Patterns of autism spectrum symptomatology in individuals with Down syndrome without comorbid autism spectrum disorder

Background

Prevalence estimates of autism spectrum disorder (ASD) in Down syndrome (DS) are highly varied. This variation is partly due to the difficulty of screening for and diagnosing comorbid ASD in individuals with a syndrome that carries its own set of social communicative and behavioral difficulties that are not well documented. The aim of this study was to identify the typical range of social communicative impairments observed in children, adolescents, and young adults with DS who do not have comorbid ASD.

Methods

We examined patterns of scores from the five subscales of the Social Responsiveness Scale (SRS) in 46 individuals with DS (ages 10–21 years) without comorbid ASD relative to the published normative sample. We also explored the correlations between SRS symptomatology and age, nonverbal cognition, and receptive language.

Results

SRS scores were elevated (i.e., more ASD symptoms endorsed), with mean scores falling into the clinically significant range. Analysis by subscale revealed a specific pattern, with Autistic Mannerisms and Social Cognition scores significantly more elevated than Social Communication scores, which were significantly more elevated than Social Awareness and Social Motivation scores. Correlations between SRS scores and the other measures varied by subscale.

Conclusions

General elevated ASD symptomatology on the SRS indicates the need for developing population-based norms specific to DS. The pattern of scores across subscales should inform clinicians of the typical range of behaviors observed in DS so that individuals with atypical patterns of behavior can be more easily identified and considered for a full ASD evaluation.     

Trajectory of behavior and emotional problems in autism

High rates of behavior and emotional problems have been consistently reported in children and adolescents with autism. Elevated rates of mental health problems have also been reported in adults with autism. Little is known, however, about the longitudinal development of behavior and emotional problems in autism. This study followed a cohort of children and adolescents over 18 years. Outcomes were evaluated in terms of behavior and emotional problems and autism symptomatology. The role of childhood factors (age, gender, IQ, behavior, and emotional problems) and the environment (socioeconomic disadvantage) were considered in terms of adult outcomes. Overall, improvements in comorbid behavior and emotional problems and autism symptomatology were observed. However, rates of comorbid behavior and emotional problems in adulthood remained high.     

Patterns of adaptive behavior in very young children with autism

The Vineland Adaptive Behavior Scales were used to investigate patterns of adaptive behavior in children with autism who were under 36 months of age. Subjects were 30 children with autism and 30 children with developmental delay matched on CA and MA. Relative to controls, the autistic group demonstrated weaker socialization and communication skills and greater discrepancies between adaptive behavior and MA. Different patterns of relations between adaptive behavior domains and cognitive and language skills were obtained for the two groups. Preliminary support for the utility of adaptive behavior profiles in identifying subgroups of children with autism is provided. Results are discussed in terms of their implications for early diagnosis of autism.     

Behavioural problems and autism in children with hydrocephalus

Objective To investigate the prevalence of behavioural problems and autism in a population-based group of children with hydrocephalus and to see whether learning disabilities, cerebral palsy (CP), epilepsy, myelomeningocele (MMC) or preterm birth increase the risk of these problems. Method In the 107 children with hydrocephalus born in western Sweden in 1989–1993, behaviour was assessed using the Conners’ parent rating scales in 66 and the teacher’s rating scales in 57. Autism was investigated using the Childhood Autism Rating Scale. Results Parents rated 67% of the children and teachers 39% of the children as having behavioural problems (>1.5 SD, or T score >65). Learning disabilities increased the risk significantly and almost all the children with CP and/or epilepsy had behavioural problems. Autism was present in nine children (13%), in 20% of those without MMC and in one of 26 with MMC. Autism was significantly more frequent in children with learning disabilities (27% vs. 7%) and in children with CP and/or epilepsy (33% vs. 6%). Conclusion The majority of children with hydrocephalus have behavioural problems and many have autism. It is therefore important to assess and understand all the aspects of cognition and behaviour in these children in order to minimise disability and enhance participation for the child.     

Patterns of psychological problems in Parkinson's disease

OBJECTIVE: To identify patterns of psychological problems in Parkinson's disease (PD). METHOD: A sample of 3075 patients was surveyed to determine frequencies of psychological problems and cross-validated cluster analyses were computed to identify patterns of these problems. RESULTS: An increase of symptoms during arousal was reported by 68%, sleep disturbances by 32% of the sample, and sexual problems by 57% of men and 22% of women. Less frequently reported were difficulties in communicating (27%), needing help of others (38%), and depressive moods (20%). Four patterns of psychological problems were identified: general low stress, general high stress, sexual and social problems, and non-social problems. CONCLUSION: The study confirms the clinical observation that PD patients differ not only in degree, but also in structure of psychological stress. Social and non-social stress constitute principal types of stress experienced in PD. This distinction should be taken into account for any approach to support people with PD.     

Sixteen-year comparisons of parent-reported emotional and behaviour problems and competencies in Norwegian children aged 7–9 years

Abstract

Background: Studies about changes in the prevalence of emotional and behaviour problems across time are lacking, especially among younger children. Aim: To determine if the level of parent-reported emotional and behaviour problems and competencies in young Norwegian school children had changed across a 16-year time interval. Methods: We compared parent reports obtained by the Child Behavior Checklist in two samples of children aged 7–9 years from the general population assessed in 1991 and 2007. Results: The results demonstrated overall stability or slight decreases of emotional and behaviour problems and a significant increase in competencies, mainly due to increased activity and social competence scores in the 2007 sample. Boys obtained higher scores than girls in Total Problems, Externalizing and Attention problems at both time points and there was a high stability of the rank order of items. Conclusions: The findings suggest stability in child emotional and behaviour problems, and an increase of competencies across the period.     

Variables related to sleep problems in children with autism

Our study of 477 children with autism (1–15 years, IQs 9–146) showed that parent reported sleep problems are found in most children with autism and are not significantly related to age, IQ, gender, race, parent occupation, neuropsychological functioning, and learning ability. However, sleep problems increased with severity of autistic symptoms and with severity of parent reported symptoms known to be associated with autism (i.e., oppositional behavior, aggression, explosiveness, attention deficit, impulsivity, hyperactivity, anxiety, depression, and mood variability). This suggests that sleep disturbance is part of the autism symptom complex and increases with increasing autism severity. The strongest predictors of sleep disturbance were parent ratings of autism severity, hyperactivity, mood variability, and aggression. The most frequent sleep problems were difficulty falling asleep and restlessness during sleep. Daytime sleepiness was not significantly correlated with sleeping less than normal, but was associated with sleeping more than normal. Children who were sleepier during the day were also sleepier at night. Medical practitioners and clinicians should be aware of the risk of sleep disturbance in children with autism and should routinely screen for this. Empirically proven interventions (e.g., behavior therapy and melatonin) are available to improve sleep in children with autism.     

Assessment of feeding problems in children with autism spectrum disorder

There is growing, but inconsistent, literature on feeding problems for children with Autism Spectrum Disorder. The purposes of this study were to (a) investigate the relation of feeding problems to autism severity, (b) assess the validity of parent-report questionnaires widely used to assess feeding problems in terms of their relation to systematic behavior observations, and (c) determine the relation between child feeding behavior and family mealtime environment. Thirty-eight children and their parents participated in the study. Parents completed questionnaires, and both parents and children participated in mealtime observations. Results indicated that autism severity predicted scores on a measure of feeding problems as well as the duration of negative vocalizations during meal observations. Food Frequency Questionnaires better predicted behavior during meals than the Brief Mealtime Autism Behavior Inventory. Family environment alone did not explain feeding difficulties.     

Comorbidity of physical and motor problems in children with autism

Autism and the related pervasive developmental disorders are a heavily researched group of neurodevelopmental conditions. In addition to core symptoms, there are a number of other physical and motor conditions that co-occur at high rates. This paper provides a review of factors and behaviors that correlate highly with disorders on the autism spectrum. Among these conditions are premature birth, birth defects, gross and fine motor skills, and obesity. Each of these topics is addressed, and what researchers have found are presented. These data have important implications for the types of collateral behaviors that should be assessed and treated, along with the core symptoms of autism.     

Event-related potential response to auditory social stimuli,parent-reported social communicative deficits and autism risk in school-aged children with congenital visual impairment

Communication with visual signals, like facial expression, is important in early social development, but the question if these signals are necessary for typical social development remains to be addressed. The potential impact on social development of being born with no or very low levels of vision is therefore of high theoretical and clinical interest. The current study investigated event-related potential responses to basic social stimuli in a rare group of school-aged children with congenital visual disorders of the anterior visual system (globe of the eye, retina, anterior optic nerve). Early-latency event-related potential responses showed no difference between the VI and control group, suggesting similar initial auditory processing. However, the mean amplitude over central and right frontal channels between 280 and 320 ms was reduced in response to own-name stimuli, but not control stimuli, in children with VI suggesting differences in social processing. Children with VI also showed an increased rate of autistic-related behaviours, pragmatic language deficits, as well as peer relationship and emotional problems on standard parent questionnaires. These findings suggest that vision may be necessary for the typical development of social processing across modalities.     

Emotional and behavioural problems in children and young people with autism spectrum disorder in specialist autism schools

We investigated emotional and behavioural problems in a sample (N = 615) of children and young people with autism spectrum disorders (ASD), most of whom also had intellectual disability (ID), attending specialist autism schools. High rates of parent- and teacher-reported problems were recorded. Teacher-reported levels of hyperactivity were higher in younger children. Teacher- but not parent-reported levels of conduct problems and hyperactivity were highest in children without phrase speech. Greater use of mental health services was associated with higher levels of emotional and behavioural problems, but only a minority of participants had accessed mental health services in the previous 6 months.     

Screening for autism in extremely preterm infants: problems in interpretation

Aim The aim of this article was to report the prevalence of, and risk factors for, positive autism screens using the Modified Checklist for Autism in Toddlers (M‐CHAT) in children born extremely preterm in England. Method All children born at not more than 26 weeks' gestational age in England during 2006 were recruited to the EPICure‐2 study. At 2 years of age, postal questionnaires incorporating the M‐CHAT and additional developmental questions were sent to the parents of each survivor (n=1031; 499 male, 532 female), of which 523 (266 male, 257 female; 51%) were returned completed. Results The prevalence of positive M‐CHAT screens in this extremely preterm population was 41% (216/523; 130 male; 86 female). Severe bronchopulmonary dysplasia, administration of postnatal steroids, late‐onset bacteraemia, and being male were statistically significantly associated with a positive screen. Coexisting disabilities were present in 320 (62%) children. Of 200 children without disability, 16.5% screened positive. In contrast, 63 (95.5%) of those with severe motor impairment (odds ratio 42; 95% confidence interval [CI] 12.9–135) and 175 (55.9%) of those with cognitive impairment (odds ratio 5.3; CI 3.5–8) screened positive. All children with a significant vision or hearing impairment screened positive. Interpretation The prevalence of positive M‐CHAT screens in extremely preterm children is high, especially in children with neurodevelopmental impairment. Positive screens should be interpreted in the light of other neurodevelopmental sequelae in clinical practice to avoid false‐positive referrals.     

Sleep problems as possible predictors of intensified symptoms of autism

Researchers have been placing an increased importance on discovering what variables contribute to better prognosis during behavioral interventions for children with autism. This article preliminarily identifies sleep problems that may exacerbate symptoms of autism; thus, possibly influencing effectiveness of daytime interventions. A data-base of parent report of sleep problems of children with autism (N=55), ranging from 5 to 12 years of age (M=8.2 years) was evaluated. Results suggested that fewer hours of sleep per night predicted overall autism scores and social skills deficits. Similarly, stereotypic behavior was predicted by fewer hours of sleep per night and screaming during the night. Increased sensitivity to environmental stimuli in the bedroom and screaming at night predicted communication problems. Finally, sensitivity to environmental stimuli in the bedroom also predicted fewer developmental sequence disturbances. The results indicate that sleep problems and the diagnostic characteristics of autism may be related. However, future research must be completed to determine the specific relationship.     

Psychiatric problems of Chinese college students with high autism traits

Recent research has documented increased psychiatric problems in individuals who report elevated traits of autism spectrum disorder (ASD). However, most of the studies are conducted in Western countries, and suicidal behaviors in particular are scarcely examined in this population. The objective of the current study was to examine the prevalence of Chinese college students who surpassed a clinical cutoff for ASD, the correlations between ASD traits and psychiatric problems (i.e., depression, anxiety, obsessive-compulsive disorder [OCD], suicidal behaviors), and factors that possibly mediated the relations between ASD traits and suicidal behaviors. Results indicated that 1.50% of individuals in the sample surpassed the clinical cutoff score for ASD. Among this group who surpassed the clinical cutoff for ASD, severity of OCD symptoms was the highest among the measured psychiatric problems. ASD traits were significantly positively correlated with depression, anxiety, suicide ideation and plans, as well as OCD and its six dimensions (i.e., ordering, washing, hoarding, checking, obsession, and neutralizing). After controlling other psychiatric indicators, however, partial correlation analysis indicated that associations between ASD traits and suicide behaviors were no longer significant. Though, depression symptoms were found to mediate the link between the ASD traits and suicide ideation (for females and males) and suicide plans (for males only). Overall, these results provide a deeper insight into the characteristics of ASD traits, as well as the relationship between ASD traits and co-occurring psychiatric symptoms in a non-Western sample of Chinese college students.