Plasma β-Endorphin, Adrenocorticotropin Hormone, and Cortisol in Autism

Plasma levels of the hypothalamo-pituitary-adrenal axis hormones β-endorphin (BE), adrenocorticotropin hormone (ACTH), and cortisol were measured in autistic (N = 48), mentally retarded/cognitively impaired (MR/CI, N = 16), and normal control (N= 26) individuals. Comparison of log transformed data from the three groups revealed that levels of BE and ACTH were significantly higher (p < .05) in the autistic individuals than in normal controls. The higher means in the autistic group were due to significantly higher plasma levels of BE and ACTH, indices of acute stress response, in the more severely affected individuals. The data support the idea that individuals with severe autism have a heightened response to acute stressors rather than chronic hyperarousal or elevated basal stress response system functioning.     

Autism in adults: symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood

BACKGROUND: Few studies have looked at the very long-term outcome of individuals with autism who were diagnosed in childhood. METHODS: A longitudinal, prospective, community-based follow-up study of adults who had received the diagnosis of autism (classic and atypical) in childhood (n = 105) was conducted. A structured interview (the Diagnostic Interview for Social and COmmunication disorders--the DISCO) was used in order to evaluate symptoms and symptom patterns 13-22 years after original diagnosis. Childhood measures, including IQ-level at time of childhood diagnosis and communicative speech registered before age 5 years, were studied in relation to the presence of autism symptoms at follow-up. RESULTS: The classical and atypical autism groups were fairly homogeneously impaired in terms of symptoms in the social interaction category whereas other common childhood autism symptoms, including maladaptive and stereotyped behaviours, were more variable in the study group at follow-up. Odd responses to sensory stimuli were still extremely common. Speech before 5 years of age, IQ, gender, diagnosed medical disorder and onset of epilepsy before 5 years were variables that correlated to outcome on the DISCO algorithm for autistic spectrum disorders (Wing & Gould, 1979) concerning style and quality of social interaction, communication style and pattern of self-chosen activities. CONCLUSIONS: Social interaction problems were still present in the vast majority of adults with autism/atypical autism, but behavioural impairments were much more variable in adulthood. Almost all cases were reported to show persistent perceptual problems. Certain childhood measures were found to prospectively predict adult social interaction style, communication type, and pattern of self-chosen activities, which still met diagnostic criteria for autism/atypical autism in adulthood.     

Social Understanding in Autism: Eye Gaze as a Measure of Core Insights

Twenty-eight children with autism and 33 MLD children were given two tasks tapping social understanding and a control task tapping probability understanding. For each task there was a measure of eye gaze (where children looked when anticipating the return of a story character or an object) and a verbal measure (a direct question). We found that eye gaze was better than verbal performance at differentiating children with autism from children with MLD. Children with autism did not look to the correct location in anticipation of the story character's return in the social tasks, but they did look to the correct location in the nonsocial probability task. We also found that within the autistic group, children who looked least to the correct location were rated as having the most severe autistic characteristics. Further, we found that whereas verbal performance correlated with general language ability in the autistic group, eye gaze did not. We argue that: (a) eye gaze probably taps unconscious but core insights into social behavior and as such is better than verbal measures at differentiating children with autism from mentally handicapped controls, (b) eye gaze taps either spontaneous processes of simulation or rudimentary pattern recognition, both of which are less based in language, and (c) the social understanding of children with autism is probably based mostly on verbally mediated theories whereas control children also possess more spontaneous insights indexed by eye gaze.     

Active epilepsy in mentally retarded children. I. Prevalence and additional neuroimpairments

A population-based study of active epilepsy was conducted in 6-13-year-old mentally retarded children born between 1975 and 1986. The population at risk comprised 48 873 children. Ninety-eight children were identified, 35 mildly and 63 severely retarded. The prevalence was 2.0 per 1000; 0.7 per 1000 for mildly and 1.3 per 1000 for severely retarded children. Sixty-nine children had at least one additional neuroimpairment. Cerebral palsy was found in 42 children with a majority of spastic/ dystonic tetraplegias; visual impairment was present in 24 and autism in 24. Thirty-three children had only a mild or no gross motor disability and mild mental retardation, while 23 had IQs <20 and a very severe gross motor disability. This study underlines the fact that active epilepsy in mentally retarded children is often associated with additional neuroimpairments, especially a combination of severe cerebral palsy and severe visual impairment. Children, epilepsy, mental retardation, neuroimpairments, prevalence     

Legal implications of sterilization of the mentally retarded

For more than 50 years, sterilization of mentally retarded persons was an accepted practice in many states as a way to reduce the number of persons born with mental defects. In recent years, the practice has come under heavy challenge, both medically and legally. At present, only 19 states have statutes that allow sterilizations for eugenic reasons. This article examines important court decisions regarding eugenic sterilization laws and the legal status of sterilization of mentally retarded adults and minors, as well as the consequent legal implications for physicians. Federal funding restrictions on sterilization of mentally impaired persons are discussed. The requirement of voluntary, informed consent is considered in light of an increasing emphasis on the rights of mentally retarded persons as well as greater awareness of the psychological effects of involuntary sterilization.     

The evaluation of reaction time on mentally retarded children

This study was designed to compare the parameters of reaction time on mentally retarded and healthy children and also to find out the effect of sport on reaction time. The study consisted of 20 non-retarded (group I), 20 non-sporting trainable mentally retarded (group II), and 20 sporting trainable mentally retarded (group III). The avarage age of subjects were determined as 15.35 +/- 0.21 years in group I, 15.00 +/- 0.22 years in group II, and 15.15 +/- 0.21 years in group III. The audiovisual reaction time of both non-retarded and retarded children were measured. It was found that reaction time is lower in trainable mentally retarded children (p < 0.05). It can be concluded that sport is a valid and effective means of training which affects the reaction time positively.     

A complex chromosome rearrangement in a boy with autism.

Autism is a rare behavioral phenotype defined by a qualitative impairment in reciprocal social interaction, impairment in communication and imaginative activity, and a markedly restricted repertoire of activities and interests. It is the most severe and prototypical form of the general category of Pervasive Developmental Disorders of Childhood. Using even strict diagnostic criteria, the currently described etiologies of autism are heterogeneous, with the majority of cases continuing to be idiopathic. At present, it is not clear whether autism is merely a behaviorally defined phenotype arising from diverse etiologies or a separate category of psychological dysfunction for which some unifying etiology exists. Complex chromosome rearrangements (CCR) are rare structural abnormalities involving at least three chromosomes and three or more break-points. We report a 6.5-year-old boy with classic infantile autism and a CCR involving chromosomes 1, 7, and 21. We discuss the possible relationship of his chromosome abnormality to the etiology of his autism.     

INFANTILE AUTISM AND OTHER CHILDHOOD PSYCHOSES IN A SWEDISH URBAN REGION. EPIDEMIOLOGICCAL ASPECTS

A total population screening of children born during 1962-1976 and living in the Gothenburg region at the end of 1980 was carried out in order to obtain prevalence figures for infantile autism and other childhood psychoses. It was found that the prevalence figure for infantile autism was 2.0 per 10,000 and for other childhood psychoses 1.9 per 10,000. Boys were much more often affected by infantile autism than girls. In the case of other psychoses, no such over-representation was seen. A majority of the children were mentally retarded, and only 4% had tested IQs exceeding 100. The results are in good agreement with the three earlier epidemiological studies concerned with childhood psychosis.     

Pediatricians' perceptions of mentally retarded individuals

Three hundred randomly selected members of the American Academy of Pediatrics were surveyed to determine their perceptions of mildly, moderately, and severely mentally retarded individuals. For each of the three categories of mental retardation, pediatricians completed the Prognostic Beliefs Scale which consisted of 27 functional capabilities and choices of residential and vocational placement. Of the 169 (56%) questionnaires returned, 142 (47%) were available for analysis. The pediatricians' perceptions were different for mildly, moderately, and severely retarded individuals. Most pediatricians believed mildly retarded individuals could do all but tasks requiring judgment, could function in unskilled competitive employment, and were likely to live in their own apartments. They believed that those with moderate retardation were limited in their capacity to simple and supervised tasks, could function in sheltered workshops, and were likely to live in group-home settings. They believed that severely retarded individuals were restricted to simple feeding tasks and following one-stage commands, were not capable of any productive employment, and would most likely live in institutions. Pediatric expectations and prognostications for placements were significantly lower than those of other professionals caring for mentally retarded individuals.     

Quality of survival after severe birth asphyxia.

Thirty-one children who survived severe birth asphyxia defined by a 1-minute Apgar score of 0, or a 5-minute Apgar score of less than 4, have been seen at age 5 to 10 years for neurological and psychological assessment. Their progress has been compared with that of controls matched for sex, birthweight, gestational age, and social class. 29(93%) of the 31 asphyxiated group and all the controls had no serious neurological or mental handicap. 2 were severely disabled and mentally retarded. Detailed studies of psychological function showed no significant differences between the two groups. 2 apparently stillborn infants have made normal progress. It was not possible to identify any perinatal factor which predicted the occurrence of serious handicap with certainty. We considered that the quality of life enjoyed by the large majority of the survivors was such as to justify a positive approach to the resuscitation of very severely asphyxiated neonates.     

Autism and mental retardation: a study of the early social communication]

OBJECTIVE: To determine developmental communication profiles in young autistic children with mental retardation. METHODS: A group of 19 autistic children (mean age=43 months) were matched with a group of 11 mentally retarded children (mean age=39 months) on mental age (17,6 months). All of these children were without speech (less than 5 words of vocabulary). Communication skills were assessed with the Guidetti-Tourrette scales (ECSP), French adaptation of the Seibert-Hogan scales. RESULTS: Autistic children displayed a much lower score than mentally retarded children in the 3 functions of early social communication (behavior regulation, social interaction and joint attention). The developmental communication profiles was the same in the 2 groups. DISCUSSION: The results showed evidence of distortion in autistic children development: they displayed important deficits in communication skills, in comparison with cognitive skills. Autistic children mainly displayed requesting gestures: they used adults to help them to reach a goal, instead of regarding them as social partners. However, young children who have mental age less than 18 months mainly use the same functions of communication, with or without autistic trouble. CONCLUSIONS: There is a same developmental sequence in communication skills in young children, with or without autistic trouble.     

Health pedagogic foster families. A model for the rehabilitation of handicapped children from families at-risk

Rehabilitation of retarded children puts an enormous strain on parents. Families with various social risk factors are frequently not able to cope with these problems. Admission to institutes is a frequent consequence. Since 1982 47 mentally and psychologically handicapped children from families with various psychosocial problems were admitted to foster families. Foster parents were carefully selected and educated by a team of physicians, psychologists and social workers and given continuing supervision. Children were evaluated by medical and psychological testing: The majority of children showed significant improvement of performance in psychologic testing, alleviation in their psychosocial as well as medical problems. Numbers and duration of hospital admissions were substantially reduced. The overall condition of these children was markedly improved by foster families.     

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.     

Resting cortical brain activity and social behavior in higher functioning children with autism

BACKGROUND: Psychophysiological measurement of processes related to social behavior may be valuable for research on individual differences and subgroups among children with autism spectrum disorders (Coleman, 1987; Dawson, Klinger, Panagiotides, Lewy, & Castelloe, 1995; Modahl et al., 1998). In particular, recent research and theory suggests that measures of resting anterior EEG asymmetry reflect complex brain processes associated with individual differences in approach or avoidance motivation that may be associated with social and emotional interaction tendencies among children with autism. METHOD: This hypothesis was examined in a study of the relations among resting anterior asymmetry, social impairment, and social anxiety in 23 high functioning children with autism (HFA) and 20 controls (age range 9-14 years). RESULTS: These groups were significantly different on the measures of anterior asymmetry, social symptoms and anxiety-related measures. Moreover, HFA children who displayed right frontal asymmetry (RFA group) displayed more symptoms of social impairments and better visual analytic skills than did children who displayed left frontal asymmetry (LFA group). Alternatively, while the LFA group displayed fewer symptoms of social impairment they also reported greater levels of social anxiety, social stress, and lower satisfaction with interpersonal relations than did the RFA group. CONCLUSIONS: These observations indicate that anterior EEG asymmetry may be a marker of motivation and emotion processes that refract the autism taxon into important individual differences in social presentation among higher functioning children.     

The clinical significance of multiple hair whorls and their association with unusual dermatoglyphics and dysmorphic features in mentally retarded Israeli children

The prevalence of multiple hair whorls in a group of mentally retarded patients was 8% as opposed to 3.6% in a group of healthy children. A statistically significant relationship was demonstrated between mental retardation, multiple hair whorls, more than two dysmorphic features, and unusual dermatoglyphics. The results confirm the importance of multiple hair whorls as a genuine dysmorphic feature. The significance of these markers in the evaluation of mentally retarded subjects is discussed, with special reference to the timing of the fetal insult.     

Biochemical screening in mental retardation

Biochemical screening of 3000 mentally retarded individuals led to the detection of 64 cases with metabolic defects comprising phenylketonuria, homocystimuria, histidinemia, Hartnup disease, Hurler syndrome, Hunter syndrome, hydroxy-prolinemia, Tay-Sach disease, kinky hair disease and Lesch-Nyhan syndrome. The largest number of cases of PKU reported from India originate from Karnataka state. The biochemical procedures found useful and reliable in screening for metabolic defects among the mentally retarded, as well as the newborn cases have been indicated. These include tests for detecting errors of metabolism in aminoacids, mucopolysaccharides, lipids and reducing substances.     

Difficulties of families with handicapped children after the Hanshin-Awaji earthquake

In order to clarify the difficulties which handicapped people experienced in the Hanshin-Awaji earthquake disaster, 678 families with handicapped children were studied 1.5 months after the earthquake. All the students who were enrolled in this study were going to some type of school or training classes for handicapped children in January 1995. The study was completed between 1 and 10 March. The questionnaires which were designed for this study consisted of three parts: the difficulties which the families were faced with, their requirements for social and medical services and the symptoms and reactions of their children after the earthquake. A total of 466 answers were obtained from their parents. The kinds of difficulties differed between the families of mentally retarded children and those of the physically handicapped. While many parents with physically handicapped children desired better medical information or materials, many parents with mentally retarded children wanted better care services for their children. Physical and psychological effects of the earthquake were only temporary in most cases. However, some of the handicapped children were still suffering from such reactions as of 10 March. From the results of our study it became evident that a systematic relief program for these handicapped people should be established. The relief program should include the distribution of information regarding medical and social services. Psychological reactions such as panic, excitement and suppression of mental activity were still observed in some handicapped children on 10 March. Further observation will therefore be necessary.     

Optimal outcome in individuals with a history of autism

Background: Although autism spectrum disorders (ASDs) are generally considered lifelong disabilities, literature suggests that a minority of individuals with an ASD will lose the diagnosis. However, the existence of this phenomenon, as well as its frequency and interpretation, is still controversial: were they misdiagnosed initially, is this a rare event, did they lose the full diagnosis, but still suffer significant social and communication impairments or did they lose all symptoms of ASD and function socially within the normal range? Methods: The present study documents a group of these optimal outcome individuals (OO group, n = 34) by comparing their functioning on standardized measures to age, sex, and nonverbal IQ matched individuals with high‐functioning autism (HFA group, n = 44) or typical development (TD group, n = 34). For this study, ‘optimal outcome’ requires losing all symptoms of ASD in addition to the diagnosis, and functioning within the nonautistic range of social interaction and communication. Domains explored include language, face recognition, socialization, communication, and autism symptoms. Results: Optimal outcome and TD groups’ mean scores did not differ on socialization, communication, face recognition, or most language subscales, although three OO individuals showed below‐average scores on face recognition. Early in their development, the OO group displayed milder symptoms than the HFA group in the social domain, but had equally severe difficulties with communication and repetitive behaviors. Conclusions: Although possible deficits in more subtle aspects of social interaction or cognition are not ruled out, the results substantiate the possibility of OO from autism spectrum disorders and demonstrate an overall level of functioning within normal limits for this group.     

Selbstverletzendes Verhalten bei Kindern mit intellektueller Beeinträchtigung

Self-injurious behavior like hitting, biting or head banging are common among mentally retarded children and/or children with developmental disorders. The frequently stereotyped behavior can cause serious tissue damage and is a major source of distress for parents and caring staff. Self-injury may originate for different reasons. Self-injurious behavior is one characteristic feature in several genetic syndromes. Many mentally retarded children use stereotypic self-injurious behavior as a means of self-regulation. In addition, social reinforcement processes play a major role in eliciting and maintaining the behavior. Assessment of self-injurious behavior focuses on identifying the factors that elicit and maintain the behavior. This behavioral problem can be effectively reduced by behavioral and pharmacotherapeutic interventions.