Diagnosis Of Autistic Disorder Research Articles

Autistic disorder diagnosis through EEG power spectrum

Autistic disorder diagnosis through EEG power spectrum

Problems of medical and social care for children with autism spectrum disorders

The aim is to identify, through a sociological survey of legitimate representatives of children with autism spectrum disorders (ASD), the problems that they face in their lives, to further improve the provision of medical and social assistance.
 Materials and methods. A survey of legal representatives of ASD minors (aged 1–11 years) was conducted.
 Results. The study of the living conditions of a child with autism in the family, the assessment by parents of his state of health, problems arising in the registration of disability, in the provision of medical and rehabilitation assistance and issues of medical and social support made it possible to determine the situation of this group of the child population in modern medical and social conditions. The main problems were the collection of a large number of documents during the registration of disability, the long wait for the day of examination, the remoteness of the location of the medical and social examination bureau, the lack of specialist doctors, the lack of consideration of the individual needs of the child when conducting individual rehabilitation programs, the need to contact various institutions and departments, the lack of medical and social assistance, violation of rights in the provision of medical services to a child with autism.
 Conclusion. It is necessary both to expand research aimed at studying etiopathogenetic factors and developing strategies for the prevention and early diagnosis of autistic disorders in childhood, destigmatization, and educational work in society.

Associação entre o transtorno do espectro do autismo e eventos periparto: estudo de caso-controle

Objective:To assess the association between peripartum events and autism spectrum disorder (ASD) development in children and adolescents.Methods:The current research is a case–control study in northern Minas Gerais state, Brazil. The inclusion criteria in the case group included individuals whose medical records reported an autistic disorder diagnosis, individuals had this diagnosis further confirmed by Northern Minas Autistic Support Association and specialized clinics, and their mothers had to answer positively to the question: “Was your child diagnosed with autism spectrum disorder?” in the data collection instrument. Thus, the case group included 253 mothers of children/adolescents of 2–15 years old diagnosed with autism. The inclusion criteria in the control group included 852 individuals belonging to the same age group and enrolled in the same schools as the case group. A semi-structured questionnaire was applied for mothers of children/adolescents, and the multiple logistic regression model was adopted for data analysis. Gross and adjusted Odds Ratios (ORa) were used to estimate the magnitude of the associations.Results:Autistic disorder was associated with the presence of meconium in amniotic fluid (AF) (ORa 1.67; 95% confidence interval [95%CI] 1.06–2.65) and cesarean delivery type (ORa 1.65; 95%CI 1.17–2.32). Emergency cesarean section increased autistic disorder development likelihood (ORa 2.38; 95%CI 1.61–3.51). Children and adolescents with ASD were more likely to have been exposed to two or more unfavorable peripartum events and obstetric complications than control groups (ORa 1.59; 95%CI 1.01–2.51).Conclusions:Meconium stained amniotic fluid, delivery by cesarean, and two or more unfavorable peripartum events are variables that should be considered in studies about ASD etiology.

키워드 네트워크 분석을 통한 자폐성장애 진단 관련 연구 동향 분석: 2011-2020년까지 발행된 국내 전문학술지 중심으로*

This study to analyze the research trends of papers related to the diagnosis of autism spectrum disorder by using keyword network analysis. The analysis papers were 42 papers related to the diagnosis of autism disorder published from 2011-2020. As for the analysis data, general research trends, frequency analysis of major keywords, and network analysis were conducted using textome and UCINET. The results of this study are as follows. First, it was confirmed that a total of 42 studies were conducted from 2011 to 2020. Second, most of the papers related to the diagnosis of autism spectrum disorder were found to be academic journals in the field of special education. Third, as a result of examining the frequency of occurrence of major keywords in research related to the diagnosis of autism disorder, it was found in the order of ‘autism spectrum disorder’, ‘early diagnosis’, ‘focus’, ‘early screening’, and ‘infants’. Fourth, the result of TF-IDF weight analysis showed similar results to the order of appearance frequency. Fifth, in the N-gram analysis, the keywords that are highly related to the keyword ‘autism spectrum disorder’ were found to be in the order of ‘early diagnosis’, ‘early screening’, ‘children’, and ‘infants’. In addition, in the analysis of the semantic network, the keyword ‘autism spectrum disorder’ showed ‘early diagnosis’ and the highest degree of center of connection. Sixth, in the CONCOR analysis, the main clusters such as characteristics and support system for ‘autism spectrum disorder’, ‘diagnosis tool development’, and ‘early diagnosis’ were identified. This study analyzed the trends of research related to the diagnosis of autistic disorder, and discussed and suggested future research directions.

One-Year Follow-Up Diagnostic Stability of Autism Spectrum Disorder Diagnosis in a Clinical Sample of Children and Toddlers.

Some studies show that the diagnosis of Autism Spectrum Disorder could be considered reliable and stable in children aged 18 to 24 months. Nevertheless, the diagnostic stability of early ASD diagnosis has not yet been fully demonstrated. This observational study examines the one-year diagnostic stability of autism spectrum disorder diagnosis in a clinical sample of 147 children diagnosed between 18 and 48 months of age. The ADOS-2 scores were used in order to stratify children in three levels of symptom severity: Autism (AD; comparison score 5–7), Autism Spectrum Disorder (ASD; comparison score 3–4), and Sub-Threshold Symptoms; (STS; comparison score 1–2). Results: Overall, the largest part of children and toddlers diagnosed with autism spectrum disorder between 18 and 48 months continued to show autistic symptoms at one-year follow-up evaluation. Nevertheless, a significant percentage of children with higher ADOS severity scores exhibited a reduction of symptom severity and, therefore, moved towards a milder severity class one year later. Conversely, the number of subjects of the STS group meaningfully increased. Therefore, at one-year follow-up a statistically significant (χ2(2) = 181.46, p < 0.0001) percentage of subjects (25.2% of the total) who had received a categorical diagnosis of Autistic Disorder or Autism Spectrum Disorder in baseline no longer met the criteria for a categorical diagnosis. Furthermore, children who no longer met the criteria for autism spectrum disorder continue to show delays in one or more neurodevelopmental areas, possibly related to the emergence of other neurodevelopmental/neuropsychiatric disorders. Overall, the comprehensive results of the study account for a high sensibility but a moderate stability of ASD early diagnosis.

Prediction of Suicide-Related Events by Analyzing Electronic Medical Records from PTSD Patients with Bipolar Disorder.

Around 800,000 people worldwide die from suicide every year and it’s the 10th leading cause of death in the US. It is of great value to build a mathematic model that can accurately predict suicide especially in high-risk populations. Several different ML-based models were trained and evaluated using features obtained from electronic medical records (EMRs). The contribution of each feature was calculated to determine how it impacted the model predictions. The best-performing model was selected for analysis and decomposition. Random forest showed the best performance with true positive rates (TPR) and positive predictive values (PPV) of greater than 80%. The use of Sertraline, Fentanyl, Aripiprazole, Lamotrigine, and Tramadol were strong indicators for no SREs within one year. The use of Haloperidol, Trazodone and Citalopram, a diagnosis of autistic disorder, schizophrenic disorder, or substance use disorder at the time of a diagnosis of both PTSD and bipolar disorder, predicted the onset of SREs within one year. Additional features with potential protective or hazardous effects for SREs were identified by the model. We constructed an ML-based model that was successful in identifying patients in a subpopulation at high-risk for SREs within a year of diagnosis of both PTSD and bipolar disorder. The model also provides feature decompositions to guide mechanism studies. The validation of this model with additional EMR datasets will be of great value in resource allocation and clinical decision making.

Maternal Influenza A(H1N1) Immunization During Pregnancy and Risk for Autism Spectrum Disorder in Offspring : A Cohort Study.

There are concerns that influenza vaccine exposure during pregnancy may be associated with increased risk for autism spectrum disorder (ASD). To examine the risk for ASD in offspring of mothers who were vaccinated against influenza A(H1N1)pdm09 ("swine flu") during pregnancy. Population-based cohort study using nationwide registers. Seven health care regions in Sweden. Live births between October 2009 and September 2010, with follow-up through December 2016. In total, 39726 infants were prenatally exposed to H1N1 vaccine (13845 during the first trimester) and 29293 infants were unexposed. Cox regression was used to estimate hazard ratios (HRs) for the primary outcome, ASD, before and after adjustment for potential confounders. The secondary outcome was autistic disorder (AD). Mean follow-up was 6.7 years in both unexposed and exposed children. During follow-up, 394 (1.0%) vaccine-exposed and 330 (1.1%) unexposed children had a diagnosis of ASD. In adjusted analyses, prenatal exposure to H1N1 vaccination was not associated with a later diagnosis of ASD (adjusted HR [aHR], 0.95 [95% CI, 0.81 to 1.12]) or AD (aHR, 0.96 [CI, 0.80 to 1.16]). The 6-year standardized cumulative incidence difference between the unexposed and exposed children was 0.04% (CI, -0.09% to 0.17%) for ASD and 0.02% (CI, -0.09% to 0.14%) for AD. Restricting the analysis to vaccination in the first trimester of pregnancy did not influence risk estimates (aHR, 0.92 [CI, 0.74 to 1.16] for ASD and 0.91 [CI, 0.70 to 1.18] for AD). Data on H1N1 influenza infection are lacking. This large cohort study found no association between maternal H1N1 vaccination during pregnancy and risk for ASD in the offspring. Swedish Research Council.

L’ADI-R et l’ADOS face au diagnostic différentiel des troubles du spectre autistique : intérêts, limites et ouvertures

IntroductionCurrent developments in international public health are leading qualified authorities to release clinical practice guidelines for Autism Spectrum Disorders (ASD) assessment and diagnosis. Such documents incorporate procedures that rely on the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS) which are considered to be the “gold standard” assessment measures in the evaluation of ASD. Although these tools do prove their effectiveness in the evaluation of autistic symptomatology, they nevertheless stumble whenever the situation becomes more complex and reveal differential diagnostic issues in infantile and adult autism cases. This differential diagnostic issue remains significant in the clinical practice of daily life and has strong implications for the course of therapeutic treatment. ObjectivesOur objective is to underline and nuance the metrological qualities of the ADI-R and the ADOS in the differential diagnosis of autistic disorders by presenting a synthesis of recent studies, thus supporting the interest of maintaining an open debate on diagnostic practices. MethodsOur selective review of the recent literature focuses on studies that confront the ADI-R and the ADOS — used either independently or in a combination — with various differential issues in adulthood and childhood autism in order to highlight their qualities and limits. ResultsThe ADI-R is a semi-structured interview applied by trained examiners and applied to relatives and/or caregivers who collect developmental information about the patient's first years of life on a variety of behaviors and skills. It is therefore relatively dependent on the availability and personal bias of the interviewed third parties. Metric features highlighted by the reviewed studies straightforwardly reveal a certain effectiveness of the tool and a good discrimination of childhood disorders. At the same time, the tool's discriminatory capacity seems insufficient when applied to toddlers, very young children, and adults alike. The latter seems particularly true when it comes to differentiating between autistic and schizophrenic spectrum disorders. The ADOS is a semi-structured standardized observation assessment tool that has experienced several successive developments, such as optimizations concerning the sensitivity of its cutoffs. Many works have contributed to building such a tool with reliable and solid metric qualities which nevertheless retain important biases such as the subjectivity of the caregiver or the evaluator during the scoring process. For assessments of autistic children the tool still has a good diagnostic validity but seems to retain cases of incorrect diagnosis of ASD (false positives). In other words, disorders or developmental disabilities of some children and adolescents could not be distinguished from ASD when relying on this test alone. The ADOS Module 4, designed for the diagnosis of adolescents and adults with fluent speech, has undergone less updating. This revisited algorithm has metrological qualities useful for clinicians and remains one of the few available tools for this population. Unfortunately, its diagnostic accuracy is lower when applied to women, the elderly, people with personality disorders or higher intellectual abilities, or for the discrimination between ASD and schizophrenia. Overall, scores from these two instruments bring strong evidence of their usefulness in the diagnostic process of ASD, provided that they are used with caution and a critical clinical perspective, and only as a secondary technical support. Their use in combination is effective since they are complementary and compensate for each other's limitations. However, their globalized hegemony as “gold-standard” tools constitutes a setback insofar as it constrains the diagnosis of ASD to a set of stereotyped items. The latter in turn sets a normative model of autism that excludes other phenotypic forms, especially in the case of women and the elderly. Finally, the discrimination between autism and psychosis for children seems to remain an insoluble task even for the ADI-R/ADOS combination. ConclusionsThe problematics of differential diagnosis remain critical for clinical approaches to autism. Therefore, formalizations of the diagnostic procedures must be able to remain open-minded and accompanied by a creative clinical approach, especially in the case of complex situations that are not soluble by means of conventional diagnostic tools. One possibility may lie in the deepening of the phenomenological approach to autism as an attempt to model the subjective phenomena of autistic subjects and thus operationalize elements that serve the diagnostic process. In the same way, a psychodynamic epistemology could help clinicians to go beyond the consideration of observable behaviors and scores, introducing a psychoanalytic point of view that interfaces objective behaviors with the individual's dynamic intrapsychic functioning. This project could be articulated with projective methodologies — notably the Rorschach test — which respects the needs for standardization and quantification of conventionally used diagnostic tools.

The effect of group therapy using the cognitive approach on the empowerment of mothers raising a child with autistic disorder:A randomized-controlled clinical trial

Introduction: The diagnosis of autistic disorder may impose stress on the child’s parents especially the mother of the baby. Raising a child with autistic disorder reduces parents' quality of life. This study examined the effect of group therapy using a cognitive approach on empowerment in the mothers of children with autistic disorder. Methods: This randomized clinical trial was carried out with 80 mothers of children with the autistic disorder. They referred to Autism Society Rehabilitation Center in Tabriz, Iran. The mothers were randomly allocated into intervention and control groups. The intervention group was divided into 4 groups of 10, and each group participated in 10 sessions of group therapy using the cognitive approach. The control group received the routine care. Data were collected using the Family Empowerment Scale (FES) before the intervention and two months after the intervention. Data were analysed using descriptive and inferential statistics [t-test, χ2, and analysis of covariance (ANCOVA)] via the SPSS software. Results: The independent t-test showed that the means of total empowerment and its dimensions had no statistically significant differences before the intervention. However, after the intervention, such differences between the groups were statistically significant (P &lt; 0.001); so that the mothers in the intervention group achieved higher scores on empowerment and its dimensions compared with the control group. Conclusion: Group therapy using the cognitive approach can be used by healthcare professionals in rehabilitation centers for empowering the mothers of children with autistic disorder.

Age of Initial Identification of Autism Spectrum Disorder in a Diverse Urban Sample.

This paper examines age of autism spectrum disorder (ASD) identification and related factors in a diverse urban sample, focusing on ASD identification in the East African Somali community. The overall average age of initial ASD identification was 4.8years. Somali children received an initial clinical diagnosis of Autistic Disorder later than White children, and Somali children diagnosed with ASD born outside of Minnesota (MN) received their first comprehensive evaluation later than Somali children diagnosed with ASD born in MN. Most children had noted developmental concerns before age 3, with no significant racial or ethnic differences in those concerns. The current study contributes to a limited number of studies on early ASD identification in culturally and linguistically diverse populations.

TRATAMIENTO ESTOMATOLÓGICO MULTIDISCIPLINARIO DE UN PACIENTE CON TRASTORNO DE ESPECTRO AUTISTA: REPORTE DE UN CASO

El Trastorno de Espectro Autista (TEA) es un desorden neurológico que perdura por toda la vida, provocandoalteraciones conductuales. Sus síntomas principales son las alteraciones en el comportamiento social, así como en lacomunicación verbal y no verbal del niño. Objetivo: El propósito de este trabajo es enfatizar la importancia del apoyomultidisciplinario para el eficiente manejo estomatológico en los pacientes con TEA. Presentación del caso: Acude a la clínicade Odontopediatría un paciente masculino de 12 años de edad, con diagnóstico médico de Trastorno Autista, presentando unaumento de volumen en la zona retromolar inferior derecha, con patrón conductual Frankl 1 por lo que se decide hacerel tratamiento en un procedimiento bajo anestesia general. El manejo estomatológico fue realizado en tres tratamientos:1. Tratamiento restaurador. 2. Tratamiento quirúrgico. 3. Tratamiento de control. Conclusiones: El profesional que brindeatención a pacientes con TEA tiene la misión de darles una mejor calidad de vida. Para esto, es indispensable conocer suscaracterísticas y así determinar cómo se tratara a cada uno en base a su caso particular y al grado de severidad del trastorno.

Changes in the frequency and characteristics of children diagnosed with autistic disorder in two Norwegian cohorts: 1992 and 2009

Abstract Background: Is the increasing prevalence of autistic disorder (AD) a well-documented trend or merely a reflection of the wider recognition of AD among both the public at large and health care professionals? Data from relevant studies are frequently compromised by comparisons of different sites and different diagnostic methods. Objectives: To explore changes over time, we reviewed the following: 1) the frequency of AD diagnoses; 2) the characteristics of the diagnosed children; and 3) the ages of the children when initial concerns were addressed and AD diagnoses made. Method: We compared the case records of children between the ages of 1 and 17 years who were residing in Nordland County, Norway, and who were diagnosed with AD during two different data collection periods: 1992 (Cohort 1) and 2009 (Cohort 2). Results: In Cohort 1, 28 children were diagnosed with AD; 71 children in Cohort 2 received AD diagnoses. The increase was greatest among children with intelligence quotient (IQ) values of at least 70. The proportion of children with genetic syndromes was around 20% in both cohorts. Median age at AD diagnosis did not differ between the two cohorts (4.5 vs. 5.0 years, respectively). When the two cohorts were combined, children with IQ values of 70 or more without a genetic syndrome and those with IQ values of less than 50 with genetic syndromes were diagnosed at approximately the same age (5.5 and 5.3 years, respectively). Both groups were significantly older at diagnosis as compared with children with IQ values of less than 50 without genetic syndromes (3.5 years). Conclusions: The increase in the number of children diagnosed with AD is consistent with findings from international studies. Contrary to predictions, the age at diagnosis was not reduced over time. A higher proportion of children with IQ values in the average range in the latter cohort may have contributed to this. A delayed diagnosis of AD among children with genetic syndromes may indicate that early autism symptoms are attributed to the genetic condition. Clinical implications are discussed.

Evidence of a reduction over time in the behavioral severity of autistic disorder diagnoses

The increasing prevalence of Autism Spectrum Disorders (ASD) may in part be due to a shift in the diagnostic threshold that has led to individuals with a less severe behavioral phenotype receiving a clinical diagnosis. This study examined whether there were changes over time in the qualitative and quantitative phenotype of individuals who received the diagnosis of Autistic Disorder. Data were from a prospective register of new diagnoses in Western Australia (n = 1252). From 2000 to 2006, we examined differences in both the percentage of newly diagnosed cases that met each criterion as well as severity ratings of the behaviors observed (not met, partially met, mild/moderate and extreme). Linear regression determined there was a statistically significant reduction from 2000 to 2006 in the percentage of new diagnoses meeting two of 12 criteria. There was also a reduction across the study period in the proportion of new cases rated as having extreme severity on six criteria. There was a reduction in the proportion of individuals with three or more criteria rated as extreme from 2000 (16.0%) to 2006 (1.6%), while percentage of new cases with no "extreme" rating on any criteria increased from 58.5% to 86.6% across the same period. This study provides the first clear evidence of a reduction over time in the behavioral severity of individuals diagnosed with Autistic Disorder during a period of stability in diagnostic criteria. A shift toward diagnosing individuals with less severe behavioral symptoms may have contributed to the increasing prevalence of Autistic Disorder diagnoses. Autism Res 2017, 10: 179-187. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Complementary and alternative medicine use in children with autistic spectrum disorder in Mauritius

This study has been designed to explore CAM used in the management of Autistic spectrum disorder (ASD) in Mauritius. Parents and/or legal guardians of individuals with ASD were surveyed. Effectiveness, method of use, possible side-effects, reasons behind using CAM, source of recommendation, and beliefs behind the cause of ASD were studied. Out of the 23 individuals with ASD recruited, 73.9% presented with a formal diagnosis of autistic disorder while 26.1% had only traits of autism. Educational techniques (13.6%), prescribed drugs (35.6%), speech therapy interventions (15.3%), occupational therapy interventions (22.0%), and applied behavioural analysis (13.6%) were used by the individuals with ASD as common therapies. Eighteen different types CAM interventions were used by the subjects. The most used therapies were omega-3 (6.6%), vitamins (7.9%), music therapies (9.2%), sensory integration therapy (7.9%), spiritual healing (14.5%), hippotherapy (7.9%), and hydrotherapy (6.6%). The use of CAM is in common use among ASD patients.

Stressful life events during pregnancy as risk factors for developing autistic disorder in children

Introduction: This study aimed to examine the role of prenatal stressful events in mothers of children and adolescents with autistic disorder (AD). Methods: This case-control study was conducted in 2014. A total number of 115 children and adolescents with AD were selected by convenience method from the autism rehabilitation centers in Tabriz, Iran. Moreover, 112 typically developing (TD) children and adolescents were selected from public schools using a random clustering method. Two groups were matched in terms of mother's and child's age and mother's educational level. The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) semi-structured diagnostic interview was used to evaluate the presence of psychiatric disorders. The diagnosis of AD was made based on the DSM-IV criteria during separate diagnostic interviews by two child and adolescent psychiatrists. The life stressful events’ inventory was used to assess the presence of stressful events during pregnancy. Results: According to Fisher's exact test, the frequency of stressful life events including failure to achieve life goals, high debt, frequent marital conflict, conflict with spouse's family, changes in sleeping habits, and sexual difficulties in the mothers of AD children during pregnancy was significantly higher than the mothers of TD children. Also, mothers of AD children reported significantly higher frequency for the positive stressful life events including the major job progress, starting or finishing education, change of education, location, and summer vacation during pregnancy. Conclusion: Some stressful life events in mothers during pregnancy may be considered as risk factors for developing AD in their children. Further researches are needed to establish the results of this study.

A joint behavioral and emotive analysis of synchrony in music therapy of children with autism spectrum disorders

&lt;b&gt;Background&lt;/b&gt;&lt;br /&gt; Synchrony is an essential component of interactive exchanges. In mother-infant interaction, synchrony underlies reciprocity and emotive regulation. A severe lack of synchrony is indeed a core issue within the communication and interaction deficit that characterizes autism spectrum disorders (ASD) in accordance with the DSM-5 classification. Based on emerging evidence that music therapy can improve the communication and regulation ability in children with ASD, we aim to verify quantitatively whether: 1) children with ASD improve synchrony with their therapist during music therapy sessions, and 2) this ability persists in different structured contexts.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Participants and procedure&lt;/b&gt;&lt;br /&gt; Twenty-five children, aged from 4 to 6 years (M = 57.80, SD = 16.70), with an autistic disorder diagnosis based on DSM IV-TR and the Autism Diagnostic Observation Schedule (ADOS), participated in the study. An observational tool for coding behaviors and emotive states of synchrony (Child Behavioral and Emotional status Code [CBEC] and Adult Behavioral and Emotional status Code [ABEC]) was applied in video recorded sessions of improvisational music therapy (IMT) for the subject-therapist pair. For each subject, we considered the 20 central minutes of the first, tenth and twentieth session of IMT. To verify the persistence of effect in a different context with a different adult, we administered and coded the interactive ADOS section (anticipation of a routine with objects) applied after session 20 of therapy. &lt;br /&gt; &lt;br /&gt; &lt;b&gt;Results&lt;/b&gt;&lt;br /&gt; During the IMT cycle, the amount of synchronic activity increases, with a significant difference from Session 1 to Session 20 in behavioral synchrony and emotional attunement. Also, the increase of synchrony is confirmed at the end of the therapy cycle as measured by an interactive ADOS section.&lt;br /&gt; &lt;br /&gt; &lt;b&gt;Conclusions&lt;/b&gt;&lt;br /&gt; Synchrony is an effective indicator of efficacy for music therapy in children with ASD, in particular to evaluate the expansion of positive emotive exchanges.

Social Communication Questionnaire scoring procedures for autism spectrum disorder and the prevalence of potential social communication disorder in ASD.

In analyzing data from the National Database for Autism Research, we utilized Mokken scaling techniques as a means of creating a more effective and efficient screening procedure for autism spectrum disorder (ASD) via the Social Communication Questionnaire (SCQ). With a sample of 1,040, approximately 80% (n = 827) of the sample were males while approximately 20% (n = 213) were females. In regard to ethnicity, approximately 68% of the sample were White/Caucasian, while 7% were African American, 16% were Hispanic, 4% were Asian, and 1% were Native American or American Indian. As the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) states that, "individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger's disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder," (American Psychiatric Association, 2013, p. 51), the primary labeling difference between the DSM-IV and the DSM-5 would appear to be in identifying social communication disorder as a newly introduced disorder in the DSM-5, which we discuss. Though school psychologists are not dependent on the DSM to the same extent as clinical psychologists to provide services, school psychology is invested in the effective and efficient assessment of ASD. The current study demonstrates how Mokken scaling procedures may be utilized with respect to ASD identification via the SCQ as well as providing information regarding the prevalence of potential social communication disorder as a new disorder and its discrimination with ASD. (PsycINFO Database Record

Metformin for Treatment of Overweight Induced by Atypical Antipsychotic Medication in Young People With Autism Spectrum Disorder: A Randomized Clinical Trial.

Atypical antipsychotic medications are indicated for the treatment of irritability and agitation symptoms in children with autism spectrum disorder (ASD). Unfortunately, these medications are associated with weight gain and metabolic complications that are especially troubling in children and with long-term use. To evaluate the efficacy of metformin for weight gain associated with atypical antipsychotic medications in children and adolescents with ASD (defined in the protocol as DSM-IV diagnosis of autistic disorder, Asperger disorder, or pervasive developmental disorder not otherwise specified), aged 6 to 17 years. A 16-week, double-blind, placebo-controlled, randomized clinical trial was conducted at 4 centers in Toronto, Ontario, Canada; Columbus, Ohio; Pittsburgh, Pennsylvania; and Nashville, Tennessee. In all, 209 potential participants were screened by telephone, 69 individuals provided consent, and 61 participants were randomized to receive metformin or placebo between April 26, 2013, and June 24, 2015. Metformin or matching placebo titrated up to 500 mg twice daily for children aged 6 to 9 years and 850 mg twice daily for those 10 to 17 years. The primary outcome measure was change in body mass index (BMI) z score during 16 weeks of treatment. Secondary outcomes included changes in additional body composition and metabolic variables. Safety, tolerability, and efficacy analyses all used a modified intent-to-treat sample comprising all participants who received at least 1 dose of medication. Of the 61 randomized participants, 60 participants initiated treatment (45 [75%] male; mean [SD] age, 12.8 [2.7] years). Metformin reduced BMI z scores from baseline to week 16 significantly more than placebo (difference in 16-week change scores vs placebo, -0.10 [95% CI, -0.16 to -0.04]; P = .003). Statistically significant improvements were also noted in secondary body composition measures (raw BMI, -0.95 [95% CI, -1.46 to -0.45] and raw weight, -2.73 [95% CI, -4.04 to -1.43]) but not in metabolic variables. Overall, metformin was well tolerated. Five participants in the metformin group discontinued treatment owing to adverse events (agitation, 4; sedation, 1). Participants receiving metformin vs placebo experienced gastrointestinal adverse events during a significantly higher percentage of treatment days (25.1% vs 6.8%; P = .005). Metformin may be effective in decreasing weight gain associated with atypical antipsychotic use and is well tolerated by children and adolescents with ASD. clinicaltrials.gov Identifier: NCT01825798.

A randomised, double blind, placebo-controlled trial of a fixed dose of N-acetyl cysteine in children with autistic disorder.

Oxidative stress, inflammation and heavy metals have been implicated in the aetiology of autistic disorder. N-acetyl cysteine has been shown to modulate these pathways, providing a rationale to trial N-acetyl cysteine for autistic disorder. There are now two published pilot studies suggesting efficacy, particularly in symptoms of irritability. This study aimed to explore if N-acetyl cysteine is a useful treatment for autistic disorder. This was a placebo-controlled, randomised clinical trial of 500 mg/day oral N-acetyl cysteine over 6 months, in addition to treatment as usual, in children with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of autistic disorder. The study was conducted in Victoria, Australia. The primary outcome measures were the Social Responsiveness Scale, Children's Communication Checklist-Second Edition and the Repetitive Behavior Scale-Revised. Additionally, demographic data, the parent-completed Vineland Adaptive Behavior Scales, Social Communication Questionnaire and clinician-administered Autism Diagnostic Observation Schedule were completed. A total of 102 children were randomised into the study, and 98 (79 male, 19 female; age range: 3.1-9.9 years) attended the baseline appointment with their parent/guardian, forming the Intention to Treat sample. There were no differences between N-acetyl cysteine and placebo-treated groups on any of the outcome measures for either primary or secondary endpoints. There was no significant difference in the number and severity of adverse events between groups. This study failed to demonstrate any benefit of adjunctive N-acetyl cysteine in treating autistic disorder. While this may reflect a true null result, methodological issues particularly the lower dose utilised in this study may be confounders.

Minocycline as Adjunctive Treatment to Risperidone in Children with Autistic Disorder: A Randomized, Double-Blind Placebo-Controlled Trial.

This is an investigation of minocycline efficacy and safety as an adjuvant to risperidone in management of children with autism. Forty-six children with diagnosis of autistic disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR) criteria and a score of ≥12 on the Aberrant Behavior Checklist-Community (ABC-C) irritability subscale, who were already drug-free for at least 6 months participated in a randomized controlled trial and underwent 10 weeks of treatment with either minocycline (50 mg twice per day) or placebo in addition to risperidone titrated up to 2 mg/day (based on bodyweight). Patients were evaluated using ABC-C at baseline and at weeks 5 and 10. General linear model repeated measures showed significant effect for time × treatment interaction on the irritability [F(2, 88) = 3.94, p = 0.02] and hyperactivity/noncompliance [F(1.50, 66.05) = 7.92, p = 0.002], but not for lethargy/social withdrawal [F(1.61, 71.02) = 0.98, p = 0.36], stereotypic behavior [F(1.34, 58.80) = 1.55, p = 0.22], and inappropriate speech subscale scores [F(1.52, 66.88) = 1.15, p = 0.31]. By week 10, 21 (91.3%) patients in the minocycline group and 15 (65.5%) patients in the placebo group achieved at least partial response (p = 0.03). Frequencies of adverse events were not significantly different between groups. Minocycline seems to be a safe and effective adjuvant in management of patients with autistic disorder. Future studies with larger sample sizes, longer follow-ups, and inflammatory cytokine measurements are warranted to confirm these findings and provide insight into minocycline mechanism of action in autistic disorder.