed to the nontransient nature of the stimuli used and the predictability of the protagonists' reactions in the two tasks on which they succeeded.

Schizophrenia with childhood onset: a phenomenological study of 38 cases

Thirty-eight hospitalized children, ages 5.7 to 11.11 years, diagnosed with schizophrenic disorder by DSM-III criteria, are characterized regarding age, sex, race, socioeconomic status, pre- and perinatal complications, electroencephalogram, intelligence quotient, and family history of major psychiatric disorder. Clinical course, including age at onset of general and psychotic psychiatric symptoms and initial diagnosis of schizophrenic disorder, presence of DSM-III symptoms, hospital course, and response to antipsychotics are reviewed.