Stimulant medication treatment of target behaviors in children with autism: a population-based study

OBJECTIVE: This study provides detailed information about stimulant medication treatment for the target symptoms of hyperactivity, impulsivity, disinhibition, and inattention in children with autism. METHODS: In a previous study, 124 subjects fulfilling DSM-IV-based research criteria for autistic disorder were identified among all 0-21 year old residents of Olmsted County, MN from 1976-1997. For each of these 124 children with research-identified autism, information was abstracted on all prescribed psychopharmacological medications. RESULTS: Psychostimulants were used to treat 52.4% (N = 65) of the 124 subjects. The median total duration of psychostimulant treatment was 4.0 years. There were 398 episodes of psychostimulant treatment. Favorable responses were associated with 69.4% of treatment episodes. Of the 398 episodes of stimulant treatment, 16.8% were associated with a documented side effect. At least one side effect was experienced by 66% of the children. CONCLUSION: These results indicate that psychostimulants are commonly prescribed for children with autism, and suggest that these medications may improve the target symptoms of hyperactivity, impulsivity, disinhibition and inattention.     

Diagnostic labelling of autism spectrum disorders in NSW

Aim:   To describe the use of diagnostic labels by clinicians for children with autism spectrum disorders (ASD) and calculate the label-specific and overall agreement between diagnostic labels and Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV) diagnoses provided by the same clinician.
Methods:   State-wide active surveillance was used to ascertain children newly recognised with one or more DSM-IV criteria for autistic disorder aged 0–15 years (incident cases) in New South Wales (NSW) between July 1999 and December 2000. Clinicians were asked to supply a diagnostic label and then complete DSM-IV criteria for each child reported.
Results:   Questionnaires with diagnostic label and DSM-IV criteria were returned for 348 children. The agreement between labels used and diagnosis based on DSM-IV classification system was the highest for autism (97%) and lower for labels of Asperger disorder, pervasive developmental disorder – not otherwise specified or atypical autism (27%). Kappa overall agreement was 0.31. Level of agreement between label and DSM-IV diagnosis was similar for questionnaires completed by multidisciplinary teams, psychiatrists, paediatricians and psychologists working as part of a team.
Conclusion:   A lack of agreement between the diagnostic labelling used by clinicians and diagnosis based on DSM-IV criteria indicates a lack of consistency in diagnostic communication that is necessary to provide best clinical care, appropriate services and relevant information to parents and carers.     

Autistic traits in a population-based ADHD twin sample

BACKGROUND: Most diagnostic nomenclatures do not allow for the concurrent diagnosis of autism and attention-deficit/hyperactivity disorder (ADHD). Clinic-based studies suggest autistic symptoms are common in children with ADHD, but such studies are prone to referral bias. This study assesses whether children with ADHD selected from the general twin population have elevated levels of autistic traits. METHODS: Nine hundred forty-six twins identified by Missouri birth records were assigned to DSM-IV ADHD diagnoses and seven population-derived ADHD subtypes defined through latent class analysis of DSM-IV ADHD symptoms. The Social Responsiveness Scale (SRS) was used as a quantitative measure of autistic traits. Linear regression was used to evaluate whether mean SRS scores differed between ADHD diagnostic groups. RESULTS: Mean SRS scores for DSM-IV predominantly inattentive subtype and combined subtype ADHD groups were significantly higher than for subjects without DSM-IV ADHD (p < .001, both comparisons). Five of the population-derived ADHD subtypes (talkative-impulsive, mild and severe inattentive, mild and severe combined) had significantly higher mean SRS scores compared to the latent class subtype with few ADHD symptoms (p < .001, all comparisons). DSM-IV combined subtype and the population-derived severe combined subtype had the highest mean total SRS scores and the highest mean scores for each of the three autism symptom domains, with a substantial proportion of individuals scoring in the clinically significant range. CONCLUSIONS: This study provides population-based evidence for clinically significant elevations of autistic traits in children meeting diagnostic criteria for ADHD. These results have implications for the design and interpretation of studies of both disorders.     

孤独症患儿发育倒退特征的研究

目的：大约30%左右孤独症的患儿在2岁左右出现发育倒退。“倒退型”患儿的病程发展、临床表现尚不十分清楚,因此该研究对一组有发育倒退特征的孤独症患儿进行了研究。方法：符合DSM-IV孤独症诊断标准的孤独症患儿152例, 年龄2.5～6.5岁,根据有无语言发育倒退进行分组。调查患儿的围产期情况、发育史及发育倒退的特征,并对两组患儿的症状进行比较。结果：33例(21.7％)患儿在生后16~21个月时出现语言及社交功能的倒退。CARS量表(Childhood Autism Rating Scale)的评分比较显示倒退组明显高于非倒退组（P<0.05）;倒退组中重症患儿所占比例（66.7%）明显高于非倒退组（45.4%）（P<0.05）。结论：发育倒退在孤独症中占有一定的比例,对于孤独症的诊断具有意义。倒退型患儿的症状程度比非倒退型患儿更为严重,提示倒退型可能为孤独症的一类特殊表型。［中国当代儿科杂志,2010,12（10）：781-783］     

Ferritin and iron levels in children with autistic disorder

Iron has an important role on cognitive, behavioral, and motor development. High prevalence of iron deficiency has been reported in autism. The aim of this study was to investigate iron status in a group of children with autistic disorder. The sample was composed of 116 children between 3 and 16 years with a diagnosis of autistic disorder according to DSM-IV criteria. Serum ferritin, iron, hemoglobin, hematocrit, mean corpuscular volume, and red cell distribution width values were measured. We found that 24.1% of subjects had iron deficiency, and 15.5% had anemia. There was a significant positive correlation between age and ferritin and hematological measures. Results of this study confirmed that iron deficiency and anemia are common in children with autistic disorder. Conclusion: These findings suggest that ferritin levels should be measured in subjects with autism as a part of routine investigation.     

Prevalence of autism and parentally reported triggers in a north east London population.

BACKGROUND: The recorded prevalence of autistic spectrum disorders has risen over recent decades. Measles, mumps and rubella (MMR) vaccine has been blamed, by causing a "new variant" form of "regressive autism" associated with "autistic enterocolitis". AIMS: To estimate the prevalence of autism and to assess any changes in parental perception regarding the onset or causes of autism. METHODS AND RESULTS: A total of 567 children with autistic spectrum disorder in five districts in north east London were identified, born 1979-98. Reported autism, excluding the 94 cases of Asperger's syndrome, increased by year of birth until 1992, since when prevalence has plateaued. This flattening off persisted after allowing for expected delay in diagnosis in more recent birth cohorts. The age at diagnosis of autistic spectrum disorder was estimated to have decreased per five year period since 1983, by 8.7% for childhood autism and by 11.0% for atypical autism. There was some evidence that MMR was more likely to be mentioned as a trigger after August 1997 than before. CONCLUSIONS: The prevalence of autism, which was apparently rising from 1979 to 1992, reached a plateau from 1992 to 1996 at a rate of some 2.6 per 1000 live births. This levelling off, together with the reducing age at diagnosis, suggests that the earlier recorded rise in prevalence was not a real increase but was likely due to factors such as increased recognition, a greater willingness on the part of educationalists and families to accept the diagnostic label, and better recording systems. The proportion of parents attributing their child's autism to MMR appears to have increased since August 1997.     

Prevalence of autism and parentally reported triggers in a north east London population

Background: The recorded prevalence of autistic spectrum disorders has risen over recent decades. Measles, mumps and rubella (MMR) vaccine has been blamed, by causing a "new variant" form of "regressive autism" associated with "autistic enterocolitis". Aims: To estimate the prevalence of autism and to assess any changes in parental perception regarding the onset or causes of autism. Methods and Results: A total of 567 children with autistic spectrum disorder in five districts in north east London were identified, born 1979–98. Reported autism, excluding the 94 cases of Asperger''s syndrome, increased by year of birth until 1992, since when prevalence has plateaued. This flattening off persisted after allowing for expected delay in diagnosis in more recent birth cohorts. The age at diagnosis of autistic spectrum disorder was estimated to have decreased per five year period since 1983, by 8.7% for childhood autism and by 11.0% for atypical autism. There was some evidence that MMR was more likely to be mentioned as a trigger after August 1997 than before. Conclusions: The prevalence of autism, which was apparently rising from 1979 to 1992, reached a plateau from 1992 to 1996 at a rate of some 2.6 per 1000 live births. This levelling off, together with the reducing age at diagnosis, suggests that the earlier recorded rise in prevalence was not a real increase but was likely due to factors such as increased recognition, a greater willingness on the part of educationalists and families to accept the diagnostic label, and better recording systems. The proportion of parents attributing their child''s autism to MMR appears to have increased since August 1997.     

孤独症儿童脆性位点精神发育迟滞1基因检测

目的对孤独症儿童进行脆性位点精神发育迟滞1(FMR-1)基因检测,探讨儿童孤独症与FMR-1基因的关系。方法孤独症患儿75例。用一般情况调查表进行调查,以儿童孤独症评定量表、孤独症行为检查量表筛查可疑患儿,按照中国精神障碍分类与诊断标准第3版(CCMD-3)的儿童孤独症诊断标准进行诊断和FMR-1基因检测。结果孤独症患儿FMR-1基因异常率极低,仅1.3%。结论儿童孤独症遗传学发病机制可能与FMR-1基因无关。     

Time trends in reported diagnoses of childhood neuropsychiatric disorders: a Danish cohort study

OBJECTIVES: To examine trends in autism (autism spectrum disorder and childhood autism) in the context of 3 additional childhood neuropsychiatric disorders: hyperkinetic disorder, Tourette syndrome, and obsessive-compulsive disorder. DESIGN: Population-based cohort study. SETTING: Children were identified in the Danish Medical Birth Registry. Relevant outcomes were obtained via linkage with the Danish National Psychiatric Register, which included reported diagnoses through 2004 by psychiatrists using diagnostic criteria from the International Statistical Classification of Diseases, 10th Revision. PARTICIPANTS: All children born in Denmark from 1990 through 1999, a total of 669 995 children. MAIN OUTCOME MEASURES: Cumulative incidence proportion by age, stratified by year of birth, for each disorder. RESULTS: Statistically significant increases were found in cumulative incidence across specific birth years for autism spectrum disorder, childhood autism, hyperkinetic disorder, and Tourette syndrome. No significant change in cumulative incidence was observed for obsessive-compulsive disorder. CONCLUSIONS: Recent increases in reported autism diagnoses might not be unique among childhood neuropsychiatric disorders and might be part of a more widespread epidemiologic phenomenon. The reasons for the observed common pattern of change in reported cumulative incidence could not be determined in this study, but the data underscore the growing awareness of and demand for services for children with neurodevelopmental disorders in general.     

Children with autistic behavior in a self-contained unit in the public schools

The diagnosis of "autism" has been used to encompass a heterogeneous group of children who may differ in etiology, clinical manifestations, prognosis, and needed treatment. This paper presents the results of a comprehensive evaluation, using strict diagnostic criteria, of 33 children comprising the entire population of a self-contained unit for "autistic" children in the public school system of Hillsborough County, Florida. Only five of the children fit the criteria for early infantile autism. Six were diagnosed as suffering from schizophrenia, two as atypical developmental disorders. Twelve of the 33 showed evidence of neurological or recognized genetic abnormality, five had specific developmental language disorders, and three were severely retarded, cause unknown. Of the 12 children with evidence of neurological disease, five had chromosome abnormalities evident on cytogenetic study, two had high serum Cux++, one had histidinemia, one had maternal rubella, and three had dyskinesis of unknown origin. The heterogeneous nature of this group underlines the need for comprehensive evaluation of the autistic syndrome.     

Disintegrative Disorder or "Late Onset" Autism

Ten cases of disintegrative disorder were identified within a larger sample of 165 individuals who met behavioral criteria for autism. These cases were compared to autistic individuals whose disorder had been recognized by age 2 and to those whose disorder had been recognized after age 2. Consistent with previous reports, children with disintegrative disorder had a period of normal development preceding the onset of a profound developmental regression from which they made, at best, only a limited recovery. Both clinical features at the time of regression and various outcome measures support the validity of the diagnostic concept, particularly when such cases are compared to "late onset" autistic ones.     

Autistic symptoms in childhood arrestees: longitudinal association with delinquent behavior

Background: To compare childhood arrestees with matched comparison groups on levels of autistic symptoms and to assess the unique predictive value of autistic symptoms for future delinquent behavior in childhood arrestees. Methods: Childhood first‐time arrestees (n = 308, baseline age 10.7 ± 1.5 years) were followed up for 2 years. Autistic symptoms, externalizing disorders and delinquent behavior were assessed yearly. Childhood arrestees were compared on autistic symptoms with matched (age, gender) general population and clinical autism spectrum disorder samples. The predictive value of autistic symptoms for delinquent behavior was analyzed using generalized estimating equations. Results: At each assessment, levels of autistic symptoms in childhood arrestees were in between levels found in the general population and autism spectrum disorder samples. Autistic symptoms were positively associated with delinquent behavior in childhood arrestees, even after adjustment for externalizing disorders: IRR (incidence rate ratio) 1.23; 95% CI 1.11–1.36 and IRR 1.29; 95% CI 1.15–1.45 for core autistic symptoms and total symptom score, respectively. Conclusions: Autistic symptoms are more prevalent in childhood arrestees compared to the general population and are uniquely associated with future delinquent behavior. Attention should, therefore, be given to the possible presence of autism related symptomatology in these children. Implications for diagnostic assessment and intervention need further investigation.     

Predictive validity of ICD-10 hyperkinetic disorder relative to DSM-IV attention-deficit/hyperactivity disorder among younger children

BACKGROUND: Little is known about the predictive validity of hyperkinetic disorder (HKD) as defined by the Diagnostic Criteria for Research for mental and behavioral disorders of the tenth edition of the International Classification of Diseases (ICD-10; World Health Organization, 1993), particularly when the diagnosis is given to younger children. METHODS: The predictive validity of HKD was evaluated over a 6-year period and compared to the predictive validity of DSM-IV attention-deficit/hyperactivity disorder (ADHD) in 95 4-6-year-old children who met full criteria for at least ADHD and 122 demographically-matched nonreferred comparison children. Diagnoses were based on structured assessments of both parents and teachers. RESULTS: All children who met full criteria for HKD also met full DSM-IV criteria for ADHD, but only 26% of ADHD children met criteria for HKD. Children who met criteria for HKD (N = 24), children who would have met criteria for HKD but were excluded from the diagnosis because they concurrently met criteria for an anxiety disorder or depression (N = 16), and the remaining children who met DSM-IV criteria for ADHD (N = 55) all exhibited significantly more symptoms of ADHD and greater social and academic impairment during years 2-7 than nonreferred comparison children. Unlike the two other diagnostic groups, however, children who met strict criteria for HKD were not more likely than comparison children to be injured unintentionally or to be placed in special education. CONCLUSIONS: Both ICD-10 HKD and DSM-IV ADHD exhibit predictive validity over 6 years, but ICD-10 HKD appears to under-identify children with persistent ADHD symptoms and related impairment. Children who met criteria for DSM-IV ADHD but not HKD exhibited at least as much functional impairment over time as hyperkinetic children.     

Incidence of Enuresis and Encopresis Among Children With Attention-Deficit/Hyperactivity Disorder in a Population-Based Birth Cohort

ObjectiveThis study reports the incidence of enuresis and encopresis among children with attention-deficit/hyperactivity disorder (ADHD) versus those without ADHD.MethodsSubjects included 358 children (74.5% boys) with research-identified ADHD from a 1976 to 1982 population-based birth cohort (n = 5718) and 729 (75.2% boys) non-ADHD control subjects from the same birth cohort, matched by gender and age. All subjects were retrospectively followed from birth until a diagnosis of enuresis or encopresis was made or last follow-up before 18 years of age. The complete medical record for each subject was reviewed to obtain information on age of initial diagnosis of an elimination disorder, frequency and duration of symptoms, and identification of exclusionary criteria specified by DSM-IV, with confirmation of the diagnosis by expert consensus.ResultsChildren with ADHD were 2.1 (95% confidence interval [CI], 1.3–3.4; P = .002) times more likely to meet DSM-IV criteria for enuresis than non-ADHD controls; they were 1.8 (95% CI, 1.2–2.7; P = .006) times more likely to do so than non-ADHD controls when less stringent criteria for a diagnosis of enuresis were employed. Though not significant, children with ADHD were 1.8 (95% CI, 0.7–4.6; P = .23) times more likely to meet criteria for encopresis than non-ADHD controls. The relative risk was 2.0 (95% CI, 1.0–4.1; P = .05) when a less stringent definition for encopresis was utilized.ConclusionsChildren with ADHD are more likely than their peers without ADHD to develop enuresis with a similar trend for encopresis.     

Chickenpox hospitalizations among residents of Olmsted County, Minnesota, 1962 through 1981. A population-based study

Age-specific incidence rates were determined for hospitalizations resulting from complications of chickenpox. We reviewed medical records for all Olmsted County, Minnesota, residents hospitalized for chickenpox during the 20-year period 1962 through 1981. Incidence rates based on these 25 cases showed good agreement with national rates computed from information compiled by the Commission on Professional and Hospital Activities for 669 statistically selected patients, representing about 5% of US varicella hospitalizations from January 1979 through June 1982 (about 4,000 hospitalizations annually). The most common complications were bacterial superinfections in children younger than 5 years old, varicella encephalitis (mainly acute cerebellar ataxia) and dehydration in 5- to 9-year-olds, and varicella pneumonia in adults. The high prevalence of chickenpox and its association with infectious and neurologic complications make it a continuing source of morbidity.     

Diagnostic Rules for Children with PDD-NOS and Multiple Complex Developmental Disorder

This study was designed to examine the classification performance of diagnostic rules for pervasive developmental disorder not otherwise specified (PDD-NOS) and multiple complex developmental disorder (McDD), with clinical diagnosis as the gold standard. McDD is an heuristic concept of a developmental disorder characterised by social impairments, affective dysregulation, and thought disturbance. Detailed information on the symptoms, reliably extracted from the charts of 103 children with PDD-NOS and McDD, 32 with autistic disorder, and 96 with non-PDD disorders, was used to determine the presence of the DSMIV criteria of autistic disorder and the criteria of McDD. A scoring rule for PDD-NOS based on a short set of seven DSM-IV criteria with a cut-off point of three items and one social interaction item set as mandatory had the best balance between high sensitivity and high specificity. The most effective and simple rule based on McDD criteria had a cut-off of three items, out of six items of anxieties and thought disturbance.     

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目的探讨孤独症患儿感觉统合失调和注意缺陷多动障碍(ADHD)症状的发生情况。方法 2007年7月至2007年11月北京大学精神卫生研究所儿科门诊4岁以上的孤独症患儿56例,进行孤独症行为检查量表(ABC)、Conner父母症状问卷、感觉统合能力发展评定量表(SIS)的评定,并运用DSM-IVADHD诊断标准对年龄≥6岁者进行诊断。结果 49例(87.5%)患儿存在感觉统合失调,其中38例(77.55%)为重度感觉统合失调;大肌肉及平衡感、触觉防御及情绪、本体感及协调3个因子分与ABC总分及ABC各因子分呈显著负相关(r=-0.272～-0.685,P<0.05及0.01);感觉统合失调组ABC总分、ABC感觉、交往及躯体因子分均明显高于非感觉统合失调组(P=0.036～0.003)。33例(58.9%)患儿存在多动症状,≥6岁29例中22例(75.9%)符合ADHD症状学诊断标准;伴多动症状或符合ADHD症状学诊断标准组ABC总分及躯体因子分均明显高于不伴多动症状或不符合ADHD症状学诊断标准组(P<0.05);存在多动症状组大肌肉及平衡感分明显低于不存在多动症状组(P<0.05);符合ADHD症状学诊断标准...     

Exploring the borderlands of autistic disorder and specific language impairment: a study using standardised diagnostic instruments

BACKGROUND: Two studies were conducted to test claims that pragmatic language impairment (PLI - previously referred to as semantic-pragmatic disorder) is simply another term for autistic disorder or pervasive developmental disorder not otherwise specified (PDDNOS). METHOD: In Study 1, 21 children aged from 6 to 9 years with language impairments were subdivided on the basis of the Children's Communication Checklist into 13 cases of pragmatic language impairment (PLI) and eight cases of typical specific language impairment (SLI-T). Parents completed the Autism Diagnostic Interview - Revised (ADI-R) and the Social Communication Questionnaire (SCQ), and the children were given the Autism Diagnostic Observation Schedule - Generic (ADOS-G). In Study 2, a further 11 children with SLI-T and 18 with PLI were assessed using the SCQ and ADOS-G. In addition, six children diagnosed with high-functioning autism and 18 normally developing children were assessed. RESULTS: There was good agreement between ADI-R and SCQ diagnoses, but poor agreement between diagnoses based on these parental report measures and those based on ADOS-G. In many children, symptom profiles changed with age. Four PLI children from Study 1 and one from Study 2 met criteria for autistic disorder on both parental report (ADI-R or SCQ) and ADOS-G. Many of the others showed some autistic features, but there was a subset of children with pragmatic difficulties who were not diagnosed as having autism or PDDNOS by either instrument. These children tended to use stereotyped language with abnormal intonation/prosody, but they appeared sociable and communicative, had normal nonverbal communication, and showed few abnormalities outside the language/social communication domains. CONCLUSIONS: Presence of pragmatic difficulties in a child with communication problems should prompt the clinician to evaluate autistic symptomatology, but it is dangerous to assume that all children with pragmatic difficulties have autism or PDDNOS.     

Variability in outcome for children with an ASD diagnosis at age 2

BACKGROUND: Few studies have examined the variability in outcomes of children diagnosed with autism spectrum disorder (ASD) at age 2. Research is needed to understand the children whose symptoms - or diagnoses - change over time. The objectives of this study were to examine the behavioral and diagnostic outcomes of a carefully defined sample of 2-year-old children with ASD, and to identify child and environmental factors that contribute to variability in outcomes at age 4. METHODS: Forty-eight children diagnosed with autism or pervasive developmental disorder not otherwise specified (PDDNOS) at age 2 were followed to age 4. Diagnostic measures included the Autism Diagnostic Observation Schedule - Generic (ADOS-G) and clinical diagnosis at ages 2 and 4, and the ADI-R at age 4. RESULTS: Diagnostic stability for an ASD diagnosis (autism or PDDNOS) was 63%, and for an autism diagnosis was 68%. Children who failed to meet diagnostic criteria for ASD at follow-up were more likely to: 1) be 30 months or younger at initial evaluation; 2) have milder symptoms of autism, particularly in the social domain; and 3) have higher cognitive scores at age 2. No differences between children with stable and unstable diagnoses were found for amount of intervention services received. Among the children with unstable diagnoses, all but one continued to have developmental disorders, most commonly in the area of language. CONCLUSIONS: The stability of ASD was lower in the present study than has been reported previously, a finding largely attributable to children who were diagnosed at 30 months or younger. Implications for clinical practice are discussed.