Abstract
This study examined the presence of neurodevelopmental regression and its effects on the clinical manifestations and the severity of autism spectrum disorder (ASD) in a group of children with autism compared with those without neurodevelopmental regression at the time of initial classification and subsequently.Methods and Subjects: ASD patients were classified into two subgroups, neurodevelopmental regressive (AMR) and non-regressive (ANMR), using a questionnaire based on the Autism Diagnostic Interview-Revised test. The severity of ASD and neurodevelopment were assessed with the Childhood Autism Rating Scale Test-2, Strengths and Difficulties Questionnaire, and Pervasive Developmental Disorders Behavior Inventory Parent Ratings (PDDBI) and with the Battelle Developmental Inventory tests at the beginning of the study and after 24 months of follow-up. Fifty-two patients aged 2–6 years with ASD were included. Nineteen were classified with AMR, and 33 were classified with ANMR.Results: The AMR subgroup presented greater severity of autistic symptoms and higher autism scores. Additionally, they showed lower overall neurodevelopment. The AMR subgroup at 24 months had poorer scores on the Battelle Developmental Inventory test in the following areas: Total personal/social (p < 0.03), Total Motor (p < 0.04), Expressive (p < 0.01), and Battelle Total (p < 0.04). On the PDDBI test, the AMR subgroup had scores indicating significantly more severe ASD symptoms in the variables: ritual score (p < 0.038), social approach behaviors (p < 0.048), expressive language (p < 0.002), and autism score (p < 0.003).Conclusions: ASD patients exhibited a set of different neurological phenotypes. The AMR and ANMR subgroups presented different clinical manifestations and prognoses in terms of the severity of autistic symptoms and neurodevelopment.
Highlights
Autism and childhood disintegrative disorder (CDD) were classified as separate entities within pervasive developmental disorders [1] prior to the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) [2]
The most widely used criteria are those of the Autism Diagnostic Interview-Revised (ADI-R) test, while aspects related to the loss of language and social skills are the most widely studied and reviewed [5]
Fifty-three patients with autism spectrum disorder (ASD) were selected, and one was excluded on the grounds that neurodevelopmental regression could not be determined because the patient was an adoptee from another country and the family did not have the required information
Summary
Autism and childhood disintegrative disorder (CDD) were classified as separate entities within pervasive developmental disorders [1] prior to the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) [2]. CDD was characterized by a period of at least 2 years of apparently normal development, followed by a clinically significant loss of previously acquired skills (before 10 years of age) in at least two of the following areas: expressive and receptive language, social skills and adaptive behavior, bowel and bladder control, and play and motor skills. The fact that up to a third of patients with autism spectrum disorder (ASD) present neurodevelopmental regression [3], combined with the difficulty of identifying completely normal development during the first 2 years of life, has led to the disappearance of CDD as a diagnostic category, and it is included within ASD. The most widely used criteria are those of the Autism Diagnostic Interview-Revised (ADI-R) test, while aspects related to the loss of language and social skills are the most widely studied and reviewed [5]. A review of 28 studies [4] reported that the mean age of the onset of regression was 20 months
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