Bayonet-shaped language development in autism with regression: a retrospective study / D. GAGNON in Molecular Autism, 12 (2021)  

Public ISBD [article]  inMolecular Autism > 12 (2021) . - 35 p. Titre : Bayonet-shaped language development in autism with regression: a retrospective study Type de document : Texte imprimé et/ou numérique Auteurs : D. GAGNON, Auteur ; A. ZERIBI, Auteur ; É DOUARD, Auteur ; V. COURCHESNE, Auteur ; B. RODRÍGUEZ-HERREROS, Auteur ; G. HUGUET, Auteur ; S. JACQUEMONT, Auteur ; M. A. LOUM, Auteur ; L. MOTTRON, Auteur Article en page(s) : 35 p. Langues : Anglais (eng) Mots-clés : Autism  Heterogeneity  Language  Regression  Speech Index. décimale : PER Périodiques Résumé : BACKGROUND: Language delay is one of the major referral criteria for an autism evaluation. Once an autism spectrum diagnosis is established, the language prognosis is among the main parental concerns. Early language regression (ELR) is observed by 10-50% of parents but its relevance to late language level and socio-communicative ability is uncertain. This study aimed to establish the predictive value of ELR on the progression of language development and socio-communicative outcomes to guide clinicians in addressing parents' concerns at the time of diagnosis. METHODS: We used socio-communicative, language, and cognitive data of 2,047 autism spectrum participants from the Simons Simplex Collection, aged 4-18 years (mean?=?9 years; SD?=?3.6). Cox proportional hazard and logistic regression models were used to evaluate the effect of ELR on language milestones and the probability of using complex and flexible language, as defined by the choice of ADOS module at enrollment. Linear models were then used to evaluate the relationship of ELR and non-verbal IQ with socio-communicative and language levels. RESULTS: ELR is associated with earlier language milestones but delayed attainment of fluent, complex, and flexible language. However, this language outcome can be expected for almost all autistic children without intellectual disability at 18 years of age. It is mostly influenced by non-verbal IQ, not ELR. The language and socio-communicative level of participants with flexible language, as measured by the Vineland and ADOS socio-communicative subscales, was not affected by ELR. LIMITATIONS: This study is based on a relatively coarse measure of ultimate language level and relies on retrospective reporting of early language milestones and ELR. It does not prospectively document the age at which language catches up, the relationship between ELR and other behavioral areas of regression, nor the effects of intervention. CONCLUSIONS: For autistic individuals with ELR and a normal level of non-verbal intelligence, language development follows a "bayonet shape" trajectory: early first words followed by regression, a plateau with limited progress, and then language catch up. En ligne : http://dx.doi.org/10.1186/s13229-021-00444-8 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=459 [article] Bayonet-shaped language development in autism with regression: a retrospective study [Texte imprimé et/ou numérique] / D. GAGNON, Auteur ; A. ZERIBI, Auteur ; É DOUARD, Auteur ; V. COURCHESNE, Auteur ; B. RODRÍGUEZ-HERREROS, Auteur ; G. HUGUET, Auteur ; S. JACQUEMONT, Auteur ; M. A. LOUM, Auteur ; L. MOTTRON, Auteur . - 35 p. Langues : Anglais (eng) in Molecular Autism > 12 (2021) . - 35 p. Mots-clés : Autism  Heterogeneity  Language  Regression  Speech Index. décimale : PER Périodiques Résumé : BACKGROUND: Language delay is one of the major referral criteria for an autism evaluation. Once an autism spectrum diagnosis is established, the language prognosis is among the main parental concerns. Early language regression (ELR) is observed by 10-50% of parents but its relevance to late language level and socio-communicative ability is uncertain. This study aimed to establish the predictive value of ELR on the progression of language development and socio-communicative outcomes to guide clinicians in addressing parents' concerns at the time of diagnosis. METHODS: We used socio-communicative, language, and cognitive data of 2,047 autism spectrum participants from the Simons Simplex Collection, aged 4-18 years (mean?=?9 years; SD?=?3.6). Cox proportional hazard and logistic regression models were used to evaluate the effect of ELR on language milestones and the probability of using complex and flexible language, as defined by the choice of ADOS module at enrollment. Linear models were then used to evaluate the relationship of ELR and non-verbal IQ with socio-communicative and language levels. RESULTS: ELR is associated with earlier language milestones but delayed attainment of fluent, complex, and flexible language. However, this language outcome can be expected for almost all autistic children without intellectual disability at 18 years of age. It is mostly influenced by non-verbal IQ, not ELR. The language and socio-communicative level of participants with flexible language, as measured by the Vineland and ADOS socio-communicative subscales, was not affected by ELR. LIMITATIONS: This study is based on a relatively coarse measure of ultimate language level and relies on retrospective reporting of early language milestones and ELR. It does not prospectively document the age at which language catches up, the relationship between ELR and other behavioral areas of regression, nor the effects of intervention. CONCLUSIONS: For autistic individuals with ELR and a normal level of non-verbal intelligence, language development follows a "bayonet shape" trajectory: early first words followed by regression, a plateau with limited progress, and then language catch up. En ligne : http://dx.doi.org/10.1186/s13229-021-00444-8 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=459

Childhood diagnoses in individuals identified as autistics in adulthood / E. M. RØDGAARD in Molecular Autism, 12 (2021)  

Public ISBD [article]  inMolecular Autism > 12 (2021) . - 73 p. Titre : Childhood diagnoses in individuals identified as autistics in adulthood Type de document : Texte imprimé et/ou numérique Auteurs : E. M. RØDGAARD, Auteur ; K. JENSEN, Auteur ; K. W. MISKOWIAK, Auteur ; L. MOTTRON, Auteur Article en page(s) : 73 p. Langues : Anglais (eng) Mots-clés : Adult  Autism  Comorbidity  Late diagnosis  A/S in the past three years. EMR, KJ, and LM declare no competing interests. Index. décimale : PER Périodiques Résumé : BACKGROUND: Autism is a developmental condition, where symptoms are expected to occur in childhood, but a significant number of individuals are diagnosed with autism for the first time in adulthood. Here, we examine diagnoses given in childhood among individuals that are diagnosed with autism in adulthood, to investigate whether the late autism diagnosis might be explained by misdiagnosis in childhood or diagnostic overshadowing. METHODS: Through the Danish National Patient Registry, we identified individuals diagnosed with autism in adulthood (N?=?2199), as well as a control sample with no records of an autism diagnosis (N?=?460,798) and calculated how many had received different psychiatric or neurological diagnoses in childhood. RESULTS: We found that most childhood diagnoses were overrepresented in those with an adult autism diagnosis, and attention-deficit hyperactivity disorder, affective disorders, anxiety, and stress disorders were the most prevalent childhood conditions in this group. However, 69% of males and 61% of females with adult autism diagnoses were not found to have received any of the investigated diagnoses before 18 years of age, and most childhood diagnoses were given after the age of 12. LIMITATIONS: Milder to moderate cases of psychiatric conditions that have been solely treated by family physicians or school psychologists may not be fully included in our dataset. The study is based on data from the Danish health care system, and further research is needed to assess whether the findings can be generalized to other countries. CONCLUSION: A majority of those with an adult autism diagnosis had no records of having received any of the investigated diagnoses in childhood. In these cases, the late autism diagnosis is therefore unlikely to be explained by either misdiagnosis or overshadowing. This result is at odds with the prevailing notion that autistic symptoms tend to diminish with age. Therefore, further research is warranted to examine how and if early signs of autism may have manifested among these individuals, and how similar they are to autistic people diagnosed earlier in their development. En ligne : http://dx.doi.org/10.1186/s13229-021-00478-y Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=459 [article] Childhood diagnoses in individuals identified as autistics in adulthood [Texte imprimé et/ou numérique] / E. M. RØDGAARD, Auteur ; K. JENSEN, Auteur ; K. W. MISKOWIAK, Auteur ; L. MOTTRON, Auteur . - 73 p. Langues : Anglais (eng) in Molecular Autism > 12 (2021) . - 73 p. Mots-clés : Adult  Autism  Comorbidity  Late diagnosis  A/S in the past three years. EMR, KJ, and LM declare no competing interests. Index. décimale : PER Périodiques Résumé : BACKGROUND: Autism is a developmental condition, where symptoms are expected to occur in childhood, but a significant number of individuals are diagnosed with autism for the first time in adulthood. Here, we examine diagnoses given in childhood among individuals that are diagnosed with autism in adulthood, to investigate whether the late autism diagnosis might be explained by misdiagnosis in childhood or diagnostic overshadowing. METHODS: Through the Danish National Patient Registry, we identified individuals diagnosed with autism in adulthood (N?=?2199), as well as a control sample with no records of an autism diagnosis (N?=?460,798) and calculated how many had received different psychiatric or neurological diagnoses in childhood. RESULTS: We found that most childhood diagnoses were overrepresented in those with an adult autism diagnosis, and attention-deficit hyperactivity disorder, affective disorders, anxiety, and stress disorders were the most prevalent childhood conditions in this group. However, 69% of males and 61% of females with adult autism diagnoses were not found to have received any of the investigated diagnoses before 18 years of age, and most childhood diagnoses were given after the age of 12. LIMITATIONS: Milder to moderate cases of psychiatric conditions that have been solely treated by family physicians or school psychologists may not be fully included in our dataset. The study is based on data from the Danish health care system, and further research is needed to assess whether the findings can be generalized to other countries. CONCLUSION: A majority of those with an adult autism diagnosis had no records of having received any of the investigated diagnoses in childhood. In these cases, the late autism diagnosis is therefore unlikely to be explained by either misdiagnosis or overshadowing. This result is at odds with the prevailing notion that autistic symptoms tend to diminish with age. Therefore, further research is warranted to examine how and if early signs of autism may have manifested among these individuals, and how similar they are to autistic people diagnosed earlier in their development. En ligne : http://dx.doi.org/10.1186/s13229-021-00478-y Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=459

Progress in autism research requires several recognition-definition-investigation cycles / L. MOTTRON in Autism Research, 14-10 (October 2021)  

Public ISBD [article]  inAutism Research > 14-10 (October 2021) . - p.2230-2234 Titre : Progress in autism research requires several recognition-definition-investigation cycles Type de document : Texte imprimé et/ou numérique Auteurs : L. MOTTRON, Auteur Article en page(s) : p.2230-2234 Langues : Anglais (eng) Mots-clés : Autism Spectrum Disorder  Autistic Disorder  Humans  Recognition, Psychology Index. décimale : PER Périodiques En ligne : http://dx.doi.org/10.1002/aur.2524 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=450 [article] Progress in autism research requires several recognition-definition-investigation cycles [Texte imprimé et/ou numérique] / L. MOTTRON, Auteur . - p.2230-2234. Langues : Anglais (eng) in Autism Research > 14-10 (October 2021) . - p.2230-2234 Mots-clés : Autism Spectrum Disorder  Autistic Disorder  Humans  Recognition, Psychology Index. décimale : PER Périodiques En ligne : http://dx.doi.org/10.1002/aur.2524 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=450

A radical change in our autism research strategy is needed: Back to prototypes / L. MOTTRON in Autism Research, 14-10 (October 2021)  

Public ISBD [article]  inAutism Research > 14-10 (October 2021) . - p.2213-2220 Titre : A radical change in our autism research strategy is needed: Back to prototypes Type de document : Texte imprimé et/ou numérique Auteurs : L. MOTTRON, Auteur Article en page(s) : p.2213-2220 Langues : Anglais (eng) Mots-clés : Autism Spectrum Disorder  Autistic Disorder/diagnosis/epidemiology  Humans  Prevalence  Reproducibility of Results  Research Design  diagnostic  polythetic criteria  prototype  reliability  type 2 error Index. décimale : PER Périodiques Résumé : The evolution of autism diagnosis, from its discovery to its current delineation using standardized instruments, has been paralleled by a steady increase in its prevalence and heterogeneity. In clinical settings, the diagnosis of autism is now too vague to specify the type of support required by the concerned individuals. In research, the inclusion of individuals categorically defined by over-inclusive, polythetic criteria in autism cohorts results in a population whose heterogeneity runs contrary to the advancement of scientific progress. Investigating individuals sharing only a trivial resemblance produces a large-scale type-2 error (not finding differences between autistic and dominant population) rather than detecting mechanistic differences to explain their phenotypic divergences. The dimensional approach of autism proposed to cure the disease of its categorical diagnosis is plagued by the arbitrariness of the dimensions under study. Here, we argue that an emphasis on the reliability rather than specificity of diagnostic criteria and the misuse of diagnostic instruments, which ignore the recognition of a prototype, leads to confound autism with the entire range of neurodevelopmental conditions and personality variants. We propose centering research on cohorts in which individuals are selected based on their expert judged prototypicality to advance the theoretical and practical pervasive issues pertaining to autism diagnostic thresholds. Reversing the current research strategy by giving more weight to specificity than reliability should increase our ability to discover the mechanisms of autism. LAY SUMMARY: Scientific research into the causes of autism and its mechanisms is carried out on large cohorts of people who are less and less different from the general population. This historical trend may explain the poor harvest of results obtained. Services and intervention are provided according to a diagnosis that now encompasses extremely different individuals. Last, we accept as a biological reality the constant increase over the years in the proportion of autistic people among the general population. These drifts are made possible by the attribution of a diagnosis of autism to people who meet vague criteria, rather than to people who experienced clinicians recognize as autistic. We propose to change our research strategy by focusing on the study of the latter, fewer in number, but more representative of the "prototype" of autism. To do this, it is necessary to clearly distinguish the population on which the research is carried out from that to which we provide support. People must receive services according to their needs, and not according to the clarity of their diagnosis. En ligne : http://dx.doi.org/10.1002/aur.2494 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=450 [article] A radical change in our autism research strategy is needed: Back to prototypes [Texte imprimé et/ou numérique] / L. MOTTRON, Auteur . - p.2213-2220. Langues : Anglais (eng) in Autism Research > 14-10 (October 2021) . - p.2213-2220 Mots-clés : Autism Spectrum Disorder  Autistic Disorder/diagnosis/epidemiology  Humans  Prevalence  Reproducibility of Results  Research Design  diagnostic  polythetic criteria  prototype  reliability  type 2 error Index. décimale : PER Périodiques Résumé : The evolution of autism diagnosis, from its discovery to its current delineation using standardized instruments, has been paralleled by a steady increase in its prevalence and heterogeneity. In clinical settings, the diagnosis of autism is now too vague to specify the type of support required by the concerned individuals. In research, the inclusion of individuals categorically defined by over-inclusive, polythetic criteria in autism cohorts results in a population whose heterogeneity runs contrary to the advancement of scientific progress. Investigating individuals sharing only a trivial resemblance produces a large-scale type-2 error (not finding differences between autistic and dominant population) rather than detecting mechanistic differences to explain their phenotypic divergences. The dimensional approach of autism proposed to cure the disease of its categorical diagnosis is plagued by the arbitrariness of the dimensions under study. Here, we argue that an emphasis on the reliability rather than specificity of diagnostic criteria and the misuse of diagnostic instruments, which ignore the recognition of a prototype, leads to confound autism with the entire range of neurodevelopmental conditions and personality variants. We propose centering research on cohorts in which individuals are selected based on their expert judged prototypicality to advance the theoretical and practical pervasive issues pertaining to autism diagnostic thresholds. Reversing the current research strategy by giving more weight to specificity than reliability should increase our ability to discover the mechanisms of autism. LAY SUMMARY: Scientific research into the causes of autism and its mechanisms is carried out on large cohorts of people who are less and less different from the general population. This historical trend may explain the poor harvest of results obtained. Services and intervention are provided according to a diagnosis that now encompasses extremely different individuals. Last, we accept as a biological reality the constant increase over the years in the proportion of autistic people among the general population. These drifts are made possible by the attribution of a diagnosis of autism to people who meet vague criteria, rather than to people who experienced clinicians recognize as autistic. We propose to change our research strategy by focusing on the study of the latter, fewer in number, but more representative of the "prototype" of autism. To do this, it is necessary to clearly distinguish the population on which the research is carried out from that to which we provide support. People must receive services according to their needs, and not according to the clarity of their diagnosis. En ligne : http://dx.doi.org/10.1002/aur.2494 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=450

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