Diagnosis Of Infantile Autism Research Articles

Injury Patterns among Individuals Diagnosed with Infantile Autism during Childhood: A Case-Control Study

Background: To date, injury risk among people with infantile autism (IA) has been a relatively poorly researched issue. Objective: The purpose of our study was to compare the prevalence and types of injuries in a clinical sample of 118 patients diagnosed with IA during childhood with those of 336 age- and sex-matched controls from the general population. Method: All participants were screened through the nationwide Danish National Hospital Register. The average amount of time that the participants were observed was 30.3 years (range, 27.3 to 30.4 years), and the mean patient age at the end of the observation period was 42.7 years (range, 27.3 to 57.3 years). Results: Among the 118 patients with IA, a total of 52 (44.1%) were registered in the Danish National Hospital Register with at least one injury diagnosis. In the comparison group, 226 of 336 individuals (67.3%) had at least one such diagnosis. The difference is statistically significant (P < .0001; odds ratio, 0.4; 95% confidence interval, 0.3 to 0.6), and the nature of the injuries also seems to differ. Gender, intellectual level, and concurrent epilepsy were not predictive of injury risk. Conclusions: Our results lend support to the notion that injuries that require medical attention are not uncommon among an adult population of people diagnosed with IA during childhood, but they are less common than the rate found in a comparison group from the general population. It is proposed that a diagnosis of IA is related to the likelihood of institutional care, which may have a protective effect with respect to acute hospital use.

ASSESSMENT OF A LONG-TERM DEVELOPMENTAL RELATIONSHIP-BASED APPROACH IN CHILDREN WITH AUTISM SPECTRUM DISORDER.

90 Italian children (72 boys, 18 girls) with a diagnosis of infantile autism (age range = 2.5-16.5 yr.) were assessed with a non-verbal intelligence test (Leiter-R). The test was repeated 3 times in four years. The measures used were IQ and Fluid Reasoning (FR), as evaluation of inductive and deductive reasoning, and the Autism Diagnostic Observation Schedule (ADOS), indicative of the severity of autistic symptoms at the beginning and at the end of therapy. The increase in the average IQ and FR scores at retests demonstrates the effectiveness of a treatment that emphasizes the centrality of the relationship-based approach. Moreover, the FR score at intake was predictive of a significant decrease of ADOS scores after four years of treatment, and of the increase in IQ observed in later evaluations. The data support the hypothesis that a relationship-based intervention allows cognitive improvement regardless of the autism severity expressed in the ADOS score.

Neonatal jaundice: a risk factor for infantile autism?

In a previous study, we found that infants transferred to a neonatal ward after delivery had an almost twofold increased risk of being diagnosed with infantile autism later in childhood in spite of extensive controlling of obstetric risk factors. We therefore decided to investigate other reasons for transfer to a neonatal ward, in particular hyperbilirubinaemia and neurological abnormalities. We conducted a population-based matched case-control study of 473 children with autism and 473 matched controls born from 1990 to 1999 in Denmark. Cases were children reported with a diagnosis of infantile autism in the Danish Psychiatric Central Register. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals [CI] and likelihood ratio tests were used to test for effect modification. We found an almost fourfold risk for infantile autism in infants who had hyperbilirubinaemia after birth (OR 3.7 [95% CI 1.3, 10.5]). In stratified analysis, the association appeared limited to term infants (>or=37 weeks gestation). A strong association was also observed between abnormal neurological signs after birth and infantile autism, especially hypertonicity (OR 6.7 [95% CI 1.5, 29.7]). No associations were found between infantile autism and low Apgar scores, acidosis or hypoglycaemia. Our findings suggest that hyperbilirubinaemia and neurological abnormalities in the neonatal period are important factors to consider when studying causes of infantile autism.

Ausschluß rezeptiver Sprachstörungen mittels des ADOS (Autism Diagnostic Observation Schedule) *Die Daten wurden im Rahmen der Doktorarbeit von cand. med. U. Kurz erhoben.

The purpose of our pilot study was to assess the reliability and diagnostic validity of the Autism Diagnostic Observation Schedule (ADOS). The usefulness of the schedule in the differentiation between children with autism and children with a severe specific receptive language disorder is examined. Eight boys with early infantile autism and eight age- and IQ-matched boys with a specific receptive language disorder were examined with the ADOS. The reliability of the instrument was assessed using the ratings of eight pairs of raters. The agreement between diagnostic classification based on the ADOS ICD-10 algorithm and the independent clinical psychiatric diagnosis of two experts was used as the measure of validity. The reliability of the different ADOS items proved to be good among experienced raters. Various ADOS items clearly discriminate both groups. Using the ADOS ICD-10 algorithm, the clinical diagnosis of infantile autism could be confirmed for five of the eight children in this group. None of the children with the clinical diagnosis of a receptive language disorder was identified as autistic according to the algorithm. In the hands of experienced raters the ADOS is a reliable diagnostic instrument. It can support the differentiation between autism and specific receptive language disorder, but additional parent information is needed to confirm the diagnosis.

Early diagnosis of infantile autism: Preliminary findings

Early diagnosis of infantile autism: Preliminary findings

Infantile autism: diagnosis and treatment

This article reviews recent developments in the diagnosis and treatment of infantile autism. Autism is currently conceptualized as a behavioural syndrome with multiple biological aetiologies. A diagnosis of infantile autism implies that a thorough neurobiological investigation is called for. The core psychological deficit necessary and sufficient to cause central autism symptoms is gradually being defined. The multiple aetiologies of autism will lead to multiple treatment in the future. At the present stage structured education and behaviour modification provide the cornerstones of any treatment programme.

An Evaluation of DSM-III Criteria for Infantile Autism

DSM-III represents the most recent effort to provide diagnostic criteria for infantile autism. In this study the adequacy of DSM-III diagnostic criteria was assessed in a group of 50 individuals, all of whom had been diagnosed as autistic before age 5 and had been followed at our Center. A structured developmental history was completed by parents, and items relating to the child's early development and behavior before age 6 were abstracted and used to operationalize DSM-III criteria. Problems arose in the specificity and applicability of these criteria. While DSM-III represents an advance in the diagnosis of infantile autism, these problems limit its applicability to autistic children; operationally defined criteria for this disorder are needed. The question of possible continuities between infantile autism and other pervasive developmental disorders must be addressed.

Early childhood autism and the question of egocentrism.

An individual's social competence is often considered in terms of his role-taking abilities. In the light of studies by Piaget, it has been supposed that a child's developing capacity to appreciate the viewpoints of others in a social context is reflected in his ability to recognize points of view in a visuospatial setting. If this is valid, then visuospatial role-taking tasks may afford a measure of some relatively "cognitive" component of the capacity to engage in social behavior. Tasks in which subjects were required to make judgments about different and yet related views of a three-dimensional scene or object, together with tests of operational thinking, were presented to normal children and to subjects with the diagnosis of infantile autism. The results indicate that autistic children are not more impaired in their recognition of visuospatial perspectives than are normal children of comparable intellectual level in tests of operational thinking. A further, more limited study yielded suggestive evidence that over this series of tasks, autistic children perform as well as subjects with Down's syndrome who have a similar verbal mental age. These findings render it improbable that autistic children are especially "egocentric" in their appreciation of visuospatial perspectives.

Developmental Trends in Cognitive Skills for Children Diagnosed as Autistic and Schizophrenic

102 children whose histories included a diagnosis of infantile autism or childhood schizophrenia were followed longitudinally to assess cognitive developmental trends. Despite some sample attrition, administration of a test battery of 5 language skill measures and 2 perception skill measures during 5 test periods over 4 years yielded 336 usable test batteries. After all tests had been administered, diagnosis of subjects for autism and schizophrenia using developmental histories and behavioral observations drawn at the time of first test-battery administration showed 111 test batteries on 33 children diagnosed as autistic, and 100 test batteries on 27 children diagnosed as schizophrenic. Comparisons of age and test score correlations, comparisons of cross-sequential means, and trends for means for diagnostic subgroups and normal controls suggest developmental delay for all skills at all ages for both autistic and schizophrenic children. Findings also suggest a trend for steady prepubertal cognitive skill development, followed by a postpubertal decline in skills for both diagnostic groups.

Infantile autism. I: A prospective study of the diagnosis.

A prospective study was made of 200 consecutive children to evaluate the usefulness in the diagnosis of infantile autism of the behavioral scale reported by Clancy and coworkers in 1969. On this scale seven or more of 14 behavioral manifestations must be present before a diagnosis of autism can be made. Using this scale alone, 48 of the 200 children studied were "scale positive", i.e. could be considered autistic. However, further study of this group showed that only one child fulfilled the classical criteria of Kanner (1943) for a diagnosis of early infantile autism. Scale "positivity" was found to correlate with mental retardation and to be associated with other developmental defects, especially learning disorders and hearing loss.

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.

The diagnosis of infantile autism.

SUMMARYThe results are piesented of the first part of a study designed to clarify the diagnosis of infantile autism. The nine‐point scale devised by Creak and others in 1961 was used as the source of reference for data collection.The symptoms of a group of children clinically diagnosed as having infantile autism were analysed. Control groups of normal children, children diagnosed as rubella deaf, as cerebral palsied and as subnormal, were compared with the autistic test group.Using the method of numerical taxonomy, 14 major manifestations of infantile autism were isolated. The following criteria are established for the diagnosis of this condition: No one item of the 14 major manifestations is significant in isolation. The diagnostic value of the scale is in the grouping of the symptoms. A child must show a minimum of 7 items before the diagnosis of infantile autism can be considered. As originally specified by Kanner, the child's symptoms must begin in the first three years of life.RÉSUMÉDiagnostic de Vautisme infantileLes résultats sont tires de la premiére partie d'une étude destinee à préciser le diagnostic de I'autisme infantile. L'echelle en neuf points decrite par Creak et collaborateurs en 1961 a été utilisee comme source de reference pour les renseignements recueillis.Les symptomes presentes par un groupe d'enfants chez qui le diagnostic clinique d'autisme infantile avait été poite ont été analyses. Des groupes controles d'enfants normaux, d'enfants sourds a la suite de rubeole, d'enfants infirmes moteurs cerebraux, et d'enfants sub‐normaux ont été compares avec le groupe autistique.En utilisant une methode de toxonomie numerique, 14 manifestations principales d'autisme infantile ont pu etre isolees. Les criteres suivants ont été etablis pour le diagnostic de I'autisme: aucune des 14 manifestations prise isolement n'est significative, la valeur diagnostique de l'echelle leside dans le groupement des symptomes. Un enfant doit presenter un minimum de 7 items avant que le diagnostic d'autisme puisse être envisage. Comme cela a deja été precise par Kanner, les symptomes doivent apparaitre dans les trois premieres annees de la vie.ZUSAMMENFASSUNGDie Diagnose des kindlichen AutismusDie Ergebnisse des ersten Teiles einer Untersuchung, die die Diagnose des kindlichen Autismus klaren soil, werden dargestellt. Die Neun‐Punkte‐Skala, von Creak und anderen 1961 das erste Mai beschrieben, wurde als Bezugsquelle fiir die Unterlagensammlung benutzt.Es werden die Symptome an einer Gruppe von Kindern, bei denen klinisch ein kindlicher Autismus diagnostiziert worden ist, untersucht. Kontrollgruppen von normalen Kindern, von Kindern mit Roteln‐Taubheit, mit cerebralen Lahmungen und von subnormalen Kindern werden mit einer autistischen Testgruppe verglichen.Unter Verwendung der Methode der numerischen Taxonomie werden 14 wichtige Manifestationen des kindlichen Autismus isoliert. Zur Diagnose dieses Krankheitsbildes werden die folgenden Kriterien festgesetzt: Nicht eine einzelne der 14 wichtigen Manifestationen ist fiir sich significant. Der diagnostische Wert der Skala besteht in der gruppierten Einordnung der Symptome. Ein Kind muB mindestens 7 Symptome aufweisen, bevor die Diagnose des kindlichen Autismus in Betracht kommen kann. Wie ursprunglich von Kanner spezifiziert, miissen die Symptome beim Kind in den ersten drei Lebensjahren beginnen.RESUMENEl diagnóstico del autismo infantilSe dan los resultados de la primera parte de un estudio cuyo objeto fue la clarification del diagn6stico del autismo infantil. Se utiliz6 la escala de nueve escalones inventada por Creak y otros en 1961 como referencia de origen para la colecci6n de datos.Se analizaron los sintomas de un grupo de niños que tenian un diagndstico clinico de autismo infantil. Se compararon con el grupo autfstico, grupos testigo que comprendian niños sanos, niños diagnosticados como sordos a causa de rubeola materna, niños afectos de una paralisis cerebral, y niños subnormales.Por el metodo de taxonomia numerica se aislaron 14 signos mayores del autismo infantil. Se establecieron los criterios siguientes para el diagn6stico de este estado: ninguno de los 14 signos es significativo si ocurre sole. El valor diagndstico de la escala depende de la agrupaci6n de los sintomas. Un niiio debe presentar por lo menos 7 de los criterios antes de que se pueda considerar un diagndstico de autismo infantil. Como especificd original‐mente Kanner, los sintomas deben presentarse durante los tres primeros afios de la vida.

Studies on 5-hydroxyindole metabolism in autistic and other mentally retarded children

Summary Aspects of 5-hydroxyindole metabolism have been studied in some groups of mentally retarded children. Six of 23 children with the diagnosis of infantile autism had consistently elevated blood 5-HT levels. The mean level of blood 5-HT of other severely retarded children was higher than that of the mildly retarded group. No specific clinical signs could be found in these children.