Quality of life: A case-controlled long-term follow-up study,comparing young high-functioning adults with autism spectrum disorders with adults with other psychiatric disorders diagnosed in childhood

Background

Long term outcome in childhood autism spectrum disorders (ASD) was evaluated by studying quality of life (QoL) in young adulthood in comparison to the outcome of other child psychiatric disorders.

Methods

In this follow-up study, objective and subjective QoL of 169 high-functioning (IQ > 70) adults with ASD (19 to 30 years) was contrasted with QoL data of age matched adults diagnosed with attention deficit/hyperactivity disorder (N = 85), disruptive behaviour disorders (N = 83), and affective disorders (N = 85) during childhood. The mean follow-up period of the ASD patients was 13.9 years. Objective QoL included marital status, living arrangements, level of education, employment, and usage of mental health care. Subjective QoL included satisfaction concerning living arrangements, work or education, physical condition, partner relationship, social relationships, state of mind, and future perspective.

Results

QoL was more compromised in adults diagnosed with ASD in childhood than in adults with other psychiatric disorders in childhood. A relatively large proportion of the adults with ASD were single, few lived with a partner or a family and many of them were institutionalized. Adults with ASD had lower educational levels, relatively few had paid employment and many were social security recipients, as compared to the other psychiatric patients. In case the adults with ASD used medication, 47% used anti-psychotics. Regarding the subjective QoL, the adults with ASD were less satisfied about their work or education, partner relationship, and future perspective than the other groups. Even when highly educated adults with ASD were compared to highly educated adults diagnosed with other childhood disorders, the QoL appeared to be more disadvantageous in adults with ASD.

Conclusion

Many studies have shown that QoL is threatened in psychiatric patients, but findings of this study indicate that young high-functioning adults diagnosed with ASD in childhood are at relatively high risk for poor QoL compared to other childhood psychiatric disorders.     

Language abilities in monolingual- and bilingual- exposed children with autism or other developmental disorders

BackgroundParents and providers are sometimes concerned that exposure to two languages will impair language acquisition in children with autism spectrum disorder (ASD) or other developmental disorders (DD). However, research to date suggests that language milestones and abilities are unaffected by this exposure. The current study explored language abilities in toddlers with ASD or DD exposed to one versus multiple languages, prior to intervention. To our knowledge, this is the largest investigation of language learning in bilingual-exposed (BE) children with ASD.MethodsParticipants were 388 children evaluated as part of a larger study on the early detection of ASD. Parents were asked to list all languages that primary caretakers use to communicate with their child. One hundred six BE children (57 ASD, 49 DD) were compared to 282 monolingual-exposed (ME) children (176 ASD, 106 DD). The Mullen Scales of Early Learning assessed nonverbal and verbal abilities. Multiple regression was used to evaluate the relationship of BE to language abilities, beyond the influence of nonverbal cognitive abilities, diagnosis, and socioeconomic status.ResultsResults showed greater language impairment in ASD than DD, but no main effect for language exposure group nor any interaction of language group by diagnosis. Results remained consistent after controlling for socioeconomic status.ConclusionThis study suggests that bilingual caregivers can communicate with their children in both languages without adverse effects on their children’s language functioning.     

Motor stereotypies in children with autism and other developmental disorders

The purpose of the study was to count and characterize the range of stereotypies – repetitive rhythmical, apparently purposeless movements – in developmentally impaired children with and without autism, and to determine whether some types are more prevalent and diagnostically useful in children with autism. We described each motor stereotypy recorded during 15 minutes of archived videos of standardized play sessions in 277 children (209 males, 68 females; mean age 4y 6mo [SD 1y 5mo], range 2y 11mo–8y 1mo), 129 with autistic disorder (DSM-III-R), and 148 cognitively-matched non-autistic developmentally disordered (NADD) comparison children divided into developmental language disorder and non-autism, low IQ (NALIQ) sub-groups. The parts of the body involved and characteristics of all stereotypies were scored blind to diagnosis. More children with autism had stereotypies than the NADD comparison children. Autism and, to a lesser degree, nonverbal IQ (NVIQ) <80, especially in females contributed independently to the occurrence, number, and variety of stereotypies, with non-autistic children without cognitive impairment having the least number of stereotypies and children with autism and low NVIQ the most. Autism contributed independently to gait and hand/finger stereotypies and NVIQ <80 to head/trunk stereotypies. Atypical gazing at fingers and objects was rare but virtually limited to autism. Stereotypies are environmentally modulated movement disorders, some highly suggestive, but not pathognomonic, of autism. Their underlying brain basis and genetic correlates need investigation.     

The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders

ObjectiveTo determine the relationship of motor skills and adaptive behavior skills in young children with autism.DesignA multiple regression analysis tested the relationship of motor skills on the adaptive behavior composite, daily living, adaptive social and adaptive communicative skills holding constant age, non-verbal problem solving, and calibrated autism severity.SettingMajority of the data collected took place in an autism clinic.ParticipantsA cohort of 233 young children with ASD (n = 172), PDD-NOS (n = 22) and non-ASD (developmental delay, n = 39) between the ages of 14–49 months were recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of scores indicted through calibrated autism severity.InterventionsNot applicable.Main outcome measuresThe primary outcome measures in this study were adaptive behavior skills.ResultsFine motor skills significantly predicted all adaptive behavior skills (p < 0.01). Gross motor skills were predictive of daily living skills (p < 0.05). Children with weaker motor skills displayed greater deficits in adaptive behavior skills.ConclusionsThe fine and gross motor skills are significantly related to adaptive behavior skills in young children with autism spectrum disorder. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.     

Patterns of adaptive behavior in very young children with autism

The Vineland Adaptive Behavior Scales were used to investigate patterns of adaptive behavior in children with autism who were under 36 months of age. Subjects were 30 children with autism and 30 children with developmental delay matched on CA and MA. Relative to controls, the autistic group demonstrated weaker socialization and communication skills and greater discrepancies between adaptive behavior and MA. Different patterns of relations between adaptive behavior domains and cognitive and language skills were obtained for the two groups. Preliminary support for the utility of adaptive behavior profiles in identifying subgroups of children with autism is provided. Results are discussed in terms of their implications for early diagnosis of autism.     

A cytogenetic study of children with psychiatric disorders.

The development of techniques permitting the visualization of chromosomal cross-bands has greatly enhanced the field of human cytogenetics. It has led to the exact identification of chromosomes and the detection of subtle chromosomal changes characterizing new clinical syndromes.^1–4The G (Giemsa) and Q (Quinacrine mustard) banding techniques are the most widely used. As a relatively simple and replicable procedure, G banding is the method of choice for clinical application. It is attained by staining the chromosome preparation with Giemsa-like stains. The resulting thick dark staining cross-bands that alternate with lighter ones confer distinctive features to each chromosomal pair.By using elongated chromosomes from late prophase or early metaphase instead of the customary late metaphases, the visual resolution is greatly increased, making it feasible to detect chromosomal changes on different groups of patients. The major psychiatric illnesses are important to study with the new techniques because (1) they have a strong genetic component and (2) an association between chromosomal changes and psychiatric disorders has been proposed.A population of children affected with psychiatric disorders was chosen for the present study since extraneous factors such as drugs, chronic physical illness, and institutionalization are less likely to play a role in the nature-nurture interaction.     

An exploration of concomitant psychiatric disorders in children with autism spectrum disorder

ObjectiveWe explored patterns of concomitant psychiatric disorders in a large sample of treatment-seeking children and adolescents with autism spectrum disorder (ASD).MethodsParticipants were 658 children with ASD (age 3–17 years; mean = 7.2 years) in one of six federally-funded multisite randomized clinical trials (RCT) between 1999 and 2014. All children were referred for hyperactivity or irritability. Study designs varied, but all used the Child and Adolescent Symptom Inventory or Early Childhood Inventory to assess Attention Deficit Hyperactivity Disorder (ADHD), Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), Anxiety Disorders, and Mood Disorders. In addition, several measures in common were used to assess demographic and clinical characteristics.ResultsOf the 658 children, 73% were Caucasian and 59% had an IQ >70. The rates of concomitant disorders across studies were: ADHD 81%, ODD 46%, CD 12%, any anxiety disorder 42%, and any mood disorder 8%. Two or more psychiatric disorders were identified in 66% of the sample. Of those who met criteria for ADHD, 50% also met criteria for ODD and 46% for any anxiety disorder. Associations between types of concomitant disorders and a number of demographic and clinical characteristics are presented.ConclusionIn this well-characterized sample of treatment-seeking children with ASD, rates of concomitant psychiatric disorders were high and the presence of two or more co-occurring disorders was common. Findings highlight the importance of improving diagnostic practice in ASD and understanding possible mechanisms of comorbidity.     

Explosive, oppositional, and aggressive behavior in children with autism compared to other clinical disorders and typical children

Maternal ratings of explosiveness, opposition, and aggression were analyzed in 1609 children 6-16 years of age. Behavior problems were common in autism, ADHD-Combined type, and depression, whereas children with ADHD-Inattentive type, anxiety disorder, and acquired brain injury did not differ from typical controls. More than 40% of children with autism, ADHD-Combined type, and depression met criteria for oppositional-defiant disorder (ODD), and less than 15% did in the other groups. Male gender and low SES increased the risk of behavior problems, but correlations were small between behavior problems and age and IQ. Our findings have implications for new DSM-V diagnostic categories and criteria. The DSM-V needs to clarify whether or not an additional diagnosis of ODD should be made in children with autism who meet ODD criteria. The proposed DSM-V states that ADHD and temper dysregulation disorder with dysphoria not be diagnosed in autism, but does not mention ODD. Our study also suggests that diagnoses of temper dysregulation disorder with dysphoria and prepubertal bipolar disorder may be redundant to a diagnosis of ODD.     

Aggressive behavior in a sample of children with autism spectrum disorders

Little is known about the manifestation of aggressive behavior in children with autism, although it is commonly cited as a significant problem. Existing reports in autism do not emphasize subtypes of aggression, whereas distinguishing forms of aggression is commonplace in the typically developing literature. This study compared a sample of 121 children aged 3–20 years with autism spectrum disorders (ASD) to 244 children with other intellectual and developmental disabilities (IDD; age 4–21 years). Item- and subscale-level data from the Children's Scale for Hostility and Aggression: Reactive/Proactive (C-SHARP) were reported. Children with ASDs received higher ratings than those with IDD on several subscales tapping physical and reactive aggression. Within the ASD group, children with Asperger's disorder were rated significantly higher than children with autism on subscales tapping covert and verbal behaviors. Results indicate that at least some types of aggression were more common in children with ASDs than those with IDDs.     

Social use of language in children with reactive attachment disorder and autism spectrum disorders

Children with a diagnosis of reactive attachment disorder (RAD) appear to show difficulties in social understanding. We aimed to compare the pragmatic language functioning of children with (RAD) and autism spectrum disorder (ASD). Assessments were made in three groups of children aged 5–8 years, with verbal IQ estimates in the normal range: 35 with a RAD diagnosis, 52 with an ASD diagnosis and 39 with typical development. The Children’s Communication Checklist (CCC) was used to compare their pragmatic language skills, and ADI-R algorithms were used to compare autistic symptomatology, according to parent report. According to the CCC, the RAD group demonstrated significant problems in their use of context, rapport and social relationships with a degree of severity equivalent to children in the ASD comparison group. More than 60% of the group with RAD met ADI-R clinical criteria on the Use of Language and Other Social Communication Skills subscale, 46% on the Reciprocal Social Interaction subscale, and 20% had significant repetitive and stereotyped behaviours. Children with RAD appear to be at least as impaired as children with ASD in certain domains of social relatedness, particularly in their pragmatic language skills.     

Cognitive, behavior and intervention outcome in young children with autism

The relations between cognition and autism severity, head size and intervention outcome, were examined. Change in cognitive level with intervention was measured in children with autism and compared to children with developmental disabilities (DD). Eighty-one children (mean age 25.9 months) with autism (n = 44) and DD (n = 37) were assessed at pre- and post 1 year of intervention. Cognitive abilities and autism severity were measured by standardized tests. Three pre-intervention cognitive level groups: normal (IQ > 90), borderline (70 < IQ < 89) and impaired (50 < IQ < 69) were examined. The impaired group had more severe autism symptoms than the borderline and the normal cognitive groups. However, following intervention the groups did not differ in the change in core autism symptoms. IQ scores increased significantly more in the autism group than in the DD group. IQ improvements correlated significantly with reduction in autism symptoms and mostly in stereotyped behaviors.Conclusions: Cognitive ability in autism is associated with autism severity. Two distinct subtypes based on cognitive level are identified. However, baseline cognitive level cannot predict the progress rate in autism symptoms with intervention. Improvement of social–communicative behaviors and the intensive intervention are related to significant cognitive increments in autism.     

A comparison of intensive behavior analytic and eclectic treatments for young children with autism

We compared the effects of three treatment approaches on preschool-age children with autism spectrum disorders. Twenty-nine children received intensive behavior analytic intervention (IBT; 1:1 adult:child ratio, 25-40 h per week). A comparison group (n=16) received intensive "eclectic" intervention (a combination of methods, 1:1 or 1:2 ratio, 30 h per week) in public special education classrooms (designated the AP group). A second comparison group (GP) comprised 16 children in non-intensive public early intervention programs (a combination of methods, small groups, 15 h per week). Independent examiners administered standardized tests of cognitive, language, and adaptive skills to children in all three groups at intake and about 14 months after treatment began. The groups were similar on key variables at intake. At follow-up, the IBT group had higher mean standard scores in all skill domains than the AP and GP groups. The differences were statistically significant for all domains except motor skills. There were no statistically significant differences between the mean scores of the AP and GP groups. Learning rates at follow-up were also substantially higher for children in the IBT group than for either of the other two groups. These findings are consistent with other research showing that IBT is considerably more efficacious than "eclectic" intervention.     

Development of a continuum of services for children and adults with autism and other severe behavior disorders.

The development of a 12-step continuum of services for individuals with autism is described. The operation and funding of outreach parent training; homebased early intervention; preschool, vocational, and adult intermediate care; and school consultation programs are outlined. The use and importance of evaluative data on both treatment outcome and staff skills are emphasized.     

Diagnosing young children with autism

The starting point for any research on Autism Spectrum Disorder (ASD) involves the identification of people who evince the condition. From this point follows research on symptom presentation, genetics, epidemiology, animal models, treatment efficacy, and many other important topics. Major advances have been made in differential diagnosis, particularly with young children. This fact is particularly important since ASD is a life long condition. This review documents recent advances and the current state of research on this topic.     

Re-examining the cognitive phenotype in autism: A study with young Chinese children

Deficits consistently found in autism include an impaired “theory of mind”, weak central coherence, and deficits in executive function. The current study examined whether this traditional cluster of symptoms existed in a group of Chinese-speaking children with autism. Sixteen high-functioning, non-retarded children with autism were matched to 16 typically developing (TD) children on gender, non-verbal IQ and age. Non-verbal IQ's of all participants were measured using the Raven Progressive Matrices. Each participant was tested individually on measures of “theory of mind”, central coherence and executive function. Results indicated that most, but not all, participants with autism performed significantly poorer on two standard measures of first-order “theory of mind,” although there was no significant difference on two other measures of that domain. As expected, they performed significantly worse on executive function tasks. However, the hypothesis of weak central coherence in autism was not substantiated. There was no evidence that these three cognitive impairments co-existed in individuals with autism. More likely, each of these deficits appears singly or in pair instead of forming a cluster.     

Examination of correlates of different imitative functions in young children with autism spectrum disorders

Children with autism spectrum disorders (ASD) have difficulties with social-communication skills, including imitation, language, joint attention, and play. This study investigated whether imitation performance in two different contexts (structured-elicited vs. social-interactive) was differentially related to attention-following, social reciprocity, language, and play in children with ASD. This study used a concurrent, correlational design to investigate the relationships between these skills in 23, 2–4-year-old children with autism. Participants imitated more actions on the structured-elicited than social-interactive task. After controlling for developmental level, imitation in the structured-elicited condition was correlated with vocabulary size and imitation in the social-interactive condition was correlated with vocabulary size, social reciprocity, and symbolic play. These findings suggest different skills may underlie imitation in different contexts. In addition, while imitation in both contexts appears to be important for vocabulary development at this age, imitation in a social context may be more important in the development of symbolic play skills.     

Intramodal and cross-modal matching of emotional expression in young children with autism spectrum disorders

Children with autism spectrum disorders (ASDs) exhibit difficulties in their comprehension of others’ emotions. According to a variety of experimental procedures, many of them can be classified into two types according to the modality of their stimuli and responses. These are intramodal (visual stimulus–visual stimulus) and cross-modal (auditory stimulus–visual stimulus) matching. Previous studies tested both intramodal and cross-modal matching only in adolescents with ASD, although young children with ASD have also been found to have difficulties with cross-modal matching but not intramodal matching. The purpose of this study was to compare the intramodal and cross-modal matching of emotional expression in young children with ASD and typically developing (TD) children. Ten children with ASD aged 4–8 and 22 developmental age (DA)-matched TD children aged 3–6 participated in this study. Pictures of facial expressions were used as visual stimuli, and affective prosodies were used as auditory stimuli. The results showed that the children with ASD were less accurate than the TD children in cross-modal matching but equally accurate on intramodal matching. These findings are discussed along with the modality of stimuli and responses, and the ages of the participants.