Characterizing the metabolomic signature of attention-deficit hyperactivity disorder in twins

Emerging evidence implicate the gut microbiota as a potential susceptibility factor in attention-deficit hyperactivity disorder (ADHD), a common multifactorial neurodevelopmental condition. However, little is known about the biochemical signature of ADHD, including the metabolic contribution of the microbiota via the gut-brain axis, and the relative contribution of genetics and environmental factors. Here, we perform unbiased metabolomic profiling of urine and fecal samples collected from a well-characterized Swedish twin cohort enriched for ADHD (33 ADHD, 79 non-ADHD), using ¹H nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry. Our results highlight sex-specific patterns in the metabolic phenotype of individuals with ADHD. Specifically, the urine profile of males, but not females, with ADHD was characterized by greater excretion of hippurate, a product of microbial-host co-metabolism that can cross the blood-brain-barrier with bioactivity of potential relevance to ADHD. This trans-genomic metabolite was also negatively correlated with IQ in males and was significantly correlated with fecal metabolites associated with gut microbial metabolism. The fecal profile of ADHD individuals was characterized by increased excretion of stearoyl-linoleoyl-glycerol, 3,7-dimethylurate, and FAD and lower amounts of glycerol 3-phosphate, thymine, 2(¹H)-quinolinone, aspartate, xanthine, hypoxanthine, and orotate. These changes were independent of ADHD medication, age, and BMI. Furthermore, our specific twins' models revealed that many of these gut metabolites had a stronger genetic influence than environmental. These findings suggest that metabolic disturbances in ADHD, involving combined gut microbial and host metabolic processes, may largely derive from gene variants previously linked to behavioral symptoms in this disorder.

Screening for autism spectrum disorder in deaf adults with intellectual disability: Feasibility and accuracy of two autism screening instruments

BACKGROUND

There is a lack of autism screening instruments for deaf or hard of hearing (DHH) adults with intellectual disability.

AIMS

This study examined the diagnostic validity of the Pervasive Developmental Disorder in Mental Retardation Scale and the Diagnostic Behavioral Assessment for autism spectrum disorder - Revised in this rare population.

METHODS AND PARTICIPANTS

56 DHH adults with intellectual disability living in three specialized therapeutic communities were examined, 9 of whom met criteria for autism.

OUTCOMES AND RESULTS

With minimal adaptions regarding item interpretation, both tools showed good diagnostic and high convergent validity. Items probing for difficulties in reciprocal social interaction and restricted interests were discriminant between individuals with and without autism.

CONCLUSION

These data suggest that both autism screening tools are feasible and psychometrically sound when used with appropriate adaptations for DHH adults with intellectual disability.

Preference for biological motion is reduced in ASD: implications for clinical trials and the search for biomarkers

BACKGROUND

The neurocognitive mechanisms underlying autism spectrum disorder (ASD) remain unclear. Progress has been largely hampered by small sample sizes, variable age ranges and resulting inconsistent findings. There is a pressing need for large definitive studies to delineate the nature and extent of key case/control differences to direct research towards fruitful areas for future investigation. Here we focus on perception of biological motion, a promising index of social brain function which may be altered in ASD. In a large sample ranging from childhood to adulthood, we assess whether biological motion preference differs in ASD compared to neurotypical participants (NT), how differences are modulated by age and sex and whether they are associated with dimensional variation in concurrent or later symptomatology.

METHODS

Eye-tracking data were collected from 486 6-to-30-year-old autistic (N = 282) and non-autistic control (N = 204) participants whilst they viewed 28 trials pairing biological (BM) and control (non-biological, CTRL) motion. Preference for the biological motion stimulus was calculated as (1) proportion looking time difference (BM-CTRL) and (2) peak look duration difference (BM-CTRL).

RESULTS

The ASD group showed a present but weaker preference for biological motion than the NT group. The nature of the control stimulus modulated preference for biological motion in both groups. Biological motion preference did not vary with age, gender, or concurrent or prospective social communicative skill within the ASD group, although a lack of clear preference for either stimulus was associated with higher social-communicative symptoms at baseline.

LIMITATIONS

The paired visual preference we used may underestimate preference for a stimulus in younger and lower IQ individuals. Our ASD group had a lower average IQ by approximately seven points. 18% of our sample was not analysed for various technical and behavioural reasons.

CONCLUSIONS

Biological motion preference elicits small-to-medium-sized case-control effects, but individual differences do not strongly relate to core social autism associated symptomatology. We interpret this as an autistic difference (as opposed to a deficit) likely manifest in social brain regions. The extent to which this is an innate difference present from birth and central to the autistic phenotype, or the consequence of a life lived with ASD, is unclear.

Experiences of Parents of Specialist Peer Mentored Autistic University Students

ABSTRCTBackground: Parents continue to support to autistic university students, and consequently, experience considerable stress.Aim: To explore the experiences of parents of specialist peer mentored university students and to examine these using the ICF as a theoretical framework.Method: Thirteen semi-structured interviews were completed and analyzed using thematic analysis. Directive content analysis linked the data to the ICF core set for autism spectrum disorders (ASD).Results: Five interrelated themes emerged: The mentoring relationship is a facilitator, Developing skills for university, Mentoring changes lives, Mentoring is not a substitute for other supports, and University is an emotional rollercoaster. Specialist peer mentoring was linked to Activity and Participation (44%) and Environmental factors (32%) of the ICF core set for ASD.Conclusion: These results add to the specialist peer mentoring evidence-base, and indicate perceived benefits for autistic university students and their parents. An unintended consequence was that parents broadened their participation in activities.

Assessment of Autism Spectrum Disorder in Deaf Adults with Intellectual Disability: Feasibility and Psychometric Properties of an Adapted Version of the Autism Diagnostic Observation Schedule (ADOS-2)

This study describes the adaptation of the autism diagnostic observation schedule (ADOS-2) to assess autism spectrum disorder (ASD) in adults with intellectual disability (ID) and hearing loss who communicate primarily visually. This adapted ADOS-2 was applied to residents of specialized therapeutic living communities (n = 56). The internal consistency of the adapted ADOS-2 was excellent for the Social Affect of modules 2 and 3 and acceptable for Restricted and Repetitive Behaviors subscale of module 2, but poor for module 3. Interrater reliability was comparable to standard ADOS-2 modules 1–3. Results suggest that autism symptoms of deaf adults with ID can be reliably identified by an adapted ADOS-2, provided adequate expertise in deafness, ID, ASD and proficiency in signed language by the administrator.

Perceptual processing links autism and synesthesia: A twin study

Introduction

Synesthesia is a non-pathological condition where sensory stimuli (e.g. letters or sounds) lead to additional sensations (e.g. color). It occurs more commonly in individuals diagnosed with Autism Spectrum Condition (ASC) and is associated with increased autistic traits and autism-related perceptual processing characteristics, including a more detail-focused attentional style and altered sensory sensitivity. In addition, autistic traits correlate with the degree of synesthesia (consistency of color choices on an objective synesthesia test) in non-synesthetes.

Objectives

We aimed to investigate whether the degree of synesthesia for graphemes is associated with autistic traits and perceptual processing alterations within twin pairs, where all factors shared by twins (e.g. age, family background, and 50-100% genetics) are implicitly controlled for.

Methods

We investigated a predominantly non-synesthetic twin sample, enriched for ASC and other neurodevelopmental disorders (n=65, 14-34 years, 60% female), modelling the linear relationships between the degree of synesthesia and autistic traits, sensory sensitivity, and visual perception, both within-twin pairs (22 pairs) and across the entire cohort.

Results

A higher degree of synesthesia was associated with increased autistic traits only within the attention to details domain, with sensory hyper-, but not hypo-sensitivity and with being better in identifying fragmented images. These associations were stronger within-twin pairs compared to across the sample.

Conclusions

Consistent with previous findings, the results support an association between the degree of synesthesia and autistic traits and autism-related perceptual features, however restricted to specific domains. Further, the results indicate that a twin design can be more sensitive for detecting these associations.

Disclosure

No significant relationships.

Individual risk and familial liability for suicide attempt and suicide in autism: a population-based study

BACKGROUND

Studies on the individual gender-specific risk and familial co-aggregation of suicidal behaviour in autism spectrum disorder (ASD) are lacking.

METHODS

We conducted a matched case-cohort study applying conditional logistic regression models on 54 168 individuals recorded in 1987-2013 with ASD in Swedish national registers: ASD without ID n = 43 570 (out of which n = 19035, 43.69% with ADHD); ASD + ID n = 10 598 (out of which n = 2894 individuals, 27.31% with ADHD), and 270 840 controls, as well as 347 155 relatives of individuals with ASD and 1 735 775 control relatives.

RESULTS

The risk for suicidal behaviours [reported as odds ratio OR (95% confidence interval CI)] was most increased in the ASD without ID group with comorbid ADHD [suicide attempt 7.25 (6.79-7.73); most severe attempts i.e. requiring inpatient stay 12.37 (11.33-13.52); suicide 13.09 (8.54-20.08)]. The risk was also increased in ASD + ID group [all suicide attempts 2.60 (2.31-2.92); inpatient only 3.45 (2.96-4.02); suicide 2.31 (1.16-4.57)]. Females with ASD without ID had generally higher risk for suicidal behaviours than males, while both genders had highest risk in the case of comorbid ADHD [females, suicide attempts 10.27 (9.27-11.37); inpatient only 13.42 (11.87-15.18); suicide 14.26 (6.03-33.72); males, suicide attempts 5.55 (5.10-6.05); inpatient only 11.33 (9.98-12.86); suicide 12.72 (7.77-20.82)]. Adjustment for psychiatric comorbidity attenuated the risk estimates. In comparison to controls, relatives of individuals with ASD also had an increased risk of suicidal behaviour.

CONCLUSIONS

Clinicians treating patients with ASD should be vigilant for suicidal behaviour and consider treatment of psychiatric comorbidity.

Global and local visual processing in autism - a co-twin-control study

BACKGROUND

Autism Spectrum Disorder (ASD) is associated with altered global and local visual processing. However, the nature of these alterations remains controversial, with contradictory findings and notions ranging from a reduced drive to integrate information into a coherent 'gestalt' ("weak central coherence" = WCC) to an enhanced perceptual functioning (EPF) in local processing.

METHODS

This study assessed the association between autism and global/local visual processing, using a large sample of monozygotic (MZ) and dizygotic (DZ) twins (N = 290, 48% females, age = 8-31 years). The Fragmented Pictures Test (FPT) assessed global processing, whereas local processing was estimated with the Embedded Figures Test (EFT) and the Block Design Test (BDT). Autism was assessed both categorically (clinical diagnosis), and dimensionally (autistic traits). Associations between visual tasks and autism were estimated both across the cohort and within-twin pairs where all factors shared between twins are implicitly controlled.

RESULTS

Clinical diagnosis and autistic traits predicted a need for more visual information for gestalt processing in the FPT across the cohort. For clinical diagnosis, this association remained within-pairs and at trend-level even within MZ twin pairs alone. ASD and higher autistic traits predicted lower EFT and BDT performance across the cohort, but these associations were lost within-pairs.

CONCLUSIONS

In line with the WCC account, our findings indicate an association between autism and reduced global visual processing in children, adolescents and young adults (but no evidence for EPF). Observing a similar association within MZ twins suggests a non-shared environmental contribution.

"I don't want to be a patient": Peer mentoring partnership fosters communication for autistic university students

Background: Despite recognition of the benefits of post-school education in improving life outcomes for autistic adults their university completion rates remain low.Aim: To explore the experiences of undergraduate autistic university students participating in specialist peer mentoring (SPM) to identify active ingredients in the peer mentoring process and to examine the impact of SPM on social communication.Material and method: A total of 30 (8 female; M age = 22.3; SD = 6.7) undergraduate autistic university students engaged in SPM participated in this study. A quantitative pre-test post-test design examined changes in autistic traits. In parallel, the experiences of participating in SPM were explored through semi-structured interviews.Results: Improvements were noted at post-test on the Social Responsiveness Scale-2 total score p = 0.02), and its Social Communication, (p = 0.03) and Social Motivation (p = 0.03) sub-scales. Four themes emerged from the interviews: Developing Partnership and Understanding, Modelling and Practising Communication, Psychological Support and Grading and Planning Skills.Conclusions: These results indicated that the mentor-mentee partnership was a crucial active ingredient of SPM. This partnership appeared to modify social cognition and motivation for autistic university students through modelling and practising communication.Significance: These results demonstrate that SPM can support participation at university for autistic university students.

Social Cognition in Autism and Other Neurodevelopmental Disorders: A Co-twin Control Study

Alterations in social cognition (SC) are hypothesized to underlie social communication and interaction challenges in autism spectrum disorder (ASD). The aetiological underpinnings driving this association remain unclear. We examined SC in 196 twins with ASD, other neurodevelopmental disorders or typical development using the naturalistic Movie for the Assessment of Social Cognition. Autism and its severity were assessed with the Autism Diagnostic Observation Schedule-2, and autistic traits with the Social Responsiveness Scale-2. Using within twin-pair regression models, controlling for age, sex, IQ, and unmeasured familial confounders such as genetic background and shared-environment, SC correlated with ASD diagnosis, autism severity, and autistic traits. Our findings highlight the importance of SC alterations in autism and suggest a non-shared environmental impact on the association.

Evaluating Sex and Age Differences in ADI-R and ADOS Scores in a Large European Multi-site Sample of Individuals with Autism Spectrum Disorder

Research on sex-related differences in Autism Spectrum Disorder (ASD) has been impeded by small samples. We pooled 28 datasets from 18 sites across nine European countries to examine sex differences in the ASD phenotype on the ADI-R (376 females, 1763 males) and ADOS (233 females, 1187 males). On the ADI-R, early childhood restricted and repetitive behaviours were lower in females than males, alongside comparable levels of social interaction and communication difficulties in females and males. Current ADI-R and ADOS scores showed no sex differences for ASD severity. There were lower socio-communicative symptoms in older compared to younger individuals. This large European ASD sample adds to the literature on sex and age variations of ASD symptomatology.

How can clinicians detect and treat autism early? Methodological trends of technology use in research

We reviewed original research papers that used quantifiable technology to detect early autism spectrum disorder (ASD) and identified 376 studies from 34 countries from 1965 to 2013. Publications have increased significantly since 2000, with most coming from the USA. Electroencephalogram, magnetic resonance imaging and eye tracking were the most frequently used technologies.

CONCLUSION

The use of quantifiable technology to detect early ASD has increased in recent decades, but has had limited impact on early detection and treatment. Further scientific developments are anticipated, and we hope that they will increasingly be used in clinical practice for early ASD screening, diagnosis and intervention.

Cognitive behavior therapy-based psychoeducational groups for adults with ADHD and their significant others (PEGASUS): an open clinical feasibility trial

The aim of this pilot study was to investigate the feasibility and effectiveness of a new psychoeducative intervention program (PEGASUS) for adults with ADHD and their significant others in a psychiatric outpatient context. At three outpatient psychiatric clinics, adults with ADHD and their significant others took part in PEGASUS, a psychoeducational program based on theories from cognitive behavioral therapy, neuropsychology, and cross-disciplinary evidence regarding ADHD. In total, 108 adults were allocated to treatment (51 with ADHD and their 57 significant others). Feasibility was evaluated regarding suitability of the intervention at a psychiatric outpatient clinic and treatment completion. Preliminary efficacy was evaluated per protocol from baseline to post-intervention (n = 41 adults with ADHD and 40 significant others). In a feasibility analysis, the intervention was judged to be a suitable treatment option for 94.5 % of all individuals with a primary diagnosis of ADHD at an outpatient psychiatric clinic. In total, 43 out of 51 allocated individuals with ADHD (84.3 %) completed the intervention. The corresponding figures for their significant others were 42 out of 57 (73.7 %). Knowledge about ADHD increased, and both the quality of relationships and psychological well-being improved from baseline to post-intervention in all participants. The significant others reported a reduction in the subjective burden of care, such as worry and guilt. The objective burden of care (such as financial problems) did not change. The findings support the potential value of psychoeducation for adults with ADHD and their significant others. An ongoing randomized controlled trial will generate further evidence concerning the PEGASUS program.

Calendar calculating in savants with autism and healthy calendar calculators

BACKGROUND

Calendar calculation is the ability to quickly name the day that a given date falls on. Previous research has suggested that savant calendar calculation is based on rote memory and the use of rule-based arithmetic skills. The objective of this study was to identify the cognitive processes that distinguish calendar calculation in savant individuals from healthy calendar calculators.

METHOD

Savant calendar calculators with autism (ACC, n=3), healthy calendar calculators (HCC, n=3), non-savant subjects with autism (n=6) and healthy calendar calculator laymen (n=18) were included in the study. All participants calculated dates of the present (current month). In addition, ACC and HCC also calculated dates of the past and future 50 years.

RESULTS

ACC showed shorter reaction times and fewer errors than HCC and non-savant subjects with autism, and significantly fewer errors than healthy calendar calculator laymen when calculating dates of the present. Moreover, ACC performed faster and more accurate than HCC regarding past dates. However, no differences between ACC and HCC were detected for future date calculation.

CONCLUSIONS

The findings may imply distinct calendar calculation strategies in ACC and HCC, with HCC relying on calendar regularities for all types of dates and an involvement of (rote) memory in ACC when processing dates of the past and the present.

Suizidalität bei depressiven Kindern und Jugendlichen unter Behandlung mit selektiven Serotoninwiederaufnahmehemmern

Due to concerns that selective serotonin reuptake inhibitors (SSRI) might be associated with an increased risk of suicidal ideation and suicide attempts in depressive children and adolescents, treatment with these drugs is controversial. All available data from randomised controlled trials on SSRIs treating depression in these age groups were examined regarding efficacy and suicidality. Results suggest that fluoxetine and, less clearly, sertraline are effective in such treatment. A meta-analysis yielded no statistically significant difference between treatment with SSRI and placebo with regard to the occurrence of suicidal behavior. Following evidence-based criteria, the risk:benefit ratio is favourable for fluoxetine and sertraline. Their use in the pharmacotherapy of depressive children and adolescents is indicated.

Functional imbalance of visual pathways indicates alternative face processing strategies in autism

OBJECTIVE

To investigate whether autistic subjects show a different pattern of neural activity than healthy individuals during processing of faces and complex patterns.

METHODS

Blood oxygen level-dependent (BOLD) signal changes accompanying visual processing of faces and complex patterns were analyzed in an autistic group (n = 7; 25.3 [6.9] years) and a control group (n = 7; 27.7 [7.8] years).

RESULTS

Compared with unaffected subjects, autistic subjects demonstrated lower BOLD signals in the fusiform gyrus, most prominently during face processing, and higher signals in the more object-related medial occipital gyrus. Further signal increases in autistic subjects vs controls were found in regions highly important for visual search: the superior parietal lobule and the medial frontal gyrus, where the frontal eye fields are located.

CONCLUSIONS

The cortical activation pattern during face processing indicates deficits in the face-specific regions, with higher activations in regions involved in visual search. These findings reflect different strategies for visual processing, supporting models that propose a predisposition to local rather than global modes of information processing in autism.

Diagnostische Beobachtungsskala für Autistische Störungen (ADOS): Erste Ergebnisse zur Zuverlässigkeit und Gültigkeit

Zusammenfassung: Fragestellung: Abklärung der psychometrischen Eigenschaften der Diagnostischen Beobachtungsskala für Autistische Störungen, der deutschsprachigen Fassung des Autism Diagnostic Observation Schedule (ADOS). Methodik: In einer Stichprobe von 137 Probanden mit frühkindlichem Autismus, 23 mit atypischem Autismus oder nicht näher bezeichneter tiefgreifender Entwicklungsstörung, 16 mit Asperger-Syndrom und 13 mit einer anderen psychiatrischen Störung nach ICD-10 wurden die Interrater- und Retestreliabilität, interne Konsistenz, konvergente und diagnostische Validität bestimmt. Ergebnisse: Interrater- und Retestreliabilität erwiesen sich sowohl auf Diagnosen- (kappaw = 1.00 bzw. .62) als auch auf Skalenebene (rtt = .84 bzw. .79) als gut, ebenso die interne Konsistenz der Algorithmusskala Kommunikation und soziale Interaktion der Module 1 bis 4 (rtt = .78 bis .89). Die Diagnosenkonvergenz mit dem Autismus Diagnostischen Interview-Revision (ADI-R) lag bei 79% (kappa = .23), bei moderater Korrelation der korrespondierenden Subskalen der Verfahren (rtc = .31 bis .45). Die Übereinstimmung von ADOS und klinischer Konsensusdiagnose war 77% (kappaw = .37), bei einer Sensitivität des Verfahrens von 90.4% und einer Spezifität von 48.1% für die Diskrimination von Autismus und anderen autistischen Störungen. Schlussfolgerungen: Das ADOS ist ein für die Erfassung autistischer Störungen zuverlässiges und ausreichend sensitives klinisches Diagnostikum. Damit eine psychiatrische Diagnose nach ICD-10 und DSM-IV gestellt werden kann und um hohe Spezifität der psychiatrischen Klassifikation zu gewährleisten, muss das ADOS durch Informationen zu stereotypem, repetitivem Verhalten sowie anamnestische Daten (z.B. aus dem ADI-R) ergänzt werden.

[Intervention in autistic disorders: status quo, evidence-based, questionable and doubtful techniques]

OBJECTIVE

We describe and critically discuss intervention methods that have been used to modify autistic behaviors.

METHODS

Early intervention methods, training of social skills, pharmacological treatment and alternative approaches are reviewed in the light of the empirical evidence.

RESULTS

Autism is a persistent and phenotypically heterogeneous disorder for which no cure has been found to date. However, individually composed care and therapies can lead to remarkable quantitative improvement.

CONCLUSIONS

Further research is needed to evaluate the true impact of psychological and biological intervention techniques in autistic disorders. Among other things, the therapy studies carried out up to now often lack an adequate diagnostic assessment.

[Factor structure of the Autism Diagnostic Interview-Revised (ADI-R): a study of dimensional versus categorical classification of autistic disorders]

OBJECTIVES

This study investigated whether empirically derived dimensions of autistic behavior are consistent with the content-valid construction of the autistic behavior domains according to ICD-10 and DSM-IV (social interaction, communication and repetitive, stereotyped behavior).

METHODS

A principal component exploratory factor analysis routine with varimax-rotation and extraction of factors following the Scree criterion was run using data from the Autism Diagnostic Interview-Revised (ADI-R) of N = 262 individuals exhibiting autism or autistic features.

RESULTS

A three-factor solution consisting of two socio-communicative and one language dimension and accounting for 46.1% of the total variance was found to best describe the data. These factors yielded only vague correspondence with the idea of behavior domains described in ICD-10 and DSM-IV. In addition, factor loadings of items representing repetitive, stereotyped patterns were generally weak.

CONCLUSIONS

The factor-analytic approach to autism indicates a conception of the disorder divergent from that defined in the contemporary psychiatric classification systems, especially regarding the area of repetitive, stereotyped behavior.

[Factor structure of the Autism Diagnostic Interview-Revised (ADI-R): a study of dimensional versus categorical classification of autistic disorders]

OBJECTIVES

This study investigated whether empirically derived dimensions of autistic behavior are consistent with the content-valid construction of the autistic behavior domains according to ICD-10 and DSM-IV (social interaction, communication and repetitive, stereotyped behavior).

METHODS

A principal component exploratory factor analysis routine with varimax-rotation and extraction of factors following the Scree criterion was run using data from the Autism Diagnostic Interview-Revised (ADI-R) of N = 262 individuals exhibiting autism or autistic features.

RESULTS

A three-factor solution consisting of two socio-communicative and one language dimension and accounting for 46.1% of the total variance was found to best describe the data. These factors yielded only vague correspondence with the idea of behavior domains described in ICD-10 and DSM-IV. In addition, factor loadings of items representing repetitive, stereotyped patterns were generally weak.

CONCLUSIONS

The factor-analytic approach to autism indicates a conception of the disorder divergent from that defined in the contemporary psychiatric classification systems, especially regarding the area of repetitive, stereotyped behavior.

Stability and interpersonal agreement of the interview-based diagnosis of autism

Interpersonal agreement and stability of the Autism Diagnostic Interview-Revised (ADI-R) was examined in this study. Four raters judging 55 subjects agreed moderately to excellently on the items of the diagnostic algorithm, operationalizing the main autistic symptoms according to the classification guidelines of ICD-10 and DSM-IV. When retesting 33 individuals, some items revealed only weak stability. On the level of domains of autistic behavior and diagnosis, the interrater reliability and retest reliability were consistently convincing.

[Speech development and intelligence in autism. How uniform is Asperger syndrome?]

Since the introduction of a separate diagnosis for Asperger's syndrome in the ICD-10 and DSM-IV classification systems, a controversial debate has continued on whether Asperger's syndrome is a specific, clearly distinguishable disorder within the autistic spectrum or whether it represents a milder phenotypical variation of autism. The effect on the amount of autistic symptoms of the variables language delay and level of intelligence was analyzed within a sample of individuals exhibiting autism diagnosed by standardized methods. Both variables showed a significant effect on the degree of autistic symptoms in that impairments in social interaction were less noticeable. In addition, a subsample of individuals exhibited symptoms assumed to be characteristic for Asperger's syndrome. The findings support the assumption that autism and Asperger's syndrome represent "extreme points" on a scale of severity, which leads to the suggestion that the classification of different subtypes of autism could be abandoned in favor of a dimensional (multiaxial) approach.

[Utilization of psychological tests for diagnosis in German child and adolescent psychiatry: results of a survey]

92 inpatient and outpatient child and adolescent psychiatric institutions all over Germany were surveyed on practice and attitude towards psychological tests. Leading psychologists were contacted by mail and given a 15 item questionnaire. All institutions reported keeping at least a small test-inventory and using psychological tests in diagnostics. Half of the clinics carried out individual tests obligatory in the routine. Additionally, one third applied self-constructed instruments, which in the minority of cases had been psychometrically investigated or published. Computer-aided testing was established in one third of the institutions. Colleagues, test-compendia, scientific journals and the internet are quite often consulted for test-information. Intelligence measures are the most frequently administered test in child and adolescent psychiatry, while structured interviews are applied rarely. Among the highly frequent used individual tests were the Wechsler-Intelligence-Scales for children and adults, the CFT-scales, the projective Sceno-test and the d2-attention endurance test. One forth of the surveyed clinics reported refusal of individual or groups of tests, including projective and cognitive assessments. Thereby, ethic aspects were never mentioned as a reason for rejection. A range of diagnosticians reported to miss adequate measures for diverse constructs, e.g. learning disabilities. Furthermore, new norms and up-dates for regularly used instruments were often demanded. Some single survey-results also give reason for critically reviewing aspects of test-usage in German child and adolescent psychiatry.

[Utilization of psychological tests for diagnosis in German child and adolescent psychiatry: results of a survey]

92 inpatient and outpatient child and adolescent psychiatric institutions all over Germany were surveyed on practice and attitude towards psychological tests. Leading psychologists were contacted by mail and given a 15 item questionnaire. All institutions reported keeping at least a small test-inventory and using psychological tests in diagnostics. Half of the clinics carried out individual tests obligatory in the routine. Additionally, one third applied self-constructed instruments, which in the minority of cases had been psychometrically investigated or published. Computer-aided testing was established in one third of the institutions. Colleagues, test-compendia, scientific journals and the internet are quite often consulted for test-information. Intelligence measures are the most frequently administered test in child and adolescent psychiatry, while structured interviews are applied rarely. Among the highly frequent used individual tests were the Wechsler-Intelligence-Scales for children and adults, the CFT-scales, the projective Sceno-test and the d2-attention endurance test. One forth of the surveyed clinics reported refusal of individual or groups of tests, including projective and cognitive assessments. Thereby, ethic aspects were never mentioned as a reason for rejection. A range of diagnosticians reported to miss adequate measures for diverse constructs, e.g. learning disabilities. Furthermore, new norms and up-dates for regularly used instruments were often demanded. Some single survey-results also give reason for critically reviewing aspects of test-usage in German child and adolescent psychiatry.

Patterns of parent-reported problems indicative in autism

Parental report Child Behavior Checklists (CBCL) of 77 male and female subjects aged 4-18 years were analyzed in this study. Individuals had been given diagnoses of autistic disorder using the Autism Diagnostic-Interview-Revised (ADI-R) within a research project on the genetics of autism. A feature of behavior problems independent of sex but influenced by age and IQ level could be identified for the autistic sample with highest relative scores on the scales measuring attention problems, social problems and thought problems and low scores on the scale for somatic complaints.