A systematic review of the diagnostic stability of Autism Spectrum Disorder

There is debate in the current literature regarding the permanence of an Autism Spectrum Disorder (ASD) diagnosis. We undertook a systematic review of the diagnostic stability of ASD to summarise current evidence. A comprehensive search strategy was used to identify studies. Participants were children with ASD. Risk of bias was assessed by examining the sample selected, recruitment method, completeness of follow up, timing of diagnosis and blinding.Twenty three studies assessed diagnostic stability with a total of 1466 participants. Fifty three to100% of children still had a diagnosis of Autistic Disorder (AD) and 14-100% of children still had a diagnosis of another form of ASD at follow up. There is some evidence that Autistic Disorder is a reasonably stable diagnosis; however a significant minority of children will no longer meet diagnostic criteria after a period of follow up, particularly those diagnosed in the preschool years with cognitive impairment. Other Autism Spectrum Disorders have very variable stability between studies and clinicians when using this diagnosis need inform parents of its instability. This study supports the stricter diagnostic criteria in DSM-V. There is a need for long term, large population cohort studies measuring diagnostic stability.     

Brief Report: Outcomes of a Teacher Training Program for Autism Spectrum Disorders

In this study a teacher training program for Autism Spectrum Disorders (ASD), based on “structured teaching” (Mesibov et al., The TEACCH approach to autism spectrum disorders, 2006) was developed and evaluated within a Pre–Post design. In total, 10 teachers working with 10 students with ASD (mean age 10.0 years) in special education classrooms in Germany were involved in the training, The Pre–Post outcomes measured by teacher questionnaires indicated significant improvement on the Classroom Child Behavioral Symptom Scale as well as on the corresponding Classroom Teachers’ Stress Reaction Scale. In addition, teachers implemented two structured teaching methods on average in their classrooms. These findings provide some first evidence for the clinical and social validity of the training program examined.     

Final DSM-5 under-identifies mild Autism Spectrum Disorder: Agreement between the DSM-5, CARS,CASD, and clinical diagnoses

Agreement between the final DSM-5 ASD criteria, Childhood Autism Rating Scale (CARS), and Checklist for Autism Spectrum Disorder (CASD) was assessed in 143 children with ASD and other disorders (e.g., ADHD, intellectual disability, and oppositional defiant disorder). Diagnostic agreement between the CARS and CASD was high (94%), but their agreement with the DSM-5 was lower (84% and 88%). Agreement between the DSM-5 and both the CARS and CASD increased to 94% and diagnostic accuracy increased from 92% to 96% when one less DSM-5 social communication and interaction symptom was required for a diagnosis. Children with ASD not meeting DSM-5 criteria most often did not have criterion A2 (deficits in nonverbal social communication). Total scores on the DSM-5, CASD, and CARS were far higher for children with mild ASD (formerly PDDNOS) than no ASD, indicating that these children are clearly on the autism spectrum and are quite different from children with other disorders. However, only one child with mild ASD was identified by the DSM-5. This study and 11 others show that the DSM-5 under-identifies children with ASD, particularly children at the mild end of the spectrum. This can be rectified by requiring one less social communication and interaction symptom for a diagnosis.     

Autism spectrum disorder and vitamin D status: A cross-sectional study of children in a developing country in Southeast Asia

BackgroundDetermine the prevalence and risk factors of vitamin D deficiency (<35 nmol/L) in children with autism spectrum disorder (ASD); and explore the association between vitamin D deficiency with ASD severity and behavioural symptoms.MethodCross-sectional study of children with ASD at a tertiary hospital. Children with vitamin D deficiency (<35.0 nmol/L) were treated (1200IU cholecalciferol, daily for 3 months). ASD severity was determined via the Childhood Autism Rating Scale, 2nd Edition (CARS-2); and behavioural symptoms via the Aberrant Behaviour Checklist, 2nd Edition (ABC-2). Scores were compared between the vitamin D deficient and non-deficient groups.ResultsThere were 103 participants (85.4 % male). Mean age: 6.2 years (SD = 2.4), 19 % were vitamin D deficient and 42 % were insufficient. Mean vitamin D concentration was 45.8 nmol/L (SD = 13.5). Female gender was significantly associated with vitamin D deficiency (OR 5.05, 95 % CI: 1.56, 16.31, p = 0.007). Post-vitamin D treatment, there was a significant reduction in CARS-2 scores (p < 0.05), but not ABC-2 scores.ConclusionsNearly two-thirds (61 %) of Malaysian children with ASD have vitamin D deficiency (19 %) and insufficiency (42 %). Vitamin D treatment among vitamin D deficient children with ASD resulted in improvement in ASD symptom severity but not behavioural symptoms.     

Brief Report: Imitation of Meaningless Gestures in Individuals with Asperger Syndrome and High-functioning Autism

Nineteen people with Asperger syndrome (AS)/High-Functioning Autism (HFA) (ages 7–15) were tested on imitation of two types of meaningless gesture: hand postures and finger positions. The individuals with AS/HFA achieved lower scores in the imitation of both hand and finger positions relative to a matched neurotypical group. The between-group difference was primarily accounted for by performance on a test of visual motor integration, together with a hand imitation deficit which was specifically due to errors in body part orientation. Our findings implicate both visuomotor processes (Damasio and Maurer, 1978) and self-other mapping (Rogers and Pennington, 1991) in ASD imitation deficits. Following Goldenberg (1999), we propose that difficulties with body part orientation may underlie problems in meaningless gesture imitation.     

Treating Anxiety Disorders in Children with High Functioning Autism Spectrum Disorders: A Controlled Trial

A family-based, cognitive behavioural treatment for anxiety in 47 children with comorbid anxiety disorders and High Functioning Autism Spectrum Disorder (HFA) was evaluated. Treatment involved 12 weekly group sessions and was compared with a waiting list condition. Changes between pre- and post-treatment were examined using clinical interviews as well as child-, parent- and teacher-report measures. Following treatment, 71.4% of the treated participants no longer fulfilled diagnostic criteria for an anxiety disorder. Comparisons between the two conditions indicated significant reductions in anxiety symptoms as measured by self-report, parent report and teacher report. Discussion focuses on the implications for the use of cognitive behaviour therapy with HFA children, for theory of mind research and for further research on the treatment components.     

Attention and basic literacy and numeracy in children with Autism Spectrum Disorder: A one-year follow-up study

Little is known about the link between Executive Functioning (EF) and academic performance in children with Autism Spectrum Disorder (ASD) and how such links develop over time. This study examined word reading, basic mathematics, attention switching, sustained attention and their development. Two age, gender and perceptual IQ matched groups of cognitively able 7–12 year olds (ASD N = 40; typical developing [TYP] N = 40) were assessed at baseline and one year later, completing Word Reading and Numerical Operations tests and computerized tasks tapping attention switching and sustained attention. Children with ASD had similar word reading and numerical operations performance and similar development of these skills relative to TYP children. A delay in attention switching but similar development was found in children with ASD relative to TYP children. The EF tasks were correlated with reading and mathematics in ASD children only, however, in regression analyses these factors were not significant predictors of Time 2 reading and mathematics after accounting for Time 1 reading and mathematics scores. These findings indicate similar word reading and mathematics development but atypical attention profiles in cognitively able children with ASD. Implications for educators are discussed.     

Predictors of persistence in girls with attention deficit hyperactivity disorder: results from an 11-year controlled follow-up study

OBJECTIVE: This study sought to examine the age-dependent persistence of attention deficit hyperactivity disorder (ADHD) and its predictors in a large sample of girls with and without ADHD followed prospectively for 11 years into young adulthood. METHOD: Participants were girls with (N=96) and without (N=91) ADHD and were 6-17 years old at the baseline assessment (mean age, 11 years) and 15-30 years old at the follow-up assessment (mean: 22 years). Participants were comprehensively and blindly assessed with structured diagnostic interviews and assessments of cognitive, social, school, and family functioning. Results: At the 11-year follow-up, 33.3% met full criteria for ADHD, 29.2% showed partial persistence of the disorder, 10.4% had impaired functioning, and 4.2% were remitted but treated (77.1% of the sample). Predictors of persistence were psychiatric comorbidity, family history of psychopathology, and family and school functioning at baseline. Conclusion: These long-term, prospective, follow-up findings extend to girls findings that ADHD is persistent over the long term and can be predicted from psychosocial adversity and psychiatric comorbidity ascertained 11 years earlier.     

Autism Diagnostic Interview-Revised and the Childhood Autism Rating Scale: convergence and discrepancy in diagnosing autism

The agreement between the Autism Diagnostic Interview–Revised (ADI-R) and the Childhood Autism Rating Scale (CARS) was investigated in the diagnostic assessment of 54 children aged 22–114 months referred for possible autism. The observed agreement between the two systems was 66.7% (Cohen's kappa = .40) when the ADI-R definition for autism was applied (i.e., scores reaching cutoff in three domains on the ADI-R), but increased considerably with less stringent criteria; that is, scores reaching cutoffs in two domains and in one domain on the ADI-R. As predicted, the CARS identified more cases of autism than the ADI-R. Children classified as autistic according to both instruments had significantly lower IQ/DQ and more severe autistic symptomatology than those classified with the CARS only.     

Autism spectrum disorder symptoms in children with ADHD: A community-based study

This study examined the prevalence of autism spectrum disorder (ASD) symptoms in a community-based sample of children with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD controls. We also examined the relationship between ASD symptoms and ADHD subtype, ADHD symptom severity and child gender. Participants were 6–10-year-old children (164 ADHD; 198 non-ADHD control) attending 43 schools in Melbourne, Australia, who were participating in the Children's Attention Project. ADHD was assessed in two stages using the parent and teacher Conners’ 3 ADHD index and the Diagnostic Interview Schedule for Children IV (DISC-IV). ASD symptoms were identified using the Social Communication Questionnaire (SCQ). Unadjusted and adjusted linear and logistic regression examined continuous and categorical outcomes, respectively. Children with ADHD had more ASD symptoms than non-ADHD controls (adjusted mean difference = 4.0, 95% confidence interval (CI) 2.8; 5.3, p < 0.001, effect size = 0.7). Boys with ADHD had greater ASD symptom severity than girls with ADHD (adjusted mean difference = 2.9, 95% CI 0.8; 5.2, p = 0.01, effect size = 0.4). Greater ADHD symptom severity was associated with greater ASD symptom severity (regression co-efficient = 1.6, 95% CI 1.2; 2.0, p < 0.001). No differences were observed by ADHD subtype. Greater hyperactive/impulsive symptoms were associated with greater ASD symptoms (regression coefficient = 1.0; 95% CI 0.0; 2.0, p = 0.04) however, this finding attenuated in adjusted analyses (p = 0.45). ASD symptoms are common in children with ADHD. It is important for clinicians to assess for ASD symptoms to ensure appropriate intervention.     

Glutamatergic agents in Autism Spectrum Disorders: Current trends

Glutamate transmission dysfunction has been found in various preclinical models of Autism Spectrum Disorders (ASD), thus the glutamate system is a target for therapeutics. This report reviews current treatments for glutamate dysfunction in ASD models and clinical trials. Antagonists of metabotropic glutamate receptor subtype 5 (mGluR5) have been tested in preclinical models of autism. Black and Tan Bachyuric (BTBR) mice model behavioral phenotypes of the three core diagnostic domains of autism, e.g. social deficits, impaired language and communication, and repetitive behaviors. A significant reduction in repetitive self-grooming was observed after mGluR5 antagonist administration in BTBR mice. SHANK 3 deficient mice which have altered synaptic transmission and plasticity, were administered IGF-1 treatment to reverse these deficits based on the hypothesis that reduced AMPA receptor levels reflect less mature synapses. Clinical trials have been carried out in ASD with glutamate NMDA receptors, but current findings are not sufficient for conclusions on safety and efficacy. Memantine is an NMDA antagonist under investigation in controlled trials that hopefully will provide new insight on its use in autism. Studies using novel treatments with other glutamatergic agents are also underway and encouraging results have been observed with N-acetylcysteine in treating irritability in ASD.     

Predictive value of alexithymia in patients with eating disorders: a 3-year prospective study

OBJECTIVE: Several cross-sectional studies have reported high levels of alexithymia in populations with eating disorders. However, only few studies, fraught with multiple methodological biases, have assessed the prognostic value of alexithymic features in these disorders. The aim of the present study was to investigate the long-term prognostic value of alexithymic features in a sample of patients with eating disorders. METHODS: Within the framework of a European research project on eating disorders (INSERM Network No. 494013), we conducted a 3-year longitudinal study exploring a sample of 102 DSM-IV eating disorder patients using the Toronto Alexithymia Scale (TAS-20) and the Beck Depression Inventory. RESULTS: At the 3-year assessment, 74% (n=76) of the sample still presented a syndromal or subsyndromal eating disorder (unfavorable outcome: score of > or =3 on the Psychiatric Status Rating Scale for anorexia nervosa or bulimia nervosa). In logistic and hierarchical regression analyses, the Difficulty Identifying Feelings factor of the TAS-20 emerged as a significant predictor of treatment outcome, independent of depressive symptoms and eating disorder severity. CONCLUSIONS: The results of this study indicate that difficulty in identifying feelings can act as a negative prognostic factor of the long-term outcome of patients with eating disorders. Professionals should carefully monitor emotional identification and expression in patients with eating disorders and develop specific strategies to encourage labeling and sharing of emotions.     

Autism spectrum traits in children and adolescents with obsessive-compulsive disorder (OCD)

OBJECTIVE: Assess the prevalence of autistic traits (AST) in pediatric obsessive-compulsive disorder (OCD) and relate them to OCD co-morbidity and compare them with published normative data. METHODS: Pediatric patients with obsessive-compulsive disorder (n=109) according to the DSM-IV were studied using parent ratings of the Autistic Symptom/Syndrome Questionnaire to assess AST symptoms as a continuous rather than categorical trait. The KSADS, a semi-structured psychiatric interview, was used for the psychiatric diagnostic evaluation. Also, the Children's Yale-Brown Obsessive-Compulsive Scale was used to assess OCD severity and other clinical features. RESULTS: AST was common among our patients. Symptom scores were highest in cases with co-morbid Autistic Spectrum Disorders, but cases with other co-morbidities as tics/Tourette and attention/behavioral disorders also scored higher. All sub-groups, including OCD without these co-morbidities scored higher than the Swedish normative group. Using ANOVA, co-morbid ASD and tics/Tourette (plus a term for gender by tic interaction indicating that girls with tics scored high, otherwise low) and pathological doubt contributed (R2=.41) to the AST-traits, while OCD severity and co-morbid anxiety- and depressive disorders did not. CONCLUSION: AST traits are prevalent in OCD and seem to be intricately associated with the co-morbidities as well as the OCD syndrome itself. The findings might have implication for our nosological understanding of OCD which currently is discussed.     

Moving on the spectrum: Dance/movement therapy as a potential early intervention tool for children with Autism Spectrum Disorders

The rising number of Autism Spectrum Disorder (ASD) diagnoses, in addition to the ability to recognize the disorder early, has led to much interest in early intervention tools. This theoretical work examines how dance/movement therapy (DMT) might be applied to address the early developmental connections between social and communication challenges and early motor maturation in young children diagnosed with ASDs. As a foundation for this discussion, literature pertaining to the early relationship of motor challenges and social/communication deficits is reviewed. A theoretical framework is proposed that promotes the integration and early development of these two realms based on DMT interventions and principles in children at high risk for or diagnosed with an ASD.     

Interoception in Autism Spectrum Disorder: A review

PurposeThis review article summarizes original scientific research published to date on interoception in individuals with Autism Spectrum Disorder (ASD). Sensory processing has been shown to be atypical in ASD, yet physiological processing and subjective experience of internal sensation processing, namely interoception, has not been reported sufficiently in research or clinical settings.BackgroundThere is a small but growing body of scientific research on interoception in ASD, which is relevant to understanding the behavioral and cognitive characteristics inherent in this condition, and may provide a foundation for clinical interventions such as biofeedback, pain management, and brain stimulation techniques.MethodsA literature review of original research was performed using major scientific databases.ResultsInteroception, which occurs due to multisensory connections and integration of internal afferents in cortical and subcortical areas, is atypical in ASD, but the degree and directionality of this abnormality is not yet clear due to the heterogeneity of the condition. Between-group interoceptive differences in individuals with and without ASD have been repeatedly demonstrated, with a slight tendency towards hyporeactivity in interoceptive awareness in individuals with ASD.SignificanceMultidimensional research combining neuroimaging with psychophysiological and self-report measures guided by a clear theoretical model is necessary to understand how interoceptive differences link to the behavioral and cognitive characteristics of ASD. Sensory processing models and autism theory should also be updated to incorporate these recent findings.     

Autism spectrum disorders in children with seizures in the first year of life - a population-based study

PURPOSE: To describe autistic spectrum disorders (ASDs) in a cohort of children with history of unprovoked seizures other than infantile spasms in the first year of life. METHODS: The source of data was computer records from all the three pediatric departments in Iceland. Children diagnosed 1982-2000 with unprovoked seizures with onset between 28 days and 12 months of age (N = 102) were invited to participate in a study. Children with known developmental disorders and those whose parents had concerns regarding their child's development or behavior were investigated for possible ASD. Parents were asked to complete the Social Communication Questionnaire and children scoring 10 points or higher were further examined with the Autism Diagnostic Interview-Revised and observational measures. RESULTS: Eighty-four children (82.4%), 28 boys and 56 girls, participated in the study and 36.9% (31/84) were investigated for possible ASD. Twenty-four (28.6%) had at least one neurodevelopmental disorder, 14.3% had mental retardation (MR), and six (7.1%) were diagnosed with ASD, all of whom also had MR and three of whom had congenital brain abnormalities. CONCLUSION: These results suggest that the estimated prevalence of ASD is higher in children with history of seizure in the first year of life than it is in the general population. There are indications that support the view that children with ASD and history of seizure in the first year of life have higher prevalence of congenital brain abnormalities and are more often female, than other children with ASD.     

Relationship between local gyrification index and age,intelligence quotient,symptom severity with Autism Spectrum Disorder: A large-scale MRI study

Gyrification is one of the most important characteristics in the cerebral cortex and the local gyrification index (LGI) was used to quantify the regional changes in gyrification. The aim of this study was to evaluate LGI alterations in autism spectrum disorder (ASD) individuals in comparison with typically developing (TD) controls and the association of the LGI with age, intelligence quotient (IQ), and symptom severity in a large multicenter dataset. Structural MRI datasets selected from Autism Brain Imaging Data Exchange I and II (ABIDE I and ABIDE II) repository (606 ASD individuals and 765 age-matched TD controls) were used to calculate LGI values. The correlation between the LGI and age, IQ, and other clinical measurements were assessed. No differences in LGI were found between ASD individuals and TD controls after FDR multiple comparison correction, however, LGI decreased with age in both ASD and TD groups. In the TD group, a significant positive correlation was found between the LGI and full IQ (FIQ) in the parahippocampal gyrus, parsopercularis of left hemisphere and entorhinal cortex, parahippocampal, superior temporal gyrus of right hemisphere, but was not observed in the ASD group. Furthermore, a positive correlation between the LGI and Autism Diagnostic Interview-Revised (ADI-R) Repetitive and Restrictive Behaviors (RRB) score was found in the left inferior parietal lobule, lateral occipital cortex, superior frontal gyrus and right superior frontal gyrus, inferior temporal gyrus. In summary, these results demonstrate that the ASD is a truly heterogeneous neurodevelopmental disorder. Future investigations are required that group ASD patients into more homogeneous subtypes.     

The non-fitness-related benefits of exergames for young individuals diagnosed with autism spectrum disorder: A systematic review

BackgroundAutism Spectrum Disorder (ASD) is a common neurodevelopmental condition characterized by social-communication deficits and is often accompanied by an array of autism-specific traits, including cognitive and motor differences. Research has begun to investigate the utility of exergames (virtual exercise games) for combating some of the functionally impairing facets of ASD. However, no review to date has investigated the positive effects of exergaming for young autistic individuals, exclusive of their effects on fitness-related/health-related outcomes.MethodsWe systematically reviewed the literature for articles published between 1990 and 2020, which aimed to examine the effectiveness of exergames for targeting some of the facets observed in autistic children, exclusive of physical fitness-related outcomes.ResultsOut of 193 relevant articles, 10 met the inclusion criteria. Some studies showed initial beneficial effects of exergaming for executive function and motor skills, however more work is needed to examine the beneficial effects of exergaming for social development in young autistic individuals.ConclusionThe present review suggests the potential use of exergaming for enhancing some functions in ASD and future research is needed to expand the use of exergames for supporting social-communication skills. Furthermore, additional studies using rigorous research designs are needed to draw stronger conclusions about the effects of exergames for the young autistic population.