Clinical Characteristics Associated with Language Regression for Children with Autism Spectrum Disorders

We investigated correlates of language regression for children diagnosed with autism spectrum disorders (ASD). Using archival data, children diagnosed with ASD (N = 114, M age = 41.4 months) were divided into four groups based on language development (i.e., regression, plateau, general delay, no delay) and compared on developmental, adaptive behavior, symptom severity, and behavioral adjustment variables. Few overall differences emerged between groups, including similar non-language developmental history, equal risk for seizure disorder, and comparable behavioral adjustment. Groups did not differ with respect to autism symptomatology as measured by the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised. Language plateau was associated with better adaptive social skills as measured by the Vineland Adaptive Behavior Scales. Implications and study limitations are discussed.     

Brief Report: Plasma Leptin Levels are Elevated in Autism: Association with Early Onset Phenotype?

There is evidence of both immune dysregulation and autoimmune phenomena in children with autism spectrum disorders (ASD). We examined the hormone/cytokine leptin in 70 children diagnosed with autism (including 37 with regression) compared with 99 age-matched controls including 50 typically developing (TD) controls, 26 siblings without autism, and 23 children with developmental disabilities (DD). Children with autism had significantly higher plasma leptin levels compared with TD controls (p < .006). When further sub-classified into regression or early onset autism, children with early onset autism had significantly higher plasma leptin levels compared with children with regressive autism (p < .042), TD controls (p < .0015), and DD controls (p < .004). We demonstrated an increase in leptin levels in autism, a finding driven by the early onset group.     

Variation in Early Developmental Course in Autism and its Relation with Behavioral Outcome at 3–4 Years of Age

The aims of the present study were to describe variations in the early course of development in autism by utilizing an in-depth parent interview that incorporated techniques to improve accuracy of parent recall, and to examine the relation between variations in early developmental course in autism and behavioral outcome at 3–4 years of age. The Early Development Interview, which consisted of questions about child’s behavior in several domains from birth through 2 years of age, was created and administered to parents of 72 3–4-year-old children with autism spectrum disorder and 34 3–4-year-old children with developmental delay, who were matched on mental and chronological age, and 39 1–4-year-old typically developing children, who were matched to the clinical groups on mental age. At 3–4 years of age, children were administered standardized measures (some clinician administered and some parent report); these included verbal and nonverbal IQ, autism symptom severity, and adaptive and aberrant behavior. Based on the Early Development Interview, children with autism spectrum disorder (ASD) were reported to have elevated symptoms in the social and regulatory domains by 3–6 months. By 12–15 months, parents of children with ASD reported significantly higher levels of social symptoms than parents of children with developmental delay. At 3–4 years of age, children with autism with early vs. late onset of symptoms, and with vs. without a history of loss of skills (regression) were not found to differ on standardized tests of verbal and nonverbal IQ and observational measures of autism symptom severity.     

Nonverbal Communication Skills in Young Children with Autism

Objective The study was to examine nonverbal communication in young children with autism. Methods The participants were 23 young children with autism (mean CA = 32.79 months), 23 CA and MA-matched children with developmental delay and 22 18–20-month-old, and 22 13–15-month-old typically developing toddlers and infants. The abbreviated Early Social Communication Scales [Mundy et al. 1996, Early social communication scales (ESCS)] were used to test three types of nonverbal communicative skills, i.e., joint attention, requesting, and social interaction. Both frequency and proportion analyses were done in group comparisons. Results (1) Two- to three-year-old children with autism displayed deficits in joint attention ability, especially high-level skills. (2) The deficit in terms of frequency of communication was marked even compared with typically developing infants with younger mental age. (3) Young children with autism had different nonverbal communication profile compared with all three comparison groups. Conclusion Early social-communicative difficulties in autism involve early triadic communications involving joint attention and possibly dyadic turn-taking skills, which has implications for both early screening and early intervention.     

Anxiety Disorders in Typically Developing Youth: Autism Spectrum Symptoms as a Predictor of Cognitive-Behavioral Treatment

Symptoms of autism spectrum disorder (ASD) were assessed (Social Responsiveness Scale-Parent (SRS-P); coded in-session behavior) in typically-developing, anxiety-disordered children (N = 50) treated with cognitive-behavioral therapy (CBT). Study 1: children with moderate autistic symptomology (per SRS-P) were significantly more likely to improve from family CBT (FCBT) than individual CBT (ICBT; OR = 8.67). Coded behavior did not predict outcome. Study 2: CBT components were compared by treatment and ASD symptom status. At-home exposure completion was greater in FCBT and there was an interaction in child involvement for treatment and ASD status. Though both treatments reduced anxiety, FCBT outperformed ICBT for children with moderate ASD symptoms, a benefit potentially linked to more at-home exposures and greater child involvement in FCBT.     

Brief Report: The Vineland Adaptive Behavior Scales in Young Children with Autism Spectrum Disorders at Different Cognitive Levels

Vineland Adaptive Behavior Scales (VABS) data were examined in a large sample of young children with ASD (n = 290) of varying cognitive levels. IQ was higher than VABS composite score among high functioning children only; the opposite pattern was found in lower IQ subgroups. Profile analysis of VABS domains across cognitive levels demonstrated different profiles in different subgroups. A characteristic “autism profile” was found for most subgroups for Age Equivalents but not Standard Scores. In a small set of matched pairs (n = 28) of children with autism versus MR, significantly different profiles were found, with Socialization and Communication lower in autism, but no differences were found between matched pairs of children with autism and PDD-NOS (n = 48). Correlations between age, cognitive level, and adaptive level were also reported, and regression analyses indicated that autism severity accounts for a modest amount of unique variance in Socialization and Daily Living Skills.     

How Young Children Treat Objects and People: An Empirical Study of the First Year of Life in Autism

Objective. To figure out features of autism before the age of one and to explore the pathways of early social and nonsocial attention in autism through home movies.Method. Home movies of 15 children later diagnosed with autism, are compared with home movies of 13 typical children. The films of the two groups have been mixed and rated by blind observers through a Grid composed of social and nonsocial item and applied to two age ranges: 0–6 months (T1) and 7–12 months (T2). Two MANOVAs, an ANOVA and discriminant analyses were applied.Results. Significant differences between the two groups were found only for the item in the Social area at T1 but not at T2, when groups did not differ in either social or nonsocial areas. At T2 children with autism had significantly higher scores in the nonsocial area while normal children did not show significant differences between areas. Discriminant analyses revealed that social attention can distinguish the two groups at T1 but not at T2.Conclusions. The fundamental impairment of joint attention in autism could be considered a consequence of the early atypical developmental gap and of a later disconnection between attention to people and objects. Abnormal developmental trajectories for social and nonsocial attention could help us in the future to understand relationships between adaptive capacities and symptoms, and set the stage for appropriate early screening instruments.This study was supported by grant RC 6/02 from National Institute of Health.     

Inter-rater reliability and stability of diagnoses of autism spectrum disorder in children identified through screening at a very young age

To examine the inter-rater reliability and stability of autism spectrum disorder (ASD) diagnoses made at a very early age in children identified through a screening procedure around 14 months of age. In a prospective design, preschoolers were recruited from a screening study for ASD. The inter-rater reliability of the diagnosis of ASD was measured through an independent assessment of a randomly selected subsample of 38 patients by two other psychiatrists. The diagnoses at 23 months and 42 months of 131 patients, based on the clinical assessment and the diagnostic classifications of standardised instruments, were compared to evaluate stability of the diagnosis of ASD. Inter-rater reliability on a diagnosis of ASD versus non-ASD at 23 months was 87% with a weighted κ of 0.74 (SE 0.11). The stability of the different diagnoses in the autism spectrum was 63% for autistic disorder, 54% for pervasive developmental disorder, not otherwise specified (PDD-NOS), and 91% for the whole category of ASD. Most diagnostic changes at 42 months were within the autism spectrum from autistic disorder to PDD-NOS and were mainly due to diminished symptom severity. Children who moved outside the ASD category at 42 months made significantly larger gains in cognitive and language skills than children with a stable ASD diagnosis. In conclusion, the inter-rater reliability and stability of the diagnoses of ASD established at 23 months in this population-based sample of very young children are good.     

Regression, Developmental Trajectory and Associated Problems in Disorders in the Autism Spectrum: The SNAP Study

We report rates of regression and associated findings in a population derived group of 255 children aged 9–14 years, participating in a prevalence study of autism spectrum disorders (ASD); 53 with narrowly defined autism, 105 with broader ASD and 97 with non-ASD neurodevelopmental problems, drawn from those with special educational needs within a population of 56,946 children. Language regression was reported in 30% with narrowly defined autism, 8% with broader ASD and less than 3% with developmental problems without ASD. A smaller group of children were identified who underwent a less clear setback. Regression was associated with higher rates of autistic symptoms and a deviation in developmental trajectory. Regression was not associated with epilepsy or gastrointestinal problems.     

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.     

Investigating the Clinical Usefulness of the Social Responsiveness Scale (SRS) in a Tertiary Level, Autism Spectrum Disorder Specific Assessment Clinic

The Social Responsiveness Scale (SRS; Constantino and Gruber in Social Responsiveness Scale (SRS). Western Psychological Services, Los Angeles, 2005) is a commonly used screening tool for identifying children with possible autism spectrum disorder (ASD). This study investigated the relationship between SRS scores and eventual diagnostic outcome for children referred to a tertiary level, autism specific assessment service. Forty eight children (mean age = 8.10; 92% male) underwent a comprehensive ASD assessment. Parent and teacher SRS scores were subsequently compared with diagnostic outcome. Sensitivity was high (91% for parent report; 84% for teacher report), however specificity was much lower (8% for parent report; 41% for teacher report). Results demonstrate a need for caution when interpreting SRS results based on current cut-off scores, particularly in children with previously identified social developmental problems.     

Regression of language and non-language skills in pervasive developmental disorders

Background As part of the pervasive developmental disorders (PDD), there is a subgroup of individuals reported to have a different onset of symptom appearance consisting of an apparently normal early development, followed by a loss of verbal and/or non‐verbal skills prior to 2 years of age. This study aims at comparing the symptomatology of children who displayed a regression and often an associated intellectual disability through investigation of two types of loss, namely language and other skill regression. Methods This study examined the occurrence of regression in 135 children with PDD, mean age 6.3 years. The sample was composed of 80 (59.4%) children diagnosed with autism, 44 (32.6%) with pervasive developmental disorder‐not otherwise specified (PDD‐NOS) and 11 (8%) with Asperger syndrome. The Autism Diagnostic Interview Revised (ADI‐R) was used to evaluate the type of loss and to characterise associated factors including birth rank, gender and thimerosal exposure through vaccination. Results A total of 30 (22%) subjects regressed: nine (30%) underwent language regression alone, 17 (57%) lost a skill other than language and four (13%) lost both language and another skill. Significantly higher levels of regression were found in autism (30%) compared with PDD‐NOS (14%) and Asperger syndrome (0%). Children who regressed in language skills spoke at a significantly earlier age ( = 12 months) than those who did not regress in this domain ( = 26 months). Parents and interviewers consistently reported developmental abnormalities prior to the loss. ADI‐R domain mean scores indicated a more severe autistic symptomatology profile in children who regressed compared with those who did not, especially in the repetitive behaviour domain. Regression was not associated to thimerosal exposure, indirectly estimated by year of birth. Conclusions A loss of skill, present in one out of five children with PDD, is associated with a slightly more severe symptomatology as measured by the ADI‐R, particularly in the repetitive behaviours domain. Furthermore, although abnormalities are often noticed by the caregivers at the time of regression, the ADI‐R reveals that other atypical behaviours were in fact present prior to the onset of regression in most cases. None of the secondary factors investigated were associated with regression. In children unexposed to thimerosal‐containing vaccines, the rate of regression was similar to that reported in studies of samples exposed to thimerosal, suggesting that thimerosal has no specific association with regressive autism.     

Brief Report: Effects of Cognitive Behavioral Therapy on Parent-Reported Autism Symptoms in School-Age Children with High-Functioning Autism

This pilot study tested the effect of cognitive behavioral therapy (CBT) on parent-reported autism symptoms. Nineteen children with autism spectrum disorders and an anxiety disorder (7–11 years old) were randomly assigned to 16 sessions of CBT or a waitlist condition. The CBT program emphasized in vivo exposure supported by parent training and school consultation to promote social communication and emotion regulation skills. Parents completed a standardized autism symptom checklist at baseline and posttreatment/postwaitlist and 3-month follow-up assessments. CBT outperformed the waitlist condition at posttreatment/postwaitlist on total parent-reported autism symptoms (Cohen’s d effect size = .77). Treatment gains were maintained at 3-month follow-up. Further investigation of this intervention modality with larger samples and broader outcome measures appears to be indicated.     

Predictors of Psychiatric Symptoms in Children with an Autism Spectrum Disorder

This study examined mental health risk/protective factors for DSM-IV psychiatric symptoms in children with an autism spectrum disorder (ASD) and their contribution to functioning separate from ASD symptom severity. Mothers/teachers completed measures of risk/protection and social, adaptive, and school functioning in 6- to 12-year-olds with a diagnosed ASD (N = 238). Bivariate correlations and simultaneous regression analyses indicated a unique pattern of predictors for attention-deficit/hyperactivity disorder, aggression, anxiety, and depression symptoms. Moreover, psychiatric symptoms differentially predicted social and school performance. Findings indicate that co-occurring psychiatric symptoms and their associated mental health risk/protective factors may have important clinical implications and generally support a biopsychosocial model of psychopathology in children with an ASD that appears to share many similarities with models for nonASD children.     

Socio-Behavioral Characteristics of Children with Rubinstein-Taybi Syndrome

Research regarding the behavioral aspects of children with Rubinstein-Taybi syndrome (RTS) has suggested some possible behavioral patterns including autistic features. Caregivers of 39 children (mean age = 8.4 years) with RTS (49% showing abnormality in CREBBP gene) and 39 children (mean age = 8.6 years) matched on developmental level, age and gender were administered the Child Behavior Checklist and the Children’s Social Behavior Questionnaire. Children with RTS did not exhibit higher internalizing (affective and anxiety symptoms) or externalizing (disruptive symptoms) behavioral problems than expected for their age/developmental range. However, they displayed some specific behaviors: short attention span, motor stereotypies, poor coordination, and overweight. The presence of an identified CREBBP gene abnormality was possibly related to the motor difficulties through impaired motor skills learning.     

Multi-informant Ratings of Psychiatric Symptom Severity in Children with Autism Spectrum Disorders: The Importance of Environmental Context

The present study examines co-occurring psychiatric syndromes in a well-characterized sample of youths with autism spectrum disorders (ASD; n = 177) and their siblings (n = 148), reported independently by parents and teachers. In ASD, parents reported substantial comorbidity with affective (26%), anxiety (25%), attentional (25%), conduct (16%), oppositional (15%), and somatic problems (6%). Teachers reported a much lower prevalence. Autistic severity scores for children with ASD exhibited moderate correlations with general psychopathology within- but not across-informants, whereas, sibling correlations were significant both within- and across-informants. Results support the role of environmental context in psychiatric symptom expression in children affected by autism and suggest that informant discrepancies may more provide critical cues for these children via specific environmental modifications.     

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.     

Age-Related Changes in the Anatomy of Language Regions in Autism Spectrum Disorder

Impairments in language and communication are core features of autism spectrum disorder (ASD). The anatomy of critical language areas has been studied in ASD with inconsistent findings. We used MRI to measure gray matter volume and asymmetry of Heschl’s gyrus, planum temporale, pars triangularis, and pars opercularis in 40 children and adolescents with ASD and 40 typically developing individuals, each divided into younger (7–11 years) and older (12–19 years) cohorts. The older group had larger left planum temporale volume and stronger leftward asymmetry than the younger group, regardless of diagnosis. The pars triangularis and opercularis together were larger in ASD than controls. Correlations between frontal language areas with language and symptom severity scores were significant in younger ASD children. Results suggest similar developmental changes in planum temporale anatomy in both groups, but group differences in pars triangularis and opercularis that may be related to language abilities and autism symptom severity.     

PERVASIVE DISINTEGRATIVE DISORDER: ARE RETT SYNDROME AND HELLER DEMENTIA INFANTILIS SUBTYPES?

Children with developmental regression and emerging symptoms of autism have been given a variety of classifications. The authors compare two boys with Heller dementia with six girls with Rett syndrome. They all differed from children with classic autism in that they had normal prenatal and perinatal periods, followed by marked developmental regression, after which they acquired few or no skills. The boys differed from the girls in terms of estimated prevalence, age at onset, stereotypic breathing patterns, midline hand stereotypies, hand and gait apraxia and speech development. It is suggested that these children should be distinguished from those with classic autism, and should be classified as 'pervasive disintegrative disorder, Heller type' and 'pervasive disintegrative disorder, Rett type'.     

Social and communication development in toddlers with early and later diagnosis of autism spectrum disorders

CONTEXT: To our knowledge, no prospective studies of the developmental course of early and later diagnosis of autism spectrum disorders from 14 months of age exist. OBJECTIVE: To examine patterns of development from 14 to 24 months in children with early and later diagnosis of autism spectrum disorders. DESIGN: Prospective, longitudinal design in which 125 infants at high and low risk for autism were tested from age 14 to 36 months. Comprehensive standardized assessments included measures of social, communication, and play behavior. SETTING: Testing occurred at a major medical and research institution as part of a large, ongoing longitudinal study. PARTICIPANTS: Low-risk controls (n = 18) and siblings of children with autism, grouped on the basis of outcome diagnostic classification at 30 or 36 months: autism spectrum disorders (early diagnosis, n = 16; later diagnosis, n = 14), broader autism phenotype (n = 19), and non-broader autism phenotype (n = 58). MAIN OUTCOME MEASURES: Social, communication, and symbolic abilities were assessed. RESULTS: Social, communication, and play behavior in the early-diagnosis group differed from that in all other groups by 14 months of age. By 24 months, the later-diagnosis group differed from the non-autism spectrum disorder groups in social and communication behavior, but not from the early-diagnosis group. Examination of growth trajectories suggests that autism may involve developmental arrest, slowing, or even regression. CONCLUSION: This study provides insight into different patterns of development of children with early vs later diagnosis of autism spectrum disorders.