Minerals in the hair and nutrient intake of autistic children

The concentrations of calcium, magnesium, zinc, copper, lead, and cadmium were determined in scalp hair samples from a group of 12 autistic children and a group of 12 nonautistic control children. The only statistically significant difference between median concentrations of minerals in the hair from the two groups was a 62% decrease in the concentration of cadmium in the hair of autistic children. This decrease was probably not physiologically significant. The nutrient intake of autistic children as a group was found to be adequate and typical of well-fed American children. It was concluded that the children in neither the autistic nor the nonautistic control group showed evidence of toxicity or deficiency of the minerals or nutrients studied, but because of food idiosyncracies nutrient intake should be monitored.     

A comparative study of attachment behavior in young children with autism or other psychiatric disorders

The present study examined attachment behavior in children with autism and children with other developmental or psychiatric disorders. The groups were matched on chronological and mental age, IQ, and socioeconomic status. When a modified Strange Situation paradigm was used, no group differences were found in proximity seeking, contact maintenance, proximity avoidance, or contact resistance; the groups also did not differ in their overall security ratings. Attachment security was related to several developmental variables in the autistic group but not in the nonautistic comparison group. This suggests that attachment formation may involve different processes in autistic children than in nonautistic children of equivalent intellectual level.     

Social attachments in autistic children

Social responses of young autistic children to separation from and reunion with their caregivers did not differ from the social responses to similar situations of young mentally retarded nonautistic children. Most autistic children directed more social behaviors to their caregivers than to strangers and increased their preferential behavior after separation. Individual differences in social responses were not associated with the level of representational skills shown by the autistic children.     

Developmental changes in brain serotonin synthesis capacity in autistic and nonautistic children

Serotonin content, serotonin uptake sites, and serotonin receptor binding measured in animal studies are all higher in the developing brain, compared with adult values, and decline before puberty. Furthermore, a disruption of synaptic connectivity in sensory cortical regions can result from experimental increase or decrease of brain serotonin before puberty. The purpose of the present study was to determine whether brain serotonin synthesis capacity is higher in children than in adults and whether there are differences in serotonin synthesis capacity between autistic and nonautistic children. Serotonin synthesis capacity was measured in autistic and nonautistic children at different ages, using alpha[11C]methyl-L-tryptophan and positron emission tomography. Global brain values for serotonin synthesis capacity (K complex) were obtained for autistic children (n = 30), their nonautistic siblings (n = 8), and epileptic children without autism (n = 16). K-complex values were plotted according to age and fitted to linear and five-parameter functions, to determine developmental changes and differences in serotonin synthesis between groups. For nonautistic children, serotonin synthesis capacity was more than 200% of adult values until the age of 5 years and then declined toward adult values. Serotonin synthesis capacity values declined at an earlier age in girls than in boys. In autistic children, serotonin synthesis capacity increased gradually between the ages of 2 years and 15 years to values 1.5 times adult normal values and showed no sex difference. Significant differences were detected between the autistic and epileptic groups and between the autistic and sibling groups for the change with age in the serotonin synthesis capacity. These data suggest that humans undergo a period of high brain serotonin synthesis capacity during childhood, and that this developmental process is disrupted in autistic children.     

Comparison and item analysis of the MESSY for autistic and normal children

Seventeen autistic children were matched for age, race, and sex with 17 nonautistic children, and group differences in social skills were assessed. Appropriate social skills and levels of inappropriate assertiveness/impulsiveness were assessed and evaluated using the Matson Evaluation of Social Skills with Youngsters (MESSY). Significant differences in both the appropriate and inappropriate social behaviors displayed by the two groups were found. The implications of these results are discussed.     

Comparisons between autistic and nonautistic children on the Test for Auditory Comprehension of Language

Expressive language differences between autistic and nonautistic populations have been a topic of research in the past decade, yet little information is available in regard to the receptive language performances based on standardized tests. Questions as to the existence of sex differences in language have also been raised. The study examines the performance of 19 matched pairs of autistic and nonautistic children on the Test for Auditory Comprehension of Language. As well, the data were analyzed according to sex for each group. The results indicated that there were no significant differences between groups or between the sexes in either group. Questions for further research are raised.     

Social class and infantile autism

Twenty infantile autistic children, constituting what is likely to be the majority of the total population of autistic children born in the years 1962 through 1973 and living in Göteborg, Sweden, by the end of 1978, were compared with a random population sample of 59 7-year-old Göteborg children with regard to social class. Two different social classification systems were used, one that takes account only of the father's occupation and one that includes several other parameters. The distributions of social class were almost identical in the infantile autism group and in the random group. With respect to some other social circumstances the two groups were very similar. Thus, the present results lend no support for the view that autistic children tend to come from high social classes.This work has been financially supported by the Swedish Save the Children Federation (Rädda Barnens Riksförbund).     

Monoamine Oxidase Activity in Blood-Platelets From Autistic Children

In order to evaluate the possible abnormality in monoamine oxidase (MAO) activity in early infantile autism, blood platelet samples were obtained from 20 autistic children, aged 2–12 years. MAO activity, measured fluorometrically using serotonin as substrate, was 5.24 ± 1.65 (Mean ± Standard Deviation) nM/mg protein/hour in these autistic children. This value was not significantly different from either that in 30 age-matched normal children or that in 39 nonautistic children with various psychiatric and neurological disorders, although autistic children had higher platelet serotonin concentrations than these nonautistic individuals.     

Role taking and social competence in autism and mental retardation

Recent data suggest that individuals with autism show deficits in social cognitive abilities when compared with nonautistic persons matched for mental age. These deficits have been proposed as a basis for the social interaction difficulties seen in autistic persons. In the present study, autistic youth were compared with a matched group of nonautistic mentally retarded youth on three role-taking tasks and three measures of social competence. Results indicated that the autistic group was relatively deficient on each of the social competence measures and on one of the role-taking measures. The role-taking measure on which the groups differed also correlated significantly with each of the social competence measures. Results were discussed in terms of the interplay between social cognitive abilities and social interaction.     

Laboratory predictions of infantile autism based on 5-hydroxytryptamine efflux from blood platelets and their correlation with the rimland E-2 score

Experiments were conducted to determine the possibility of predicting a diagnosis of autism on the basis of an abnormally high release of¹⁴C-5-hydroxy-tryptamine from 5-HT loaded blood platelets of children. Such increased 5-HT release was previously reported by the authors for blood platelets of children diagnosed as autistic according to the Rimland E-2 score. The platelets of 10 psychotic children (including a number of subjects diagnosed as autistic by the E-2 score) were examined without knowledge of the diagnosis, in order to determine whether the biochemical results correlated with the E-2 score. On the basis of experimental data it was possible to predict that six children were autistic and four were nonautistic psychotics. According to the E-2 score, seven children were autistic and three nonautistic psychotics. The authors conclude that there is a correlation between a diagnosis of infantile autism by the E-2 score and enhanced release of radioactive 5-HT from 5-HT-loaded blood plateletsin vitro.This research was supported in part by National Institutes of Health Grant RR 00 284 and National Institute of Mental Health Grant HD 08429.     

Uptake and efflux of serotonin from platelets of autistic and nonautistic children

This study examined, in vitro, the uptake and efflux of serotonin by platelets from autistic children, nonautistic hospitalized comparison cases, and normal children. The autistic patients were carefully selected according to previously established diagnostic criteria. The hospitalized comparison children were utilized to assess possible environmental and dietary influences upon the results. Uptake methods were similar to those used by previous investigators. Two efflux procedures were utilized to explore the possibility that methodological factors accounted for previously reported differences between autistic and comparison groups. The results failed to indicate statistically significant differences in uptake or efflux between the autistic and the hospitalized comparison groups or the normals. Methodologic considerations which could possibly account for the failure to confirm previous findings are discussed in detail.     

Depression in Children with Autism/Pervasive Developmental Disorders: A Case-Control Family History Study

Limited information is available about the occurrence of depression in children with autism and other pervasive developmental disorders (PDD). Although depression has been described in autistic children, questions about its validity have often been raised. One approach to address this issue is to investigate family histories of those autistic children diagnosed with clinical depression. Based on data available in nonautistic children, autistic children with depression would be expected to show an increased family history of depression. Since studies of this nature have not been attempted in autistic children, we compared the family history of 13 autistic/PDD children with depression (11 male; 2 female; M full-scale IQ 86.2, SD 24.2; M age 10.4 years, SD 2.2) with 10 autistic/PDD children without a history of current or previous depression (9 male; 1 female; M full-scale IQ 67, SD 12.9; M age 10.5 years, SD 1.6). Diagnosis of depression was based on the DSM-III-R criteria and confirmed independently by two psychiatrists. Ten (77%) of the depressed children had a positive family history of depression compared to 3 (30%) of the nondepressed group, t(21) = –2.4; p = .02. These findings lend support to the validity of depression as a distinct condition in some children with autism/PDD and suggest that, as in the normal population, autistic children who suffer from depression are more likely to have a family history of depression.     

Monoamine oxidase activity in blood platelets from autistic children

In order to evaluate the possible abnormality in monoamine oxidase (MAO) activity in early infantile autism, blood platelet samples were obtained from 20 autistic children, aged 2--12 years. MAO activity, measured fluorometrically using serotonin as substrate, was 5.24 +/- 1.65 (Mean +/- Standard Deviation) nM/MG protein/hour in these autistic children. This value was not significantly different from either that in 30 age-matched normal children or that in 39 nonautistic children with various psychiatric and neurological disorders, although autistic children had higher platelet serotonin concentration than these nonautistic individuals.     

A comparison of obstetrical records of autistic and nonautistic referrals for psychoeducational evaluations

Heretofore most studies dealing with the association between perinatal complications and autism have used a normal comparison group. In this study obstetrical records of 59 autistic children were compared to those of 28 nonautistic children whose intelligence has a similar range and distribution as the autistic sample. Using an optimality score to reflect number of obstetrical complications, we found that the nonautistic controls experienced less optimal conditions than the autistic sample. Abnormal presentation at birth is the only factor that occurred more frequently for the autistic sample than control sample.We are grateful to our friends and colleagues, Sam Odom and Arthur Koch, for assistance with the statistical treatment of the data. We also acknowlege the support of Henry Schroeder, Director of the Institute for the Study of Developmental Disabilities.     

Delay Versus Deviance in Autistic Social Behavior

The pattern of acquisition of social, communication, and daily living skills was examined for autistic children, compared to retarded and normal controls, by quantifying intradomain scatter on the Vineland Adaptive Behavior Scales. Autistic children were matched to normal children and mentally retarded children on Vineland raw scores; group differences in scatter were examined for each domain of adaptive behavior. Autistic children had significantly more scatter on Communication and Socialization than both control groups. Item analyses showed that the autistic children had particular weaknesses on items reflecting attention to and pragmatic use of language, as well as play and reciprocal social interaction; the autistic children had particular strengths on items reflecting written language and rote language skills, and rule-governed social behavior. The number of items showing consistent group differences, however, was small, suggesting that although autistic development appears sequentially deviant and not merely delayed, individual autistic children derive their scatter from different items, and are a developmentally heterogenous group.     

Sensitivity and specificity of the Behavioral Summarized Evaluation (BSE) for the assessment of autistic behaviors

The Behavior Summarized Evaluation (BSE), developed for the assessment of autistic behavior, was specifically designed to evaluate the severity of behavioral problems in autistic children involved in bioclinical and therapeutic studies. The reliability studies and the factorial analysis of this scale have been previously published. The present paper examines the effectiveness of the BSE to discriminate 58 autistic from 58 nonautistic mentally retarded children. The BSE clearly separated the two samples of children. A most efficient combination of 8 items emerged from the stepwise item selection procedure. The between-group differences were highest on 4 items, indicating that the most particular pattern in autistic compared to nonautistic children could be the association of autistic withdrawal and stereotypic behaviors. Our findings suggest that the BSE could help in the detection and evaluation of autistic developmental deviance. Implications for further research are discussed.The authors gratefully acknowledge Jacques Fermanian for his helpful advice and suggestions. This study was supported by INSERM U.316, INSERM Réseau No. 489001, CRAMTS No. 998313, Conseil Régional de la Région Centre, and Foundation Langlois. Special thanks to Monique Barré, Annick Lardeux, and Danièle Lioret for their technical assistance.     

Austism diagnostic observation schedule: A standardized observation of communicative and social behavior

The Autism Diagnostic Observation Schedule (ADOS), a standardized protocol for observation of social and communicative behavior associated with autism, is described. The instrument consists of a series of structured and semistructured presses for interaction, accompanied by coding, of specific target behaviors associated with particular tasks and by general ratings of the quality of behaviors. Interrater reliability for five raters exceeded weighted kappas of .55 for each item and each pair of raters for matched samples of 15 to 40 autistic and nonautistic, mildly mentally handicapped children (M IQ=59) between the ages of 6 and 18 years. Test-retest reliability was adequate. Further analyses compared these groups to two additional samples of autistic and nonautistic subjects with normal intelligence (M IQ=95), matched for sex and chronological age. Analyses yielded clear diagnostic differences in general ratings of social behavior, specific aspects of communication, and restricted or stereotypic behaviors and interests. Clinical guidelines for the diagnosis of autism in the draft version of ICD-10 were operationalized in terms of abnormalities on specific ADOS items. An algorithm based on these items was shown to have high reliability and discriminant validity.This research was funded in part by grants from the Social Sciences and Humanities Research Council of Canada, the Alberta Heritage Foundation for Medical Research, and the Medical Sciences Institute to the first author. Susan Goode was supported by a grant from the Bethlem-Maudsley Research Fund. Lynn Mawhood was supported by a postgraduate studentship funded by the John D. and Catherine T. MacArthur Foundation. We acknowledge the work of Joyce Magill, Deborah Dewey, and numerous members of the Department of Child and Adolescent Psychiatry at the Institute of Psychiatry, Division TEACCH, and Glenrose Rehabilitation Hospital for their help in the development of this scale.     

Perception of human and nonhuman facial age by developmentally disabled children

Human and nonhuman faces were shown to clinical controls, autistic, mentally retarded, and language-disordered children to assess their ability to detect and draw inferences about facial age. Children were asked to select from sets of three faces the one that appeared youthful or to select faces that would be associated with some age-related characteristic. In two studies, it was found that, relative to other children, autistic children had more difficulty perceiving youthfulness in nonhuman faces compared with human faces. These data are discussed with respect to differences in mechanisms and processes that may underlie facial information processing in autistic and nonautistic children.     

Comparison of clinical diagnoses and Rimland E2 scores in severely disturbed children

The Rimland E2 questionnaire was applied to three groups of children for whom clinical diagnoses of Infantile Autism, Autism with Associated Symptoms, and Mental Retardation had been made, as well as to normal controls. The results confirm that the Rimland scale is accurate in differentiating autistic from nonautistic children. But the scale does not appear to permit clear differentiation of infantile autism from autism with associated symptoms, and the more typical autistic children (diagnosed as Kanner's EIA) did not all yield high scores. Several possible explanations for this fact are put forward.This work was supported by Grants Nos. 80-07 (Ministry of Public Health); CNRS (ERA 697) Biological Methods in Neuropsychiatry; INSERM C.L. 79-1-422-6; DGRST, DNP 78-7-2787; and Fondation pour la Recherche Medicale S-O-C-1979. We thank coinvestigators J. L. Adrien and B. Garreau. M. L. Metais, D. Lioret, and C. Depienne assisted in technical phases of the research.     

Autistic social impairment in the siblings of children with pervasive developmental disorders

OBJECTIVE: Sibling recurrence risk in autism has been estimated to be approximately 10%. This study investigated subsyndromal autistic impairments among siblings of probands with pervasive developmental disorders. METHOD: The authors used the Social Responsiveness Scale to obtain quantitative assessments of autistic social impairment in three groups of proband-sibling pairs: 1) autistic children from multiple-incidence families and their closest in age nonautistic brothers (N=49 pairs); 2) children with any pervasive developmental disorder, including autism, and their closest-in-age brothers (N=100 pairs), and 3) children with psychopathology unrelated to autism and their closest-in-age brothers (N=45 pairs). RESULTS: Sibling Social Responsiveness Scale scores were continuously distributed and substantially elevated for both the autistic and pervasive developmental disorder groups. Highest scores (i.e., greatest impairment) were seen among siblings of autistic probands from multiple-incidence families, followed by siblings of probands with any pervasive developmental disorder, then siblings of probands with psychopathology unrelated to autism. CONCLUSIONS: Taken together with previous findings, these results support the notion that genetic susceptibility factors responsible for common, subsyndromal social impairments may be related to the causes of categorically defined pervasive developmental disorders.