Oppositional Defiant Disorder as a Clinical Phenotype in Children with Autism Spectrum Disorder

To examine the validity of oppositional defiant disorder (ODD) as a clinical phenotype distinct from attention-deficit hyperactivity disorder (ADHD), parents and teachers completed a DSM-IV-referenced rating scale and a background questionnaire for 608 children (ages 3-12 years) with autism spectrum disorder (ASD). The ASD sample was separated into four groups: ODD, ADHD, ODD + ADHD, and neither (NONE). Comparison samples were non-ASD clinic (n = 326) and community (n > 800) controls. In the ASD sample, all three ODD/ADHD groups were clearly differentiated from the NONE group, and the ODD + ADHD group had the most severe co-occurring symptoms, medication use, and environmental disadvantage. There were few differences between ASD + ODD and ASD + ADHD groups. Findings for ASD and control samples were similar, supporting overlapping mechanisms in the pathogenesis of ODD.     

Association of a Monoamine Oxidase-A Gene Promoter Polymorphism With ADHD and Anxiety in Boys With Autism Spectrum Disorder

The aim of the present study was to examine the association between a variable number tandem repeat (VNTR) functional polymorphism in the promoter region of the MAO-A gene and severity of ADHD and anxiety in boys with ASD. Parents and teachers completed a DSM-IV-referenced rating scale for 5- to 14-year-old boys with ASD (n = 43). Planned comparisons indicated that children with the 4- versus 3-repeat allele had significantly (p < 05) more severe parent-rated ADHD inattention and impulsivity, and more severe teacher-rated symptoms of generalized anxiety. Our results support a growing body of research indicating that concomitant behavioral disturbances in children with ASD warrant consideration as clinical phenotypes, but replication with independent samples is necessary to confirm this preliminary finding.     

Parent-Assisted Friendship Training for Children with Autism Spectrum Disorders: Effects of Psychotropic Medication

Twenty-five 6 to 13-year-old children with autism spectrum disorders, who were high functioning, were given 12 weeks of parent-assisted children’s friendship training. Thirteen were prescribed various psychotropic medications by physicians in the community prior to treatment (medicated) while 12 were not (unmedicated). Two parent-rated and three teacher-rated social measures served as outcome variables. Results revealed that unmedicated subjects had greater positive change on three of these five measures when compared to children in the medicated group. It was hypothesized that being prescribed psychotropic medication was a marker for refractory psychosocial treatment response by children with autism spectrum disorders.     

A Preliminary Study on Screening Prevalence of Pervasive Developmental Disorder in Schoolchildren in Iran

To study prevalence rates of pervasive developmental disorder (PDD) symptoms and differences between subtypes in school age Iranian children. A random sample of 2,000 school age children from both genders was selected. A parent-completed, DSM-IV-referenced rating scale of PDD symptoms was used. About 1.9% of the sample obtained screening cutoff scores for probable autistic disorder and 0.5 for probable asperger’s disorder. The rate of probable PDD was not more in girls than the boys. The rate of suspected cases of PDD in Iran is very high and probable autistic disorder is not gender related. It shows the need for more consideration of PDD in the mental health programs planning.     

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.     

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

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

Impact of DSM-5 on epidemiology of Autism Spectrum Disorder

This paper extensively and comprehensively reviews the literature on epidemiology of autism focusing on the prevalence rates of Autistic Disorder (AD) and Autism Spectrum Disorder (ASD), and the potential negative impact of DSM-5 ASD on future ASD prevalence studies. Between 1966 and 2013, there are 72 published prevalence studies of AD and 61 published studies of ASD. The AD has a broad range of prevalence rates and has shown a trend of increasing rates over time. But there are also some evidences showing that the increase seems to have leveled off. The current prevalence of AD is estimated in the range of 10–30 per 10,000 people (i.e., 1 in 1000 to 1 in 333). The ASD also has a wide range of prevalence rates with a median rate of 69.5 per 10,000 people (1 in 144). When the prevalence rates are subdivided into several sub-ranges (e.g., 10–20, 20–40, etc. per 10,000), it is difficult to pick a particular sub-range to represent the prevalence of ASD. The present review notes that several recent studies comparing the utility of DSM-IV/DSM-IV-TR ASD and the DSM-5 ASD have reported that about 9–54% of DSM-IV ASD cases do not qualify for the DSM-5 ASD. Suggestions of research designs for future ASD prevalence studies are offered.     

Validity and reliability of the Korean Version of Autism Spectrum Disorders-Diagnostic for Children (ASD-DC)

The purpose of the present study was to develop and evaluate the psychometric properties of the Autism Spectrum Disorders-Child (ASD-DC). Mothers of children with Autism spectrum disorders (N = 333) and mothers of typically developing children (N = 223) ages from 2 to 16 years completed the ASD-DC. The confirmatory factor analysis revealed that the 4-factor structure of the ASD-DC fits the data well, comprising the following factors: nonverbal communication/socialization, verbal communication, social relationships, and insistence of sameness/restricted interests. The ASD-DC was associated with high internal consistency and test–retest reliability. The discriminant validity was demonstrated by the mean differences between ASD and control group. High correlations between several subscales of ASD-DC and Social Communication Questionnaire (SCQ) were found, showing concurrent validity. High correlations between several subscales were found. Optimal cutoff scores for Autism, Asperger's disorder, and PDD-NOS were found via ROC curve analysis. Clinical and research implications as well as limitations are discussed.     

Brief Report: Atypical Social Cognition and Social Behaviours in Autism Spectrum Disorder: A Different Way of Processing Rather than an Impairment

A central question to autism research is whether autism is largely the result of an impairment in social cognition and/or motivation or the result of a more general processing difference. This review discusses problems with the “social deficit” model of autism spectrum disorder (ASD). It is suggested that superior attention to low-level perceptual information potentially coupled with decreased attention to global information may provide a more comprehensive explanation for atypical social behaviours in ASD. This processing style may reflect increased activation of occipital-temporal regions and reduced functional (and possibly anatomical) connectivity. It is concluded that atypical social behaviours in ASD are more likely to be a consequence reflective of a general processing difference than impairment in social cognition and/or motivation.     

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.     

Focused Stimulation for a Child with Autism Spectrum Disorder: A Treatment Study

This study explored the use of focused stimulation as an intervention technique for a three-year-old boy diagnosed with autism spectrum disorder (ASD). His parents were trained to use focused stimulation to facilitate comprehension of what is x doing question forms. Responses to question probes were collected at both pre- and post-treatment intervals. At the beginning of the study, the child did not respond correctly to any of the target questions. Following intervention, the child made significant gains towards the target goal, but little change towards a control goal used for comparison. These findings provide preliminary support for the usefulness of focused stimulation as an intervention strategy for at least some children with ASD.     

Applying Artificial Intelligence for Diagnostic Classification of Korean Autism Spectrum Disorder

ObjectiveThe primary objective of this study was to predict subgroups of autism spectrum disorder (ASD) based on the Diagnostic Statistical Manual for Mental Disorders-IV Text Revision (DSM-IV-TR) by machine learning (ML). The secondary objective was to set up a ranking of Autism Diagnostic Interview-Revised (ADI-R) diagnostic algorithm items based on ML, and to confirm whether ML can sufficiently predict the diagnosis with these minimum items. MethodsIn the first experiment, a multiclass decision forest algorithm was applied, and the diagnostic algorithm score value of 1,269 Korean ADI-R test data was used for prediction. In the second experiment, we used 539 Korean ADI-R case data (over 48 months with verbal language) to apply mutual information to rank items used in the ADI diagnostic algorithm. ResultsIn the first experiment, the results of predicting in the case of pervasive developmental disorder not otherwise specified as “ASD” were almost three times higher than predicting it as “No diagnosis.” In the second experiment, the top 10 ranking items of ADI-R were mainly related to the quality abnormality of communication. ConclusionIn conclusion, we verified the applicability of ML in diagnosis and found that the application of artificial intelligence for rapid diagnosis or screening of ASD patients may be useful.     

DSM-5 Autism Spectrum Disorder: In search of essential behaviours for diagnosis

The objective of this study was to identify a set of ‘essential’ behaviours sufficient for diagnosis of DSM-5 Autism Spectrum Disorder (ASD). Highly discriminating, ‘essential’ behaviours were identified from the published DSM-5 algorithm developed for the Diagnostic Interview for Social and Communication Disorders (DISCO). Study 1 identified a reduced item set (48 items) with good predictive validity (as measured using receiver operating characteristic curves) that represented all symptom sub-domains described in the DSM-5 ASD criteria but lacked sensitivity for individuals with higher ability. An adjusted essential item set (54 items; Study 2) had good sensitivity when applied to individuals with higher ability and performance was comparable to the published full DISCO DSM-5 algorithm. Investigation at the item level revealed that the most highly discriminating items predominantly measured social-communication behaviours. This work represents a first attempt to derive a reduced set of behaviours for DSM-5 directly from an existing standardised ASD developmental history interview and has implications for the use of DSM-5 criteria for clinical and research practice.     

Atypical Lexical/Semantic Processing in High-Functioning Autism Spectrum Disorders without Early Language Delay

Although autism is associated with impaired language functions, the nature of semantic processing in high-functioning pervasive developmental disorders (HFPDD) without a history of early language delay has been debated. In this study, we aimed to examine whether the automatic lexical/semantic aspect of language is impaired or intact in these population. Eleven individuals with Asperger’s Disorder (AS) or HFPDD-Not Otherwise Specified (NOS) and age-, IQ-, and gender-matched typically developing individuals performed a semantic decision task in four conditions using an indirect priming paradigm. Semantic priming effects were found for near-semantically related word pairs in the controls, whereas this was not the case in the AS or HFPDDNOS participants. This finding suggests similarities in the underlying semantic processing of language across PDD subtypes.     

When does the Autism Spectrum Screening Questionnaire (ASSQ) predict autism spectrum disorders in primary school-aged children?

The aims of this study were, firstly, to study the association between parents’ and teachers’ ratings for the Finnish version of the Autism Spectrum Screening Questionnaire (ASSQ), secondly, to find out whether the original cut-off scores of the ASSQ identify primary school-aged children with Asperger syndrome (AS) or autism by using the Finnish ASSQ, and thirdly, to evaluate the validity of the ASSQ. Parents and/or teachers of higher-functioning (full-scale intelligence quotient ≥ 50) 8-year-old total population school children (n = 4,408) and 7–12-year-old outpatients with AS/autism (n = 47) completed the Finnish version of the ASSQ. Agreement between informants was slight. In the whole total population, low positive correlation was found between parents’ and teachers’ ratings, while in the sample of high-scoring children the correlation turned out to be negative. A cut-off of 30 for parents’ and teacher's summed score and 22 for teachers’ single score is recommended. A valid cut-off for parents’ single score could not been estimated. The clinicians are reminded that the ASSQ is a screening instrument, not a diagnosing instrument. The importance of using both parents’ and teachers’ ratings for screening in clinical settings is underlined.     

Educational Placements and Service Use Patterns of Individuals with Autism Spectrum Disorders

This project was undertaken to identify child characteristics associated with educational placement and service use in high-functioning children with autism spectrum disorders. The sample of 101 (nine females) had a mean age of 12 ± 3 years (mean IQ = 101.77 ± 19.50). Results indicate that lower-cognitive ability and communication skill were associated with placement in special education. Based on parent-report, most students stayed in the same placement (regular or special education) in which they began first grade and the majority of students received special services in their schools (most often speech/language intervention). Findings highlight the emphasis placed on certain child characteristics (e.g., cognitive ability), with far less emphasis on other areas (e.g., degree of social deficit), in educational placement and service provision.     

Executive Functioning in Children with an Autism Spectrum Disorder: Can We Differentiate Within the Spectrum?

The aim of this study was to investigate whether children with high-functioning autism (HFA), Asperger's syndrome (AS), and pervasive developmental disorder not otherwise specified (PDDNOS) can be differentiated from each other and from normal controls on their neurocognitive executive functioning (EF) profile. Children with HFA and AS showed the most EF deficits. The EF profile of the PDDNOS group was more disturbed that the normal control group, but was less disturbed than the profile of the HFA and AS groups. Little difference was found between the three PDD subtypes with respect to EF. This study supports the view that executive dysfunctioning plays an important role in autism. The usefulness of a distinction between different PDD subtypes was not demonstrated.