1. Cortesi F, Giannotti F, Ivanenko A, Johnson K. {{Sleep in children with autistic spectrum disorder}}. {Sleep Med} (Jul 3)

Children and adolescents with autistic spectrum disorders (ASD) suffer from sleep problems, particularly insomnia, at a higher rate than typically developing children, ranging from 40% to 80%. Sleep problems in ASD might occur as a result of complex interactions between biological, psychological, social/environmental, and family factors, including child rearing practices that are not conducive to good sleep. Interestingly, children with a history of developmental regression have a more disturbed sleep pattern than children without regression. Even though regulation of sleep in children with ASD is still poorly understood, circadian abnormalities in autism might be the result of genetic abnormalities related to melatonin synthesis and melatonin’s role in modulating synaptic transmission. Recently a bifurcation of the sleep/wake cycle with increased sensitivity to external noise and short sleep duration causing irregular sleep onset and wake up times has been suggested. Identifying and treating sleep disorders may result not only in improved sleep, but also impact favorably on daytime behavior and family functioning. Several studies have also demonstrated effectiveness of behavioral interventions for sleep onset and maintenance problems in these populations. When behavioral interventions are not effective or lead only to a partial response, pharmacological treatment options should be considered. Studies of melatonin use in children with ASD provide evidence for its effectiveness and safety in the long run. The clinician assessing a child with an ASD should screen carefully for sleep disorders and make referrals as indicated.

2. Isler JR, Martien KM, Grieve PG, Stark RI, Herbert MR. {{Reduced functional connectivity in visual evoked potentials in children with autism spectrum disorder}}. {Clin Neurophysiol} (Jun 2)

OBJECTIVE: An analysis of EEG synchrony between homologous early visual areas tested the hypothesis that interhemispheric functional connectivity during visual stimulation is reduced in children with autism compared to controls. METHODS: EEG power and coherence within and between two homologous regions of the occipital cortex were measured during long latency flash visual evoked potentials. Measures were compared between two groups of children (5.5-8.5years), one with autism spectrum disorders and the other with typical development. RESULTS: In and below the theta band, interhemispheric synchrony was reduced in autistic subjects compared to typical controls by as much as 50%. Above the theta band interhemispheric synchrony in autistic children became indistinguishable from what would occur for uncorrelated cortical activity. Interhemispheric synchrony in autistic subjects was decreased in spite of bilaterally increased power. Wavelet power showed autistic children had a more rapid initial response to stimulation, a slower recovery, and more modulation at longer latencies. CONCLUSIONS: Results suggest that the sensory cortices of autistic children are hypersensitive to stimulation with concurrent diminished functional connectivity between hemispheres. SIGNIFICANCE: Simultaneously increased intrahemispheric power and decreased interhemispheric synchronization of elementalvisual information suggests either that power increases cause poor interhemispheric connectivity or that processes, such as thalamocortical regulation, impact power and coherence independently.

3. Klosterkotter J. {{[Autism in adults–too little attention? ]}}. {Fortschr Neurol Psychiatr} (Jul);78(7):381.

4. McDuffie A, Yoder P. {{Types of Parent Verbal Responsiveness that Predict Language in Young Children with Autism Spectrum Disorders}}. {J Speech Lang Hear Res} (Jul 6)

PURPOSE: This study examined short-term predictive associations between five different types of parent verbal responsiveness and later spoken vocabulary for 32 young children with a confirmed diagnosis of an autism spectrum disorder (ASD). METHOD: Parent verbal utterances were coded from videotapes of naturalistic parent-child play sessions using interval and event-based coding. A vocabulary difference score, calculated using the MacArthur-Bates Communicative Development Inventory, was used as the outcome measure of spoken vocabulary six-months later. RESULTS: Parent follow-in comments and follow-in directives predicted spoken vocabulary after controlling for child engagement. Parent expansions of child verbal utterances predicted spoken vocabulary after controlling for child talkativeness. When entered together into a regression analysis, metrics that represented a) the number of parent utterances following into the child’s focus of attention, and (b) the number of parent utterances responding to child verbal communication acts both accounted for unique variance in predicting change in spoken vocabulary from Time 1 to Time 2. CONCLUSION: Parent verbal utterances that follow into the child’s current focus of attention or respond to child verbal communication acts may facilitate the process of early vocabulary acquisition by mitigating the need for children with ASD to use attention-following as a word learning strategy.

5. Michel TM, Sheldrick AJ, Frentzel TG, Herpertz-Dahlmann B, Herpertz S, Habel U, Bruegmann E, Schneider K, Schneider F. {{[Evaluation of diagnostic and therapeutic services in German university hospitals for adults with autism spectrum disorder (ASD)]}}. {Fortschr Neurol Psychiatr} (Jul);78(7):402-413.

INTRODUCTION: Autism spectrum disorders (ASD), are pervasive developmental disorders, which are defined by qualitative impairment in reciprocal social interaction and communication as well as by stereotyped repetitive behaviour. Newer epidemiological studies report a prevalence of 1 %. However, parents and self-help organisations report a considerable lack of diagnostic services, especially in the university hospital setting. In order to receive funding for adequate treatment at an « autism therapy centre », a Consultant psychiatrist has to diagnose ASD. METHODS: We assessed the diagnostic and therapeutic facilities for adults with ASD by sending out questionnaires to 33 German university hospitals. Furthermore, we evaluated the demographic data of the first 74 patients that presented at the specialist clinic for adults with ASD at the Department for Psychiatry and Psychotherapy, RWTH Aachen University. RESULTS: At the time of the evaluation, only 9 university hospitals in Germany offered a specialist clinic for diagnostics and/or treatment for adults with ASD. A comorbid psychiatric disorder was diagnosed in 52.9 % of the patients presenting at the specialist clinic for adult ASD. These were mostly mental retardation and affective disorders. The most common differential diagnosis for the patients presenting at the service were affective and personality disorders. CONCLUSION: There is still great need of specialist services at university hospitals in Germany for adults with ASD, although more services have been established over the past few years. Over half of the patients with ASD had other psychiatric comorbid disorders, which were mostly mental retardation and affective disorders. The most common differential diagnosis for patients presenting at the clinics were personality disorders and depression.