Prevalence of pervasive developmental disorder in a sample of psychiatrically hospitalized children and adolescents

Transcranial Photobiomodulation in Adults with High-Functioning Autism Spectrum Disorder: Positive Findings from a Proof-of-Concept Study

Objective: To assess the efficacy and safety of transcranial photobiomodulation (tPBM) in adults with autism spectrum disorder (ASD). Methods: Adults with high-functioning-ASD, between 18 and 59 years of age, were enrolled to receive twice a week tPBM for 8 weeks in an open-label single group design. ASD symptom severity was assessed at baseline, midpoint, and end-point, by clinician-, self-, and informant-rated measures. Treatment response was defined as a ≥30% reduction in Social Responsiveness Scale-2nd Edition (SRS-2) total score and ASD Clinical Global Impression-Improvement score ≤2. Any possible adverse events were recorded at each visit. Paired-samples t-test analyses were performed. Results: Eleven participants were enrolled, and 10 participants (9 males; 30.0 ± 11.9 years) completed the study. One participant withdrew consent before baseline. All 10 completers were included in efficacy and safety analyses. Five participants (50%) met responder criteria at end-point. Overall, 8-week tPBM was associated with significant reduction in SRS-2 total scores at end-point (SRS-2: -30.6 ± 23, p < 0.001) particularly in Social Awareness (-3.0 ± 1.9, p < 0.001), Social Communication (-10.3 ± 6, p < 0.001), Social Motivation (-5.0 ± 2.4, p < 0.001), and Restricted/Repetitive Behaviors (-7.4 ± 4.1, p < 0.001). There were statistically significant improvements at end-point in Global Assessment of Functioning scores (+12.8 ± 4.2, p < 0.001) and Quality of Life Enjoyment and Satisfaction Questionnaire scores (+6.0 ± 7.9, p = 0.02). Three participants experienced transient, mild side effects (insomnia, headache, and warmth at treatment application site). No adverse events required changes in tPBM protocol. Adherence rate was 98%. Conclusions: tPBM is a safe and feasible treatment approach that has the potential to treat core features of ASD. Further research is necessary and warranted. ClinicalTrials.gov Identifier: NCT03724552.

A Retrospective Chart Review of Buspirone for the Treatment of Anxiety in Psychiatrically Referred Youth with High-Functioning Autism Spectrum Disorder

OBJECTIVES

Anxiety disorders (ADs) are commonly associated with high-functioning Autism Spectrum Disorder (HF-ASD) and often worsen with age. Buspirone is a commonly prescribed anxiolytic drug with a favorable tolerability profile that may offer potential benefits in anxiety management for patients with HF-ASD. This study examines inadequately explored tolerability and effectiveness of buspirone in treating ADs comorbid with high-functioning ASD.

METHODS

A retrospective chart review of a 1-year period was conducted in psychiatrically referred population of HF-ASD youth with AD (age 8-17 years) who were treated with buspirone (N = 31). Information on the demographics and treatment history was recorded. Effectiveness was assessed through the Clinical Global Impressions Scale (CGI) severity (CGI-S) and improvement (CGI-I) scores noted by the treating clinician.

RESULTS

A total of 31 patients were prescribed buspirone during the determined period, at a mean dose of 41.61 ± 24.10 mg for an average duration of 272 ± 125 days. Change in the CGI-S mean scores with treatment suggests an overall improvement in the severity of anxiety symptoms (M_T1 = 4.9 ± 0.7; M_T2 = 2.8 ± 0.87; p < 0.001). Significant improvement in anxiety symptoms (CGI-I ≤ 2) was observed in 58% and mild improvement (CGI-I = 3) in 29% of the HF-ASD patients who received buspirone treatment. Buspirone was well tolerated with no adverse events reported by the majority of participants, with the exception of two subjects who developed treatment emergent adverse events (activation and mood lability).

CONCLUSIONS

Findings from this retrospective chart review suggest a promising role of buspirone in managing anxiety among youth with HF-ASD. Further research with prospective and randomized-controlled trials is necessary.

Examining the clinical correlates of autism spectrum disorder in youth by ascertainment source

To examine whether presentation of autism spectrum disorder (ASD) and associated patterns of psychiatric comorbidity and dysfunction vary by referral source. ASD youth referred to a specialized ambulatory program for ASD (N = 143) were compared to ASD youth referred to a general child psychiatry clinic (N = 217). More ASD clinic youth met criteria for a more robust form of ASD (autistic disorder); more youth referred to the psychiatry clinic met criteria for broader spectrum ASD (pervasive developmental disorder not otherwise specified). General psychiatry clinic youth with ASD suffered from a greater burden of psychopathologies and higher levels of dysfunction. The presentation of ASD in psychiatrically referred youth differs between general and ASD-specialized clinics, though both referral populations have high levels of comorbidity and dysfunction.

Child behavior checklist clinical scales discriminate referred youth with autism spectrum disorder: a preliminary study

OBJECTIVE

To evaluate the properties of clinical scales of the Child Behavior Checklist in discriminating referred children with autism spectrum disorders (ASDs) (autistic disorder, Asperger's disorder, and pervasive developmental disorder not otherwise specified) from psychiatrically referred children without ASDs.

METHOD

Comparisons were made between children with ASDs (n = 65) with intelligence quotient >70 and children without ASDs (N = 83) on the clinical scales of the Child Behavior Checklist. Stepwise logistic regression was used to identify those scales that best predicted ASDs when compared with the non-ASD comparison group. Receiver operating characteristic curves examined the ability of the significant predictor T-scores to identify ASDs versus the non-ASD subjects.

RESULTS

Withdrawn, Social Problems, and Thought Problems T-scores were the best independent predictors of ASD status. The Withdrawn + Social + Thought Problems T-scores yielded an area under the curve of 0.86, indicating an 86% chance that a randomly selected sample of ASD subject will have abnormal scores on these scales than a randomly selected sample of non-ASD subjects.

CONCLUSION

These findings suggest that a new Child Behavior Checklist-ASD profile consisting of the Child Behavior Checklist-Withdrawn, Social, and Thought Problems scales could serve as a rapid and cost-effective screening instrument to help identify cases likely to meet clinical criteria for ASDs in the clinical setting.

Psychiatric disorders in individuals with pervasive developmental disorder

Pervasive developmental disorders (PDD) refer to the group of heterogeneous conditions that make up a continuum or spectrum of autistic disorders and share a core triad of impairments consisting of qualitative disturbances in social interaction and verbal and nonverbal communication and imagination. It has long been believed that the prevalence of autism was 2-4 per 10,000 children. However, studies using broader definitions of autistic disorder have suggested that the prevalence of autism spectrum disorder may be as high as 90 per 10,000 and that a greater proportion of individuals with PDD have intellectual levels above 70. Clinicians and researchers have commented on the apparent increase in prevalence of the disorder and have offered a number of explanations, including better recognition and diagnosis of the autism spectrum of disorders and a real increase in the disturbance. It is being increasingly recognized that individuals with PDD are at risk for a wide array of psychiatric disturbances, including affective disorder, anxiety disorders, schizophrenia-like psychosis, aggression, antisocial behavior, and Tourette's disorder (TD). Evidence indicates that PDD is significantly related to the comorbid psychiatric disorders and TD. Because PDD is not rare, individuals with autism spectrum disorder may represent significant subgroups of severely emotionally disturbed patients referred for psychiatric treatment. Because of lack of awareness that the clinical manifestations of PDD are heterogeneous and often mild and that comorbid psychiatric disturbances may obscure the symptoms of the developmental disorder, the diagnosis of PDD may be missed. Implications for practicing clinicians are discussed.

The economic impact of autism in Britain

Little is known about the economic impact of autism. This study estimated the economic consequences of autism in the United Kingdom, based on published evidence and on the reanalysis of data holdings at the Centre for the Economics of Mental Health (CEMH). With an assumed prevalence of 5 per 10,000, the annual societal cost for the UK was estimated to exceed ł1 billion. The lifetime cost for a person with autism exceeded ł2.4 million. The main costs were for living support and day activities. Family costs account for only 2.3 percent of the total cost, but a lack of relevant information limited our ability to estimate these costs. Minor improvements in life outcome for people with autism could substantially reduce costs over the lifetime.

Toward a developmental operational definition of autism

Traditional approaches to diagnosing autism emphasize delays in communication and socialization. Traditional diagnostic schemes typically list symptoms (e.g., lack of eye contact), but provide little guidance on how to incorporate information about developmental level in making a diagnosis. Because standardized measures of adaptive behavior can provide information about children's communication, socialization, and other behavior relative to their age, they may be useful tools for diagnosing autism. This study investigated the ability of the Vineland Adaptive Behavior Scales to identify children with autism. Vineland scores and measures of intellectual functioning were obtained for children with autism, PDDNOS, and other developmental disorders (DD). Discriminant function analyses indicated that the autism and combined nonautism (PDDNOS and DD) groups could be differentiated on the basis of socialization, daily living skills, and serious maladaptive behaviors. Socialization alone accounted for 48% of the variance in diagnosis. Using regression analyses derived from a large normative sample, adaptive behavior scores were predicted from chronological age (CA) and mental age (MA). Socialization scores in the autism group were substantially below the level predicted from CA or MA. An index derived from the ratio of actual to predicted socialization scores correctly classified 86% of both autism and nonautism cases. Findings suggest that comparison of obtained Vineland socialization scores to those predicted by CA or MA may be useful in clarifying the diagnosis of autism.

Associated psychopathology in children with both ADHD and chronic tic disorder

OBJECTIVE

To examine the relation between severity of tic disorder and comorbid psychopathology in 47 prepubertal children with tic disorder who were referred for clinical evaluation of and treatment for attention-deficit hyperactivity disorder (ADHD), oppositional behaviors, and aggressive behaviors.

METHOD

Parents and teachers completed the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) for each child.

RESULTS

Seventy-five percent of the sample was in the clinical range in at least two categories of psychopathology. When the children were divided into two groups on the basis of tic severity, significantly higher scores were obtained for children with more severe tics on the narrow-band Depressed, Uncommunicative, Obsessive-Compulsive, and Aggressive scales, and the broad-band internalizing scale of the CBCL. The severity groups did not differ on TRF scores. Children who were more aggressive also received higher CBCL scores.

CONCLUSIONS

The findings from this study suggest that the severity of chronic tics is a clinical indicator of complex psychopathology in children with ADHD who are referred for psychiatric evaluation.

Studies of the c-Harvey-Ras gene in psychiatric disorders

Hérault et al. (1993) previously reported a significant association between autism and the larger fragments of the c-Harvey-Ras (HRAS) Bam H1 polymorphism. We have sought to verify this finding and determine if there was any evidence for an association with other psychiatric disorders. Because of its greater sensitivity, we have examined the HRAS Msp 1 polymorphism. We found a just significant increase in the prevalence of the > 2.1 kb alleles in 48 subjects with autism versus 50 control subjects. There was no increase in the prevalence of the > 2.1 kb alleles in 164 probands with Tourette's syndrome. Examination of 16 preselected symptom clusters, however, showed a significant trend toward higher scores for obsessive-compulsive and phobic symptoms in > 2.1 kb homozygotes. While this locus requires further study, in conjunction with the results of Hérault et al., the present findings suggest that genetic defects in HRAS, and possibly other components of the G protein secondary messenger system, may play a role in some psychiatric disorders.