Atypical Behaviors Research Articles

Disinhibited social engagement in postinstitutionalized children: Differentiating normal from atypical behavior

The most commonly reported socially aberrant behavior in postinstitutionalized (PI) children is disinhibited social engagement (DSE; also known as indiscriminate friendliness). There is no gold standard for measurement of this phenomenon nor agreement on how to differentiate it from normative behavior. We adopted a developmental psychopathology approach (Cicchetti, 1984) to study this phenomenon by comparing it to normative social development and by studying its patterns over time in 50 newly adopted PI children (16-36 months at adoption) compared with 41 children adopted early from foster care overseas and 47 nonadopted (NA) controls. Using coded behavioral observations of the child's interaction with an unfamiliar adult, atypical behaviors were differentiated from normative behaviors. Principal components analysis identified two dimensions of social disinhibition. The nonphysical social dimension (e.g., initiations, proximity) showed wide variation in NA children and is therefore considered a typical form of sociability. Displays of physical contact and intimacy were rare in NA children, suggesting that they represent an atypical pattern of behavior. Both adopted groups demonstrated more physical DSE behavior than NA children. There were no group differences on the nonphysical factor, and it increased over time in all groups. Implications for understanding the etiology of DSE and future directions are discussed.

Ethological Approach to Autism Spectrum Disorders

The purpose of the study was to develop a new ethogram for the assessment of children and adolescents with autism spectrum disorders (ASD) and intellectual developmental disorder (IDD) and to test whether this instrument accurately distinguishes ASD participants (n = 61) from IDD participants (n = 61). An ethogram with 88 behavior elements was generated, including body postures, verbalizations, facial expressions, motor stereotypies, head postures, gaze behavior, gestures, and interpersonal distance. Significant differences were detected between both groups in classic ASD behaviors; in behaviors that are deficient in ASD according to established theoretical models, such as symbolic play, gaze direction, gaze following, and use of mental state language; in atypical behaviors that have also been described previously in ethological studies with ASD; and in the nonspecific behaviors of ASD, such as walk, look own body, explore, and cry. The predictive success of a diagnosis of ASD in the logistic regression model with the ethogram's factors was 98.4%. The results suggest that this ethogram is a powerful and useful tool for both the detailed study of the social behaviors of autistic children and adolescents, and for discriminating ASD and IDD.

Individual differences in autistic traits predict the perception of direct gaze for males, but not for females

Despite the emphasis of autism spectrum disorders as a continuum of atypical social behaviors and the sexual heterogeneity of phenotypic manifestations, whether gaze processing constitutes an autistic endophenotype in both sexes remains unclear. Using the Autism-Spectrum Quotient and a psychophysical approach in a normal population (N = 128), here we demonstrated that individual differences in autistic traits predicted direct-gaze perception for males, but not for females. Our findings suggest that direct-gaze perception may not constitute an autistic endophenotype in both sexes, and highlight the importance of sex differences when considering relationships between autistic traits and behaviors.

Advancing a Multidimensional, Developmental Spectrum Approach to Preschool Disruptive Behavior

Dimensional approaches are gaining scientific traction. However, their potential forelucidating developmental aspects of psychopathology has not been fully realized. The goal of this article is to apply a multidimensional, developmental framework to model the normal-abnormal spectrum of preschool disruptive behavior. The Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB), a novel measure, was used to model dimensional severity across developmental parameters theorized to distinguish the normative misbehavior of early childhood from clinically salient disruptive behavior. The 4 MAP-DB dimensions are Temper Loss, Noncompliance, Aggression, and Low Concern for Others. Parents of a diverse sample of 1,488 preschoolers completed the MAP-DB. Multidimensional item response theory (IRT) was used for dimensional modeling. The 4-dimensional, developmentally informed model demonstrated excellent fit. Its factor loadings did not differ across demographic subgroups. All dimensions provided good coverage of the abnormal end of the severity continuum, but only Temper Loss and Noncompliance provided good coverage of milder, normatively occurring behaviors. The developmental expectability and quality of behaviors distinguished normative from atypical behaviors. The point at which frequency of behaviors was atypical varied based on dimensional location for Temper Loss, Noncompliance, and Aggression. The MAP-DB provides an innovative method for operationalizing developmentally specified, dimensional phenotypes in early childhood. Establishing the validity of these dimensional phenotypes in relation to clinical outcomes, neurocognitive substrates, and etiologic pathways will be a crucial test of their clinical utility.

The development of thought problems: a longitudinal family risk study of offspring of bipolar, unipolar, and well parents.

There is growing evidence that many offspring of parents with bipolar disorder (BD) will develop moderate to severe forms of psychopathology during childhood and adolescence, including thought problems. The purpose of this study was to evaluate the developmental progression of thought problems within the context of a family risk study. Repeated assessments of thought problems, spanning approximately 15 years, were conducted in offspring (N = 192 from 98 families) of parents diagnosed with BD (O-BD), unipolar depression (O-UNI), or no significant psychiatric or medical problems (O-WELL). Survival analysis showed that the O-BD group had the greatest estimated probability of developing thought problems over time, followed by O-UNI, and then O-WELL and O-BD exhibiting higher levels of persistence than O-WELL. Parent-reported thought problems in childhood and adolescence predicted a range of problems in young adulthood. Disturbances in reality testing and other atypical behaviors are likely to disrupt progression through important developmental periods and to associate with poor outcomes. These findings are likely relevant to preventing the occurrence or progression of problems in offspring of bipolar parents. The study of thought problems across development represents an important area of continued research in children at risk for development of affective disorders.

Unraveling the Longstanding Scars of Early Neurodevelopmental Stress

Early neurodevelopment, both in utero and in the postnatal phase, is a time when stressors can produce long-lasting changes that significantly increase the risk of mental health problems in adulthood (1). Pregnancy complications such as depression in the mother and childhood trauma can impact on neurodevelopment and increase the likelihood of psychiatric illnesses, such as major depression together with anxiety and personality disorders. Large-scale prospective studies indicate that the increased risk of these disorders following early adversity persists into old age. It is equally clear that not everyone who experiences early stressors develops psychiatric illness in adulthood and neither is there a relationship between any specific stress and a particular psychiatric disorder. If we are to ameliorate the impact of early stress, it is important that we gain an increased understanding of the manner in which such stress impacts on biological development and the psychosocial and genetic factors that help decrease the toxic effects of stress. In this regard, two articles in this issue of Biological Psychiatry focus on the underlying persistent neuronal alterations in subjects who have been exposed to, albeit qualitatively different and potent, early-life stressors (2,3). Interestingly, both articles highlight an important role for the amygdala in these effects. Olsavsky et al. (2) provide evidence in a functional magnetic resonance imaging experiment that altered activation of the amygdala plays a role in long-term behavioral problems in maternally deprived children that had been subsequently adopted (children were aged between 6 and 15 years at the time of scanning). Behaviorally, they found that this cohort had indiscriminate friendliness, which can be defined as an uncharacteristic reduced reticence and atypical approach behaviors towards adults, including strangers, being unable to distinguish adopted mothers from strangers and that this was also demonstrable in terms of amygdala discrimination to both types of stimuli. Interestingly, there was a positive correlation between age at adoption and hence duration of maternal deprivation and extent of the amygdala discrimination and behavioral response in terms of indiscriminate friendliness. On the other hand, Rifkin-Graboi et al. (3) takes a different approach, but once again, this study highlights the role of the amygdala in the long-term effects of early-life stress. They show that microstructural changes in the right amygdala (as assessed within the first 2 weeks of life) can be induced as a result of depression in the mother. The study adds further to our understanding of the toxic effect of maternal depression on the developing fetus. It is also worth noting that recent studies are pointing to a link between maternal childhood maltreatment and maternal antenatal depression (4), thus continuing the cycle of stress-induced effects across the generations with the cooccurrence of both insults significantly increasing the risk of offspring adversity. The mechanism for both of these associations is unclear and may include genomic and environmental influences both during fetal development and postnatally. Experimental studies in animals involving gestation stress or in early life are proving invaluable in uncovering key changes in the neurodevelopment of limbic structures, including alteration in amygdala size, neuronal activity, and expression of key stress-related genes (5). Moreover, starting with the work of Levine et al. (6) in Stanford and Meaney et al. (7) in McGill, a growing body of preclinical data in both rodents and nonhuman primates has been focused on understanding the consequences of alterations in maternal care in early life to both the susceptibility and resilience to psychopathology [see (1) for review].

Fetal antiepileptic drug exposure: Adaptive and emotional/behavioral functioning at age 6 years

The Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study is a prospective observational multicenter study in the USA and UK, which enrolled pregnant women with epilepsy on antiepileptic drug (AED) monotherapy from 1999 to 2004. The study aimed to determine if differential long-term neurodevelopmental effects exist across four commonly used AEDs (carbamazepine, lamotrigine, phenytoin, and valproate). In this report, we examine fetal AED exposure effects on adaptive and emotional/behavioral functioning at 6years of age in 195 children (including three sets of twins) whose parent (in most cases, the mother) completed at least one of the rating scales. Adjusted mean scores for the four AED groups were in the low average to average range for parent ratings of adaptive functioning on the Adaptive Behavior Assessment System—Second Edition (ABAS-II) and for parent and teacher ratings of emotional/behavioral functioning on the Behavior Assessment System for Children (BASC). However, children whose mothers took valproate during pregnancy had significantly lower General Adaptive Composite scores than the lamotrigine and phenytoin groups. Further, a significant dose-related performance decline in parental ratings of adaptive functioning was seen for both valproate and phenytoin. Children whose mothers took valproate were also rated by their parents as exhibiting significantly more atypical behaviors and inattention than those in the lamotrigine and phenytoin groups. Based upon BASC parent and teacher ratings of attention span and hyperactivity, children of mothers who took valproate during their pregnancy were at a significantly greater risk for a diagnosis of ADHD. The increased likelihood of difficulty with adaptive functioning and ADHD with fetal valproate exposure should be communicated to women with epilepsy who require antiepileptic medication. Finally, additional research is needed to confirm these findings in larger prospective study samples, examine potential risks associated with other AEDs, better define the risks to the neonate that are associated with AEDs for treatment of seizures, and understand the underlying mechanisms of adverse AED effects on the immature brain.

Guidelines and best practices for electrophysiological data collection, analysis and reporting in autism.

The EEG reflects the activation of large populations of neurons that act in synchrony and propagate to the scalp surface. This activity reflects both the brain's background electrical activity and when the brain is being challenged by a task. Despite strong theoretical and methodological arguments for the use of EEG in understanding the neural correlates of autism, the practice of collecting, processing and evaluating EEG data is complex. Scientists should take into consideration both the nature of development in autism given the life-long, pervasive course of the disorder and the disability of altered or atypical social, communicative, and motor behaviors, all of which require accommodations to traditional EEG environments and paradigms. This paper presents guidelines for the recording, analyzing, and interpreting of EEG data with participants with autism. The goal is to articulate a set of scientific standards as well as methodological considerations that will increase the general field's understanding of EEG methods, provide support for collaborative projects, and contribute to the evaluation of results and conclusions.

Mastigação e deglutição em mulheres jovens com desordem temporomandibular

To evaluate chewing and swallowing functions in women with and without temporomandibular disorder (TMD) and investigate the position of the mandible and the hyoid bone as they are important structures in the development of these functions. Seventy women were evaluated in relation to TMD diagnosis according to the Research Diagnostic Criteria, among them, 34 composed the study group (SG) with TMD and 36 took part in the control group (CG). Evaluation of the masticatory and swallowing functions was performed according to the Protocol of Orofacial Myofunctional Evaluation with Scores. Mandibular and hyoid bone position variables were measured by cephalometric analysis. TMD subjects showed a significant difference on tongue (p=0.03) and lip (p=0.04) posture during swallowing function, and a more frequent adoption of a chronic unilateral chewing pattern as well (p=0.03). Moreover, they presented a lower position of the hyoid bone in relation to the mandible (p=0,00). TMD presence resulted on a higher frequency of myofunctional alterations during masticatory and swallowing functions. A greater distance from hyoid bone to the mandible in addition with the presence of painful symptom can justify, partly, the atypical behaviors of the tongue and lips observed on TMD group. The TMD repercussion on alimentaires functions in a young age group justifies the importance of an earlier diagnosis and therapeutic intervention in these individuals.

Young foster children and their carers: An approach to assessing relationships

This article outlines an approach to assessing the quality of relationships between young foster children and their carers. These children are at high risk of disorganised attachment relationships and of developmental psychopathology given their relational experiences prior to and in care. During a semi-structured play interaction the emphasis is on identifying behaviours of clinical interest. This can be complex given the likelihood of atypical or unexpected behaviours expressed within relationships. The paper draws on literature on the clinical application of attachment theory to the assessment of relationships and on the authors' experience of developing and delivering an assessment and intervention service for children aged 0 to 5-years-old within a mental health service for children in foster care. Clinical material is used to illustrate and develop the issues. The case for including a semi-structured observational procedure as part of a comprehensive assessment of foster children and their carers is outlined. This is argued to have more clinical utility than formal approaches to attachment classification. The benefits of including a semi-structured and relational approach to clinical assessment of foster children are outlined along with the need to be cautious in the use of attachment related terminology when formal assessments have not been undertaken.

Pain, Sedation, and Delirium Management in the Neurocritically Ill: Lessons Learned from Recent Research

Critically ill patients with a primary neurological injury or illness pose unique challenges for pain, agitation, and delirium management in intensive care units (ICUs). Detection and monitoring can be limited by contextual level of consciousness (LOC) alterations, cognition, expression, or language deficits. Recent data suggest that existing pain assessment tools may not be applicable to all neurocritically ill patients, especially in those with LOC alterations and atypical pain-associated behaviors. Targeted sedation goals may be neurologically disease specific; for instance, intracranial pressure (ICP) targets will supersede sedation titration by other criteria. Technology such as bispectral index (BIS) may be beneficial in avoiding excessive medication administration in deeply sedated neurologically injured ICU patients. Given the wide variety of pathology in the neurocritically ill patients, it is unclear if delirium can be diagnosed and unequivocally differentiated from symptoms of the underlying neurological pathology. However, delirium symptoms may herald life-threatening primary insult progression or result from a new secondary neurological injury and should be monitored. Patients with neurological injury or illness are often excluded from ICU studies addressing pain, sedation, and delirium, but this need not be the case. We review what is understood in this area based on current evidence.

Intervention for Infants at Risk of Developing Autism: A Case Series

Theory and evidence suggest the potential value of prodromal intervention for infants at risk of developing autism. We report an initial case series (n=8) of a parent-mediated, video-aided and interaction-focused intervention with infant siblings of autistic probands, beginning at 8-10months of age. We outline the theory and evidence base behind this model and present data on feasibility, acceptability and measures ranging from parent-infant social interaction, to infant atypical behaviors, attention and cognition. The intervention proves to be both feasible and acceptable to families. Measurement across domains was successful and on larger samples promise to be an effective test of whether such an intervention in infancy will modify emergent atypical developmental trajectories in infants at risk for autism.

Persistent Neurological Damage Associated With Spontaneous Recurrent Seizures and Atypical Aggressive Behavior of Domoic Acid Epileptic Disease

The harmful alga Pseudo-nitzschia sp. is the cause of human amnesic shellfish poisoning and the stranding of thousands of sea lions with seizures as a hallmark symptom. A human case study and epidemiological report of hundreds of stranded sea lions found individuals presenting months after recovery with a neurological disease similar to temporal lobe epilepsy. A rat model developed to establish and better predict how epileptic disease results from domoic acid poisoning demonstrated that a single episode of status epilepticus (SE), after a latent period, leads to a progressive state of spontaneous recurrent seizure (SRS) and expression of atypical aggressive behaviors. Structural damage associated with domoic acid-induced SE is prominent in olfactory pathways. Here, we examine structural damage in seven rats that progressed to epileptic disease. Diseased animals show progressive neuronal loss in the piriform cortex and degeneration of terminal fields in these layers and the posteromedial cortical amygdaloid nucleus. Animals that display aggressive behavior had additional neuronal damage to the anterior olfactory cortex. This study provides insight into the structural basis for the progression of domoic acid epileptic disease and relates to the California sea lion, where poisoned animals progress to a disease characterized by SRS and aggressive behaviors.

Multilevel alterations in the processing of audio–visual emotion expressions in autism spectrum disorders

The abilities to recognize and integrate emotions from another person's facial and vocal expressions are fundamental cognitive skills involved in the effective regulation of social interactions. Deficits in such abilities have been suggested as a possible source for certain atypical social behaviors manifested by persons with autism spectrum disorders (ASD). In the present study, we assessed the recognition and integration of emotional expressions in ASD using a validated set of ecological stimuli comprised of dynamic visual and auditory (non-verbal) vocal clips. Autistic participants and typically developing controls (TD) were asked to discriminate between clips depicting expressions of disgust and fear presented either visually, auditorily or audio-visually. The group of autistic participants was less efficient to discriminate emotional expressions across all conditions (unimodal and bimodal). Moreover, they necessitated a higher signal-to-noise ratio for the discrimination of visual or auditory presentations of disgust versus fear expressions. These results suggest an altered sensitivity to emotion expressions in this population that is not modality-specific. In addition, the group of autistic participants benefited from exposure to bimodal information to a lesser extent than did the TD group, indicative of a decreased multisensory gain in this population. These results are the first to compellingly demonstrate joint alterations for both the perception and the integration of multisensory emotion expressions in ASD.

Children born prematurely have atypical Sensory Profiles

To determine if children born prematurely exhibit atypical responses to normally occurring sensory stimuli, as measured by the Sensory Profile. This is a cross-sectional study of children born at 32 weeks gestation, followed at 1 to 8 years of age. The Sensory Profile questionnaire was completed by each child's primary caregiver. The overall Sensory Profile was considered atypical if any quadrant or section score was >2 s.d. from the mean of the Sensory Profile validation group. Bivariate analyses were performed to determine associations between risk factors for adverse neurodevelopment and overall atypical Sensory Profiles. A section or quadrant was considered atypical if its score was >2 s.d. from the mean. A test of proportions was used to compute observed versus expected scores for each section and quadrant (Sensory Profile scores were based on a normal distribution so one would expect approximately 95% of participants to score within 2 s.d. of the mean). Of our 107 participants, 39% had an atypical score in at least one section or quadrant. No specific perinatal or neonatal risk factors were associated with atypical overall Sensory Profiles (P0.05 for all). Children born prematurely were at risk of having atypical scores in the auditory, tactile and vestibular processing sections, and in the four Sensory Profile quadrants (P<0.05). Children born prematurely exhibit atypical sensory behaviors on the Sensory Profile. Further investigation to understand the underlying neural mechanisms and to develop effective interventions are critical to support neurodevelopment for these children.

Atypical visual change processing in children with autism: An electrophysiological Study

Children with Autism Spectrum Disorder (ASD) may display atypical behaviors in reaction to unattended changes that occur in all sensory modalities. Atypical automatic auditory change processing has been highlighted in ASD via the analysis of mismatch negativity (MMN). The present study investigated visual deviancy detection in children with ASD in order to determine whether unusual reactions to change operate in other sensory modalities. Twelve children with ASD were presented with a passive visual oddball paradigm using dynamic stimuli. Compared to controls, children with ASD showed an earlier visual mismatch response, suggesting a hypersensitivity to visual deviancy. This study is thus consistent with the hypothesis of the existence of "general" atypical change detection processing in children with ASD that might contribute to their intolerance of change.

Dopamine Agonists and Impulse Control Disorders in Parkinson’s Disease

The emergence of the behavioral syndrome known as impulse control disorder (ICD) in Parkinson’s disease (PD) has increasingly been associated with dopamine agonist (DAA) use. Clinical reports emphasize the presence of excessive, disruptive, and ‘atypical’ behaviors in PD patients that resolve after discontinuation or reductions of DAA therapy. The severity of these behaviors has resulted in a heightened clinical vigilance, especially in patients prescribed DAA. This review will discuss the historical rationale for the clinical use of DAA in PD, highlighting the increased association of ICD in patients prescribed DAA therapy. The association between DAA and the emergence of ICD supports the hypothesis that altered mesocorticolimbic function, further emphasized in behavioral and imaging studies, may account for the distinct compulsive hedonic behaviors that characterize the clinical features of this disorder. While the first-line treatment option is reduction and discontinuation of DAA therapy, other therapeutic options are discussed.

Investigating gaze of children with ASD in naturalistic settings.

BackgroundVisual behavior is known to be atypical in Autism Spectrum Disorders (ASD). Monitor-based eye-tracking studies have measured several of these atypicalities in individuals with Autism. While atypical behaviors are known to be accentuated during natural interactions, few studies have been made on gaze behavior in natural interactions. In this study we focused on i) whether the findings done in laboratory settings are also visible in a naturalistic interaction; ii) whether new atypical elements appear when studying visual behavior across the whole field of view.Methodology/Principal FindingsTen children with ASD and ten typically developing children participated in a dyadic interaction with an experimenter administering items from the Early Social Communication Scale (ESCS). The children wore a novel head-mounted eye-tracker, measuring gaze direction and presence of faces across the child's field of view. The analysis of gaze episodes to faces revealed that children with ASD looked significantly less and for shorter lapses of time at the experimenter. The analysis of gaze patterns across the child's field of view revealed that children with ASD looked downwards and made more extensive use of their lateral field of view when exploring the environment.Conclusions/SignificanceThe data gathered in naturalistic settings confirm findings previously obtained only in monitor-based studies. Moreover, the study allowed to observe a generalized strategy of lateral gaze in children with ASD when they were looking at the objects in their environment.

Relationship between craniocervical posture, mandible and hyoid bone and influence on alimentary functions

Aim: To evaluate the anatomical relationship between craniocervical posture and mandibular and hyoid bone position and the influence on the masticatory and swallowing functions. Methods: Thirty-six women aged 19 to 35 years without temporomandibular disorder diagnosis were evaluated. Variables related to the craniocervical posture and mandibular and hyoid bone position were obtained by cephalometric measurements. Masticatory and swallowing function evaluations were performed according to a protocol of orofacial myofunctional evaluation with scores. Results: Significant correlations were observed between craniovertebral angle and the linear distance from the hyoid bone to the mentum (p=0.02) and to the mandible (p=0.03). The angle that measured the forward head position also demonstrated a significant correlation with the linear distance between hyoid bone and jaw (p=0.00). The cervical curvature degree showed a significant correlation with the linear distance from hyoid bone to the third cervical vertebra (p=0.01). Modifications of the cranium base inclination in relation to the cervical column at the two levels (NSL/CVT and NSL/OPT) were the only variables, which showed a significant correlation with the mandible position. Important craniocervical postural changes were observed in the subjects, although there was no association between them and a higher frequency of atypical behaviors evaluated during masticatory and swallowing functions. Conclusions: Cephalometric findings confirm the anatomical relationship between craniocervical posture, mandible and hyoid bone. However, association between craniocervical posture alterations and masticatory and swallowing function impairments was not detected. Such findings suggest that, in the presence of a musculoskeletal imbalance, the body readapts itself ensuring that alimentary functions will not be affected.

Core emission in classical conal double pulsars

A focus on single-pulse methods has identified what appears to be core emission in pulsars B0525+21, B0301+19 and B1133+16. Such core emission has been suspected in several ‘classical’ double conal pulsars; however, previous methods of analysis have restricted our ability to look further into this possibility. While average profiles of pulsars inform about the typical behaviours of these stars, single-pulse observations shed light on the atypical behaviours and weak features of a pulsar's emission. Emission in the ‘intrapulse region’ is not detectable in the average profiles but becomes clear in low-intensity and single-pulse observations. Through a process of suppressing the outer conal emission and averaging non-consecutive pulses that exhibit peaks in a central search region, reliable partial profiles of these putative core features have been obtained. In each case, the widths of the central features squared well with the expected polar cap geometry, further strengthening their identification with core emission components.