Diagnostic assessment of communicative and interactive behaviours in children with autism and receptive language disorder

 Children with autism and children with a severe specific receptive language disorder both show clear deficits in communicative language skills and in social relationships. In this study the usefulness of the Autism Diagnostic Observation Schedule (ADOS) in the differential diagnosis between these two groups of developmentally impaired children is assessed. 11 children with early infantile autism and 20 children with a specific receptive language disorder participated in the study. 18 children with an expressive language disorder were used as a control group. The ADOS was individually administered to all children by the same examiner. The results showed that on most of the ADOS measures the autistic children were clearly more deviant than the language impaired children. There were no significant differences between the two groups of language impaired children. Eight out of 11 autistic children reached the defined cut-off values on the measures “language and communication” and “social interaction” of the ADOS algorithm, whereas only three autistic children did so on the measure “stereotyped behaviour”. None of the language-impaired children reached the cut-off values on more than one measure. The ADOS allowed for good assessment of certain types of behaviour. However, to confirm the diagnosis of infantile autism, additional information from parents is required. Accepted: 15 February 2000     

Evaluation of neuromotor deficits in children with autism and children with a specific speech and language disorder

Several studies have described problems in motor functions in children with autism and children with a specific speech and language disorder. The purpose of this study was to identify neuromotor deficits in these neurodevelopmentally impaired children. A standardised neurological examination was performed in 11 children with childhood autism, 11 children with an expressive language disorder, 11 children with a receptive language disorder and 11 control children. The children were matched for age and non-verbal IQ, not for gender. All children had a non-verbal IQ above 85. The neurological examination procedure allowed for a qualitative and quantitative assessment of five specific neurological subsystems: fine and gross motor functions, balance, coordination and oral motor functions. The high-functioning children with autism and the children with a specific language disorder (expressive or receptive) had more motor problems than the control children on most neurological subsystems. There were few statistically significant differences between the three groups of developmentally impaired children. The frequent co-occurrence of verbal and non-verbal, in particular neuromotor, deficits in developmentally impaired children put an additional burden on the development of these children and should be diagnosed as early as possible. Accepted: 8 May 2002 The research was funded by grant AM 63/4–2 of the Deutsche Forschungsgemeinschaft. Correspondence to Dr. M. Noterdaeme     

Evaluation of emotional and behavioral problems in language impaired children using the Child Behavior Checklist

Speech and language impaired children are at special risk for developing psychiatric disorders. Attention deficit, aggressive behaviour as well as overanxiety and excessive shyness have been reported in speech and language impaired children. The purpose of this study was to determine how the Child Behavior Checklist (CBCL) could be used as a screening instrument in language impaired children. In a sample of 83 language impaired children, emotional and behavioural problems were evaluated using the CBCL. Independent of this assessment, DSM-IV diagnoses were established for all children. Sixty-six of the 83 children had a psychiatric diagnosis. The use of the Total Behavior Problem score (TBP) as a global measure of behavioural disturbance showed that children with a psychiatric diagnosis had significantly higher scores on the TBP score than children without a psychiatric diagnosis. The specificity of the TBP was 88.2%, the sensitivity 75.8%, and the false classification rate 21.6%. The most frequently reported behavioural disturbances were problems on scale VI (“Attention Problems”-39 children) and on scale I (“Withdrawn”-32 children). A small group of children with a receptive language disorder and pronounced compulsive behavioural problems had elevated scores on scale V (“Thought Problems”). Accepted: 10 August 1998     

Gilles de la Tourette Syndrome in a child with congenital deafness

We present the case of a 10-year-old boy, Sam, with congenital deafness and Gilles de la Tourette Syndrome (GTS). GTS is characterised by multiple motor tics and one or more vocal tics that wax and wane. Due to his deafness Sam never developed vocal language but instead used sign language from the age of four. His tic disorder rapidly accelerated from the age of seven over a six-month period and soon sign language was incorporated into tics as complex “vocal” tics. Bursting out “words”in sign language would also occur in front of people unfamiliar with sign language and often with an obscene content although this was not evident to someone not trained in sign language. To our knowledge this is the first reported case of a congenital deaf child with GTS. The case presented here supports previously published work that the intentional share of the tics in GTS is very small. This case also questions former theories on which regions and circuits of the brain are involved in GTS. Accepted: 16 May 2001     

Evaluation of attention problems in children with autism and children with a specific language disorder

Children with autism and children with a specific language disorder show additional attention deficits. The literature on the neuropsychological investigation of attention in both groups of children suggests that the nature of their attention problems might be different. The purpose of this study is to examine the attention test profiles in these two groups of children with developmental disorders. Nineteen children and adolescents with autism, 17 subjects with a specific language disorder and 19 control subjects participated in the study. Non-verbal intelligence was normal for all subjects. The “Testbatterie zur Aufmerksamkeitsprüfung” was administered to all subjects. This instrument provides the possibility to examine a wide range of attention functions and executive functions. The results showed that the autistic individuals had deficits in executive functions, whereas the language impaired children had deficits in auditory sustained attention, in auditory selective attention, and in the domain of executive functions. It is concluded that although both groups of developmentally impaired subjects showed attention problems, the deficits are not the same in both groups. The different neuropsychological profiles probably reflect different mechanisms in the pathogenesis of the attention deficits in both types of developmental disorders. Accepted: 1 September 2000     

Epidemiology and prognosis of specific disorders of language and scholastic skills

 Data from a prospective longitudinal study on the development of children born at biological and psychosocial risk were utilised to examine language and learning abilities of 320 children at ages 4.5 and 8 years. Following the research criteria of the ICD-10, specific developmental disorders of speech and language and specific developmental disorders of scholastic skills were diagnosed. Data were also provided for a clinical and general low achievement group according to less stringent criteria. Frequencies in the risk population were low for specific disorders (ICD-10) (0.6%–3.7% depending on age and type of disorder). Higher frequencies were found when a clinical definition (0.6%–13.6%) or overall low achievement score (0.6%–18.6%) was chosen. The impact of well-documented organic and psychosocial risks was analysed. Organic risk affected language abilities at 4.5 years of age but neither language nor learning abilities at 8 years of age. Psychosocial aspects of a child's environment proved to be associated with both specific language and learning abilities. Stability of language disorders, association between language and reading/spelling disorders as well as gender effects were investigated. Accepted: 17 December 1999     

Psychopathology in children from families with blood disorders: a cross-national study

Background: This study examines the prevalence of psychiatric disorders in affected and in unaffected siblings from families with haemophilia or β-thalassaemia. Method: Based on data derived from a cross-sectional and multi-centre study into the resilience of 115 families with blood disorders. Sociodemographic and developmental data were collected from the parent using a standardised and semi-structured interview, and medical data were elicited from the attending clinician. The children's psychopathology was assessed with the Schedule for Affective Disorders and Schizophrenia (K-SADS). Results: Children with β-thalassaemia were twice as likely to receive a diagnosis of psychiatric disorder and more likely to show a higher degree of impairment of general functioning than haemophilic boys or unaffected children from families with blood disorders. Clinical severity of haemophilia or β-thalassaemia was not associated with significant differences in prevalence of child psychiatric disorders or impairment. Mothers' evaluation of their relationship with their child as ‘less than easy’ predicted psychopathology. Conclusions: The high prevalence of psychopathology in children with β-thalassaemia reported in this study suggests that specific blood disorders have differential impact on affected children. This difference may be related to medical therapy advances in haemophilia so that haemophilic boys can lead an almost normal life. Accepted: 31 January 2001 died January 2000 died March 2002 Correspondence to: B. Taylor     

DSM-IV Conduct Disorder symptoms in adolescents as markers of registered criminality

A nationwide sample of 1,079 Norwegian adolescent psychiatric in-patients, 581 males and 498 females, were followed up after 11–33 (mean 23.2) years. On the basis of detailed records from index hospitalisation they were re-diagnosed and retrospectively scored on 14 of the 15 behaviour items listed as diagnostic criteria for conduct disorder in DSM-IV. The patient list was linked to the national criminal registry, and 48 % were found to have a criminal record. The ability of the 14 behaviour items to identify overall and specific kinds of registered criminality was investigated. In males, “stealing” was the strongest marker for overall and violent crime. “Having forced someone into sexual activity” was a strong marker for later sex offences. In females, “running away from home” was strongly associated with overall and violent registered criminality. ROC curves were constructed to test the sensitivity and specificity of the sum of conduct disorder behaviour items fulfilled in the identification of individuals with registered criminality. The area under the curve was 0.81 (95 % c. i. = 0.78–0.85) in males and 0.75 (95 % c. i. = 0.71–0.80) in females. A cut-off at 3 criteria fulfilled seemed optimal in males and somewhat high in females. Accepted: 17 May 2001     

Posttraumatic stress disorder in children after the military operation "Anfal" in Iraqi Kurdistan

 Five years after the military operation “Anfal” in Iraqi Kurdistan, 45 families were randomly selected among the survivors in two displacement camps. The Posttraumatic Stress Symptoms for Children (PTSS-C) and the Harvard Trauma Questionnaire (HTQ) were administered to the oldest child and the caregiver in each family, respectively. Posttraumatic stress disorder (PTSD) was reported in 87% of children and 60% of their caregivers. While childhood PTSD was only significantly predicted by child trauma score and the duration of captivity, it was neither predicted by maternal PTSD nor did it disappear after the reunion with the PTSD-free father. However, the small sample size makes the results hypotheses rather than conclusive. Accepted: 17 April 2000     

The opinion of caregivers on aspects of schizophrenia and major affective disorders in a Nigerian setting

Background In Nigeria the burden of caring for persons with severe mental disorders rests largely on families whose attitudes to these conditions have not been explored. Objectives To assess the opinion of relatives of 75 schizophrenics and 20 major affective disorder cases on aspects of the disease and compare with the responses of relatives of cancer, infertility and sickle cell disease (SCD) cases. Method Caregivers were assessed using a burden questionnaire that contained items on etiological beliefs and attitudes to illness. Results The responses of relatives of the two psychiatric illness groups were similar. The single most important etiological factors were that “it is Satan's work” (35.8 %) and “it is a natural illness“ (23.2 %). Other factors were “genetic” (9.5 %), “witchcraft” (10.5 %) and “curse by enemies” (10.5 %). This was similar to the opinion of cancer and infertility caregivers; but different from SCD where the most important causative factors were “genetic” (41.5 %) and “natural” (21.5 %). Psychiatric caregivers had higher frequency of anger and stigma. Over two-thirds of psychiatric caregivers felt glad caring for the patient and would not like the patient institutionalized. Most families were thought to be supportive and there was an impression that caring had made family emotional ties closer. Conclusions These families were tolerant and would cooperate with health authorities. Causative models are influenced by available knowledge and practices in the culture. To actualize the potential of families to play useful community psychosocial roles, there is a need for public mental health literacy and welfare support. Accepted: 10 July 2001     

Non-specific markers of neurodevelopmental disorder/delay in selective mutism

Selective mutism (SM) in children is frequently associated with language disorder/delay suggesting that neurobiological factors may be involved in the development of SM. Motor co-ordination problems, reduced optimality pre- and perinatally and minor physical anomalies represent other markers for neurodevelopmental disorder/delay. The present study explores these markers in referred children with SM (n=54), non-referred matched controls (n =108) and in SM subgroups with and without a communication disorder (CoD). Children with SM differed significantly from controls in parent-reported motor developmental delay, and they obtained a higher pre- and perinatal “reduced optimality score”. They scored significantly lower on a motor performance test and showed a higher frequency of minor physical anomalies compared with controls. There were no differences in these respects between SM and CoD compared with SM without CoD. The results confirm that neurobiological factors may be involved in the development of SM. Accordingly, the clinical assessment of referred children with SM should include a thorough history of motor development and an evaluation of present motor skills. The interplay of shyness/social anxiety and motor function problems has to be addressed to reduce misunderstandings of the child's behaviour and to adjust demands for motor skills to the actual level of the child. Accepted: 12 October 2001     

Reliability and validity of a child-specific cross-cultural instrument for assessing posttraumatic stress disorder

 The Posttraumatic Stress Symptoms in Children (PTSS-C) was developed as a cross-cultural semi-structured interview to diagnose posttraumatic stress disorder (PTSD) and to identify PTSD-non-related posttraumatic stress symptoms in children after various traumatic experiences. The psychometric properties were studied in two different child populations in Iraqi Kurdistan (the survivors of the military operation “Anfal”, and the orphans), in a sample of Kurdistanian refugee children in Sweden, and in a comparison sample of Swedish children. The instrument yielded satisfactory internal consistency, high interrater agreement, and excellent validity on cross-validation with the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI) and the Diagnostic Interview for Children and Adolescents (DICA) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Accepted: 14 March 2000     

Brief Report: Parental Child-Directed Speech as a Predictor of Receptive Language in Children with Autism Symptomatology

Facilitative linguistic input directly connected to children’s interest and focus of attention has become a recommended component of interventions for young children with autism spectrum disorder (ASD). This longitudinal correlational study used two assessment time points and examined the association between parental undemanding topic-continuing talk related to the child’s attentional focus (i.e., follow-in comments) and later receptive language for 37 parent–child dyads with their young (mean = 21 months, range 15–24 months) children with autism symptomology. The frequency of parental follow-in comments positively predicted later receptive language after considering children’s joint attention skills and previous receptive language abilities.     

Effects of Child Characteristics on the Autism Diagnostic Interview-Revised: Implications for Use of Scores as a Measure of ASD Severity

The Autism Diagnostic Interview-Revised (ADI-R) is commonly used to inform diagnoses of autism spectrum disorders (ASD). Considering the time dedicated to using the ADI-R, it is of interest to expand the ways in which information obtained from this interview is used. The current study examines how algorithm totals reflecting past (ADI-Diagnostic) and current (ADI-Current) behaviors are influenced by child characteristics, such as demographics, behavioral problems and developmental level. Children with less language at the time of the interview had higher ADI-Diagnostic and ADI-Current. ADI-Diagnostic totals were also associated with age; parents of older children reported more severe past behaviors. Recommendations are provided regarding the use of the ADI-R as a measure of ASD severity, taking language and age into account.     

Association of language,behavior, and parental stress in young children with a language disorder

BackgroundSeveral studies show that language problems, child behavior problems, and parental stress can co-occur in children. Still, little is known about how these domains are related in toddlers with a language disorder (LD).AimsThis study examined relations between language problems, child behaviour problems, and parental stress in toddlers with LD and if these relations differ for children with different types of LD.MethodData of 185 children with LD (mean age 38 months) were collected using Routine Outcome Monitoring. Children were divided into two groups: presence of receptive and expressive problems (REP) and expressive problems only (EP). Relations were analyzed using Structural Equation Modeling.ResultsA better receptive language was associated with less teacher-reported internalizing and externalizing problems. A better expressive vocabulary was associated with more parent-reported internalizing problems and more teacher-reported externalizing problems. No relation was found between language and parental stress. Associations between language, behavior, and parental stress did not differ for children with REP or children with EP.ConclusionsOur study shows that when specific language domains are examined, the pattern of associations between language and behavior becomes more complex, because relations exist between specific language domains and behavior, but not between all of them.     

Parental recognition of developmental abnormalities in autism

 In order to identify factors associated with the early detection and referral of children with pervasive developmental disorders, a sample of 82 consecutive referrals to an outpatient diagnostic service was studied. All children were thoroughly assessed with the Autism Diagnostic Interview (ADI), standardized psychological tests and direct observations. Data from the ADI on the first symptoms to arouse parental concern and on the first professional advice sought were analyzed. The mean age of children was 19.1 months (SD=9.4) when the parents first became concerned, and the first professional advice was sought when children were 24.1 months old (SD=11.7). The most common parental concerns were for speech and language development, followed by abnormal socio-emotional response, and medical problem or delay in milestone. In both bivariate and multiple regression analyses, the mean age of children at first parental concern and professional advice was significantly lower in the presence of mental retardation in the child, of an older sibling in the family, and of first parental concerns for medical problem/delay in milestone. More specific autistic behaviours, child’s gender, social class and place of residence did not influence the age of recognition of the disorder in this sample. Health visitors and general practitioners were the first professionals contacted by parents. The implications of these findings for early detection and diagnosis of autism are discussed. Received: 11 August 1997 Accepted: 18 November 1997     

Use of holding,restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment

The aim of the study was to analyse the use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment in Finland. The study included 504 child and adolescent psychiatric in-patients in the year 2000. Time-out had been used for 28 %, holding for 26 %, seclusion for 8 %, and mechanical restraints for 4 % of the in-patients. In multivariate analysis, aggressive acts were the strongest factor associated with all kinds of restraint practices. Psychosis, suicidal acts and older age (13–18 years) were associated with seclusion and mechanical restraints. Younger age (< 13 years), attachment disorder and autism were associated with holding. The longer children had been in treatment, the more likely they were to have been restrained. The high prevalence of restraint techniques used indicates a need for guidelines of restraint and seclusion which take into account the child's need for protection from his/her own impulses and the legal rights of the child. Accepted: 22 February 2002 Correspondence to: A. Sourander     

Children with mixed language disorder do not discriminate accurately facial identity when expressions change

We investigated the recognition of pairs of faces (same or different facial identities and expressions) in two groups of 14 children aged 6–10 years, with either an expressive language disorder (ELD), or a mixed language disorder (MLD), and two groups of 14 matched healthy controls. When looking at their global performances, children with either expressive (ELD) or MLD have few differences from controls in either face or emotional recognition. At contrary, we found that children with MLD, but not those with ELD, take identical faces to be different if their expressions change. Since children with mixed language disorders are socially more impaired than children with ELD, we think that these features may partly underpin the social difficulties of these children. We thank S. Hugues and E. Shapiro for providing us with the MNTAP. We thank the children and their parents, for their participation to the study. This work was supported by the “Fondation de France”.     

One-year Change in Repetitive Behaviours in Young Children with Communication Disorders Including Autism

Repetitive behaviours are a relatively neglected area of study in autism. Previous research has concluded that repetitive behaviour is inversely related to ability and that it tends to increase over the preschool years. One-hundred and four children ages 24-48 months, with autism, autism spectrum disorder (ASD) or other disorders, were followed for 13 months. Twelve items from the Autism Diagnostic Interview (ADI-R) were analysed, as well as diagnostic algorithm scores. Ability was related to degree of repetitive behaviours, except for one cluster of relatively able children. ADI-R repetitive behaviour algorithm scores increased over time; however, when all 12 behaviours were considered, there was a general decrease in impact upon the child's and family's activities. Reasons for this decrease are discussed.     

Clinical characteristics of children referred to a child development center for evaluation of speech, language, and communication disorders

Speech, language, and communication disorders are prominent reasons for referrals to a child development center. From 1984 to 1988, 1,090 preschool children were referred to our child development center, which serves the Tel Aviv metropolitan area. Of all referrals, 432 (41%) were primarily due to speech, language, and communication problems. After exclusion of those with IQ < 50 and those with non-language-related disabilities, 323 children remained. The children were classified into different subtypes of developmental language disorders and autistic spectrum disorders. The main developmental language disorder subtypes were combined expressive-receptive (49%) and expressive (44%). Central processing deficits were less common, occurring in 20 (7%) of the children. Parents of children with developmental language disorders had educational levels similar to those of parents of children referred to the child development center for other causes. However, parents of children with infantile autism had higher educational levels than parents of children with developmental language disorder or parents of children referred for other causes (P < .001). Our results reflect the distribution of language and related problems in an unselected population of preschool children referred to a child development center.