Diagnosis Of Autistic Disorder Research Articles

The factor structure of autistic traits.

Although DSM-IV requires symptoms in three criterion domains for a diagnosis of autistic disorder, the extent to which those domains are phenotypically independent is an unanswered and important question. The identification of 'endophenotypes' of the autistic syndrome may be very useful for genetic and neurobiologic studies of autism, but only if they represent truly independent sub domains of the disorder. In this study we examined the factor structure of autistic traits using data from 226 child psychiatric patients with and without pervasive developmental disorders, employing cluster analysis of data from the Autism Diagnostic Interview-Revised (ADI-r) and principal components factor analysis of data from the Social Responsiveness Scale (SRS, a quantitative genetic measure of autistic traits formerly known as the Social Reciprocity Scale). The results were consistent with the existence of a singular, continuously distributed underlying factor, resulting in disparate phenotypic manifestations across the three criterion domains for autistic disorder (social deficits, language deficits, and repetitive/stereotypic behaviors). The analyses generally failed to support the existence of independent sub domains of dysfunction in autism spectrum conditions. Future studies of the association between genetic/neurobiologic markers and autistic symptomatology may be enhanced by approaches which consider autistic symptoms as quantitative traits, and which are informed by ongoing research on the development and phenomenology of core deficiencies in reciprocal social behavior.

Measles, mumps, and rubella vaccine was not associated with autism in children

Madsen KM, Hviid A, Vestergaard M, et al. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med2002 ; 347 : 1477 –82 [OpenUrl][1][CrossRef][2][PubMed][3][Web of...

The measles, mumps, and rubella vaccine was not associated with autism in children

(2002) N Engl J Med 347:1477. Madsen KM, Hvid A, Vestergaard M, et al. . A population-based study of measles, mumps, and rubella vaccination and autism. . ; . :...

Race Differences in the Age at Diagnosis Among Medicaid-Eligible Children With Autism

To examine racial differences in the age at which Medicaid-eligible children first receive an autistic disorder (AD) diagnosis and to examine time in mental health treatment until an AD diagnosis was received. Philadelphia Medicaid specialty mental health claims identified 406 children who received services in 1999 for AD. Claims from 1993-1999 were used to identify the date of first mental health visit, first receipt of AD diagnosis, and number of visits occurring between those dates. Linear regression was used to examine the relationship among race, age at first diagnosis of AD, time in mental health treatment, and number of visits until the diagnosis was made. On average, white children received the AD diagnosis at 6.3 years of age, compared with 7.9 years for black children (p <.001). White children entered the mental health system at an earlier age (6.0 versus 7.1 years, p =.005); however, after adjusting for age, sex, and time eligible for Medicaid, black children required more time in treatment before receiving the diagnosis. Important disparities exist in the early detection and treatment of autism. These disparities may be the result of differences in help-seeking, advocacy and support, and clinician behaviors.

A population-based study of measles, mumps, and rubella vaccination and autism.

It has been suggested that vaccination against measles, mumps, and rubella (MMR) is a cause of autism. We conducted a retrospective cohort study of all children born in Denmark from January 1991 through December 1998. The cohort was selected on the basis of data from the Danish Civil Registration System, which assigns a unique identification number to every live-born infant and new resident in Denmark. MMR-vaccination status was obtained from the Danish National Board of Health. Information on the children's autism status was obtained from the Danish Psychiatric Central Register, which contains information on all diagnoses received by patients in psychiatric hospitals and outpatient clinics in Denmark. We obtained information on potential confounders from the Danish Medical Birth Registry, the National Hospital Registry, and Statistics Denmark. Of the 537,303 children in the cohort (representing 2,129,864 person-years), 440,655 (82.0 percent) had received the MMR vaccine. We identified 316 children with a diagnosis of autistic disorder and 422 with a diagnosis of other autistic-spectrum disorders. After adjustment for potential confounders, the relative risk of autistic disorder in the group of vaccinated children, as compared with the unvaccinated group, was 0.92 (95 percent confidence interval, 0.68 to 1.24), and the relative risk of another autistic-spectrum disorder was 0.83 (95 percent confidence interval, 0.65 to 1.07). There was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autistic disorder. This study provides strong evidence against the hypothesis that MMR vaccination causes autism.

Fluorine Magnetic Resonance Spectroscopy Measurement of Brain Fluvoxamine and Fluoxetine in Pediatric Patients Treated for Pervasive Developmental Disorders

Pediatric populations, including those with autistic disorder or other pervasive developmental disorders, increasingly are being prescribed selective serotonin reuptake inhibitors (SSRIs). Little is known about the age-related brain pharmacokinetics of SSRIs; there is a lack of data regarding optimal dosing of medications for children. The authors used fluorine magnetic resonance spectroscopy ((19)F MRS) to evaluate age effects on whole-brain concentrations of fluvoxamine and fluoxetine in children taking SSRIs. Twenty-one pediatric subjects with diagnoses of autistic disorder or other pervasive developmental disorders, 6-15 years old and stabilized with a consistent dose of fluvoxamine or fluoxetine, were recruited for the study; 16 successfully completed the imaging protocol. Whole-brain drug levels in this group were compared to similarly acquired data from 28 adults. A significant relationship between dose and brain drug concentration was observed for both drugs across the age range studied. Brain fluvoxamine concentration in the children was lower, consistent with a lower dose/body mass drug prescription; when brain concentration was adjusted for dose/mass, age effects were no longer significant. Brain fluoxetine concentration was similar between age groups; no significant age effects on brain fluoxetine drug levels remained after adjustment for dose/mass. Observations of brain fluoxetine bioavailability and elimination half-life also were similar between age groups. These findings suggest that fluvoxamine or fluoxetine prescriptions adjusted for dose/mass are an acceptable treatment approach for medicating children with autistic disorder or other pervasive developmental disorders. It must be determined whether these findings can be generalized to other pediatric populations.

Do autism spectrum disorders differ from each other and from non-spectrum disorders on emotion recognition tests?

We tested whether dimensional measures of empathic ability, theory of mind, and intelligence would differentiate autism spectrum disorders from each other and from non-spectrum disorders. Tests were administered to children with a diagnosis of Autistic Disorder (AutD; n = 20), Asperger's Disorder (AspD; n = 28), Attention Deficit/Hyperactivity Disorder (Inattentive Type) (ADHD; n = 35), Mental Retardation (Mild) (MR; n = 34), Anxiety Disorder (AnxD; n = 14), or No Psychological Disorder (NPD; n = 36). Results showed that empathic ability discriminated among groups on the autism spectrum (AutD < AspD < NPD). Because empathic ability is not independent of intelligence (AutD < AspD < NPD on intelligence; MR < ADHD < NPD on empathic ability), both dimensions are necessary to discriminate autism spectrum from non-spectrum disorders. When intelligence is covaried, empathic ability discriminated AutD, but not AspD, from other disorders (AutD < MR < ADHD < NPD = AnxD = AspD).

Does DSM-IV Asperger's disorder exist?

DSM-IV criteria for autistic and Asperger's disorders were applied to 157 children with clinical diagnoses of autism or Asperger's disorder. All children met the DSM-IV criteria for autistic disorder and none met criteria for Asperger's disorder, including those with normal intelligence and absence of early speech delay. The reason for this was that all children had social impairment and restricted and repetitive behavior and interests (required DSM-IV symptoms for both autistic and Asperger's disorders) and all had a DSM-IV communication impairment (which then qualified them for a diagnosis of autistic disorder and not Asperger's disorder). Communication problems exhibited by all children were impaired conversational speech or repetitive, stereotyped, or idiosyncratic speech (or both), which are DSM-IV criteria for autism. These findings are consistent with those of 5 other studies and indicate that a DSM-IV diagnosis of Asperger's disorder is unlikely or impossible.

Patterns of Parent-Reported Problems Indicative in Autism

Parental report Child Behavior Checklists (CBCL) of 77 male and female subjects aged 4–18 years were analyzed in this study. Individuals had been given diagnoses of autistic disorder using the Autism Diagnostic-Interview-Revised (ADI-R) within a research project on the genetics of autism. A feature of behavior problems independent of sex but influenced by age and IQ level could be identified for the autistic sample with highest relative scores on the scales measuring attention problems, social problems and thought problems and low scores on the scale for somatic complaints.

Autism and visual agnosia in a child with right occipital lobectomy

OBJECTIVESAutistic disorder is a developmental handicap with an unknown neurological basis. Current neuropsychological models for autism suggest an abnormal construction of visual perceptual representation or a deficit in executive functions....

Symptoms of pervasive developmental disorders as observed in prediagnostic home videos of infants and toddlers

Objectives: The objectives of this study were (1) to show prediagnostic abnormalities in social and communicative behaviors on home videos of children who later received a diagnosis of one of the pervasive developmental disorders (PDD) and (2) to demonstrate that prediagnostic abnormalities in social and communicative behaviors for children with PDD not otherwise specified will be less prominent than those in children with autistic disorder but still distinguishable from those of typically developing peers. Study design: Parents of children with PDD each submitted home videos of social events that were made when their child was between the ages of 12 and 30 months, before diagnosis. Two independent observers, unaware of the subjects' diagnoses or purpose of the study, scored the rates of specific anomalies in social and communicative behavior. Two additional observers scored the percentage of time the children were engaged socially or with objects. Data from the experimental group were compared with those of 25 age-matched children with no developmental disabilities. Results: Significant differences were found between the rates of social engagement and 8 of the 25 specific behaviors of the children in whom PDD was later diagnosed and those of the typical children. The children later given the diagnosis of PDD not otherwise specified had mean frequencies of some social interactions and communicative skills that fell between those of children later given the diagnosis of autistic disorder and those of children with typical development. Conclusion: In our sample children in whom PDD was later diagnosed could be differentiated from their typically developing peers on the basis of specific anomalies noted in their social and communicative behaviors, especially joint attention. In our sample children with PDD not otherwise specified could have been further differentiated on the basis of the rates of social interaction. Careful assessment of social interaction and communicative behaviors may help to identify children with PDD before the age of 30 months. (J Pediatr 1998;132:500-4)

Case Study: Comorbidity among Tourette's Syndrome, Autistic Disorder, and Bipolar Disorder

Several studies report a greater than expected concurrence for Tourette's syndrome (TS) with autistic disorder (AD). TS and bipolar disorder (BD) also may co-occur at a greater than expected rate. The authors assess whether there is a greater than expected concurrence for TS+AD+BD. Four patients who had at some time in their lives diagnoses of TS, AD, and BD were identified. Three of these had concurrent TS+AD+BD. Diagnoses were made according to DSM-III-R criteria. Each of these patients was living in North Dakota and was in the authors' care at the time of this study. The point prevalence (risk) for concurrent TS+AD+BD in North Dakota is not less than 4.6 x 10(-6). The developmental sequence of syndromes in these four patients was AD, then TS and then BD. Data from the authors' previously published, population-based prevalence studies indicate that TS+AD+BD co-occur at a greater than chance expectation. Common etiological factors may be involved in the greater than chance concurrence of TS+AD+BD.

The Prevalence of Autistic Disorder among Children with a Learning Disability

It has been suggested recently that the prevalence of autistic disorder may be rising. No prevalence study specifically among learning disabled children exists and so this study was prompted. 767 children with a learning disability who attended 16 different special schools in the Grampian region of north-east Scotland were studied for a diagnosis of autistic disorder according to the DSM-III-R criteria. The study was conducted in three stages. In the first screening stage, a questionnaire was completed for each child by their teachers. In the second stage, teachers completed another questionnaire based on DSM-III-R criteria for autistic disorder. A final diagnosis was made on the basis of examination and information gathered from the questionnaires. Questionnaires were completed for 634 (82.7%) children. 14.3% of children with a learning disability fulfilled the diagnostic criteria for autistic disorder. There was a male:female ratio of 3:1. This gave a 9 per 10,000 minimum prevalence of autistic disorder among all school-age children in the Grampian region. There was a higher prevalence of autistic disorder in the cities compared with rural areas. The prevalence did not change with age but increased with decreasing IQ. The results of the study support the view that there may be an increasing prevalence of reported cases of autistic disorder.

The DSM-III-R Field Trial of Pervasive Developmental Disorders

This article describes the method and results of a national field trial of the proposed criteria for the DSM-III-R diagnosis of autistic disorder at 11 sites which have experience in diagnosing pervasive developmental disorders. Using the diagnosis of autistic disorder made by expert clinicians as a standard, the diagnostic criteria that were finally included in DSM-III-R demonstrated high sensitivity and specificity across different age groups and in children with and without language.

Autism Under Age 3 Years: A Clinical Study of 28 Cases Referred for Autistic Symptoms in Infancy

Twenty-eight children referred with a preliminary diagnosis of autistic disorder under age 3 yrs were extensively examined from the neuropsychiatric point of view and followed up for several months to several years. A diagnosis of autistic disorder was confirmed in 75% of the cases. A variety of associated medical conditions was identified. It was concluded that autism can be diagnosed in a substantial proportion of cases before age 3 yrs and that the neurobiological background is similar to that seen in older autistic children.

Autistic disorder in Sotos syndrome: A case report

A case study of a child with Sotos syndrome, normal intelligence, and autistic disorder is presented. Initial descriptions of Sotos syndrome included severe to mild mental retardation. More recent studies indicate language and learning disabilities with normal intelligence. Our patient met criteria for a diagnosis of autistic disorder. Sotos syndrome is another genetic and neurodevelopmental syndrome that can be associated with autistic as well as communication and language disorders.

Using signal detection methodology to revise DSM-III-R: Re-analysis of the DSM-III-R national field trials for autistic disorder

Signal detection theory which takes into account the relative prevalence, sensitivity, and specificity of each of a set of criterion symptoms is used to determine an algorithm optimally predictive of a clinical diagnoses of autistic disorder using the data from the DSM-III-R national field trials. Findings support inclusion of one diagnostic criterion (marked lack of awareness of others) as mandatory, and four more (impaired imitation, abnormal social play, abnormal nonverbal communication, and abnormal speech) as alternate, associated criteria. Advantages of signal detection over other statistical methods for empirically deriving diagnostic standards are given, and implications for DSM-IV are discussed.