Deferred and immediate imitation in regressive and early onset autism

Deferred imitation has long held a privileged position in early cognitive development, considered an early marker of representational thought with links to language development and symbolic processes. Children with autism have difficulties with several abilities generally thought to be related to deferred imitation: immediate imitation, language, and symbolic play. However, few studies have examined deferred imitation in early autism. The present study examined both deferred, spontaneous imitation and immediate, elicited imitation on a set of carefully matched tasks in 36 young children with autism: 16 with early onset autism, 20 with regressive autism and two contrast groups, younger typically developing children ( n  = 20) and age matched children with significant developmental delays ( n  = 21). Analyses of co-variance controlling for differences in verbal mental age revealed significant main effects for task, but no main effect of group and no interaction of task by group. Deferred imitation scores were lower than immediate imitation scores for all groups. Imitation performance was related to overall intellectual functioning for all groups, and there were moderate and significant relations between imitation in the immediate elicited condition and in the spontaneous deferred condition for all groups. Finally, there were no differences between onset subgroups in imitation scores, suggesting that the two share a similar phenotype involving both types of imitation.     

Language abilities of siblings of children with autism

BACKGROUND: Language abilities of siblings of children with autism were examined to explore the possibility that language abilities are behavioral markers specific to the genetic liability for autism, as part of the broader phenotype. METHOD: Language abilities were compared among 27 siblings of children with autism, 23 siblings of children with mental retardation of unknown etiology (MR), and 22 siblings of children with developmental language disorders (DLD). Groups were matched by siblings' age, gender, birth order, family size, ethnicity, family income and by probands' gender and mental age. RESULTS: Siblings of children with autism achieved higher scores than siblings of children with DLD on receptive, expressive, and total language scales of the Children's Evaluation of Language Fundamentals and on verbal IQ. Moreover, within the DLD group, school problems in the domains of reading and arithmetic were more prevalent than within the other two groups. Only 2 siblings of children with autism received clinical diagnoses based on DSM-IV criteria compared to 3 siblings of children with MR and 7 siblings of children with DLD. CONCLUSIONS: After excluding data of the diagnosed siblings, no differences in language abilities could be discerned among the groups, except that more siblings in the DLD group were identified as having language difficulties. In summary, although language deficits characterize autism, siblings of children with autism were not found to demonstrate deficits in language skills assessed by formal language tests, IQ, or academic skills.     

Patterns of development in young children with autism

Objective: To determine the extent to which the developmental profile of children less than 4 years can help in distinguishing children with autism from children with developmental delay.Methods: Subjects were 32 children with autism as per the DSM IV criteria and 32 children with developmental delay matched on chronological and academic age. The Developmental Profile II was used to assess the developmental functioning in five domains including physical, social, self help, academic, and communication.Results: The two groups showed significantly different developmental profiles and these differences were accounted for mainly by significantly lower social skills and superior motor skills in the autistic group as compared to the developmentally delayed group.Conclusion: Developmental Profile II may help in distinguishing young children with autistic disorder from non-autistic children with comparable developmental delays     

Regression in autism: prevalence and associated factors in the CHARGE Study.

OBJECTIVE: The aim of this study was to examine the prevalence of regressive autism and associated demographic, medical, and developmental factors by using 2 different definitions of regression based on the Autism Diagnostic Interview, Revised. METHODS: Subjects were aged 2 to 5 years, with autism (AU) or autism spectrum disorder (ASD) confirmed by standardized measures. Children with regression, defined as a) loss of both language and social skills or b) loss of either language or social skills, were compared with each other and to children with AU or ASD with no reported loss of skills on developmental and adaptive functioning. Parents reported on seizure, gastrointestinal, and sleep concerns. RESULTS: Fifteen percent (50/333) of the combined AU-ASD group lost both language and social skills; 41% (138/333) lost either language or social skills. No differences were found between the 2 samples of children with regression. Few developmental, demographic, or medical differences were found between the combined regression group and children without loss of skills, in both the larger AU-ASD sample and the more homogeneous AU-only sample. Children with regression had significantly lower communication scores than children without regression. CONCLUSIONS: The prevalence of regression in a large sample of young children with AU and ASD varies depending on the definition used; requiring loss of language significantly underestimates the frequency of developmental regression. Children with regression performed significantly less well than those without regression on 2 measures of communication, but the clinical meaningfulness of these differences is uncertain because of the small effect sizes.     

Cognitive profiles and social-communicative functioning in children with autism spectrum disorder

BACKGROUND: Whether there is an unusual degree of unevenness in the cognitive abilities of children with autism spectrum disorder (ASD) and whether different cognitive profiles among children with ASD might index etiologically significant subgroups are questions of continued debate in autism research. METHOD: The Differential Ability Scales (DAS) and the Autism Diagnostic Observation Schedule (ADOS) were used to examine profiles of verbal and nonverbal abilities and their relationship to autistic symptomatology in 120 relatively high-functioning children with ADI-confirmed diagnoses of autism. RESULTS: Discrepancies between verbal and nonverbal ability scores occurred at a significantly higher rate than in the DAS normative sample (30%) in both a younger group of 73 children (56%) with a mean age of 5;5 and an older group of 47 children (62%) with a mean age of 8;11. Discrepancies were mainly in favor of nonverbal ability in the younger group, but occurred equally in favor of verbal and nonverbal abilities in the older group. Comparison of the two age groups suggested a growing dissociation between verbal and nonverbal (and particularly visual processing) skills with age. In the older group, children with discrepantly higher nonverbal abilities demonstrated significantly greater impairment in social functioning, as measured on the ADOS, independent of absolute level of verbal and overall ability. CONCLUSIONS: These findings demonstrate a high rate of uneven cognitive development in children with ASD. Indications of a dissociation between verbal and visual-perceptual skills among the older children, and the specific association of discrepantly high nonverbal skills with increased social symptoms suggest that the nonverbal > verbal profile may index an etiologically significant subtype of autism.     

300例语言障碍儿童的智能发育水平分析

目的 了解语言障碍儿童的智能发育特征。方法 对300例语言障碍儿童进行Gesell发育量表评估,了解其运动能、应物能、言语能、应人能4个能区的发育商。结果 300例儿童的运动能平均发育商正常,应物能、言语能及应人能平均发育商均低于正常。运动能、应物能、应人能异常的比例分别为31.0%、49.0%、52.7%。言语能发育商与其他3个能区发育商显著正相关 （r分别为0.506、0.644、0.711,P < 0.01）。结论 语言障碍儿童往往不是单纯的语言落后,而是常伴随运动能力、适应行为及社交行为等方面的落后,应对其进行诊断性的智能发育评估并对伴随的其他发育异常问题进行全面干预。     

Predictors of outcome among high functioning children with autism and Asperger syndrome

BACKGROUND: The objective of this paper is to assess the extent to which measures of cognitive abilities taken in an inception cohort of young high functioning children with autism and Asperger syndrome predict outcome roughly two and six years later. METHOD: Children who received a diagnosis of autism or Asperger syndrome (AS) and who had a nonverbal IQ score in the 'non-retarded' range were included in the inception cohort. Measures of language and nonverbal skills were taken when the children were 4-6 years of age and outcome assessments were completed when the children were 6-8 and 10-13 years of age. The three outcome measures consisted of scales of adaptive behaviours in socialisation and communication and a composite measure of autistic symptoms (abnormal language, abnormal body and object use, difficulties relating to others, sensory issues and social and self-help difficulties). RESULTS: The explanatory power of the predictor variables was greater for communication and social skills than for autistic symptoms. The power of prediction was stable over time but did differ by PDD subtype. In general, the association between language skills and outcome was stronger in the autism group than in the AS group. CONCLUSIONS: These results support the emphasis of early intervention programmes on language but more work needs to be done on understanding variables that influence outcome in social skills and autistic behaviours, particularly in those with AS.     

孤独症患儿婴儿时期的行为特征研究

目的：探讨孤独症患儿的早期特征性行为,为早期诊断提供依据。方法：采用回顾性调查方法对30例孤独症患儿及26例其他发育迟缓患儿在婴儿期的异常行为进行调查分析。结果：孤独症在婴儿时期以没有社交微笑、没有目光对视,对环境反应淡漠,很难用声音、动作或玩具吸引患儿的注意,叫其名字没有反应等症状明显区别于发育迟缓患儿(P<0.01);模仿、依恋行为差异有显著性(P<0.01或P<0.05);刻板动作及兴趣怪异仅见于孤独症患儿,但发生率较低。结论：孤独症在婴儿期即表现出许多特异性症状,表明孤独症多起病于生后早期,这些症状不同于其他智力发育迟缓患儿,对于孤独症的早期识别具有重要意义。     

Play and imitation skills in the diagnosis of autism in young children

Play behaviors and motor imitation skills of 91 children between the ages of 3 and 6 years were investigated to determine their utility in distinguishing autism from mental retardation and other communication disorders. The performance of 22 autistic children was compared with that of 15 mentally retarded, 15 hearing-impaired, 19 language-impaired, and 20 non-handicapped children. Play behaviors were assessed using structured observations of free-play activities, and imitation skills were measured using a set of 12 individually administered tasks. The autistic group spent less total time interacting with toys and using toys appropriately, engaged in fewer functional play acts, and obtained lower imitation scores compared with all other groups. Discriminant function analysis revealed that the latter three variables discriminated the autistic children from the nonautistic handicapped children, with motor imitation emerging as the most important differentiating measure. These results suggest that measuring play and imitation skills may be useful in the clinical diagnosis of autism.     

Continuity and change from early childhood to adolescence in autism

BACKGROUND: This longitudinal study of 48 children diagnosed with autism at 2-5 years of age was designed to test the hypothesis that diagnosis would remain stable for most of the sample but that there would be improvements in symptom severity, adaptive behavior, and emotional responsiveness in adolescence. METHODS: A sample of children with autism assessed in both early and middle childhood were observed in late adolescence with the Autism Diagnostic Observation Scale (ADOS) and their parents were administered the Autism Diagnostic Interview-Revised (ADI-R) and the Vineland Adaptive Behavior Scale. RESULTS: All but 2 adolescents (46 of 48) met lifetime criteria for autism according to the ADI-R, and all but 4 adolescents (40 of 44) met criteria for autism spectrum disorder on the ADOS. In contrast to the continuity in diagnosis, parents described improvements in social interactions, repetitive/stereotyped behaviors, adaptive behaviors, and emotional responsiveness to others' distress in adolescence compared to middle childhood. High-functioning adolescents with autism showed more improvement in these domains than low-functioning adolescents with autism. The extent to which the adolescents were observed to be socially engaged with their peers in school in middle childhood predicted adaptive behavior skills even when intelligence level was statistically constrained. CONCLUSIONS: The developmental trajectory of children with autism appears to show both continuity and change. In this sample, most individuals continued to be diagnosed in the autism spectrum but parents reported improvements in adolescence. The results suggest that social involvement with peers improves adaptive behavior skills, and this argues for focusing intervention programs in this area. In addition, it is clear that high-functioning adolescents improve more than low-functioning individuals not only in cognitive abilities but also in social interaction skills. Thus, any early intervention that impacts the cognitive abilities of young children with autism is likely to have a parallel influence on their social skills as they mature into late adolescence and early adulthood.     

Are language and social communication intact in children with congenital visual impairment at school age?

Background: Development of children with congenital visual impairment (VI) has been associated with vulnerable socio‐communicative outcomes often bearing striking similarities to those of sighted children with autism. 1 To date, very little is known about language and social communication in children with VI of normal intelligence. Methods: We examined the presentation of language and social communication of 15 children with VI and normal‐range verbal intelligence, age 6–12 years, using a standardised language assessment and parental reports of everyday social and communicative behaviours. Their profiles were compared to those of typically developing sighted children of similar age and verbal ability. Results: Compared to their sighted peers, and relative to their own good and potentially superior structural language skills, children with VI showed significantly poorer use of language for social purposes. Pragmatic language weaknesses were a part of a broader socio‐communicative profile of difficulties, present in a substantial proportion of these children and consistent with the pattern found in sighted children with autism. Conclusions: There are ongoing socio‐communicative and pragmatic language difficulties in children with congenital VI at school age, despite their good intellectual abilities and advanced linguistic skills. Further research is required to unpack the underlying causes and factors maintaining this vulnerability in such children.     

The Carter Neurocognitive Assessment for children with severely compromised expressive language and motor skills

In this paper, different means of assessing cognitive development in children with severe impairments in both their expressive language and their motor skills are reviewed. A range of techniques are considered, including traditional cognitive tests and behavioral and physiological measures, but these techniques are generally impractical and minimally informative when it comes to assessing children with both motor and speech impairments. Electrophysiological measures show some promise for the future, but are currently inadequate for wide-ranging cognitive assessment. Development of the Carter Neurocognitive Assessment (CNA) is described. The CNA is appropriate for use in clinical and research settings and was designed to minimalize the impact of severely impaired motor skills and expressive language on performance. The CNA is intended to itemize and quantify a range of skills reflecting a cognitive level up to approximately 18 to 24 months in four areas: Social Awareness, Visual Attention, Auditory Comprehension and Vocal Communication. The use of the CNA to assess the performance and developmental growth of eight children with Holoprosencephaly (HPE), a midline developmental brain malformation, is described. The CNA is a useful tool for the assessment of children with severely compromised motor and verbal skills and has provided a more positive view of the cognitive potential of children with severe handicaps, such as the sample of children with HPE, than that presented in the past.     

The Emanuel Miller Memorial Lecture 1997: Change and Continuity in the Development of Children with Autism

The developmental approach to childhood psychopathology identifies deviations from typical patterns of development and stability of individual characteristics over time, and precursors in early life of later functions. The application of this approach to the social, communicative, and cognitive development of children with autism is discussed. Results from a longitudinal study of children with autism and other developmental disorders are described, indicating that children with autism have stable deficits in joint attention, representational play, and responsiveness to the emotions of others, and that early variations in these abilities are important for concurrent and subsequent language development and for peer engagement many years later.     

Play therapy in children with autism: Its role,implications, and limitations

Play is a pleasurable physical or mental activity that enhances the child’s skills involving negotiation abilities,problem-solving,manual dexterity,sharing,decision-making,and working in a group.Play affects all the brain’s areas,structures,and functions.Children with autism have adaptive behavior,adaptive response,and social interaction limitations.This review explores the different applications of play therapy in helping children with autism disorder.Play is usually significantly impaired in c...     

Relations entre particularités sensorielles et imitation chez les enfants TSA de 3 à 5 ans

ObjectiveAutism Spectrum Disorder (ASD) is a neuro-developmental disorder resulting on atypical cognitive development characterized by communication and language disorders, restricted behaviors and sensory abnormalities, present in the most of subjects. These abnormalities cause many disorders, including motor and sensory-motor troubles. Imitation, which is characterized by the coordination between a visually perceived behavior and actively produced behavior, is in this perspective, a sophisticated sensory-motor coordination. It is strongly troubled in children with ASD, with significant negative effects on their future socio-communicative development. The aim of this research is to determine if imitation disorders increase with the number of sensory abnormalities.MethodsTwenty-two children (18 boys), aged from 3 to 5 years, were included in this study. Autism was assessed by the Chilhood Autism Rating Scale (CARS) and the Autism Diagnostic Observation schedule (ADOS). Dunn's Sensory and Revised Perceptual Profile was administered to determine the sensory profile for five senses: visual, auditive, tactile, proprioceptive and vestibular. Four types of imitation were evaluated: facial, motor, vocal and object. Statistical analyzes were conducted on the different scores obtained.ResultsAll children with autism have sensory abnormalities and imitation disorders. The more the children have sensory particularities, especially visual, the more their imitation skills are weak, especially in facial imitation. Imitation on object, conversely, seems less impacted.ConclusionThe sensory abnormalities could constitute a screen to the realization of the imitative tasks, by preventing the children to reach the social dimension of the imitation for example. These results illustrate the need to take into account these sensory features in specific care.     

Catatonia in a child with autistic disorder

Catatonia is a cluster of motor features that appears in many recognized psychiatric illnesses. It is being increasingly reported in individuals with autism, a disorder characterized by impaired reciprocal social interactions, aberrant language development and restricted behavioral repertoire. However, relatively little is known about the presentation and treatment of catatonia in children with autism. We describe herein an 11-year-old pediatric case with autism who developed catatonic symptoms and was treated effectively with lorazepam. The case reported here differs from previously reported cases in terms of age of onset and the display of all characteristics of catatonia as defined in the Diagnostic and Statistical Manual of Mental Disorders (4th ed) (DSM-IV). In addition, although it was stated that catatonia in autism is commonly associated with impaired language and social passivity, our case is an active verbal individual.     

Trajectoires développementales des différentes formes d’imitation et de leurs relations avec le développement cognitif et communicatif chez des enfants présentant un TSA

ObjectiveThe idea of a global imitation deficit in autism has existed for many years. Actually, a growing body of research is nuancing this idea by showing that even children with the most severe autistic profiles are able to imitate under certain conditions. However, we do not yet have longitudinal data on the developmental trajectories of different forms of imitation in children with ASD. So, the aim of the present study is: 1) to investigate the developmental trajectories of spontaneous imitation, elicited imitation, and imitation recognition in children with ASD; 2) to identify intra-individual factors associated with measured imitative performance; and 3) to examine the relationships between each of the three forms of imitation assessed and cognitive and communicative development.MethodsFourteen children with ASD aged between 3 years 8 months and 9 years 4 months were included in this study. A longitudinal experimental design involving three measurement times over a 16-month period was implemented. Nadel's imitation scale was used to assess spontaneous imitation, elicited imitation and imitation recognition. The Psycho-Educational Profile and the Snijders-Oonen non-verbal intelligence test were administered to assess cognitive and communicative development.ResultsChildren made significant progress over time on each of the three components of imitation, although we noted a heterogeneity of the developmental trajectories. The greatest gains were in elicited imitation. Motor skills, cognitive level and intensity of autistic behaviors at the beginning of the study significantly correlated with children's later imitative skills. Chronological age, however, was not. Cognitive and communicative development correlated more strongly with spontaneous imitation and imitation recognition than with elicited imitation.ConclusionRegardless of their age, children with ASD can progress in different forms of imitation. This underlines the value of regularly evaluating their skills in this area, in particular to offer them an individualized training program. On this point, our results illustrate the need not to train exclusively elicited imitation, but also to support communication through imitation.     

Loss of language in early development of autism and specific language impairment

Background: Several authors have highlighted areas of overlap in symptoms and impairment among children with autism spectrum disorder (ASD) and children with specific language impairment (SLI). By contrast, loss of language and broadly defined regression have been reported as relatively specific to autism. We compare the incidence of language loss and language progression of children with autism and SLI. Methods: We used two complementary studies: the Special Needs and Autism Project (SNAP) and the Manchester Language Study (MLS) involving children with SLI. This yielded a combined sample of 368 children (305 males and 63 females) assessed in late childhood for autism, history of language loss, epilepsy, language abilities and nonverbal IQ. Results: language loss occurred in just 1% of children with SLI but in 15% of children classified as having autism or autism spectrum disorder. Loss was more common among children with autism rather than milder ASD and is much less frequently reported when language development is delayed. For children who lost language skills before their first phrases, the phrased speech milestone was postponed but long‐term language skills were not significantly lower than children with autism but without loss. For the few who experienced language loss after acquiring phrased speech, subsequent cognitive performance is more uncertain. Conclusions: Language loss is highly specific to ASD. The underlying developmental abnormality may be more prevalent than raw data might suggest, its possible presence being hidden for children whose language development is delayed.     

Social and emotional adjustment of siblings of children with autism

BACKGROUND: Social and emotional adjustment of siblings of children with autism was examined, to explore their risk or resilience to effects of genetic liability and environmental factors involved in having a sibling with autism. METHOD: Social-emotional adjustment, behavior problems, socialization skills, and siblings' relationships were compared among 30 siblings of children with autism, 28 siblings of children with mental retardation of unknown genetic etiology (MR), and 30 siblings of children with developmental language disorders (DLD). Groups were matched by probands' gender, siblings' chronological age, gender, IQ, and birth order, and by family size, ethnicity, and parental income, employment, and stress level. RESULTS: Four siblings of children with autism, three siblings of children with MR, and seven siblings of children with DLD received DSM-IV diagnoses. Nevertheless, most of the siblings were well adjusted. CONCLUSIONS: The adjustment of siblings of children with autism is in sharp contrast to the severe social and emotional disabilities characteristic of autism, and is noteworthy considering the stress involved in having a sibling with autism.     

氧化应激与孤独症

孤独症是一种复杂的神经发育障碍性疾病,以社会交往障碍、语言交流障碍和刻板重复行为等为特征.研究表明,氧化应激与孤独症发病密切相关.基因与环境因素共同导致孤独症的氧化应激易患性.氧化应激通过膜脂代谢异常、炎症反应和兴奋毒性损伤、过度免疫以及能量代谢障碍等机制引发孤独症.抗氧化治疗是一种安全有效的治疗孤独症的方法.