The differential diagnosis of impaired reciprocal social interaction in children: a review of disorders

Impairment in reciprocal social interaction in children that is less severe than autism can be difficult to diagnose due to the variety of developmental pathways that may lead to this problem. Seven childhood disorders are reviewed that include impaired reciprocal interaction: multisystem developmental disorder, nonverbal learning disability syndrome, semantic-pragmatic disorder, attachment disorders (including a developmental theory of limbic system damage), multiplex developmental disorder, schizoid personality disorder, and pervasive developmental disorder not otherwise specified. Clarification is needed for most of the disorders in the areas of operationalized criteria, assessment tools, and documenting causal relationships.     

Community Introduction of Practice Parameters for Autistic Spectrum Disorders: Advancing Early Recognition

Objectives Within a strong interdisciplinary framework, improvement in the quality of care for children with autistic spectrum disorders through a 2 year implementation program of Practice Parameters, aimed principally at improving early detection and intervention.Method We developed Practice Parameters (PPs) for Pervasive Developmental Disorders and circulated the PPs to all child and adolescent psychiatrists practicing in the region.Results PP development and parallel information strategies resulted in a significant decrease of 1.5 years in the mean-age-at-diagnosis. However, further analysis indicated that improvement was only transient.Conclusion Despite the encouraging improvement in mean-age-at-diagnosis 2 years after PP implementation, other indicators showed a failure to maintain the improvements. A systematic screening program would be the most reliable method to reinforce the PPs.     

Effectiveness of modified parent training for mothers of children with Pervasive Developmental Disorder on parental confidence and children’s behavior

Aim: This study used parent training (PT), with modifications to smaller groups and shorter schedules (PTSS), for mothers of children with Pervasive Developmental Disorder (PDD). The usefulness of PTSS was evaluated according to the parent’s confidence and child’s behavior by questionnaire. Method: PTSS was used on 14 mothers of 14 children with PDD of preschool to elementary school age, and performed in small groups of 3-4 mothers each. One PTSS course comprised six consecutive sessions and was completed within three months. The sessions consisted mainly of training for parenting skills, understanding the children’s inappropriate behaviors, and helping the children adapt to school. The effectiveness of PTSS was assessed by changes in the scores for confidence degree questionnaire for families (CDQ) and the child behavior checklist (CBCL), determined before and after each course. Results: The average CDQ scores increased for 17 of 18 items after completion of the PTSS course in all 14 mothers. The change was statistically significant in five items. Increases in average CDQ scores were also seen in 10 of 18 items assessed in fathers, although none were significant. The CBCL total T-score decreased in 10 of 14 children (71.4%). The remaining four children showed an increased CBCL total T-score. Conclusion: These results indicated that PTSS is useful based on changes in the parents’ CDQ scores and children’s CBCL scores.     

Social Skills Development in Children with Autism Spectrum Disorders: A Review of the Intervention Research

Social reciprocity deficits are a core feature of the autism spectrum disorders (ASD). This review summarizes the state of research in group-based social skills training programs for school-age children and adolescents with ASD. All published studies of group social skills interventions between 1985 and 2006 were reviewed, as well as dissertations examining group-based social skills intervention programs. To assess the state of the science, a template developed by an NIMH work group was applied to 14 identified studies. Based on this review, the empirical support for this approach is incomplete, but promising intervention strategies were identified. Recommendations for the design of future treatment trials to guide clinical practice are offered.     

The factor structure of the Social Interaction Anxiety Scale and the Social Phobia Scale

The Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS) are two compendium measures that have become some of the most popular self-report scales of social anxiety. Despite their popularity, it remains unclear whether it is necessary to maintain two separate scales of social anxiety. The primary objective of the present study was to examine the factor analytic structure of both measures to determine the factorial validity of each scale. For this purpose, we administered both scales to 577 patients at the beginning of outpatient treatment. Analyzing both scales simultaneously, a CFA with two correlated factors showed a better fit to the data than a single factor model. An additional EFA with an oblique rotation on all 40 items using the WLSMV estimator further supported the two factor solution. These results suggest that the SIAS and SPS measure similar, but not identical facets of social anxiety. Thus, our findings provide support to retain the SIAS and SPS as two separate scales.     

An examination of the relationship between communication and socialization deficits in children with autism and PDD-NOS

Autism Spectrum Disorders (ASDs) are characterized by pervasive impairments in repetitive behaviors or interests, communication, and socialization. As the onset of these features occurs at a very young age, early detection is of the utmost importance. In an attempt to better clarify the behavioral presentation of communication and socialization deficits to aid in early assessment and intervention, impairments in these areas were examined among infants and toddlers (17-36 months) with Autistic Disorder (AD), Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), and non-ASD related developmental delay. The Baby and Infant Screen for Children with aUtIsm Traits-Part1 (BISCUIT-Part1) and the Battelle Developmental Inventory, 2nd Edition (BDI-2) were utilized to examine communication and socialization levels, respectively, among these groups. All groups significantly differed on level of socialization impairment with the Autism group displaying the greatest impairment and the non-ASD related developmental delay group evincing the least impairment. In regards to communication deficits, the non-ASD related developmentally delayed group differed significantly in comparison to the Autism and PDD-NOS groups; however, no significant differences were found between children with AD and PDD-NOS. While communication and socialization impairments were found to significantly correlate for all participants with the exception of those with PDD-NOS, these correlations were not found to significantly differ from one another across groups. The implications, limitations, and future directions of these results are discussed.     

Psychometric properties of the French Version of the Social Responsiveness Scale in autism spectrum disorder with or without attention deficit hyperactivity disorder

ObjectivesThe Social Responsiveness Scale (SRS) is an instrument that is commonly used to screen for Autism Spectrum Disorder (ASD). Attention Deficit Hyperactive Disorder (ADHD) frequently occurs with ASD and both disorders share some phenotypic similarities. In the present study, we aimed to determine the psychometric properties of the French version of the Social Responsiveness Scale (SRS) and its 5 subscales (social awareness, social cognition, social communication, social motivation, and autistic mannerisms) to discriminate between children with ADHD and those with ASD (differential diagnosis) and children with ADHD from those with a dual diagnosis of ADHD and ASD (comorbid diagnosis).MethodSRS total scores and the 5 subscores of the SRS were compared between 4 groups of children: ADHD (n = 32), ASD + ADHD (n = 30), ASD (n = 31) and typical neurodevelopment (TD; n = 30) children. The discriminant validity was estimated using the Area Under the ROC Curves (AUC).ResultsSRS Social cognition (AUC = 0.73) and Autistic mannerisms (AUC = 0.70) subscores were the most discriminating for differential diagnosis of ASD and ADHD. SRS total scores (AUC = 0.70), and Social communication (AUC = 0.66) and Autistic mannerisms (AUC = 0.75) subscores were the most discriminating for comorbid diagnosis of ASD among ADHD children.ConclusionThe SRS autistic mannerisms subscore was found to be clinically relevant for both differential diagnosis of ASD and ADHD and comorbid diagnoses of ASD among ADHD children but with a modest discriminant power.     

Cross cultural differences of parent reported social skills in children with autistic disorder: An examination between South Korea and the United States of America

Symptoms of Autism Spectrum Disorders are universally accepted; however, the reported severity of symptoms may be sensitive to cultural differences. Therefore, the aim of the current study was to examine the differences in reported symptoms of appropriate and inappropriate social skills between children and adolescents from South Korea (SK) and the United States (US). Scores on the three subscales of the Matson Evaluation of Social Skills with Youngsters, Second Edition (MESSY-II) were compared between 147 participants from either SK (n = 49) or the US (n = 98). Children and adolescents from the two countries scored statistically different from each other on the Hostile, Adaptive/Appropriate, and Inappropriately Assertive subscales. However, the mean scores for participants from the two countries fell into the same impairment level on the MESSY-II, indicating no clinically significant differences. The implications of these results are discussed.     

Adaptive Behavior in Autism and Pervasive Developmental Disorder-Not Otherwise Specified: Microanalysis of Scores on the Vineland Adaptive Behavior Scales

The purpose of this study is to provide a microanalysis of differences in adaptive functioning seen between well-matched groups of school-aged children with autism and those diagnosed as having Pervasive Developmental Disorder-Not Otherwise Specified, all of whom functioned in the mild to moderate range of intellectual impairment. Findings indicate that the major area of difference between children with autism and those with Pervasive Developmental Disorder-Not Otherwise Specified, was expressive communication; specifically, the use of elaborations in syntax and morphology and in pragmatic use of language to convey and to seek information in discourse. Linear discriminant function analysis revealed that scores on just three of these expressive communication item sets correctly identified subjects in the two diagnostic categories with 80% overall accuracy. Implications of these findings for both diagnosis and intervention with children with Autism Spectrum Disorders will be discussed.     

Psychometric evaluation of a Swedish version of the Reiss Screen for Maladaptive Behavior

Background People with intellectual disability (ID) are afflicted by mental health problems to a greater extent than other individuals, and the coexistence of ID and mental health problems involves diagnostic as well as treatment difficulties. Methods A Swedish version of the Reiss Screen for Maladaptive Behavior (RSMB), an instrument used for identification of mental health problems in people with intellectual disability (ID) was evaluated in terms of inter‐rater agreement, internal consistency, item grouping and criterion validity based on a random sample and a clinical group of adults with ID. Results The Swedish version of the RSMB had moderate‐to‐low inter‐rater agreement on specific items and good internal consistency. The total score was considered to be a fairly reliable measure of a positive or negative result on the RSMB. A principal component analysis yielded seven interpretable components. A close resemblance in sets of items between the Swedish version and the original version of RSMB was found for three subscales: Aggressive Behaviour, Avoidance Disorder and Depression (Behavioural Signs). The outcome of the criterion validity analysis indicated a higher rate of false negatives than false positives. Conclusions The potential influence of concurrent psychopharmacological treatment is discussed. It is concluded that the Swedish version of the RSMB can be used as intended by staff as a primary screening device for the identification of mental health problems among people with ID in a Swedish setting.     

社会技能训练对32例住院慢性精神分裂症患者的疗效观察

本文对３２例住院慢性精神分裂症病人进行了旨在教授有效的社会技能的治疗，总结一套系统的社会技能训练（ＳＳＴ）方法，经过多维临床检验，ＳＳＴ对病员减轻阴性症状，改善社会交往技能，提高适应性的自信水平等方面有一定效果。文中分析了产生疗效的原因以及进一步提高疗效的办法。     

Abnormal Activation of the Social Brain Network in Children with Autism Spectrum Disorder: An fMRI Study

Objective

The aim of this study is to investigate abnormal findings of social brain network in Korean children with autism spectrum disorder (ASD) compared with typically developing children (TDC).

Methods

Functional magnetic resonance imaging (fMRI) was performed to examine brain activations during the processing of emotional faces (happy, fearful, and neutral) in 17 children with ASD, 24 TDC.

Results

When emotional face stimuli were given to children with ASD, various areas of the social brain relevant to social cognition showed reduced activation. Specifically, ASD children exhibited less activation in the right amygdala (AMY), right superior temporal sulcus (STS) and right inferior frontal gyrus (IFG) than TDC group when fearful faces were shown. Activation of left insular cortex and right IFG in response to happy faces was less in the ASD group. Similar findings were also found in left superior insular gyrus and right insula in case of neutral stimulation.

Conclusion

These findings suggest that children with ASD have different processing of social and emotional experience at the neural level. In other words, the deficit of social cognition in ASD could be explained by the deterioration of the capacity for visual analysis of emotional faces, the subsequent inner imitation through mirror neuron system (MNS), and the ability to transmit it to the limbic system and to process the transmitted emotion.     

An examination of the MASC social anxiety scalein a non-referred sample of adolescents

Social phobia is prevalent during adolescence and is associated with negative outcomes. Two self-report instruments are empirically validated to specifically assess social phobia symptomatology in youth: the Social Phobia and Anxiety Inventory for Children and the Social Anxiety Scale for Adolescents. The Multidimensional Anxiety Scale for Children is a broad-band measure of anxiety containing a scale assessing the social phobia construct. The present study investigated the MASC Social Anxiety Scale in relation to other well-established measures of social phobia and depression in a non-referred sample of adolescents. Results support the convergent validity of the MASC Social Anxiety Scale and provide some support for its discriminant validity, suggesting its utility in the initial assessment of social phobia. Receiver Operating Characteristics (ROCs) calculated the sensitivity and specificity of the MASC Social Anxiety Scale. Binary logistic regression analyses determined the predictive utility of the MASC Social Anxiety Scale. Implications for assessment are discussed.     

An examination of writing pauses in the handwriting of children with Developmental Coordination Disorder

Difficulties with handwriting are reported as one of the main reasons for the referral of children with Developmental Coordination Disorder (DCD) to healthcare professionals. In a recent study we found that children with DCD produced less text than their typically developing (TD) peers and paused for 60% of a free-writing task. However, little is known about the nature of the pausing; whether they are long pauses possibly due to higher level processes of text generation or fatigue, or shorter pauses related to the movements between letters. This gap in the knowledge-base creates barriers to understanding the handwriting difficulties in children with DCD. The aim of this study was to characterise the pauses observed in the handwriting of English children with and without DCD. Twenty-eight 8–14 year-old children with a diagnosis of DCD participated in the study, with 28 TD age and gender matched controls. Participants completed the 10 min free-writing task from the Detailed Assessment of Speed of Handwriting (DASH) on a digitising writing tablet. The total overall percentage of pausing during the task was categorised into four pause time-frames, each derived from the literature on writing (250 ms to 2 s; 2–4 s; 4–10 s and >10 s). In addition, the location of the pauses was coded (within word/between word) to examine where the breakdown in the writing process occurred. The results indicated that the main group difference was driven by more pauses above 10 s in the DCD group. In addition, the DCD group paused more within words compared to TD peers, indicating a lack of automaticity in their handwriting. These findings may support the provision of additional time for children with DCD in written examinations. More importantly, they emphasise the need for intervention in children with DCD to promote the acquisition of efficient handwriting skill.     

Effects of Circumscribed Interests on the Social Behaviors of Children with Autism Spectrum Disorders

This study compared the effects of circumscribed interests (CI) to less preferred (LP) tangible stimuli on the social behaviors of three children with autism spectrum disorders (ASD). Based on single subject design methodology, the CI experimental sessions resulted in longer durations of target-child initiated social interactions in comparison to LP sessions. In addition, latency of participant’s initial social bids to peers was decreased when CI were present. The results suggest that embedding CI into dyadic play situations with typical peers can be used to increase the social behavior children with ASD direct toward typical peers. Future research should examine the specific environmental conditions that must be present in naturalistic settings to facilitate generalization of social behavior.     

Characteristics of the social environment of small group homes for individuals with severe mental illness

As part of research into small group homes run by local authorities for those with severe mental illness the characteristics of the social environment was investigated. The ideal and real versions of the Community Oriented Program Environmental Scale (COPES) were administered to residents and staff of small group homes in a county in southern Sweden. Both these groups were also interviewed on their opinions as to the main characteristics that should exist in the social environment in small group homes. High levels of support, order and organization, and program clarity and a low level of anger and aggression distinguished the real social environment according to the residents. Differences between residents' and staff's perceptions were less pronounced than in most other studies, probably owing to a greater level of resident-staff interaction in the home-like milieu. In the interviews both the residents and staff emphasized the importance of social interaction as a major constituent in the social environment of small group homes. The COPES instrument appears to be valid for use in small group homes, although some concern can be raised about two of the subscales, Involvement and Practical Orientation. The social environment, as rated by the residents and staff, was similar to that recommended for psychotic patients and to that proposed as a suitable supportive profile together with low levels of staff control and anger and aggression.     

A pilot randomised controlled trial of a group based social skills intervention for adults with autism spectrum disorder

BackgroundSocial skills training is commonly used for children and adolescents with ASD. There are few studies considering its efficacy in adults and those that exist usually compare it to standard treatment, as opposed to controlling for non-specific improvements that may result from receiving an intervention. We conducted a pilot study to investigate whether social skills training is more effective than non-specific support for adults with ASD.Methods19 adults with ASD were randomised to either social skills training or non-specific social interaction groups for 16 weeks. The Reading the Mind in the Eyes and Reading the Mind in the Voice Tasks were used to assess social cognition while the Social Responsiveness Scale (SRS-2) and the Weiss Functional Impairment Rating Scale (WFIRS-S) were used to measure real-life change pre- and post-treatment.ResultsTaken together, both groups improved across the course of the study on the ‘Eyes’ task (p = 0.049), SRS-2 (p = 0.03) and WFIRS-S (p = 0.053). However, there were no significant differences between the groups. There was some trend-level evidence that the social skills group improved more on the tests of social cognition (p ≤ 0.1 for group x time interaction). This was not the case for the SRS-2 (p = 0.25) and for the WFIRS-S there was a trend for the social interaction group to show greater improvements (p = 0.07).ConclusionsThis study did not show clear evidence of benefit from social skills training compared to facilitated social interaction, although larger studies are required to draw firm conclusions about efficacy.     

Modulation effects of the intact motor skills on the relationship between social skills and motion perceptions in children with autism spectrum disorder: A pilot study

BackgroundAn individual with autism spectrum disorder (ASD) has social skill, motor skill, and motion perception deficits. However, the relationship among them was not clarified. Therefore, this study aimed to evaluate the effects of motor skills on social skills and motion perception.MethodsFive typically developed children and fourteen children with ASD participated in our study. The N200 component, a brain activity indicating motion perception, was induced in mid-temporal (MT/V5) brain area by watching a random dot kinematograph, and was recorded using a scalp electroencephalogram. Furthermore, the social responsiveness scale (SRS) indicating the social skill deficit, the developmental coordination disorder questionnaire (DCDQ) estimating the developmental coordination disorder (DCD), and the movement assessment battery for children second edition (MABC-2) indicating motor skills were recorded in the children with ASD. A hierarchical multiple regression analysis was conducted to examine the modulation effects of motor skills on the relationship between social skills and motion perception. The dependent variable was the N200 latency, and the independent variables were SRS, MABC-2, and combined MABC-2 and SRS.ResultsThe N200 latency was more delayed in children with ASD relative that in typically developed children. Intact balance ability modulated the relationship between social skills and N200 latency in children with ASD. Within the high balance ability, when the social skills worsened, the N200 latency was shortened.ConclusionsThis is the first report that intact motor skills could modulate the relationship between social skills and motion perception.     

Social Competence Intervention Program (SCIP): A pilot study of a creative drama program for youth with social difficulties

This study explored the effects of participation in the Social Competence Intervention Program (SCIP), an innovative creative drama-based group intervention, of children diagnosed with autism spectrum disorder (ASD), nonverbal learning disability (NLD) and/or attention deficit hyperactivity disorder (ADHD). Eighteen participants in SCIP were compared to a clinical control group of 16 on changes in measures of social perception, social competence, and naturalistic observed social behavior. Hierarchical multiple regression model was used for all primary quantitative analyses. Interviews were conducted post-treatment to provide qualitative data. The treatment group showed significant improvement in key domains of observed social behavior in a natural setting compared to the clinical control group. Parents and children in the SCIP condition reported multiple positive changes in social functioning. These findings provide preliminary support for the use of a creative drama program for children with social competence deficits related to social perception problems.