1. Davidovitch M, Levit-Binnun N, Golan D, Manning-Courtney P. {{Late Diagnosis of Autism Spectrum Disorder After Initial Negative Assessment by a Multidisciplinary Team}}. {J Dev Behav Pediatr};2015 (Feb 2)
OBJECTIVE:: Describe a cohort of children who received a diagnosis of autism spectrum disorder (ASD) after age 6 and after having undergone a comprehensive multidisciplinary assessment before the age of 6, through which they were not diagnosed with ASD. METHODS:: Extensive chart review of patients’ electronic medical records comprised a representative population-based registry of patients seen during 2004 to 2011. The study focused only on the cohort of children who were diagnosed with ASD after the age of 6 but were not diagnosed with ASD at an earlier age. The charts were reviewed for the number of developmental assessments completed and the clinician’s diagnostic impressions. The charts were also examined for documentation of ASD-suggestive features pulled directly from the text of the evaluators’ reports. RESULTS:: A total of 221 patients (189 males) were diagnosed with ASD after age 6 although their initial comprehensive developmental evaluations before the age of 6 were negative for ASD. The study cohort underwent a total of 1028 developmental evaluations before the age of 6, with initial diagnostic impressions that included language deficits (70%), motor difficulties (67%), attention problems (46%), and cognitive difficulties (42%). Less than half of the cohort had ASD-suggesting features documented in their initial assessment. CONCLUSIONS:: Subsequent late diagnosis of ASD after an initial ASD-negative comprehensive assessment is a common clinical experience. Reasons for this scenario may include evolving diagnosis as well as missed and overdiagnosed cases of ASD.
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2. Gammer I, Bedford R, Elsabbagh M, Garwood H, Pasco G, Tucker L, Volein A, Johnson MH, Charman T. {{Behavioural markers for autism in infancy: Scores on the Autism Observational Scale for Infants in a prospective study of at-risk siblings}}. {Infant Behav Dev};2015 (Feb 2);38C:107-115.
We investigated early behavioural markers of autism spectrum disorder (ASD) using the Autism Observational Scale for Infants (AOSI) in a prospective familial high-risk (HR) sample of infant siblings (N=54) and low-risk (LR) controls (N=50). The AOSI was completed at 7 and 14 month infant visits and children were seen again at age 24 and 36 months. Diagnostic outcome of ASD (HR-ASD) versus no ASD (HR-No ASD) was determined for the HR sample at the latter timepoint. The HR group scored higher than the LR group at 7 months and marginally but non-significantly higher than the LR group at 14 months, although these differences did not remain when verbal and nonverbal developmental level were covaried. The HR-ASD outcome group had higher AOSI scores than the LR group at 14 months but not 7 months, even when developmental level was taken into account. The HR-No ASD outcome group had scores intermediate between the HR-ASD and LR groups. At both timepoints a few individual items were higher in the HR-ASD and HR-No ASD outcome groups compared to the LR group and these included both social (e.g. orienting to name) and non-social (e.g. visual tracking) behaviours. AOSI scores at 14 months but not at 7 months were moderately correlated with later scores on the autism diagnostic observation schedule (ADOS) suggesting continuity of autistic-like behavioural atypicality but only from the second and not first year of life. The scores of HR siblings who did not go on to have ASD were intermediate between the HR-ASD outcome and LR groups, consistent with the notion of a broader autism phenotype.
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3. Papadopoulos N, Sciberras E, Hiscock H, Mulraney M, McGillivray J, Rinehart N. {{The Efficacy of a Brief Behavioral Sleep Intervention in School-Aged Children With ADHD and Comorbid Autism Spectrum Disorder}}. {J Atten Disord};2015 (Feb 2)
OBJECTIVE: Sleep problems are common in children with autism spectrum disorders (ASD) and ADHD and impact adversely on child and parent well-being. The study evaluated the efficacy of a brief behavioral sleep intervention in children with comorbid ADHD-ASD. METHOD: A subsample of children with ADHD-ASD (n = 61; 5-13 years; 89% male) participating in the Sleeping Sound With ADHD study were included in the current investigation. The subsample comprised of 28 children randomized to the sleep intervention group, while 33 were randomized to usual clinical care. The intervention consisted of two clinical consultations and a follow-up phone call covering sleep hygiene and standardized behavioral strategies. RESULTS: Children with ADHD-ASD who received the intervention had large improvements in sleep problems and moderate improvements in child behavioral functioning 3 and 6 months post-randomization. CONCLUSION: These findings suggest that a brief behavioral sleep intervention can improve sleep problems in children with ADHD-ASD.
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4. Pittrow D, Gaese F, Colla M, Huss M, Kretschmar C, Brinkman M, Peters H, Elstner S, Weirich S, Hassler F. {{[Psychiatric and Social Aspects of Patients with Fragile X Syndrome.]}}. {Psychiatr Prax};2015 (Feb 2)
Objective: The goal of the study was to describe the burden of psychosocial risks, of mental illnesses and the ways of treatment of patients with fragile X syndrome (FRX). Method: Data from a sample of 46 FRX-patients stemming from a prospective multicenter (N = 12) registry study (EXPLAIN) were analyzed with regard to psychosocial burden and treatment. Results: More than 50 % of all participants reported about relatives suffering from FRX, too. The majority of participants did not finish school and was suffering from one or another kind of mental problems. Younger participants (< 18 yrs.) tended to suffer from expansive disorders. Older participants were rather burdened by internalizing symptoms and disorders. Disorders were usually treated by psychotropic drugs added by logopedic therapies and occupational therapies (more than once a month). In our sample 90.6 % of younger and more than 64.3 % of older patients were still living with their parents. Conclusions: Patients with FRX often suffer from additional mental disorders and should be diagnosed and treated early.
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5. Whyte EM, Nelson KE. {{Trajectories of pragmatic and nonliteral language development in children with autism spectrum disorders}}. {J Commun Disord};2015 (Jan 17)
Children with autism spectrum disorder (ASD) often have difficulties with understanding pragmatic language and also nonliteral language. However, little is understood about the development of these two language domains. The current study examines pragmatic and nonliteral language development in 69 typically developing (TD) children and 27 children with ASD, ages 5-12 years. For both groups, performance on pragmatic language and nonliteral language scores on the Comprehensive Assessment of Spoken Language increased significantly with chronological age, vocabulary, syntax, and theory of mind abilities both for children with ASD and TD children. Based on a cross-sectional trajectory analysis, the children with ASD showed slower rates of development with chronological age relative to TD children for both the pragmatic language and nonliteral language subtests. However, the groups did not show significant differences in the rate of development for either pragmatic language or nonliteral language abilities with regard to their vocabulary abilities or TOM abilities. It appears that children with ASD may reach levels of pragmatic language that are in line with their current levels of basic language abilities. Both basic language abilities and theory of mind abilities may aid in the development of pragmatic language and nonliteral language abilities. Learning outcomes: After reading this article, the reader will understand: (1) the relation between basic language abilities (vocabulary and syntax) and advanced language abilities (pragmatic and nonliteral language), (2) how the cross-sectional trajectory analysis differs from traditional group matching studies, and (3) how pragmatic and nonliteral language development for children with autism shows both similarities and differences compared to typically developing children.
