Autistic and dysphasic children. II: Epilepsy

In a previously described population of 314 autistic and 237 dysphasic nonautistic children, after exclusion of 12 autistic girls with Rett syndrome, 14% (42 of 302) of autistic children and 8% (19 of 237) of dysphasic children had epilepsy (P = .03). The major risk factors for epilepsy were severe mental deficiency and the combination of severe mental deficiency with a motor deficit. In autistic children without severe mental deficiency, motor deficit, associated perinatal or medical disorder, or a positive family history of epilepsy, epilepsy occurred in 6% (10 of 160) which was analogous to the 8% (14 of 168) found in similar dysphasic nonautistic children. The language subtype of verbal auditory agnosia is associated with the highest risk of epilepsy in autistic (41%, 7 of 17) and dysphasic (58%, 7 of 12) children. The higher percentage of epilepsy in autistic girls, 24% (18 of 74) compared with boys 11% (25 of 228) (P = .003), is attributed to the increased prevalence of cognitive and motor deficit in girls. Once the risk attributable to associated cognitive and motor disabilities is taken into account, there is no difference in the risk of epilepsy between autistic and nonautistic dysphasic children.     

Atopic features in early childhood autism

BACKGROUND: Autism is a developmental disorder of unknown etiology. Sensitivity to dietary and environmental antigens has been considered in its pathogenesis. AIM: To examine immediate hypersensitivity in early childhood autism. METHODS: We investigated 30 autistic children (23 boys, seven girls 2-4 years old) for atopic history, serum IgG, IgA, IgM, IgE levels, and skin prick tests (SPT) with 12 common antigens. RESULTS: Nine/30 autistic children (30%) and 1/39 (2.5%) age-matched neurological controls from the same hospital had a family history suggestive of atopy (p<0.005). No patient in the autism and 28% in control group had symptoms of respiratory allergy (wheezing or asthma) (p<0.005), and 6/30 (20%) autistic vs. 7/39 (17%) control children had history suggesting other allergic disorders (p=ns). Eleven/23 (47.8%) autistic children had at least one positive skin test, similar to age-matched population controls. Serum IgG, IgA, and IgM levels were within age-appropriate limits. Serum IgE was elevated in four patients (13.3%). Specific IgE levels were negative in four cases with multiple SPT positivity. CONCLUSIONS: This study suggests allergic features based on history, skin tests, and serum IgE levels are not frequent in young autistic children despite family history. This discrepancy between predisposition and manifestation might imply immunological factors or environmental conditions.     

Regression in pervasive developmental disorders: seizures and epileptiform electroencephalogram correlates

BACKGROUND: Approximately one third of the parents of children with pervasive developmental disorders or autistic spectrum disorders reports an early regression of unknown cause in their children's language, sociability, and play. Seizures or an epileptiform electroencephalogram (EEG) are associated with language regression in acquired epileptic aphasia (Landau-Kleffner syndrome) and some other pediatric epileptic syndromes. The importance of epilepsy or epileptic EEGs as contributors to autistic regression is not known. METHOD: Subjects were 482 boys and 103 girls on the autistic spectrum seen consecutively in consultation by one child neurologist. Data on autistic regression, seizures, sleep EEGs, and cognitive function were entered prospectively into a data base. RESULTS: Of the 585 children, 176 (30%) had a history of regression, and 66 children (11%) had a history of epilepsy, defined as two or more unprovoked seizures. Among 392 children with available sleep EEGs, the EEG was epileptiform in 59% of the 66 epileptic children and 8% of the 335 nonepileptic children. Regression had occurred equally among children without seizures and in those with epilepsy. Regression was associated with an epileptiform EEG in 14% of 155 nonepileptic children who had undergone a regression, as opposed to 6% of 364 children with neither regression nor epilepsy. Mean age at regression was 21 months. There was no difference in the proportion of children with epilepsy or epileptiform EEGs who had regressed before or after 2 years of age. Approximately half of the epileptiform discharges were centrotemporal, whether or not the child was epileptic or had regressed. Children with lower cognitive function were more likely to have undergone regression than those with better cognitive skills (34% vs 20%). CONCLUSION: Epilepsy or epileptiform EEGs occur in a significant minority of autistic children with a history of regression and in a smaller minority without regression. Prompt recognition of regression and recording of prolonged sleep EEGs is recommended, even though information on the potential efficacy of antiepileptic treatment to improve language and behavior in autistic children with epilepsy or an epileptiform EEG is still lacking.     

Clinical profile of pediatric somatoform disorders

OBJECTIVES: To study the prevalence, pattern, clinical and socio-demographic characteristics of somatoform disorders in children. METHODS: From Aug 2004 to July 2005, children up to 18 years with unexplained physical symptoms were evaluated prospectively using DSM-IV criteria. Detailed evaluation followed for those meeting criteria. RESULTS: The prevalence of Somatoform disorders was 0.59% and 0.78% among out-door and in-door patients respectively. Among 124 children (40 boys and 84 girls) meeting criteria, conversion disorder was the commonest (57.3%), followed by undifferentiated somatoform disorder (25.2%). Girls were significantly more represented among conversion disorder patients compared to other groups of somatoform disorders (78.9 vs. 52.8 %, P=0.002). In conversion disorder, 2/3rd patients presented within 3 months, whereas in other somatoform disorders, 2/3rd patients presented within 3 months after symptoms. Fainting attacks (52.1%) and ataxia (43.7%) in conversion disorder and pain abdomen (52.8%) and headache (52.8%) in other somatoform disorders, were the commonest symptoms. Stressors were identified in 73.4% and acute precipitating stressors were present in 14.4% children. Boys had significantly higher rates of poor inter-personal relations and communication problems within the family (72.5% vs. 41.7%, P=0.001), while girls had significantly higher rates of conflicts with the parents and other family members (21.4% vs. 5%, P=0.02). CONCLUSION: Somatoform disorders, particularly conversion disorder is commoner in girls. Important stressors are poor inter-personal relations and communication problems within the family in boys, and conflicts with family members among girls.     

Social communication deficits in conduct disorder: a clinical and community survey

BACKGROUND: Increasing numbers of children are referred to Child and Adolescent Mental Health Services because of disruptive behaviour. Recent reviews on the origins of conduct problems indicate that the most severe and persistent forms are found predominantly among males with a range of neurodevelopmental vulnerabilities, which are likely to have biological substrates. In this study, we tested the hypothesis that many children who are identified with conduct disorder actually have a primary deficit in pragmatic language skills, of a quality and degree that is similar to children on the autistic spectrum. We hypothesised that pragmatic difficulties may underlie the antisocial behaviour in a proportion of children who are labelled as conduct disordered. METHODS: Using the Children's Communication Checklist (Bishop, 1998), we surveyed 142 children who had been referred for clinical investigation, with a predominant diagnosis of either an autistic spectrum condition (n = 87) or conduct disorder (n = 55), and 60 typically developing comparison children. Among children with conduct disorders, males predominated 9:1. RESULTS: On the basis of parent and teacher ratings, two-thirds of those with conduct disorders had pragmatic language impairments and other behavioural features similar in nature and degree to those of children with autism, independent of IQ. In a further study, we surveyed 54 children who had been excluded from elementary schools in a socio-economically disadvantaged inner-London borough and found over two-thirds to have comparable deficits. CONCLUSIONS: These findings have both theoretical and practical implications. First, they indicate the presence of communicative problems in a sub-group of children in whom conduct rather than language had been the major concern. Second, they indicate that severe deficits in pragmatic abilities and autistic-like behaviours can coexist with psychiatric conditions other than autism, especially in boys. Third, they imply that the management of many disruptive children could profitably be addressed to ameliorating their social and communicative skill deficits.     

ADHD and gender: are risks and sequela of ADHD the same for boys and girls?

BACKGROUND: Research comparing treatment-referred boys and girls with attention-deficit/hyperactivity disorder (ADHD) has yielded equivocal results. Contradictory findings may be associated with differential referral practices or unexplored interactions of gender with ADHD subtypes. METHOD: We examined possible gender differences in ADHD and its subtypes among children aged 4 to 17 in a representative community sample (N = 1896) in Puerto Rico. Caretakers provided information through the Diagnostic Interview Schedule for Children (version IV) and a battery of impairment, family relations, child problems, comorbidity and treatment measures. RESULTS: ADHD was 2.3 times more common in boys than girls, but with one exception there was little evidence that the patterns of associations of ADHD with correlates were different for boys and girls. The exception was school suspension, which was more common among ADHD boys than girls. Additional gender interactions were found when ADHD subtypes were considered. Among those with combined type (n = 50), boys were more likely to be comorbid with mood disorders than girls. For those with the inattentive type (n = 47), girls were more likely to be comorbid with anxiety disorders than boys. CONCLUSIONS: Our findings lend cross-cultural generalizability to recent reports that gender does not interact with correlates for ADHD overall, but that it may play a role in subtypes.     

��ͯ��ﹲ���¶�֢

??The comorbidity of epilepsy and autism is a common clinical phenomenon. About 5%??37% of children with epilepsy have autism or have positive screening for autism. About 2%??46% of individuals with autism have epilepsy. The family history of mental disorders??adverse perinatal factors??female??autistic features??intelligence disability??genetic or neurological syndromes and genetic factors increase the risk of comorbidity of the two diseases. In children with the two diseases??epilepsy onsets earlier with two onset peaks before 5 years and during puberty??partial seizure and intractable epilepsy is more common??the symptom of autism is more severe??with more intelligence disability??more motor development and behavior problems and worse adaption behaviors. It is important to recognize?? diagnose and treat the two diseases.     

Hypothyroidism and Autism Spectrum Disorders

Five children (three boys and two girls) with autism or autistic-like conditions are described. Three of them had congenital hypothyroidism and two had mothers who had probably been hypothyroid in pregnancy. It is suggested that hypothyroid hormone deficiency in early development might cause central nervous system damage such that autistic symptoms are likely to ensue. An alternative explanation might be autoimmune factors linking hypothyroidism and autism.     

Executive functioning in high-functioning children with autism

Executive functioning was investigated in 34 children (24 boys and 10 girls) with developmental language disorder (DLD) and 21 children (18 boys and 3 girls) with high-functioning autistic disorder (HAD) matched on Full Scale IQ, Nonverbal IQ, age (mean age 9 year, 1 month), and SES. The DLD group had a Verbal IQ that was 10 points higher than the HAD group. These children were given the Wisconsin Card Sorting Test (WCST), the Mazes subtest from the WISC-R, the Underlining test, and the Rapid Automatized Naming test. In addition, these children were given the Vineland Scales of Adaptive Functioning and the Wing Diagnostic Symptom Checklist in order to assess severity of autistic symptomatology. Results indicated that the only significant difference between the two groups on the cognitive tasks was perseverative errors on the WCST; there was no significant difference on total number of categories achieved or total number of errors on the WCST or on the other executive function measures. There was also significant overlap in the scores between the two groups and the difference in perseverative errors was no longer significant when Verbal IQ was partialled out. Executive functioning was strongly related to all IQ variables in the DLD group and particularly related to Verbal IQ in the HAD group. Although there was a relationship in the HAD group between executive functioning and adaptive functioning, as well as between executive functioning and autistic symptomatology, these relationships were generally no longer significant in the HAD group after the variance due to Verbal IQ was accounted for. The results are interpreted to indicate that although impaired executive functioning is a commonly associated feature of autism, it is not universal in autism and is unlikely to cause autistic behaviors or deficits in adaptive function.     

Tuberous Sclerosis Complex in Autism

Objective

To study the prevalence rate of tuberous sclerosis complex in autistic disorder.

Methods

We studied one cohort of children followed up since 2005 until 2009, with autistic disorder, to determine the incidence of tuberous sclerosis complex. We established an autistic disorder registry in 2005 at China Rehabilitation Research Center. During the 4-year period (2005–2009), we collected a database of 429 children (390 boys and 39 girls; male to female ratio 10:1) with autistic disorder and pervasive developmental disorders. We routinely examined all children with autistic disorder for any features of tuberous sclerosis complex by looking for neurocutaneous markers such as depigmented spots. In those with infantile spasm or epilepsy, the clinical features of tuberous sclerosis complex were monitored regularly during follow-up.

Findings

Of these, five had tuberous sclerosis complex. Thus, the prevalence rate of tuberous sclerosis complex in autistic disorder is 1.17%. All of these children were mentally retarded with moderate to severe grades. Their IQ or developmental quotient was less than 70.

Conclusion

The prevalence rate of tuberous sclerosis complex in autistic disorder was 1.17% in our region; autism spectrum disorder is a condition that might be associated with development of tuberous sclerosis complex.     

Characteristics of primary vesico-ureteral reflux in Thai children

Background: The purpose of the present paper was to evaluate the clinical features of primary vesico-ureteral reflux (VUR) in Thai children.
Methods: Children with primary VUR attending in the Nephrology Division, Department of Pediatrics, Prince of Songkla University between 1987–2002 were studied.
Results: Sixty-five girls and 60 boys with primary VUR were evaluated. Age of diagnosis was significantly younger in boys than girls (median 0.6 and 2.2 years respectively, P  < 0.001). In 73% of boys and 34% of girls VUR diagnosis was made in the first year of life. Hydronephrosis was found in 22% of boys and 8% of girls ( P  = 0.004). Five per cent of children who had VUR grades I–III had hydronephrosis (6/121). Only children who had VUR grades IV and V had significant hydronephrosis: 33% (14/42) and 53% (10/19), respectively. Bilateral VUR was 60% overall and was significantly more common in boys (70% vs 40% P  < 0.028), found in grades I–V at 33%, 61%, 60%, 65%, and 77%, respectively. Of 200 refluxing ureters, the total numbers of VUR grades I–V were 32, 37, 67, 45 and 19 respectively. VUR grade was significantly different by age ( P  = 0.014) but not by left–right side or sex.
Conclusion: Primary VUR occurs equally in boys and girls, but in boys at a younger age. Bilateral VUR and hydronephrosis were significantly more common in boys, and VUR in boys was more severe. But hydronephrosis is a poor indicator for VUR screening even in high-grade VUR.     

Five- to 7-year-old children with Helicobacter pylori infection are smaller than Helicobacter-negative children: a cross-sectional population-based study of 3,315 children.

OBJECTIVE: To test whether Helicobacter pylori-positive children are smaller and weigh less than H pylori-negative children. DESIGN: Cross-sectional population-based study. PARTICIPANTS: In 3,315 5-to 7-year-old preschool and school children, the putative influence of H pylori infection on growth was investigated. Standing height and weight were analyzed in relation to H pylori infection. The diagnosis of H pylori infection was established by 13C-urea-breath test. RESULTS: The prevalence of H pylori infection in boys was 7.2% (95% confidence interval, 5.9-8.9; n = 1,550) and in girls was 6.1% (95% confidence interval, 4.9-7.3; n = 1,552) H pylori-positive children were smaller than noninfected children (117.6 +/- 5.5 cm vs. 118.9 +/- 5.7 cm; P < 0.01). Although H pylori-positive boys were 2.06 cm smaller than H pylori-negative boys (117.4 +/- 5.6 cm vs. 119.5 +/- 5.7 cm; P < 0.001), the difference in girls was not significant (117.9 +/- 5.3 cm vs. 118.4 +/- 5.7 cm). When standing height was adjusted for age, the found differences were more pronounced. Differences between the infected and noninfected children with regard to body weight were not significant (22.4 +/- 4.0 kg vs. 22.1 +/- 4.0 kg), nor was there a significant difference with regard to body-mass index. However, boys with H pylori infection had a lower weight than noninfected boys (21.6 +/- 3.3 kg vs. 22.6 +/- 4.0 kg; P < 0.01), but in girls, these differences were not observed (22.2 +/- 4.0 vs. 22.8 +/- 4.6 kg, respectively). When weight was adjusted for age, H pylori -positive children also had a lower weight than H pylori -negative children because of the lower weight of boys. CONCLUSIONS: H pylori infection is associated with growth delay, growth retardation, or both in affected children.     

How common are gastrointestinal disorders in children with autism?

We could identify no report that describes the prevalence of gastrointestinal disorders in a representative group of children with a diagnosis of autism compared with appropriate controls. Thus, we found no evidence upon which to base a confident conclusion as to whether gastrointestinal symptoms are more common in children with than without autism. However, the frequency of gastrointestinal symptoms observed in population-based samples of autistic children indicate that gastrointestinal problems are not nearly as common in children with autism as reports from pediatric gastroenterology clinics suggest.     

Health status of rural school children

The morbidity pattern and nutritional profile was evaluated of school children who resided around Mosaboni Copper Mines and in surrounding villages of Ghatsila subdivision in Singhbhum district of Bihar State, India. A total of 1424 school children (816 boys and 608 girls) between 5-17 years old were studied. Children were examined on school premises with the assistance of teachers and health visitors. Body weight and height, nutritional deficiency signs, common infective conditions, and cardiac murmurs were recorded. Evidence of morbidity was found in 52.8% boys and 67.4% girls. 11.9% boys and 12.2% girls had 2 or more conditions existing together. The average number of children per family was 5.13; it was 4.77 in families with no child illness; 5.03 with 1 illness and 6.94 if 2 or more morbid conditions were found in a child. Approximately 2% girls over 12 years old had dysmenorrhea and polymenorrhea. Only 15.4% of boys and 19% of girls weighed above 80% of the 50th percentile of the Harvard Standard. 76.4% of boys and 71.7% of girls weighed between 61% and 80%, while 8.1% of boys and 9.l% of girls weighed less than 60%. 20% of boys and girls showed features of stunting. Deficiencies of Vitamin B-complex and Vitamin A as well as clinical anemia were common while rickets and scurvy were rare. The prevalence of worm infestation, lymphadenopathy as well as skin and respiratory infections were lower than in some other studies. Dental caries was observed in 21% of cases, but the prevalence of periodontal disease and malocclusion was higher than reported by others. Convulsive disorders and myopia were less common than in urban school children. Prevalence of congenital cardiac lesions was higher than in urban studies probably due to heredity. Nutritional supplementation in schools, regular medical checkups of school children, and health education of the community with emphasis on small family norms could improve the overall health status of rural children.     

Temper tantrums. Prevalence and etiology in a non-referral outpatient setting

Of a total of 800 children (aged 3-12 years) attending a pediatric outpatient department, 182 (22.8%) were found to be having temper tantrums (mean age, 4.7 years). Temper tantrums were found to be most common at 3-5 years (75.3%), less common at 6-8 years (20.8%), and least common at 9-12 years (3.9%). Children aged 3-5 years were more likely to be of a lower social class (p less than 0.01), whereas in other age groups (6-8 years and 9-12 years) children were more likely to be of an upper social class. Boys dominated the study significantly: the ratio of boys to girls was 3.1:1. Boys having temper tantrums were more likely to be of an upper social class (p less than 0.001) compared with girls, who tended to be of a lower social class (p less than .01). Children showed a higher incidence of history of postnatal trauma and seizure disorder compared with the control group (p less than 0.05). Parental overprotection and marital discord were found to be stress factors in a significantly higher number of boys than girls (p less than 0.01); parental negligence was a significant stress factor for girls (p less than 0.01). Associated behavioral problems, such as thumb sucking, enuresis, tics, head banging, sleep disturbances, and hyperkinesis were found to be significantly higher among children with tantrums.     

Clinical considerations in the diagnosis of autism spectrum disorders

The diagnosis of autistic spectrum disorders (ASD) is being made more frequently in children and at younger ages. This paper discusses various factors to be considered in the screening of autism, early features of presentation, relevant to assessment and diagnosis, subtypes or different syndromes ithin the spectrum of autistic conditions including Asperger syndrome, the differential diagnosis from learning and language disorders and the medical and behavioural commonly associated disorders.     

Diagnosis of autistic spectrum disorders in Queensland: variations in practice

OBJECTIVE: For both paediatricians and child psychiatrists, referrals to assess possible autistic spectrum disorders (ASD) are increasing. This study examines current practices of medical specialists in the assessment of these disorders. METHODS: An anonymous, self-report questionnaire was sent to all Queensland paediatricians and child psychiatrists. The survey elicited frequencies of consultation for ASD, diagnostic method, advice provided and perceived adequacy of training for this work. RESULTS: Responses were received from 79 (85%) eligible paediatricians and 26 (58%) eligible child psychiatrists. For one-third of all clinicians, new consultations for possible ASD occurred as often as 2-3 times per week. Most specialists approached the clinical diagnosis of ASD by considering history from different sources and professional assessments. Paediatricians (86%) were more likely than child psychiatrists (62%) to request genetic studies for children with severe autism (P = 0.01). Both general paediatricians and developmental paediatricians perceived level of training for possible ASD consultations was significantly worse than child psychiatrists (P < 0.001 and P = 0.02, respectively), but no difference was found between paediatric groups (P = 0.27). Perceived adequacy of specialist training was not associated with length of experience in clinical practice. CONCLUSION: Medical practice in Queensland around diagnosis of ASD is characterized by considerable variability. There is still a long way to go if we are to achieve consistency around medical issues of organic diagnosis and practices impacting on health as well as consideration of differential developmental diagnoses. The finding that recently trained paediatricians felt just as unprepared for this work as their older colleagues suggests that the graduate training response to this 'new morbidity' has not been adequate.     

智商大于70的孤独症谱系障碍男女学龄前期儿童智力结构的病例对照研究

目的分析总智商(FSIQ)70的学龄前期孤独症谱系障碍(ASD)儿童的智力结构,为不同性别ASD儿童的早期干预以及融合教育技术改良提供参考依据。方法选取2018年8月至2019年12月复旦大学附属儿科医院(我院)ASD数据库中完成第4版中文版韦氏幼儿智力量表[WPPSI-Ⅳ(CN)]且FSIQ 70、4～6岁的全部ASD儿童,根据性别分为男女生两组。行智力水平和智力结构差异性分析。ASD诊断符合DSM-V的ASD诊断标准,ASD诊断观察量表(ADOS)评估分数符合ASD的诊断切点,由取得WPPSI-Ⅳ(CN)主试资格证书医生行智力评估。结果 24例ASD患儿进入本文分析,男生组20例,女生组4例,年龄49～78(63.9±9.4)月龄; 19例患儿在初诊时完成了ADOS评估(男16,女3),21例初诊时完成了父母文化水平的采集,ASD男女生组初诊年龄、智测年龄、ADOS评估、父母文化程度等差异均无统计学意义;FSIQ男生组(88.5±12.2)与女生组(107.5±12.5)差异有统计学意义(P=0.009); WPPSI-Ⅳ(CN)中男生组视觉空间显著高于工作记忆和加工速度(P均0.001);女生组不同功能区评估得分差异无统计学意义(P=0.403),不同功能区女生组均高于男生组,言语理解、工作记忆和加工速度差异有意义(P0.05)。结论 FSIQ70的ASD女童的智力水平高于男童,男童视觉空间指数显著高于工作记忆指数和加工速度指数,女童言语理解、工作记忆和加工速度较男童有优势。     

Patterns of Psychiatric Disorder in Adopted Girls: a Research Note

Over a 15-year period adopted children were overrepresented in a psychiatric clinic population. The excess was seen in all age groups and there was no rise of referrals of adoptees during adolescence. Adopted boys showed the same range of disorder as all referred boys. Adopted girls were more likely than other girls to have conduct disorders. Those with conduct disorders were more likely than non-adopted girls with the same disorder to be taken into care and to be given inpatient treatment. Differences in family structure and relationships were found both between conduct disordered girls of different adoptive status and between adopted girls with conduct and other disorders.