11. De Bruin EI, De Nijs PF, Verheij F, Verhagen DH, Ferdinand RF. {{Autistic features in girls from a psychiatric sample are strongly associated with a low 2D:4D ratio}}. {Autism};2009 (Sep);13(5):511-521.
Autistic features such as deficits in social interactions and communication have been associated with a low 2D:4D ratio in normal children.This study assessed this association in a large sample of children with a variety of psychiatric disorders (n = 35 girls and n = 147 boys). Autistic features were assessed with a highly valid and reliable measure (Autism Diagnostic Observation Schedule-Generic). Correlations between the 2D:4D ratio and autistic features were computed separately for boys and girls. Some small negative correlations (r = -0.17 and r = -0.19) were found in the right hand for boys; however, particularly in girls, large negative correlations (r = -0.51 to r = -0.64) were found in the left hand. A low 2D:4D ratio in girls was highly predictive of the presence of autistic features. Thus, a low ratio could possibly be used as a diagnostic predictor in clinical practice.
2. Granpeesheh D, Tarbox J, Dixon DR. {{Applied behavior analytic interventions for children with autism: a description and review of treatment research}}. {Ann Clin Psychiatry};2009 (Jul-Sep);21(3):162-173.
BACKGROUND: Autism is a disorder characterized by pervasive delays in the development of language and socialization, and the presence of stereotyped, repetitive behaviors or nonfunctional interests. Although a multitude of treatments for autism exist, very few have been the subject of scientific research. The only treatment that has been supported by substantial empirical research is treatment based on applied behavior analysis (ABA). METHODS: This article describes components of comprehensive ABA treatment programs, reviews research on effectiveness, and discusses issues related to collaboration between ABA and psychiatry. RESULTS: ABA has been supported by several hundred single case experiments and an increasing number of between-groups studies. Comprehensive ABA treatment programs are comprised of multiple intervention procedures, such as discrete trial instruction and natural environment training, and are founded on basic principles of learning and motivation, such as positive reinforcement, extinction, stimulus control, and generalization. Clinicians in the fields of ABA and psychiatry have similar goals regarding client outcome, and several ABA measurement and analysis procedures produce information that may be useful to psychiatrists. CONCLUSIONS: ABA treatment programs for individuals with autism are supported by a significant amount of scientific evidence and are therefore recommended for use. Patient care would likely benefit from a greater degree of collaboration between practitioners in the fields of ABA and psychiatry.
3. Gutstein SE. {{Empowering families through Relationship Development Intervention: an important part of the biopsychosocial management of autism spectrum disorders}}. {Ann Clin Psychiatry};2009 (Jul-Sep);21(3):174-182.
BACKGROUND: Relationship Development Intervention (RDI) is a program designed to empower and guide parents of children, adolescents and young adults with autism spectrum disorders (ASD) and similar developmental disorders to function as facilitators for their children’s mental development. RDI teaches parents to play an important role in improving critical emotional, social, and metacognitive abilities through carefully graduated, guided interaction in daily activities. METHODS: The paper reviews RDI’s theoretical underpinnings, current methodology and preliminary research results. The clinical utilization of RDI is discussed as an important part of the biopsychosocial management of ASD. RESULTS: Although a controlled, blinded study of RDI has yet to be done, preliminary research suggests that parents, through the RDI curriculum and consultation process, have the potential to exert a powerful impact on their ASD children’s experience-sharing communication, social interaction, and adaptive functioning. CONCLUSIONS: RDI should be considered as part of a comprehensive treatment regimen, in which the physician plays a clinical management role, providing medical and psychiatric consultation. The RDI clinician can function as a remediation specialist, providing accurate feedback to the physician, along with individualized training and guidance to family members.
4. Hartley SL, Sikora DM. {{Which DSM-IV-TR criteria best differentiate high-functioning autism spectrum disorder from ADHD and anxiety disorders in older children?}} {Autism};2009 (Sep);13(5):485-509.
Diagnosis of autism spectrum disorder (ASD) is often delayed in high-functioning children with milder and more varied forms of ASD. The substantial overlap between ASD and other psychiatric disorders is thought to contribute to this delay. This study examined the endorsement of DSM-IV-TR diagnostic criteria for ASD based on semi-structured parent interviews across three groups of older children referred to an ASD clinic: 55 children diagnosed with high-functioning ASD, 27 children diagnosed with attention-deficit/hyperactivity disorder (ADHD), and 23 children diagnosed with anxiety disorder. Results indicate that the criteria within the domains of communication and social relatedness were largely able to discriminate the high-functioning ASD group from the ADHD and anxiety disorder groups, but criteria within the domain of restricted/repetitive/stereotyped patterns were not.
5. Odom SL, Boyd BA, Hall LJ, Hume K. {{Erratum to: Evaluation of Comprehensive Treatment Models for Individuals with Autism Spectrum Disorders}}. {J Autism Dev Disord};2009 (Sep 16)
6. Petalas MA, Hastings RP, Nash S, Lloyd T, Dowey A. {{Emotional and behavioural adjustment in siblings of children with intellectual disability with and without autism}}. {Autism};2009 (Sep);13(5):471-483.
Siblings of children with autism may be at greater risk for psychological problems than siblings of children with another disability or of typically developing (TD) children. However, it is difficult to establish whether autism or the presence of intellectual disability (ID) explains the findings in previous research. Mothers rated the emotional and behavioural adjustment of siblings of children with ID with (N = 25) or without (N = 24) autism. Data were also available 18 months later for siblings of children with autism and ID (N = 15). Siblings of children with autism and ID had more emotional problems compared with siblings of children with ID only and with normative data. Three variables were pertinent: increasing age of the child with autism, having a brother with autism, and being younger than the child with autism. Behavioural and emotional difficulties of siblings of children with autism and ID were relatively stable over 18 months.
7. Pierce K, Glatt SJ, Liptak GS, McIntyre LL. {{The power and promise of identifying autism early: insights from the search for clinical and biological markers}}. {Ann Clin Psychiatry};2009 (Jul-Sep);21(3):132-147.
BACKGROUND: The biological changes that lead to autism likely occur during prenatal life. Although earlier identification of the disorder has occurred within the past decade, the mean age of diagnosis is still not made before a mean age of 3 years. This is because autism remains a behaviorally defined disorder, placing limits on the age at which a confident diagnosis can be made. The study of the biological basis of autism prior to age 3 is essential and can most directly be achieved with prospective research designs. METHODS: The literature on the early identification of autism is discussed, including the timescale for the onset of social symptoms. Also discussed is a new method for the prospective study of autism called the « 1-Year Well-Baby Check-Up Approach, » which allows for the prospective study of the disorder in simplex families with infants as young as 12 months of age. RESULTS: Although likely present at subtle, subclinical levels, early social abnormalities are not clearly detectable prior to 12 months in age in infants later diagnosed as having autism spectrum disorder. CONCLUSIONS: Using the 1-Year Well-Baby Check-Up Approach or other prospective design, examining early biomarkers related to early brain overgrowth, cerebellar development, gene expression patterns and immune system function may be key to early diagnosis efforts under 3 years. We also note the importance of comparing and contrasting the early « signature » of autism in children from singleton versus multiplex families, which may be etiologically distinct.
8. Rizzolatti G, Fabbri-Destro M. {{Mirror neurons: from discovery to autism}}. {Exp Brain Res};2009 (Sep 18)
9. Singh VK. {{Phenotypic expression of autoimmune autistic disorder (AAD): a major subset of autism}}. {Ann Clin Psychiatry};2009 (Jul-Sep);21(3):148-161.
BACKGROUND: Autism causes incapacitating neurologic problems in children that last a lifetime. The author of this article previously hypothesized that autism may be caused by autoimmunity to the brain, possibly triggered by a viral infection. This article is a summary of laboratory findings to date plus new data in support of an autoimmune pathogenesis for autism. METHODS: Autoimmune markers were analyzed in the sera of autistic and normal children, but the cerebrospinal fluid (CSF) of some autistic children was also analyzed. Laboratory procedures included enzyme-linked immunosorbent assay and protein immunoblotting assay. RESULTS: Autoimmunity was demonstrated by the presence of brain autoantibodies, abnormal viral serology, brain and viral antibodies in CSF, a positive correlation between brain autoantibodies and viral serology, elevated levels of proinflammatory cytokines and acute-phase reactants, and a positive response to immunotherapy. Many autistic children harbored brain myelin basic protein autoantibodies and elevated levels of antibodies to measles virus and measles-mumps-rubella (MMR) vaccine. Measles might be etiologically linked to autism because measles and MMR antibodies (a viral marker) correlated positively to brain autoantibodies (an autoimmune marker)–salient features that characterize autoimmune pathology in autism. Autistic children also showed elevated levels of acute-phase reactants–a marker of systemic inflammation. CONCLUSIONS: The scientific evidence is quite credible for our autoimmune hypothesis, leading to the identification of autoimmune autistic disorder (AAD) as a major subset of autism. AAD can be identified by immune tests to determine immune problems before administering immunotherapy. The author has advanced a speculative neuroautoimmune (NAI) model for autism, in which virus-induced autoimmunity is a key player. The latter should be targeted by immunotherapy to help children with autism.
10. Tufan AE, Kutlu H. {{Adjunctive quetiapine may help depression comorbid with pervasive developmental disorders}}. {Prog Neuropsychopharmacol Biol Psychiatry};2009 (Sep 13)
11. Walworth DD, Register D, Engel JN. {{Using the SCERTS Model Assessment Tool to Identify Music Therapy Goals for Clients with Autism Spectrum Disorder}}. {J Music Ther};2009 (Fall);46(3):204-216.
The purposes of this paper were to identify and compare goals and objectives addressed by music therapists that are contained in the SCERTS Model, for use with children at risk or diagnosed with a communication impartment including Autism Spectrum Disorder (ASD). A video analysis of music therapists working with clients at risk or diagnosed with ASD (N = 33) was conducted to: (a) identify the areas of the SCERTS assessment model that music therapists are currently addressing within their sessions for clients with ASD, and (b) compare the frequency of SCERTS domains and goals addressed by music therapists within sessions. Results of the analysis revealed that all three domains of social communication, emotional regulation, and transactional support were addressed within music therapy sessions. Within each domain both broad goals were all addressed including joint attention and symbol use for social communication, self-regulation and mutual regulation for emotional regulation, and interpersonal support and learning support for transactional support. Overall, music therapists addressed transactional support goals and subgoals more often than social communication and emotional regulation goals and subgoals. The highest frequency goal area addressed was interpersonal support (73.96%) and the lowest goal area addressed was joint attention (35.96%). For the social partner and language partner language stages, 58 of the 320 possible subgoals were addressed with 90% frequency or higher, while 13 of the same subgoals were never addressed. The SCERTS Model is designed for use by a multidisciplinary team of professionals and family members throughout a client’s treatment and contains an ongoing assessment tool with resulting goals and objectives. This analysis indicates that many SCERTS goals and objectives can be addressed in music therapy interventions. Additionally, goals and subgoals not previously recognized in music therapy treatment can be generated by the use of the SCERTS Model.
12. Yerys BE, Wallace GL, Harrison B, Celano MJ, Giedd JN, Kenworthy LE. {{Set-shifting in children with autism spectrum disorders: reversal shifting deficits on the Intradimensional/Extradimensional Shift Test correlate with repetitive behaviors}}. {Autism};2009 (Sep);13(5):523-538.
Research examining set-shifting has revealed significant difficulties for adults with autism spectrum disorders (ASDs). However, research with high-functioning children with ASDs has yielded mixed results. The current study tested 6- to 13-year-old high-functioning children with ASD and typically developing controls matched on age, gender, and IQ using the Intradimensional/Extradimensional (ID/ED) Shift Test from the Cambridge Neuropsychological Test Automated Battery. Children with ASDs completed as many ED shifts and reversal ED shifts as controls; however, they made significantly more errors than controls while completing the ED reversal shifts. Analyses on a subset of cases revealed a significant positive correlation between ED reversal errors and the number of repetitive behavior symptoms in the ASD group. These findings suggest that high-functioning children with ASDs require additional feedback to shift successfully. In addition, the relationship between set-shifting and non-social symptoms suggests its utility as a potentially informative intermediate phenotype in ASDs.
