Autism and developmental receptive language disorder--a comparative follow-up in early adult life. I: Cognitive and language outcomes

In this paper we compare adult outcome in a group of young men with autism and a group with developmental receptive language disorders. The two groups were first assessed in early childhood, when aged 7 to 8 years of age. Although matched at that time for nonverbal IQ (mean 92-93) and expressive language ability, the Autism group was significantly more impaired on most measures of social and communication skills and stereotyped behaviours. A later follow-up, in mid-childhood, suggested that although the groups were still quite distinct, social and behavioural problems had become more apparent in the Language group. The current study was completed when the participants were aged, on average, 23 to 24 years. The findings indicated that verbal IQ and receptive language scores had improved significantly more in the Autism group than in the Language group over time. Moreover, although the Language group were less severely impaired in their social use of language, many showed a number of abnormal features in this domain. There were no differences between the groups on tests of reading or spelling. Discriminant function analysis, which had clearly distinguished between the groups as children, now showed much greater overlap between them. Regression analysis indicated that although early language ability appeared to be related to outcome in the Autism group, in the Language group there was little association between measures of childhood functioning and later progress. The implications of these findings for understanding the nature of the underlying deficit in autism and the relationship between the two disorders are discussed.     

Prospective 10-year follow-up in adolescent anorexia nervosa--course, outcome, psychiatric comorbidity, and psychosocial adaptation

The aim of the present study was to follow up the long-term course of adolescent-onset anorexia nervosa by repeated assessment, to analyze the association between the course of the eating disorder and psychiatric comorbidity, and to evaluate psychosocial outcome. The sample consisted of 39 inpatients who were reinvestigated 3, 7, and 10 years after discharge. The patients and 39 controls matched for age, gender, and occupational status were assessed with structured interviews on DSM-III-R eating disorders, additional axis I and axis II psychiatric disorders, and psychosocial functioning. Results showed that 69 % of the original subjects met the criteria for full recovery at the 10-year follow-up. One patient (3%) still exhibited the full syndrome of restrictive anorexia nervosa, two patients (5%) the full syndrome of bulimia nervosa. None of the patients had died. Of the subjects, 51% currently had an axis I psychiatric disorder and 23% met the full criteria for a personality disorder. Apart from the eating disorder, anxiety disorders and avoidant-dependent and obsessive-compulsive personality disorders were the most common psychiatric diagnoses. There was a significant association between psychiatric comorbidity and the outcome of the eating disorder and between outcome and psychosocial adaptation. With regard to psychiatric morbidity and psychosocial functioning, long-term recovered patients did not differ significantly from normal controls. It is concluded that in most patients adolescent anorexia nervosa takes a prolonged course, although it seems to be more favorable than in adult-onset forms. Those who achieve complete recovery from the eating disorder have a good chance of overcoming other psychiatric disorders and to adapt to social requirements.     

Autism and developmental receptive language disorder--a follow-up comparison in early adult life. II: Social, behavioural, and psychiatric outcomes

This paper focuses on general social functioning in two groups of young men, one with autism and one with developmental receptive language disorders, who were first assessed at the ages of 7-8 years. At that time, although matched for nonverbal IQ (mean 92-93) and expressive language, the Language group showed significantly fewer social and behavioural problems. At follow-up, when aged on average, 23 to 24 years, the Autism group continued to show significantly more impairments in terms of stereotyped behaviour patterns, social relationships, jobs, and independence. However, problems in all these areas were also common in the Language group. Many still lived with their parents, few had close friends or permanent jobs, and ratings of social interaction indicated abnormalities in a number of different areas. On a composite measure of social competence only 10% of the Language group was assessed as having severe social difficulties compared to 74% of the Autism group. Nevertheless, 65% were rated as having moderate social problems and only 25% were rated as being of near/normal social functioning. Two individuals in the Language group, but none in the Autism group, had also developed a florid paranoid psychosis in late adolescence. As in the follow-up of cognitive and linguistic functioning (see Mawhood et al., 2000, this volume, pp. 547-559), discriminant function analysis, which had clearly distinguished between the groups as children, now showed much greater overlap between them. Regression analysis indicated that although early language ability appeared to be related to outcome in the Autism group, there was little association between any measures of childhood functioning and prognosis in the Language group. Theoretically, these findings have implications for our understanding of the nature of autism and other pervasive language disorders, and of the relationship between them. Practically, they demonstrate the very persistent problems experienced by individuals with developmental language disorders, and their need for much greater help and support than is presently available.     

Young adult academic outcomes in a longitudinal sample of early identified language impaired and control children

BACKGROUND: The long-term academic consequences of childhood language impairment are both theoretically and clinically important. An unbiased appraisal of these outcomes, however, requires carefully designed, longitudinal research. METHOD: A group of children first identified as having speech and/or language impairment in a community-based, longitudinal study at 5 years of age and matched controls were re-examined during young adulthood (age 19). A comprehensive battery of speech and language, cognitive and achievement tests, psychiatric interviews, and questionnaires were completed by subjects, their parents and teachers. RESULTS: While children with early speech problems showed only a few academic differences from controls in young adulthood, early language impaired (LI) young adults lagged significantly behind controls in all areas of academic achievement, even after controlling for intelligence. Further, rates of learning disabilities (LD) were significantly higher in the LI group than both the controls and community base rates. Concurrent individual difference variables, including phonological awareness, naming speed for digits, non-verbal IQ, verbal working memory, and executive function, all contributed unique variance to achievement in specific areas. CONCLUSION: Early LI rather than speech impairment is clearly associated with continued academic difficulties into adulthood. These results speak to the need for intensive, early intervention for LI youngsters.     

Show me the child at seven II: Childhood intelligence and later outcomes in adolescence and young adulthood

BACKGROUND: There has been ongoing interest in the role of intelligence in longer-term educational and occupational achievement and social adjustment. The aims of this study were to examine the extent to which IQ in middle childhood (8-9 years) was prognostic of future outcomes when due allowance was made for confounding personal and social factors. METHODS: Data were gathered on (WISC-R) IQ at ages 8-9 years and a range of educational and social adjustment measures over the course of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of 1,265 New Zealand children. RESULTS: IQ assessed at ages 8-9 years was related to a range of outcomes: later crime (offending, arrest/conviction); substance use disorders (nicotine dependence, illicit drug dependence); mental health (anxiety, suicidality); sexual adjustment (number of sexual partners, pregnancy); educational achievement (school leaving qualifications, tertiary qualifications); and occupational outcomes (unemployment, income). However, intelligence was largely unrelated to many of these outcomes: crime, mental health, sexual behaviours, and illicit substance dependence after statistical adjustment for early behaviour problems and family background. Strong relationships remained between childhood intelligence and later educational and occupational outcomes. CONCLUSIONS: Much of the association between early intelligence and later social adjustment is mediated by childhood conduct problems and family social circumstances. However, strong relationships exist between early intelligence and later academic achievement and income independently of these factors.     

Screening for minimal brain dysfunction (MBD/DAMP) at six years of age: results of motor test in relation to perinatal conditions, development and family situation

The aim of this study was to investigate if children aged 6 years of age, classified as having minimal brain dysfunction (MBD) or deficit in attention, motor control and perception (DAMP), exhibit special medical problems, specific developmental features or if special psychosocial conditions exist in the family. The screening program, using the psychoneurological part of the method developed by Gillberg et al., included 234 children who were followed-up prospectively from pregnancy and birth. The results were related to the physical and mental development of the children, to the psychosocial and socioeconomic conditions of the families, to pre- and postnatal conditions and to “reduced optimality score”, as defined by Prechtl. Mental development was assessed by the use of Griffiths' test at 10-14 months and at 4-5 years of age. At the second Griffiths' test, the mother was also interviewed about the presence of aggressiveness and other symptoms of childhood psychopathology in her child, as defined by the DSM-III criteria, and a psychological observation was also made. In addition to screening for MBD/DAMP, at 6 years of age the parents were asked to complete a questionnaire aimed at identifying attention deficit disorder (ADD). No medical or psychological intervention was made before this stage. Fourteen children (9M, 5F) (6%) were identified as having a positive MBD/DAMP screening result. The results of the screening procedure showed a weak correlation with those obtained using the questionnaire based on the DSM-III criteria for ADD. Compared with the rest of the children, those with a positive MBD/DAMP screening result had an increased number of complications during pregnancy but not a reduced optimality score. At 4 years of age the performance on the Griffiths' test was lower and the rate of child psychiatric symptoms such as aggressiveness and signs of the mother having difficulties in setting limits for the child were more common than among the rest of the cohort. No relation was found with the psychosocial or socioeconomic conditions of the family. We conclude that children suspected of having MBD/DAMP at the start of school may have exhibited signs of delayed psychoneurological development and symptoms of psychopathology at 4 years of age.