Signs Of Autism Research Articles

Malleus Malefactorum

BioTechniquesVol. 46, No. 3 From the EditorOpen AccessMalleus MalefactorumDouglas McCormickDouglas McCormick*E-mail Address: douglas.mccormick@informausa.comBioTechniquesSearch for more papers by this authorPublished Online:25 Apr 2018https://doi.org/10.2144/000113096AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail The other day, we discovered that the author of a submitted paper appeared to have cribbed some of his discussion from a web site belonging to someone else. These things happen, from time to time, and each case is different: the magnitude of the sin ranges from cardinal to venial.Consider a spate of review articles on drug delivery technologies submitted a few years ago to another journal of which I was then editor. There seemed to be dozens of them, though in reality there were only five or six. All came from second-rank technical universities in a single country (which we will not, for now, identify), and all seemed to be the products of a highly systematized process. The method was simple: type a topic into Medline, download the titles and abstracts, do a minimal rewrite (generally by turning active voice to passive and passive to active), and string the results together. Voila, there you have your review, ready for publication.Once we learned the pattern, these automated reviews were fairly easy to spot and reject.But it was uncomfortable to realize just how much journals depend on the good faith and candor of their scientific communities—and how vulnerable they are to willful deceit.Research misconduct of any kind is profoundly depressing. Every time it happens, it comes as a shock. The outrage mixes with a whisper of sympathy, to make a disorienting cocktail. “What if there's an innocent explanation?” asks a little voice, to which a louder voice rejoins, “How dare they!”One can't help imagining the forces that might drive a researcher into this sort of career-destroying crime. Sure, it's easy to loathe a conscienceless fraud—fabricating or stealing data for personal gain, for the sake of a big grant or a fat venture investment.But one imagines other cases, as well: the desperately exhausted post-doc out of his depth, panicking because his experiment has collapsed yet again, who makes up data to support results he knows have to be true, just to make the pain of failure go away. The bewildered non-English speaker who borrows a phrase, and then a sentence, and finally whole paragraphs from the web or an out-of-the-way journal, because they explain the case far better than she ever could. Confronting cases like these first-hand, or even writing about them second-hand (as we must too often do in our newsletter), is dispiriting.But is forgiveness possible, since intentional falsehood had caused so much damage, and the literature, once polluted, is so hard to cleanse?Consider just one recent case. At the beginning of February, the Sunday Times of London (1) alleged that the lead author had falsified data underlying an influential 1998 Lancet article (2). The paper linked autism and colitis with MMR (mumps, measles, and rubella) vaccination in twelve children, claiming that signs of autism appeared shortly after vaccination. In fact, said the Times, the children's medical records showed that the first symptoms of autism appeared well before or well after vaccination. The initial 1998 paper fueled parents' fears of vaccination, and sent UK vaccination rates plummeting. The result: in 1998, England and Wales saw 56 cases of measles. In 2008, there were 1,348.The literature is now corrected, but the damage is done. While one hates to fall back on proverbs, it seems that in publishing, as in medicine, an ounce of prevention really is worth a pound of cure.

Sur la prévalence de l’autisme et des troubles envahissants du développement (TED)

Estimates of the prevalence of autism and pervasive developmental disorders (PDD) are discordant and are moving towards an apparent increase in rates. The studies carried out since 1966 illustrate the variability of the protocols used and explanatory hypotheses put forward. These investigations are difficult, sparse, but still growing at the same time that a debate develops on the possible increase in actual prevalence. Indeed, the rate initially admitted for classic autism was 5/10,000, then 1/1000 with an expanded definition to the forms, but the current figures are very different (almost 0.7% for all PDD), and this increase raises questions. The arguments in favour of an apparent increase are primarily methodological. Several biases are encountered when one compares the recent publications with those of previous years. First, autism is better known and recognized than 30 or 40 years ago. Then, the diagnostic criteria used over time are changing variables, and comparisons difficult. Recent studies using the criteria of a broader definition of autism, polyhandicap with severe retardation and autism signs of lighter forms. The fact that children with autism are diagnosed more frequently in the younger age could also occasionally lead to an artificial increase in the number of cases identified in new surveys in populations of young children. Other factors are cited to explain the current increase. There could be higher rates of autism (and mental retardation) among children of migrants from distant countries, with the aetiological hypothesis of maternal infections, more frequent due to immune deficiency against infectious agents depending on the environment, metabolic decompensations also related to changes in surroundings, or more births from unions among migrant mothers and men with Asperger syndrome (with increased risk of paternity of a child with autism). Other theories relate to pollution, vaccinations, a growing number of premature babies; all assumptions that appear, for the time being, insufficiently explored and documented. The issue is also one of the motivations underlying these steps, and setting a parallel prevalence actually increased with this or that factor has presently been scientifically validated. Finally, if a careful reading of recent publications indicates that autism has become more frequent; assumptions that describe an increase in "artificial", based on methodological arguments, seem to be more consistent. EFFECTS OF EXTENSION OF DIAGNOSTIC CRITERIA AND NOSOGRAPHY FOR PDD: Today, the recruitment of individuals with autism in a population far exceeds the initial criteria of Kanner in the 1970's. It includes clinical forms with associated pathologies, or lighter and probably more frequent clinical forms. Other assumptions arouse interest, but also controversy regarding their relevance. The enumeration of cases of PDD in a population is actually at its beginning. In the 1970's, "childhood psychoses" (the term then used) seemed rare. The identification of cases was probably the main reason. Long available figures remain scarce, and their rate increases gradually from the 1990s, but is, in fact, a problem of inflation. What is the part played in this flight of changing diagnostic criteria and substitutions, or other methodological effects? Or even opportunistic effects, if we speak of an epidemic to undermine a variety of factors. The evidence provided so far is the improved identification of cases, enlargement of the concept, and better shared diagnostic criteria. However, the validity and limitations of clinical forms are still vague and unresolved. How to study epidemiology in the future - to move forward, studies should be designed with partners' medical history and medicosocial studies, based on a better consensual methodology, epidemiology, statistics and diagnosis, with a definition of the thresholds for inclusion, and arbitration procedures. On this basis, a study must also be coordinated with those concerning mental retardation, learning disorders, etc, otherwise the same topics will be counted twice or even three times. As for the addition of syndromic forms of PDD (those with known aetiology), their number is still below a proportion sufficient to be an appeal. Moreover, another problem exists: the degree of membership of each of these syndromes, or individual cases, or autistic spectrum disorders (internal variability phenotypes). For the moment, we could design two studies included better: developmental disorders and associated pathologies. Regarding the "ethic" dimension, a more regular diagnosis of PDD (preferred to that of mental retardation or learning disorder) will lead to shared practices and set limits for greater recognition.

Positive Screening Results for Autism in Ex-preterm Infants: In Reply

We thank Indredavik et al for their interest in our article and appreciate the opportunity to respond to the comments made in their letter. Our work is focused on the early detection of, and intervention for, neurodevelopmental challenges that face ex-preterm infants. The principal goal of this study was to determine the prevalence of early signs of autism in a population …

Childhood and current autistic features in adolescents with schizotypal personality disorder

The diagnostic boundaries between autistic- and schizophrenia-spectrum disorders have varied over the years, and some overlap in diagnostic criteria persists. The present study examined childhood and current signs of autistic disorder (AD) in adolescents with schizotypal personality disorder (SPD) or other personality disorders, as well as healthy controls. A structured interview was administered to rate participants' current symptoms. Participants' guardians were interviewed with the Autism Diagnostic Inventory—Revised (ADI-R), a clinical assessment of childhood and current autistic signs. Compared to both the other personality-disordered and healthy groups, adolescents with SPD were rated as having significantly more impairment on childhood and current social functioning, and having more unusual interests and behaviors. For the entire sample, impaired childhood social functioning and unusual interests and behaviors were associated with higher negative symptom scores. Current impairments in social functioning, unusual interests and behaviors, and communication were also linked with greater negative symptoms. However, neither childhood nor current autistic features significantly predicted later conversion to an Axis I psychotic disorder over the course of three years of follow-up. The findings indicate that past and current autistic signs are more common in adolescents with SPD, but neither current nor childhood autistic features are linked with conversion to psychosis.

Quirky Citizens: Autism, Gender, and Reimagining Disability

Quirky Citizens: Autism, Gender, and Reimagining Disability

What is new in autism?

Autism is now recognized in one out of 150 children. This review highlights the topics within the growing autism literature that are shaping current thinking on autism and advancing research and clinical understanding of autism spectrum disorders. The role of single-stranded microdeletions and epigenetic influences on brain development has dramatically altered our understanding of the etiology of the autisms. Recent research has focused on the role of synapse structure and function as central to the development of autism and suggests possible targets of interventions. Brain underconnectivity has been a focus in recent imaging studies and has become a central theme in conceptualizing autism. Despite increased awareness of autism there is no 'epidemic' and no one cause for autism. Data from the sibling studies are identifying early markers of autism and defining the broader autism phenotype. Larger datasets in genetics, a focus on the early signs of autism, and increased recognition of the importance of defining subgroups of children with autism are leading to a greater understanding of the etiologies of autism. A growing interest in defining the molecular biology of social cognition, which is at the core of autism, will lead to expansion of our presently limited choices of mechanistically based interventions.

Positive Screening for Autism in Ex-preterm Infants: Prevalence and Risk Factors

The survival of very low birth weight infants has increased markedly in recent years. Unfortunately, the prevalence of significant and lifelong motor, cognitive, and behavioral dysfunction has remained a major problem confronting these children. The objective of this study was to perform screening tests for early autistic features in children with a history of very low birth weight and to identify risk factors associated with a positive screening result. We studied 91 ex-preterm infants < or = 1500 g at birth. Infants underwent conventional MRI studies at preterm and/or term-adjusted age. We collected pertinent demographic, prenatal, intrapartum, acute postnatal, and short-term outcome data for all infants. Follow-up assessments were performed at a mean age of 21.9 +/- 4.7 months, using the Modified Checklist for Autism in Toddlers, the Vineland Adaptive Behavior Scale, and the Child Behavior Checklist. Twenty-six percent of ex-preterm infants had a positive result on the autism screening tool. Abnormal scores correlated highly with internalizing behavioral problems on the Child Behavior Checklist and socialization and communication deficits on the Vineland Scales. Lower birth weight, gestational age, male gender, chorioamnionitis, acute intrapartum hemorrhage, illness severity on admission, and abnormal MRI studies were significantly associated with an abnormal autism screening score. Early autistic behaviors seem to be an underrecognized feature of very low birth weight infants. The results from this study suggest that early screening for signs of autism may be warranted in this high-risk population followed by definitive autism testing in those with positive screening results.

Approches substitutive et diététique du trouble autistique de l’enfant : intérêts ou limites ?

Resume L’application de complementations ou de regimes alimentaires specifiques sont pronees par certains auteurs dans le traitement du trouble autistique de l’enfant et cette approche suscite interet chez les parents et controverse chez les professionnels. Or, a ce jour, la majorite des etudes publiees sur ce theme dans le trouble autistique ne peuvent encourager les cliniciens a recommander les regimes aux parents du fait d’un manque de lisibilite de la balance benefice–risque. Les etudes souvent isolees et non repliquees par d’autres equipes souffrent d’une methodologie dont la rigueur s’avere insatisfaisante ou trop variable et seule la supplementation en vitamine B6 semblerait avoir repondu a des criteres d’evaluation, d’efficacite et de tolerance satisfaisants. Cette supplementation reste toutefois encore largement discutee. Mais l’approche dietetique n’est pas a negliger pour autant, car ces etudes temoignent du deficit nutritionnel des enfants autistes et de la confrontation des parents a leurs comportements alimentaires particuliers dont on ne peut ignorer le retentissement somatique, comportemental ou encore familial.

Recognition of Autism Before Age 2 Years

1. Chris Plauche Johnson, MEd, MD* 1. *Editorial Board After completing this article, readers should be able to: 1. Characterize the deficits of a child who has autism. 2. Describe the role of observing linguistic and social development in children who have autism. 3. Implement a strategy for surveillance and screening of young children. 4. Discuss the management of autism, including the use of medication. Primary care physicians (PCPs) caring for 1,000 children in a general practice should expect approximately six of their patients to meet the diagnosis of an autism spectrum disorder (ASD). (1) The impact of this prevalence is illustrated by a 2004 survey of PCPs revealing that 44% cared for 10 or more patients who had an ASD. (2) The ASDs include: autistic disorder (AD), Asperger disorder, and pervasive developmental disorder—not otherwise specified (PDD-NOS), a threshold term used when a child meets some but not all criteria necessary for a diagnosis of either AD or Asperger disorder. Research has documented the positive benefit of developmental and behavioral intervention for children who have ASDs, particularly when it is initiated prior to 3 years of age. (3) Early recognition of ASDs also is important for timely genetic counseling because younger siblings of children diagnosed as having ASDs have a 10 times increased risk of also having an ASD. The purpose of this review is to help the clinician recognize signs of ASDs that occur before age 2 years. Because the signs of Asperger disorder usually appear later, they are not discussed. The term “autism” is used in this review to represent both AD and its milder form, PDD-NOS. Currently, autism is diagnosed infrequently in children younger than 3 years of age. The diagnostic process is prompted most often by parental concern about absent or delayed speech. However, signs of autism, especially deficits in social skills and in preverbal gestural language, are present …

The Autism Observation Scale for Infants: Scale Development and Reliability Data

The Autism Observation Scale for Infants (AOSI) was developed to detect and monitor early signs of autism as they emerge in high-risk infants (all with an older sibling with an autistic spectrum disorder). Here we describe the scale and its development, and provide preliminary data on its reliability. Inter-rater reliability both for total scores and total number of endorsed items is good to excellent at 6, 12 and 18 months; reliability is more modest for individual items, particularly in 6-month-olds. Test-retest reliability of the AOSI at 12 months of age is within acceptable limits. Evidence that the AOSI provides reliable data is the first critical step towards evaluating its efficacy in distinguishing high-risk infants who develop ASD.

Autism symptoms in toddlers with Down syndrome: a descriptive study.

Research suggests that children with Down syndrome may be at increased risk of having an autism spectrum disorder; however, previous studies have not utilized comprehensive, state-of-the-art diagnostic tools to address the question of comorbid autism and Down syndrome. Comprehensive evaluations for autism were conducted in 20 2-year-old children with Down syndrome. The Autism Diagnostic Observation Schedule-Generic (ADOS-G) and the Autism Diagnostic Interview-Revised (ADI-R) were administered by experienced clinicians, who then determined if the child presented with significant symptoms of autism. Eighteen children participated in a follow-up evaluation at age 4 years. Three children (15%) met criteria for an autism spectrum disorder at both time points, and two (10%) for autistic disorder. Case descriptions are provided. Several children presented with difficulties in communication and play, but did not show problems in core social relatedness. The ADOS-G, if used alone, over-identifies autism in toddlers with Down syndrome. Clinical judgement is critical in diagnosing autism in Down syndrome. Young children may show some signs of autism (particularly in the area of communication) and not have the disorder. Children who have comorbid Down syndrome and autism are particularly challenged, relative to their peers without autism.

What Factors are Related to a Negative Outcome of Self‐Injurious Behaviour During Childhood in Pervasive Developmental Disorders?

Aim To explore the factors related to the outcome of self‐injurious behaviour (SIB) in children with pervasive developmental disorders (PDD).Method Children with PDD were assessed on individual and environmental variables at time 1 and 3 years later. A questionnaire about the presence or absence of SIB was also administered at both times in order to examine the early course of SIB.Results Our findings suggest an association between a negative outcome and several aspects of the children’s behaviour. Children with a negative outcome differed from the others in having greater speech impairment, more cognitive and adaptive deficits, and more severe signs of autism. When these variables were entered into a multivariate model for predicting the outcome of SIB, only speech deficits (ORa 3.5, CI 95% 1.13–13.4) and autism severity (ORa 1.1, CI 95% 1.03–1.18) were significant risk factors.Discussion The importance of these findings for improving our understanding of SIB is discussed.

Evaluation of autism traits in Angelman syndrome: a resource to unfold autism genes

Linkage and cytogenetics studies have found the Angelman syndrome (AS) chromosomal region to be of relevance to autism disorder (AD) or autism spectrum disorder (ASD). Autism is considered part of the behavioural phenotype in AS based on formal autism assessments (autism diagnostic interview-revised [ADI-R] and autism diagnostic observation schedule [ADOS]), which have mainly addressed the deleted AS group. We explored 23 AS patients including all genetic subtypes and made a co-morbid diagnosis of AD/ASD in 14/23 (61%), which does not include 4 cases classified within the broader autism spectrum disorder (bASD). Deletions accounted for the main fraction (35%), ubiquitin-protein ligase E3A (UBE3A) mutation represented 13%, imprinting defects and uniparental disomy 9 and 4%, respectively. UBE3A mutations due to lack of the homologous to the E6-associated protein carboxyl terminus domain (n = 3) were associated with the ASD, while more distal mutations (n = 3) seem to escape from a co-morbid diagnosis of autism/autism spectrum. Differences in severity of autistic features were seen across subtypes of AS, with some behavioural features being unique to AS and some representing all forms of developmental disability. Autism signs (poor/lack of eye contact, showing, spontaneous initiation of joint attention, social quality of overtures [ADOS algorithm items for Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV)/International Statistical Classification of Diseases and Related Health Problems-10 (ICD-10) autism diagnosis belonging to the reciprocal social interaction domain]) discriminating all the co-morbid AS categories from non-autistic AS belonged to the social interaction domain. Impairments in the communication domain (gestures, pointing, use of another's body, frequency of vocalisation towards others [ADOS algorithm items for DSM-IV/ICD-10 autism diagnosis belonging to the communication domain]) justified classification of co-morbid AD/ASD vs the classification of less affected bASD. Evaluation of the behaviour domain suggested that repetitive sensory and motor behaviours correlate with a low developmental profile rather than being specific to autism.

A Prospective Case Series of High-risk Infants who Developed Autism

The present paper documents the development of autism/autistic spectrum disorder in a consecutive series of nine high-risk infants followed prospectively from 6 months of age. Evidence is provided for two broadly defined subgroups: the first subgroup (n = 6) showed a decrease in IQ between 12 and 24 or 36 months (from average/near average to severe cognitive impairment), whereas the second subgroup (n = 3) continued to obtain average or near average IQs. Signs of autism emerged and/or were more striking earlier in the first subgroup. In all nine children, early impairment in social-communicative development coexisted with atypical sensory and/or motor behaviors, as did a temperamental profile marked by irritability/distress and dysregulated state. Discussion focuses on issues raised by the pattern of findings.

Engaging autism: using the floortime approach to help children relate, communicate, and think

This is the long-awaited publication of Stanley Greenspan's revolutionary ideas on how to treat autism. Stanley Greenspan's work has long been known to all who are engaged in early intervention with autistic children, and to professionals and proactive parents who follow his research. Now, his work is about to break upon a larger scene, as the incidence of the problem rises, and Greenspan's unique developmental model is shown to have more success than the traditional behavioural approaches. Two exciting aspects distinguish Greenspan's approach: first, it is much more optimistic, showing that children with signs of autism or autistic spectrum disorders do not have a fixed, limited potential, but in many cases can join their peers and lead full, psychologically healthy lives. Secondly, his approach can be applied at a much earlier stage, when early signs appear. Thus the possibility of preventing the full development of autism is now raised. The book itself will be very straightforward: a new definition of autistic spectrum disorders, guidance for diagnosis and avoiding misdiagnosis, ways to recognize early signs, treatment guidelines, case stories and help for a number of particular challenges in relationships, language, social skills and disruptive symptoms. Unique features of this comprehensive guide include: new definition of autism; myths about autism; approaches to prevention; how to avoid misdiagnosis; earliest and ongoing signs of autism; first steps for families; new and optimistic goals for children with ASD (autistic spectrum disorders); effective help for older children and adults with ASD; floortime approach - step by step; how to design a comprehensive programme to fit each individual child; overcoming difficult symptoms such as repetitive behaviour, self-stimulation and aggression; and new research on causes and treatment outcomes.

Studying the Emergence of Autism Spectrum Disorders in High-risk Infants: Methodological and Practical Issues

Detecting early signs of autism is essential for timely diagnosis and initiation of effective interventions. Several research groups have initiated prospective studies of high-risk populations including infant siblings, to systematically collect data on early signs within a longitudinal design. Despite the potential advantages of prospective studies of young children at high-risk for autism, there are also significant methodological, ethical and practical challenges. This paper outlines several of these challenges, including those related to sampling (e.g., defining appropriate comparison groups), measurement and clinical implications (e.g., addressing the needs of infants suspected of having early signs). We suggest possible design and implementation strategies to address these various challenges, based on current research efforts in the field and previous studies involving high-risk populations.

Follow-up of children with autism spectrum disorders from age 2 to age 9

The purpose of the present study was to examine the developmental outcomes of children 7 years after their initial diagnosis. Children diagnosed with autism or PDD-NOS at age 2 received follow-up evaluations at age 9. Diagnostic stability was high, with 88 percent of the sample obtaining autism spectrum diagnoses at age 9. Cognitive scores improved considerably for a large segment of the sample, with over 50 percent obtaining scores in the average range at follow-up. Language outcomes were also positive at follow-up; 88 percent of the sample demonstrated at least some functional language, and 32 percent were able to engage in conversational exchanges. Early characteristics that predicted outcome status were: age of diagnosis, age 2 cognitive and language scores, and total hours of speech-language therapy between ages 2 and 3. These findings highlight the potential long-term benefits of both early identification and early intervention, and provide additional evidence for the importance of promoting public awareness of the early signs of autism.

Video Monitoring Documents Development of Autism

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessVideo Monitoring Documents Development of AutismJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:7 Oct 2005https://doi.org/10.1176/pn.40.19.00400028aHome videotapes have documented what parents of many autistic children have long claimed—that their children were essentially normal during the first year of life, but then deteriorated during the second year into autism.“This is the first study to use home videotapes to validate autistic regression,” Geraldine Dawson, Ph.D., director of the University of Washington Autism Center, told Psychiatric News.Dawson, along with Emily Werner, Ph.D., a doctoral student at the university, is the author of the study. Results were published in the August Archives of General Psychiatry.Most, if not all, information on the phenomenon of autistic regression has been derived either from retrospective parental recall or from a review of medical records. And even though medical records might be less subject to reporting bias than parental recall is, such records may not contain crucial details about a child's early developmental course that would divulge whether he or she was developing autism.Dawson and Werner obtained home videotapes from the first and second birthdays of 56 subjects. Twenty were typically developing children, and 36 met DSM-IV criteria for autism spectrum disorder. Furthermore, of the 36, 21 had early-onset autism according to their parents, and 15 had regressive-type autism according to theirs. Dawson and Werner then had researchers blind to subjects' diagnostic status scrutinize the videotape footages for particular behaviors—say, babbling, word usage, or looking at people—and then record when, how often, and, in the case of looking at people, how long such behaviors occurred. Dawson and Werner then compared the behavior-assessment results for all three groups of subjects at 1 year and 2 years of age.At age 1, Dawson and Werner found, the children with regression-type autism behaved more like the typically developing children than they did like the early-onset autism children. For example, they engaged in as much declarative pointing as the typically developing children did, unlike the early-onset children. Declarative pointing is used to share an experience with another person.In contrast, the children with regression-type autism differed from both the early-onset group and the typically developing group in language use. The regressed children used complex babbling and words significantly more frequently than early-onset children did, with typical children falling in between the early-onset and regressed groups in such use. In fact, the regressed children used complex babble or words nearly twice as often as typical children did.By age 2, in contrast, the regression group was behaving more like the early-onset group than like the typically developing group or in any idiosyncratic way of its own. For instance, both the regression group and the early-onset group used significantly fewer words than the typical group did. They also responded to their names significantly less often and looked at people significantly less of the time than the typical group did.Moreover, whereas the typically developing children increased their use of words dramatically between ages 1 and 2, neither the regression group nor the early-onset group made significant gains.Thus, “this study validates the existence of early autistic regression,” Werner and Dawson concluded in their study report. In fact, the results constitute the strongest scientific evidence yet that autistic regression truly occurs, Dawson contended.“This study,” she added, “again confirms that autism symptoms are apparent in some children by 1 year of age. It suggests that health professionals should be on the alert for early symptoms such as lack of eye contact, failure to gesture and point, and lack of babbling and words in infants at 1 year of age. These might be early signs of autism.“The study also confirms that an infant might appear to be developing normally at age 1 but then experience a loss of skills and develop autism in the second or third year of life. Any loss of a previous skill, such as loss of babbling, is a serious red flag. If parents report that their toddler lost skills, the child should be referred for a comprehensive neurodevelopmental evaluation.”The study was funded by the National Institute of Child Health and Human Development.An abstract of “Validation of the Phenomenon of Autistic Regression Using Home Videotapes” is posted at<http://archpsyc.ama-assn.org/cgi/content/abstract/62/8/889>.▪ Arch Gen Psychiatry 2005 62 889 ISSUES NewArchived

Disorganized rhythm and synchrony: Early signs of autism and Rett syndrome

We interpret early age-related developments in intentions and socially responsive behaviour with data from home videos of infants who later develop autism or Rett syndrome. Detailed evidence is given from a micro-analytic study of videos of monozygotic twin girls at 11 months, one of whom became autistic in the second year. Changes in this twin's attention, motor tonus, initiative and emotion reduce her prospective control of movements and her anticipations in awareness compared to her sister. These changes were reflected in the child's asynchronous social behaviour, which frustrated the father's attempts to support her attempts to walk, share toys, or play a game, confusing his anticipations, and this further reduced mutual attention and joint activity. Observations of the development of girls with Rett syndrome in the first year reveal changes in motor coordination, attention and communicative initiative, indicative of a failure of intrinsic core brain regulations of neural development and conscious activity. Notwithstanding that the two conditions show clear differences in both brain growth and early development of skills and sociability, the first signs of autism and Rett syndrome have important similarities. We conclude with recommendations for an approach to early diagnosis and treatment, applicable for the whole range of developmental brain disorders, including Rett syndrome and autism, that attempts to identify residual capacities for sympathetic motivation and collaborative learning—an approach that deliberately tries to support weakened rhythmic impulses for motor, perceptual and communicative functions in the growing infant brain.

Congenital Versus Regressive Onset of Autism Spectrum Disorders

Recent studies have validated the phenomenon of autistic regression, but little is known about how regressive and congenital onsets of the disorder influence parents' thinking about autism and its etiology. Parents (N = 327) of children with autism spectrum disorders completed an online questionnaire about their children's development. Approximately half of the sample indicated that their children showed signs of autism from birth or shortly thereafter; the remaining half described their children as developing autism in the regressive fashion. Parents' beliefs about the causes of autism varied widely, but two of the most popularly cited explanations were “genetics” and “external mechanisms” (e.g., vaccinations, environmental toxins). When analyzed relative to type of autism onset, parents more often advocated genetics as the cause for autism when their children exhibited the congenital type and external mechanisms when their children presented with the regressive type.