No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The presence or absence of certain behaviors associated with infantile autism in severely retarded autistic and nonautistic retarded children and very young normal children
Abstract
The modified Behavior Observation Scale adapted from Freeman et al. was used to compare normal, retarded, and autistic children with very low developmental ages and to determine the types of behavior that could differentiate these three diagnostic categories of children. Examination of the data revealed that there was much more overlap between autistic and retarded children than between autistic and normal children. However, a behavioral pattern of autism could be delineated and very retarded autistic children could be distinguished from the nonautistic retarded children. The autistic behavioral pattern included subclusters of symptoms that might be interpreted as disturbances of sensory modulation and motility.
... We also notice that Autophagy serves dual roles in OA, acting both to protect cells and promote cell death [62,63]. It can influence the survival and death of chondrocytes during different stages of osteoarthritis progression [62,64]. So, we need to use difference model representing different stages of OA to demonstrate the effectiveness of OMT. ...
Background
Osteoarthritis (OA) is a common degenerative joint disease characterized by persistent articular cartilage degeneration and synovitis. Oxymatrine (OMT) is a quinzolazine alkaloid extracted from the traditional Chinese medicine, matrine, and possesses anti-inflammatory properties that may help regulate the pathogenesis of OA; however, its mechanism has not been elucidated. This study aimed to investigate the effects of OMT on interleukin-1β (IL-1β)-induced damage and the potential mechanisms of action.
Methods
Chondrocytes were isolated from Sprague-Dawley rats. Toluidine blue and Collagen II immunofluorescence staining were used to determine the purity of the chondrocytes. Thereafter, the chondrocytes were subjected to IL-1β stimulation, both in the presence and absence of OMT, or the autophagy inhibitor 3-methyladenine (3-MA). Cell viability was assessed using the MTT assay and SYTOX Green staining. Additionally, flow cytometry was used to determine cell apoptosis rate and reactive oxygen species (ROS) levels. The protein levels of AKT, mTOR, LC3, P62, matrix metalloproteinase-13, and collagen II were quantitatively analyzed using western blotting. Immunofluorescence was used to assess LC3 expression.
Results
OMT alleviated IL-1β-induced damage in chondrocytes, by increasing the survival rate, reducing the apoptosis rates of chondrocytes, and preventing the degradation of the cartilage matrix. In addition, OMT decreased the ROS levels and inhibited the AKT/mTOR signaling pathway while promoting autophagy in IL-1β treated chondrocytes. However, the effectiveness of OMT in improving chondrocyte viability under IL-1β treatment was limited when autophagy was inhibited by 3-MA.
Conclusions
OMT decreases oxidative stress and inhibits the AKT/mTOR signaling pathway to enhance autophagy, thus inhibiting IL-1β-induced damage. Therefore, OMT may be a novel and effective therapeutic agent for the clinical treatment of OA.
... In several cases, a temporal association was noted between elevated blood lead levels and the emergence of autistic symptoms. 4 The empirical evidence [5][6][7][8][9] suggests that 70% of all children diagnosed with autism have sensory processing disorders (SPD), confirming the existence of sensory and motor difficulties for many children with autism at some point in their early development. The atypical eating behaviours of autistic children, along with habitual mouthing and pica, make it hard to determine whether increased lead levels are a cause or a consequence of autism. ...
Objective: To investigate the effect of OPT (Oral Placement Therapy) on Blood lead levels (BLL) measured in microgram/dl and CARS 2 ST (Childhood Autistic Rating Scale 2nd edition Standard version) scores of autistic children both in the short and long term. It also studied the clinical views in speech, feeding and sensory needs by using OPT to bring down the BLL along with levels of CARS2-ST scores in children under autism spectrum disorder. Methods: This comparative observational study was conducted from April 2019 to January 2020, used repeated measures design involving 40 children under autism spectrum aged between 3 to 8 years with concerns of mouthing and smelling of inedible things. 40 participants were recruited to understand the performance benefits of a 5 months OPT versus 10 months OPT on severity of autism as measured by the CARS2-ST from 5 months to 10 months. An asymp sign test was used to compare the differences in CARS2-ST scores in the two repeat measures.Results: Wilcoxon signed-rank test showed statistically significant median decrease in BLL (7.3) and (6.8) at 5 and 10 months respectively when compared before therapy (7.75).
... The sensory processing results differed between children with ASD and those with TD [30,31]. Deficits in the regulation of incoming sensory input have been widely reported as features of autism [42][43][44][45][46][47]. The results of this study similarly showed that many participants had a definite difference in each item of sensory sensitivity, with the majority showing a difference in visual/auditory sensitivity. ...
... In their review study, Imperatore & Reinoso (2007) concluded that, although there is no agreement on the preferred pattern, all studies concur that children with ASD have a sensory processing difficulty, a situation recently reaffirmed by Allen & Casey (2017). Adrien et al. (1987) argue that many of these studies relate these difficulties to problems with postural control and praxis. ...
Resumen La integración sensorial se apoya en múltiples antecedentes teóricos que justifican su importancia para poder integrar la información que procede de los diferentes sentidos y desarrollar una respuesta adaptada al entorno. Así también, la literatura científica ha demostrado que existe una estrecha relación entre la integración sensorial y el aprendizaje. El objetivo de este artículo es abordar el concepto de integración sensorial y su influencia en el aprendizaje, en especial, de los niños con Trastorno de Espectro Autista. La metodología utilizada ha sido mediante una revisión bibliográfica de tipo narrativa, orientada por el objetivo de la investigación. Las bases de datos consultadas han sido: Web of Science, SCOPUS, Dialnet y RedaLyC. Y los principales descriptores han sido Integración Sensorial, Aprendizaje y Trastorno de Espectro Autista (TEA). Los resultados obtenidos apoyan la idea de que los niños con TEA suelen presentar dificultades en este proceso de integración sensorial, siendo ésta la causa explicativa de algunos de los problemas de aprendizaje y conducta que presentan. Se espera que a partir de este trabajo se potencie una toma de conciencia de la necesidad de considerar este aspecto durante el diagnóstico y/o la intervención para así favorecer una auténtica inclusión de los niños con TEA en la sociedad.
... Over 90% of individuals with ASD have atypical sensory processing (Chang, 2014) in all sensory modalities. Alterations in sensory processing have been described in literature reporting autism symptomology (Adrien et al., 1987(Adrien et al., , 1992(Adrien et al., , 1993Baranek, 1999;Dahlgren & Gillberg, 1989;Kientz & Dunn, 1997;Ornitz, 1989;Ornitz et al., 1993) as well as by individuals with ASD themselves (Grandin, 1995). Sensory disruption in ASD can take three main forms, sensory hypo-responsiveness, hyper-responsiveness and sensory seeking, a behaviour characterised by a craving for a certain sensory experience (Hazen, 2014) and many individuals have a combination of the three. ...
Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterised by deficits in social communication and restricted behaviours, and associated with sensory alterations, gastrointestinal dysfunction and disruptions in the circadian rhythm. This study utilised two animal models of ASD, the BTBR T+tf/J and the prenatal exposure to VPA mouse models of ASD, compared to the control C57 BL/6J strain. The aim of this study was to investigate changes in circadian rhythm and peripheral sensation in the two mouse models of ASD, and identify potential pathways involved.
Methods: Home-cage testing was conducted using LABORAS platforms, to record the animals’ behaviour over 24 hours (C57 n = 8; BTBR = 9, VPA = 4). Cutaneous sensory thresholds were determined using the dynamic hot (DHP) and cold plate (DCP) tests (C57 n = 6; BTBR n = 6; VPA n = 4), and sensory function of the gastrointestinal tract was outlined using ex-vivo jejunum preparations, by recording the afferent nerve responses to mechanical and chemical stimuli. Values are mean +/- SEM analysed with two-way ANOVA using GraphPad Prism.
Results: the VPA mice exhibited altered circadian rhythm in the dark (active) phase compared to the BTBR and C57 mice (P=<0.05). In the DHP, the BTBR mice (n = 6) responded at a higher temperature (C57 - 38C; BTBR - 40C), responded significantly less to heat (P<0.0005), while VPA mice (n = 4) showed similar responses to the C57 mice. In the DCP, VPA mice start to respond at a lower temperature (C57 - 16C; VPA - 2C), responded slightly less to cold (P=0.055), while the BTBR mice showed similar responses to C57 mice.
In the afferent nerve recordings of the jejunum, the BTBR tissue exhibited significantly decreased responses to mechanical distension at a filling rate of 600 μl/min (P<0.0006; BTBR n = 9; C57 n = 10). Peak firing rate at 50 mmHg was 92.68 (+/- 12.80) imp/s-1 in recordings from C57 (n = 10) tissue and 76.49 (+/- 15.44) imp/s-1 in BTBR tissue (n = 9). BTBR afferents also showed an altered response profile to TRPV1 activation (P=<0.0001, BTBR n = 5; C57 n = 5), whereby nerve firing took significantly longer to desensitize compared to control afferents, suggesting altered function of TRPV1. Preparations from BTBR mice also exhibited significantly increased response to intraluminal application of an inflammatory soup (P<0.05), BTBR n = 5; C57 n = 5).
Conclusion: the VPA model of ASD showed marked alterations in circadian rhythm and reduced response to cold stimuli, and the BTBR mouse model of ASD exhibited significantly decreased response to heat and significantly altered afferent nerve activity from the jejunum in response to various stimuli. Future studies should investigate whether these changes correlate with CNS dysfunction or whether altered peripheral sensation could drive some of the central deficits observed in ASD.
... Clear physical and visual boundaries, such as fences, paths, and changes in texture or planting, can help children with ASD to understand where each area of the play environment begins and ends(Mostafa 2008), in essence increasing the recognizable structure of the play environment. Further, clear boundaries assist children with ASD in understanding the social boundaries of play in the area, when the two are designed to correspond.5.2.3 Sensory Stimuli.Children with ASD are much more likely to demonstrate unusual responses to sensory stimuli than typically developing children(Adrien et al. 1987;Kern et al. 2008;Ornitz 1983), particularly hyporesponsiveness characterized by the absence of the expected response to a stimulus. Hyporesponsiveness is associated with the appearance of passivity and disengagement ...
Autism Spectrum Disorder (ASD) is a developmental disorder characterized by impairments in social interaction and gestural communication. Various play-based interventions have been used to help children with autism develop social skills. Interventions that consider how children play, instead of the final outcome of the play session, seem to be more effective in addressing each child's needs. But because children with autism display a large range of variability the results of play interventions are usually very unpredictable. Research suggests that play environments for children with ASD need to be structured in order to be effective and structured teaching strategies are often used in the absence of well-structured environments. However, well-designed outdoor play environments may provide the necessary structure to support social interactions, creating an important place where children with ASD can learn social skills through play. The purpose of this study is to explore best practice outdoor play environment design strategies that support the social skills development of children with ASD. To do so, a scoping study was conducted to review the literature involving children with ASD, outdoor play environments, and social skill development. Scopus, Google Scholar, and EBSCOHost were searched followed by ancestral and descendent searches. While there are few studies specific to outdoor play environments, the numerous studies examining the play behaviors of children with ASD can be categorized into four primary areas of impacted development: low motor skills and coordination, sensory integration, generative play, and joint attention. Addressing these four primary areas of impacted development in the design of the outdoor play environments likely plays an important role in creating spontaneous and pleasurable play opportunities for children with ASD, and may well support social interactions, creating an important place were children with ASD can develop social skills through play.
... This could be useful when a stimulus with known preference and known reinforcing efficacy is currently unavailable, in which case the clinician could select an alternative stimulus from the same stimulus class without conducting additional assessments and without jeopardizing the child's academic performance. In beginning to identify classes of social stimuli that may have functional similarities for children with ASD, it is important to consider that sensory impairments and sensory differences from typically developing children have been widely reported in the literature (Adrien, Ornitz, Barthelemy, Sauvage, & Lelord, 1987, Adrien et al., 1992Baranek, 1999;Dahlgren & Gillberg, 1989;Kientz & Dunn, 1997;Ornitz, 1989;Ornitz, Lane, Sugiyama, & de Traversay, 1993;Osterling & Dawson, 1994). Differences across auditory (Bettison, 1996;Dahlgren & Gillberg, 1989;Gillberg & Coleman, 1996;Rimland & Edelson, 1995), tactile (Baranek, Foster, & Berkson, 1997;Cesaroni & Garber, 1991), and taste/smell (Hoshino et al., 1982;Tomchek & Dunn, 2007;Wiggins, Robins, Bakeman, & Adamson, 2009) sensory modalities have all been reported in children with ASD. ...
We evaluated the degree to which social interactions are reinforcing for two individuals with autism spectrum disorder by comparing individual components (i.e., edible, vocal, and physical interaction) alone and in combination. First, we conducted preference assessments to determine preference hierarchies within three stimulus classes: edible, vocal, and physical interaction. Second, we evaluated preference for individual stimuli across these classes. Third, we examined the relative reinforcing efficacy of highly preferred stimuli assessed individually. Fourth, with individuals for whom physical and vocal stimuli served as reinforcers, we evaluated if adding the other component, physical or vocal, increased the effectiveness of that consequence as a reinforcer. Results suggested differences in the relative reinforcing efficacy of components of social interaction. Additionally, combining components to form compound stimuli produced idiosyncratic differences in relative rates of responding.
... Research suggests 70% of all children diagnosed with autism have sensory processing disorders (SPD). The empirical evidence specified by [5]- [9], confirms the existence of sensory and motor difficulties for many children with autism at some point in their early development. ...
... We adopt the term autism spectrum behaviors, which is most consistent with prior research and current conceptualizations of these behaviors as occurring dimensionally in the general population. and subsequent studies have shown that children's early atypical sensory responses (e.g., avoidance of touch) are predictive of later ASD (Adrien, Ornitz, Barthelemy, Sauvage, & Lelord, 1987;Baranek, 1999;Ben-Sasson & Carter, 2013;Brisson, Warreyn, Serres, Foussier, & Adrien-Louis, 2012). Indeed, in light of the growing body of clinical studies that have suggested the relation between sensory functioning and autism spectrum behaviors, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V; American Psychiatric Association, 2013) included abnormal sensory response in the diagnostic criteria for ASD. ...
The experience of touch is critical for early communication and social interaction; infants who show aversion to touch may be at risk for atypical development and behavior problems. The current study aimed to clarify predictive associations between infant responses to tactile stimuli and toddler autism spectrum, internalizing, and externalizing behaviors. This study measured 9-month-old infants' (N = 561; 58% male) avoidance and negative affect during a novel tactile task in which parents painted infants' hands and feet and pressed them to paper to make a picture. Parent reports on the Pervasive Developmental Problems (PDP), Internalizing, and Externalizing scales of the Child Behavior Checklist were used to measure toddler behaviors at 18 months. Infant observed avoidance and negative affect were significantly correlated; however, avoidance predicted subsequent PDP scores only, independent of negative affect, which did not predict any toddler behaviors. Findings suggest that incorporating measures of responses to touch in the study of early social interaction may provide an important and discriminating construct for identifying children at greater risk for social impairments related to autism spectrum behaviors.
... ASD growth trajectories diverged from the LR and HR-ND groups as early as 12 months of age (but not before), and became more discrepant over time. This pattern of results is also consistent with previous work demonstrating that older children with ASD are often especially impaired in the coordination of communicative behaviors (Adrien et al. 1987;Buitelaar et al. 1991;Wetherby et al. 1989), and with more recent research with toddlers indicating that children later diagnosed with ASD demonstrate a lack of coordination of gaze, facial expressions, gesture, and vocalization relative to TD and developmentally delayed children (e.g., Shumway and Wetherby 2009;Wetherby et al. 2004). ...
This study evaluated the extent to which developmental change in coordination of social communication in early infancy differentiates children eventually diagnosed with ASD from those not likely to develop the disorder. A prospective longitudinal design was used to compare nine infants at heightened risk for ASD (HR) later diagnosed with ASD, to 13 HR infants with language delay, 28 HR infants with no diagnosis, and 30 low risk infants. Hierarchical linear modeling analyses revealed that ASD infants exhibited significantly slower growth in coordinations overall and in gestures coordinated with vocalizations, even relative to HR infants with language delay. Disruption in the development of gesture-vocalization coordinations may result in negative cascading effects that adversely impact later social and linguistic development.
... Although researchers rarely examine signs of psychopathology in healthy individuals, our search succeeded in revealing 17 studies that reported the occurrence of Table 2 Sensory and/or motor irregularities appear across disorders a Disorder Sensory and/or motor irregularities appear more frequently in disorder than in healthy controls Not different from healthy controls Autism Sensory Sensory Adamson et al., 2006; Adrien et al., 1987; Baranek, 1999; Baranek et al., 2007; Baranek et al., 2006; Baranek et al., 2013; Ben-Sasson et al., 2007; Blakemore et al., 2006; Blanche et al., 2012; Cascio et al., 2008; Cheung and Siu, 2009; Crane et al., 2009; Dickie et al., 2009; Dunn et al., 2002; Hilton et al., 2010; Hochhauser and Engel-Yeger, 2010; Kern et al., 2008; Kern et al., 2007a; Kern et al., 2007b; Kern et al., 2006; Kern et al., 2007c; Khalfa et al., 2004; Kientz and Dunn, 1997; Kwakye et al., 2011; Leekam et al., 2007; O'Brien et al., 2009; Reynolds et al., 2011; Reynolds et al., 2012; Rogers et al., 2003; Siaperas et al., 2012b; Tavassoli and Baron-Cohen, 2012b; Tomchek and Dunn, 2007; Watling et al., 2001; Weimer et al., 2001; Woodard et al., 2012 [7-41] Fuentes et al., 2011; Güçlü et al., 2007; Jones et al., 2009; Tavassoli and Baron-Cohen, 2012 [42] [43] [44] [45] Motor Motor Dewrang and Sandberg, 2010; Esposito and Venuti, 2008; Freitag et al., 2007; Gernsbacher et al., 2008; Hilton et al., 2007; Hilton et al., 2012; Lopata et al., 2007; Pan et al., 2009; Papadopoulos et al., 2012; Sahlander et al., 2008; Siaperas et al., 2012; Travers et al., 2013; Whyatt and Craig, 2012 [34] [46] [47] [48] [49] [50] [51] [52] [53] [54] [55] [56] [57] Ozonoff et al., 2008 [58] NSS ...
In addition to the primary symptoms that distinguish one disorder from the next, clinicians have identified, yet largely overlooked, another set of symptoms that appear across many disorders, termed secondary symptoms. In the emerging era of systems neuroscience, which highlights that many disorders share common deficits in global network features, the nonspecific nature of secondary symptoms should attract attention. Herein we provide a scholarly review of the literature on a subset of secondary symptoms----sensory and motor. We demonstrate that their pattern of appearance----across a wide range of psychopathologies, much before the full-blown disorder appears, and in healthy individuals who display a variety of negative symptoms----resembles the pattern of appearance of network abnormalities. We propose that sensory and motor secondary symptoms can be important indicators of underlying network aberrations and thus of vulnerable brain states putting individuals at risk for psychopathology following extreme circumstances.
... Repetitive motor stereotypies, unusual posturing, object stereotypies, and self-injurious behaviors (SIBs) should be routinely documented through parental report or observation. Hand or finger mannerisms, body rocking, and other motor disturbances such as unusual posturing, are commonly reported in 37-95% of subjects studied (Adrien, Ornitz, Barthelemy, Sauvage, & Lelord, 1987;Elliott, 1990;Le Couteur et al., 1989;Ornitz, Guthrie, & Farley, 1977), and often manifest during the preschool years (Lord, 1995). The development of stereotypies, particularly in severe forms (e.g., SIB), may profoundly influence individual outcomes and prognosis for treatment in children with autism. ...
The Child Neurology Society and American Academy of Neurology recently proposed to formulate Practice Parameters for the Diagnosis and Evaluation of Autism for their memberships. This endeavor was expanded to include representatives from nine professional organizations and four parent organizations, with liaisons from the National Institutes of Health. This document was written by this multidisciplinary Consensus Panel after systematic analysis of over 2,500 relevant scientific articles in the literature. The Panel concluded that appropriate diagnosis of autism requires a dual-level approach: (a) routine developmental surveillance, and (b) diagnosis and evaluation of autism. Specific detailed recommendations for each level have been established in this document, which are intended to improve the rate of early suspicion and diagnosis of, and therefore early intervention for, autism.
... A study in 1987, by Adrien and colleagues, endeavored to determine the types of behavior that would distinguish three different groups of children: normally developing children, children with metal retardation, and children with autism (Adrien, Ornitz, Barthelemy, Sauvage, & Lelord, 1987). Using the Behavior Observation Scale (Freeman, Ritvo, Guthrie, Schroth, & Ball, 1978), Adrien and colleagues found that children with autism were different from the other groups in that they displayed a subcluster of symptoms indicative of sensory modulation disturbances. ...
The purpose of the study was to examine sensory modulation items on the Sensory Profile in individuals with autism as compared to community controls. The data for this study were collected as part of a cross-sectional study that examined sensory processing, using the Sensory Profile, in 103 individuals with autism and/or pervasive developmental disorder (PDD), 3–43 years of age, compared to 103 age- and gender-matched community controls. Specifically, this study examined sensory modulation items on the Sensory Profile: Modulation Related to Body Position and Movement; Modulation of Movement Affecting Activity Level; Modulation of Sensory Input Affecting Emotional Responses; and Modulation of Visual Input Affecting Emotional Responses and Activity Level. Sensory modulation in individuals with autism was significantly different than community controls on all four modulation sections of the Sensory Profile, with individuals with autism engaging in the behaviors more frequently than the controls. In addition, a trend was noted in three of the four areas that the older individuals with autism were closer to the community controls than the younger individuals with autism. The results suggest that there are differences between individuals with autism and community controls in their ability to modulate sensory stimuli in areas that affect movement, emotional response, and activity level.
... Evidence suggests the profi le of atypical sensory-related behaviors in children with ASD is different than children with other developmental disorders (Ermer and Dunn, 1998; Rogers et al., 2003; Baranek et al., 2006), but studies differ on the sensory domains highlighted. For example, a study of sensory symptoms in ASD compared to children with mental retardation noted greater tactile seeking (rubbing objects, fl icking fi ngers), movement seeking (rocking, jumping), visual avoidance (poor eye contact) and auditory under-responsivity (lack of response to verbal input) in children with ASD (Adrien et al., 1987). Rogers et al. (2003) found more sensory symptoms in children with ASD compared to children with developmental disabilities of mixed etiology, but no difference compared to children with Fragile X syndrome. ...
A high incidence of sensory processing difficulties exists in children with Autism Spectrum Disorder (ASD) and children with Sensory Modulation Disorder (SMD). This is the first study to directly compare and contrast these clinical disorders. Sympathetic nervous system markers of arousal and reactivity were utilized in a laboratory paradigm that administered a series of sensory challenges across five sensory domains. The Short Sensory Profile, a standardized parent-report measure, provided a measure of sensory-related behaviors. Physiological arousal and sensory reactivity were lower in children with ASD whereas reactivity after each sensory stimulus was higher in SMD, particularly to the first stimulus in each sensory domain. Both clinical groups had significantly more sensory-related behaviors than typically developing children, with contrasting profiles. The ASD group had more taste/smell sensitivity and sensory under-responsivity while the SMD group had more atypical sensory seeking behavior. This study provides preliminary evidence distinguishing sympathetic nervous system functions and sensory-related behaviors in Autism Spectrum Disorder and Sensory Modulation Disorder. Differentiating the physiology and sensory symptoms in clinical groups is essential to the provision of appropriate interventions.
... Repetitive motor stereotypies, unusual posturing , object stereotypies, and self-injurious behaviors (SIBs) should be routinely documented through parental report or observation. Hand or finger mannerisms, body rocking, and other motor disturbances such as unusual posturing, are commonly reported in 37-95% of subjects studied (Adrien, Ornitz, Barthelemy, Sauvage, & Lelord, 1987; Elliott, 1990; Le Couteur et al., 1989; Ornitz, Guthrie, & Farley, 1977), and often manifest during the preschool years (Lord, 1995 ). The development of stereotypies , particularly in severe forms (e.g., SIB), may profoundly influence individual outcomes and prognosis for treatment in children with autism. ...
The Child Neurology Society and American Academy of Neurology recently proposed to formulate Practice Parameters for the Diagnosis and Evaluation of Autism for their memberships. This endeavor was expanded to include representatives from nine professional organizations and four parent organizations, with liaisons from the National Institutes of Health. This document was written by this multidisciplinary Consensus Panel after systematic analysis of over 2,500 relevant scientific articles in the literature. The Panel concluded that appropriate diagnosis of autism requires a dual-level approach: (a) routine developmental surveillance, and (b) diagnosis and evaluation of autism. Specific detailed recommendations for each level have been established in this document, which are intended to improve the rate of early suspicion and diagnosis of, and therefore early intervention for, autism.
... Those that exist often suffer from a variety of methodological limitations; however, these studies provide both a foundation of scientific knowledge critical for understanding the early development of children with autism and guidance for intervention planning. Empirical evidence converges to confirm the existence of sensory and motor difficulties for many children with autism at some point in their early development (Adrien et al., 1987; Baranek, 1999; Dahlgren & Gilberg, 1989; Hoshino et al., 1982; Ohta, Nagai, Hara, & Sasaki, 1987; Ornitz, Guthrie, & Farley, 1977; Scharre & Creedon, 1992), although much ...
Idiosyncratic responses to sensory stimuli and unusual motor patterns have been reported clinically in young children with autism. The etiology of these behavioral features is the subject of much speculation. Myriad sensory- and motor-based interventions have evolved for use with children with autism to address such issues; however, much controversy exists about the efficacy of such therapies. This review paper summarizes the sensory and motor difficulties often manifested in autism, and evaluates the scientific basis of various sensory and motor interventions used with this population. Implications for education and further research are described.
... For instance, in a British epidemiological study Wing (1981) found that 82% of the children with IQs below 20, 47% with IQs between 20 and 34 and 40% of the children with IQs between 35 and 50 had impairments in social interaction , communication and imaginative activities. Other studies have also shown that many individuals with severe mental retardation have characteristics of pervasive developmental disorders (Cherry, Matson, & Paclawskyj, 1997; Nordin & Gillberg, 1996) or show stereotyped repetitive behaviors (Adrien, Ornitz, Barthelemy, Sauvage, & Lelord, 1987; Thompson & Berkson, 1985). Because there are differences in behavioral characteristics depending on the developmental level of individuals; therefore, diagnostic instruments need to be appropriate for a person's mental level (Freeman, Ritvo, Guthrie, Schroth, & Ball, 1978; Vig & Jedrysek, 1999). ...
The Autism Diagnostic Observational Schedule (ADOS) is a semi-structured observational scale developed to assess social interaction, communication and play in individuals who are suspected to have autism. Since the ADOS is not suitable to be used with severely or profoundly mentally retarded adolescents and adults with very limited language skills, materials and some of the tasks of the PL-ADOS and the original ADOS (the former versions of the current ADOS) were adapted. Results indicated that almost all of the overall ratings showed good reliability and discriminative diagnostic validity. Furthermore, the combination of codings into an overall algorithm score on social/communicative behavior resulted in a sensitivity of .82 and a specificity of .85 when using a cut-off score of 15.
Social deficits may be the most long-lasting and handicapping aspects of autism (Park, 1986; Rumsey, Rapoport, & Sceery, 1985), but they are also the least well-documented in research. More encouraging, however, is that research on social deficits has increased significantly in the last 5 years, and, as it accumulates, we have had access to many vivid and remarkably similar clinical examples of the social difficulties of autistic people (Kanner, 1943; Wing, 1976). DSM-III-R, the diagnostic system in greatest current use in North America (American Psychiatric Association, 1987), in fact, consists of these examples supporting a very broad statement about a qualitative social deficit. However, to date, no comprehensive theory has been proposed that attempts to account for these examples over the course of development, although more specific accounts have been put forward (Frith, 1989; Hobson, in press).
The aim of the proposed method is to promote exchanges between the child with autism and his environment by taking into account the functions of socializing, communication and adaptation (Lelord et al., 1978). It is set within a physiological framework (Lelord, 1989).
Early infantile autism, originally described by Kanner (1943), is a syndrome defined by a set of clinical features including failure to develop normal social relationships, developmental disturbances of verbal and nonverbal communication, ritualistic and compulsive behaviors, and disturbances of motility and attention.
Sensory processing differences in preschool-age children with autism spectrum disorder (ASD) affect their engagement in everyday activities, thereby influencing opportunities to practice and develop skills such as social communication and adaptive behavior. The purpose of this study was to investigate the extent to which specific sensory processing patterns relate to aspects of development (i.e., adaptive behavior, expressive and receptive language, fine and gross motor skills, social behavior) in a sample of preschool-age children with ASD (N = 400). A retrospective chart review was used to gather clinical data. Results suggest that sensory processing patterns differentially affect children's developmental skills and adaptive behavior. Certain sensory processing patterns predicted children's development of language, motor, and adaptive skills. These findings have clear implications for occupational therapy practice with young children with ASD. Practitioners should consider how sensory processing in ASD both supports and limits children's ability to engage in social communication and learning opportunities.
Background: The ability to coordinate communicative expressions from different behavioral modalities (e.g., vocal, gestural) is a crucial component of communication (e.g., Crais et al., 2009). In addition to impairments in gesture, pre-verbal speech sounds, and expressive language, children with autism spectrum disorders (ASD) have difficulty producing these behaviors in coordination (e.g, Stone et al., 1997). This study compared the development of multimodal communication in infants at heightened ASD risk (later-born siblings of children with autism; HR) to that of infants with low ASD risk (infants with a negative family history of ASD; LR) to determine whether HR infants demonstrate communicative coordination delays and whether such impairments are related to a later ASD diagnosis.
Objectives: To investigate developmental trajectories in the production and temporal coordination of communicative behaviors from 8 to 18 months in HR and LR infants.
Methods: Forty-seven HR infants (43% male) and 29 LR infants (45% male) were observed at home for 30 minutes during everyday household activities and play with a primary caregiver. The 8, 10, 12, 14, and 18 month observations were coded for communicative gestures, words, and non-word vocalizations produced by the infant. Coordinated bouts of communicative behaviors (i.e., instances in which gestures overlapped in time with non-word vocalizations or words) were identified. At 36 months, HR infants were administered the ADOS-G (Lord et al., 2000); to date, six infants have received an ASD diagnosis (HR-ASD). The remaining HR and LR infants did not meet ASD criteria (No Diagnosis; HR-ND, LR-ND).
Results: Preliminary analyses were conducted using Hierarchical Linear Models (Bryk & Raudenbush, 1992). Unconditional and conditional growth models were estimated separately for Overall Communicativeness (the total number of all gestures and vocalizations produced in a given session) and Coordinated Bouts (the total number of all gesture-vocalization coordinations). A one parameter (slope only) linear model adequately represented the individual growth data collected in this study. After controlling for gender, Overall Communicativeness growth trajectories for the LR-ND, HR-ND, and HR-ASD groups were positive (increasing) but not significantly different from one another. However, relative to the LR-ND group, Coordinated Bouts grew at a slower rate (i.e., .79 bouts slower per month) in the HR-ND group (p = .028). This pattern was more pronounced for the HR-ASD infants, who, on average, gained 1.60 bouts fewer per month than LR-ND infants (p = .000). Over time, this slower growth rate translated into progressively larger standard deviation differences between the LR-ND and HR-ASD groups. At 12 months, scores for the HR-ASD infants fell on average 10.53 SD below those for LR-ND infants, but by 18 months the difference had more than doubled, with HR-ASD infants scoring 26.32 SD below LR-ND infants.
Conclusions: There is a broad pattern of delay in the production of temporally coordinated communicative behaviors among HR infants that cannot be simply attributed to a delay in the overall production of communicative acts. This delay appears to be more pronounced in HR infants who eventually received an ASD diagnosis, suggesting that multimodal communication may be an early behavioral marker of ASD.
Background: Numerous studies have documented impairments in language and gesture in children with ASD; and more recent work has begun to describe similar delays in the later-born siblings of children with Autism.
Objectives: This study focused on production of words, non-word vocalizations, deictic gestures (Reach, Give, Show, Point), and conventional representational gestures (e.g., Yes, No, Bye) in Infant Siblings (Sibs) and no-risk comparison infants (NR).
Methods: Twenty-one Infant Siblings (2 of whom were later diagnosed with Autism) and 18 NR infants (all later-borns) participated in this research. Infants and primary caregivers were videotaped at home for approximately 45 minutes each month between the ages of 5 and 14 months, then at 3-month intervals from 18 to 36 months. Parents completed the MacArthur-Bates Communicative Development Inventory (CDI) at all observations beginning at 8 months. Data presented here focus on the 13- and 18-month sessions.
Results: Findings indicated that: a) as a group and at both 13 and 18 months, relative to NR infants, Sibs exhibited broad delays in overall communicativeness (total production of non-word vocalizations, words, and gestures) and significantly fewer words and deictic gestures; b) at 13 but not 18 months, Sibs also had fewer non-word vocalizations; c) at 13 months the two children who later received an Autism diagnosis were at the bottom of the distribution on all variables; and d) at 18 months these children produced very few gestures of any kind and almost no words. Finally, communication variables at 18 months were significant predictors of 30-month percentile scores on the CDI.
Conclusions: Even at 13 months, variation in gesture and vocalization production may index later diagnostic outcomes. Findings are discussed in terms of their implications for an understanding of individual differences among Infant Siblings, prediction of future ASD diagnosis, and the Broader Autism Phenotype.
Research has shown that environmental enrichment plays a major role in childhood neural development. Appropriate play structures provide children with the opportunity to experience various sensory-motor stimulations. Swings, slides, seesaws, and spinning facilities, in particular, are play structures that have strong elements of vestibular sensory input, when integrated with somatosensory input, is critical to childhood perceptual-motor, cognitive and social-emotional development. Children are drawn instinctively to swings and slides on the playground without even being aware of the impacts of such experience on their brain. Given the space limitations in the average modern-day city household, community environments play an important role in providing an enriched environment for city children, and may be especially critical to the everyday stimulation of developmentally delayed or challenged children. The objective of this study is to evaluate the sensory-motor stimulation opportunities for children in Taipei City community playgrounds. Sixty parks were surveyed of their playground facilities and analyzed of their sensory-motor stimulation opportunities. The parks were selected through a stratified random sampling process, using administrative districts and park size as sampling strata. Results show that 12% of the surveyed parks had no playground facilities. Of the parks that had playgrounds, their facilities were quite similar, as 92% had slides, 75% had rocking horses, 72% had climbers, and 64% had horizontal bars. These four facilities were common in both city and community parks. City parks, on average, had more types and thus a larger number of play facilities than community parks. The most abundant playground facilities were rocking horses, slides, and climbers. When the opportunities for excitatory vestibular inputs were analyzed, slides were by far the most common and abundant source. Swings, which provide high amounts of excitatory vestibular input, were low both in their commonness (42% of city parks, and 15% of community parks) and their abundance (average 1.0 per city park and 0.4 per community park). Seesaws were also low both in their commonness and their abundance. Swings were observed to be particularly under-equipped when their per-capita time requirement is taken into account, and almost always cause long waiting lines during periods of high use. Spinning facilities were absent in the surveyed parks. We recommend that communities incorporate sensory-motor stimulation as an important factor in the design of their playgrounds, and especially recommend the increase of swings and spinning facilities in Taipei community playgrounds.
The literature describing individuals with autism spectrum disorders (ASDs) commonly includes descriptions of differences in sensory processing. The purpose of this study was to describe patterns of sensory processing found in 400 children with an ASD. Exploratory factor analysis identified 6 parsimonious factors: low energy/weak, tactile and movement sensitivity, taste/smell sensitivity, auditory and visual sensitivity, sensory seeking/distractibility, and hypo-responsivity. These factors are consistent with other reports about differences in sensory processing. Findings provide insights about practice and future research.
Reports of autistic behaviors were examined for 30 school-age girls with fragile X (fraX) and 31 age- and IQ-matched controls through a structured interview administered to each girl's parent(s). IQ scores were obtained for each participant; anxiety, neuroanatomical, and molecular-genetic data were derived for girls with fraX. Girls with fraX had significantly more autistic behaviors than controls. These behaviors were qualitatively similar to those reported for boys with fraX, but were not correlated with IQ. Anxiety in girls with fraX was positively correlated with abnormal social and communication behaviors; posterior cerebellar vermis area was negatively correlated with measures of communication and stereotypic/restricted behaviors. Severity of stereotypic/restricted behaviors was negatively correlated with the prevalence of active non-fraX chromosomes. Thus anxiety and posterior cerebellar area measures had distinct associations with subsets of autistic behaviors; these associations may have important implications for understanding the neurobiology of autism.
Visits to the emergency department (ED) are stressful for any patient and pose special challenges and potential barriers to care for those with autism spectrum disorder (ASD). In addition, people (both children and adults) with ASD differ in their perception of, or responses to, environmental stimuli. Some people with ASD present with sensory defensiveness that is environmentally moderated, but there is a gap in our knowledge about patterns or thresholds of stimulation that kindle behavioral responses. We systematically recorded visual and auditory stimuli in an ED. Data were collected in four areas, hallway, doorway of waiting room, chair in waiting room, and treatment room, over several weeks and times of day. The mean light intensity ranged from 127 to 184 lux. There were significant differences (F = 16.77, df = 3, p > 0.001) between the five ED locations. Mean sound levels ranged from a high of 63.291 dB in the waiting room chair to a low of 51.289 dB in the treatment room. The highest consistent level of noise was recorded while sitting in the waiting room chair (60.657-63.291 dB). The findings suggest significant differences in light and sound intensity in common ED locations, with the highest mean readings of light and noise in the waiting areas. The differences and descriptions of light and sound patterns support the need for additional studies in both the measurement of the ED environment and its role in stimulating sensory defensiveness in people with ASD.
This unique book is the first to fully explore the history of autism - from the first descriptions of autistic-type behaviour to the present day.
Features in-depth discussions with leading professionals and pioneers to provide an unprecedented insight into the historical changes in the perception of autism and approaches to it
Presents carefully chosen case studies and the latest findings in the field
Includes evidence from many previously unpublished documents and illustrations
Interviews with parents of autistic children acknowledge the important contribution they have made to a more profound understanding of this enigmatic condition</ul
Communication spontaneously initiated by infants at heightened risk (HR; n = 15) for autism spectrum disorders (ASD) is compared with that in low-risk (LR; n = 15) infants at 13 and 18 months of age. Infants were observed longitudinally during naturalistic in-home interaction and semistructured play with caregivers. At both ages, HR infants spontaneously produced Words, Communicative Non-Word Vocalizations, show and point Gestures, and Gesture + Non-Word Vocalization combinations at lower rates than LR peers. This difference also held for Gesture + Word combinations at 18 but not 13 months. At 36 months, all HR children were evaluated for ASD, and 3 received a diagnosis of autistic disorder. At both 13 and 18 months, these 3 children had been at or near the bottom of the distribution on all spontaneous communication variables. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
The use of an investigator-based interview (Autism Diagnostic Interview—Revised; ADI-R) in the diagnosis of 51 autistic and 43 nonautistic mentally handicapped preschool children of equivalent mental and chronological age is described. Significant differences occurred between the groups on every diagnostic subdomain from the DSM-IV/ICD-10 draft criteria, except specific aspects of stereotyped language, still relatively rare in these young children. All but one of the 51 children judged to be autistic by clinical observation and only two of the 30 nonautistic mentally handicapped children with mental ages of 18 months or higher met criteria for autism on an algorithm to DSM-IV/ICD-10 draft criteria. However, discrimination using domain totals between autistic and the 13 nonautistic, nonverbal mentally handicapped children with mental ages under 18 months was poor. Quality of social overtures to adults and peers, play, and unusual sensory behaviors and mannerisms continued to differentiate these two groups. The relevance of these findings to the diagnosis of autism in preschool children is discussed.
It is estimated that 80–90% of individuals with autism spectrum disorders (ASD) demonstrate sensory-related problem behaviors
such as self-stimulating behaviors (finger flicking or excessive rocking), avoiding behaviors (such as placing hands over
ears in response to typical levels of auditory input), sensory seeking behaviors (twirling, chewing, etc.), “tuning out” behaviors
such as not responding to their name or other environmental cues, and difficulty enacting purposeful plans of action (Baranek
et al. 2006; Huebner 2001; Kientz and Dunn 1997; O’Neill and Jones 1997; Ornitz 1974, 1989; Rogers et al. 2003; Tomchek and
Dunn 2007). These behaviors, which may have a sensory basis, are termed sensory dysfunction (SD) and findings show that they
limit participation in play, social, self-care and learning activities (Adrien et al. 1987; Baranek 1999, 2002; Edelson et
al. 1999; Grandin 1995; Leekam et al. 2007; McClure and Holtz-Yotz 1991; Leekam et al. 2007, 1997; O’Riordan and Passetti
2006; Ornitz 1974, 1989; Rapin and Katzman 1998; Rogers and Ozonoff 2005; Schaaf et al. 2010; Williams 1992, 1994). Although
interventions for SD are among the most requested services for children with ASD (Mandell et al. 2005; Green et al. 2006),
there is limited evidence about their efficacy (Baranek et al. 2006; Dawson and Watling 2000; Rogers and Ozonoff 2005). The
National Research Council (2001, p. 131) reports that there is a “pressing need for more basic and applied research to address
the sensory aspects of behavior problems (in children with ASD).” Baranek (2002) also stressed that “best practice” for children
with ASD should include interventions to address SD, but that more research is needed to guide parents, teachers, and other
professionals to make informed decisions about intervention. Most studies to date fail to link basic science findings to behavioral
or functional changes, and thus, it is not possible to determine the specific processes underlying behavioral gains reported
in intervention studies. The purpose of this chapter is to define and describe SD in ASD, evaluate the evidence for current
interventions that address SD in ASD, and discuss practice recommendations in light of these data.
Nineteen parents of children with autism were interviewed about their experiences with autism treatments. These parents had
originally participated in an Internet survey of treatments for autism and were randomly selected to participate in the follow-up
telephone interview. The questions focused on three current treatments that have varying empirical support in the research
literature, namely Applied Behavior Analysis, Sensory Integration therapy, and a combination of Vitamin B6 and Magnesium.
Most parents received information about these treatments from the Internet, other parents, and occupational therapists. In
addition to recommendations from professionals and other parents to use a particular treatment, the study showed that ease
of implementation, time commitment, and perceived effectiveness may also contribute to the continued use of treatments that
lack empirical support. The findings highlight the need for parents to have access to unbiased, scientifically validated information
about treatments for autism.
The Behavior Summarized Evaluation (BSE), developed for the assessment of autistic behavior, was specifically designed to evaluate the severity of behavioral problems in autistic children involved in bioclinical and therapeutic studies. The reliability studies and the factorial analysis of this scale have been previously published. The present paper examines the effectiveness of the BSE to discriminate 58 autistic from 58 nonautistic mentally retarded children. The BSE clearly separated the two samples of children. A most efficient combination of 8 items emerged from the stepwise item selection procedure. The between-group differences were highest on 4 items, indicating that the most particular pattern in autistic compared to nonautistic children could be the association of autistic withdrawal and stereotypic behaviors. Our findings suggest that the BSE could help in the detection and evaluation of autistic developmental deviance. Implications for further research are discussed.
Thesis (Ph. D.)--Kansas State University, 1987. Includes bibliographical references (leaves 168-174). Typescript (photocopy).
The Infant Behavioral Summarized Evaluation (IBSE) is a rating scale adapted from the Behavioral Summarized Evaluation (BSE) and specifically related to the assessment of behaviors of young children having autistic disorders. Content validity and reliability studies described in the paper were made from behavior ratings of videotapes for 89 children aged from 6 to 48 months. Results show a significant group of 19 items including some characteristic early autistic behaviors (communicative and social abnormalities) and some that are less commonly described in the syndrome (attentional, perceptive, and adaptive disorders). The value of the use of this scale for clinicians and professionals involved in behavioral evaluations and treatment of young children with developmental disorders and the necessity for further psychometric investigations are discussed.
Autism involves not only developmental delays but also aberrant behavior, both of which change in nature over time. Rating instruments may be useful to assess maladaptive and adaptive behaviors of autistic children in a standardized way and, perhaps, to measure change due to treatment. With the expansion of basic science, knowledge, and technology, there is increasing evidence that autism is etiologically heterogeneous. Currently, there is no biological marker specific to autism, although hyperserotonemia is a consistent finding in one third of autistic children. An aim of basic science research has been to develop a rational pharmacotherapy based upon the underlying neurochemistry. However, at the present time, this approach has not always been successful. It is expected that the development and use of more restrictive criteria, delineation of subtypes of autism, and interaction of descriptive, behavioral, clinical, and basic research will lead to more effective planning for treatment. The relationship of assessment to treatment response is presented and discussed.
The set of features that constitute 'autism' has been traced to numerous etiologies. Certain autistic features have been localized to dysfunction in certain neural areas, most notably frontal and temporal regions. The author hypothesizes that many of the symptoms characteristic of autism fit the clinical picture of frontal lobe seizures. Facial, vocal, and other body movements in autism are catalogued in parallel with facial, vocal and body movements that occur during frontal lobe seizures. The variety of etiologies that cause frontal lobe seizures also accounts for the variety of etiologies traced to autism.
The Behavioral Summarized Evaluation (BSE), is a 20-item paper-and-pencil rating scale specifically designed for the measurement of behavioral parameters which could be related to biological data in autistic children involved in educational programs, neurophysiological studies, and therapeutic trials. The development of the scale, the validity, and reliability studies are presented in this paper. The results suggest that the BSE is an acceptable tool for the assessment of autistic behaviors, easy to handle, and accessible to both professionals and paraprofessionals of the medico-educative staff. It is a useful addition to the bioclinical researcher's evaluation battery for bioclinical and therapeutic studies. However, more work is suggested to further investigate the psychometric properties of this behavior assessment instrument.
The method presented is based on the 3-dimensional bioclinical examination of autistic children. The covariations of behavior ratings, electrophysiological (cortical evoked potentials) and biochemical (urinary monoamine metabolites) measurements are analyzed. The systematic application of these markers provides precise information for a more rational application of therapeutics. It could help to better understand the underlying mechanisms of autism.
Infantile autism is a pervasive developmental disorder characterized by disturbances concerning not only the areas of socialization and communication ("aloneness") but also the ability to modify and change behavior ("need for sameness"). In most recent studies, various abnormal and deviant cognitive activities, such as the ability to regulate one's behavior, were considered as accounting for these signs. In this report, we examined the regulation of cognitive activity, from a developmental perspective in comparing autistic with mentally retarded children matched in a pairwise manner by global, verbal, and nonverbal developmental ages. All children were tested with tasks adapted from the Object Permanence Test which corresponds to Piaget's sensorimotor development Stages IV to VI. Results showed that autistic children had a pervasive difficulty in maintenance set, made more perseverative errors when the abstraction degree of task was higher, and were more variable in their behavioral strategies. Discussion is focused on the interests and limits of these tasks for the examination of regulation activity from diagnostic and developmental perspectives. Finally, interpretations about recent neuropsychological and neurophysiological works, and additional interdisciplinary studies are suggested.
Ratings of family home movies of 12 infants (0 to 2 years old) who were later diagnosed as autistic and 12 normal infants were performed by two diagnosis-blind psychiatrists with Infant Behavior Summarized Evaluation scale. The objective was to identify early symptoms of autism and their intensity and frequency before and after 1 year of age. Several pathological types of behavior related to socialization, communication, motility, and attention were noted during the first year of infant life and differentiated autistic and normal groups. These same differentiating behaviors, observed again in the second year, were more intense and associated with other pathological types of behavior, in particular, gaze avoidance, hypoactivity, and absence of emotional expressions. Analysis of the evolution of behavioral pathology in autistic children as a group during the 2 first years of life confirms the persistence of and the increase in some types of abnormality related to socialization, communication, motility, and attention functions. The limitations and values of this study concerning the early identification of autistic symptoms and functional impairments from home movies for diagnosis and establishing individualized treatment program are discussed.
This review addresses the issues and challenges related to the differential diagnosis of autism in preschool children with significant cognitive impairment. Issues affecting differential diagnosis include the use of traditional diagnostic guidelines for preschoolers with developmental delays, developmental changes in behavioral characteristics, the involvement of cognitive factors in symptom expression, and the overlap between autism and mental retardation in individuals with significant cognitive impairment. The usefulness of autistic features for differential diagnosis is explored in terms of the core deficits of autism.
This retrospective video study explored the usefulness of sensory-motor measures in addition to social behaviors as early predictors of autism during infancy. Three groups included 11 children with autism, 10 with developmental disabilities, and 11 typically developing children. Home videos were edited to obtain a 10-minute cross-section of situations at 9-12 months for each subjects. Using interval scoring, raters coded several behavioral categories (i.e., Looking, Affect, Response to Name, Anticipatory Postures, Motor/Object Stereotypies, Social Touch, Sensory Modulation). Nine items, in combination, were found to discriminate the three groups with a correct classification rate of 93.75%. These findings indicate that subtle symptoms of autism are present at 9-12 months, and suggest that early assessment procedures need to consider sensory processing/sensory-motor functions in addition to social responses during infancy. Furthermore, prior to a time that they reported autistic symptoms, caregivers used compensatory strategies to increase the saliency of stimuli in order to engage their children more successfully; these strategies may provide a window for earlier diagnosis.
Kanner (1943), in his classic account, described autism as a specific impairment in interpersonal relations which leaves the child's uses of objects relatively unaffected. This combination of the difficulties in relating to people and the supposedly "excellent" relations to objects figures centrally within many of the current theories of autism, which have had relatively little to say on the question of object use. This paper draws attention to evidence of widespread impairments in relating to objects, not only in interpersonal aspects of object use but also in early sensorimotor exploration and the functional and conventional uses of objects. In stressing these problems with objects, our purpose is not to downplay the social dimension of autism, but rather to highlight the reciprocal nature of the interactions between the child, other people, and objects. Given the evidence that other people play an important role in introducing objects to children, we propose that an impairment in interpersonal relations should itself lead us to expect corresponding disruption in the autistic child's use of objects. Conversely, an unusual use of objects is likely to manifest itself in disturbances in relating to other people, given the importance of a shared understanding and use of objects in facilitating interaction.
The main aim of the research is to study the early behavioral development in autistic children through home movies.
fifteen home movies, regarding the first 2 years of life of autistic children are compared with the home movies of 15 normal children. The films of the two groups were mixed and rated by blind ratings with the Grid for the Assessment of Normal Behavior in Infants and Toddlers. The grid is composed of 17 items grouped into three developmental areas: social competence, intersubjectivity and symbolic activity. For every area, we have identified specific children's behaviors.
Significant differences between the two groups are found both in the range of age 0-6 for intersubjectivity, and in the ranges of age 6-12 and 18-24 for symbolic activity.
The authors pose some hypotheses about an early-appearing impairment of intersubjectivity, the ability to represent other's state of mind, in subjects with autistic disorder.
Based on the Piagetian framework, this study examined regulation of cognitive activity and developmental communication profiles and their interrelationship in groups of autistic, mentally retarded, and normal children of comparable overall, verbal, and oculo-manual developmental ages (from 6 to 24 months). Regulation of activity was assessed with both an object permanence test and an original behavior grid, and development of communication skills with the Guidetti-Tourrette scales (French adaptation of the Seibert-Hogan scales). The results showed evidence of certain types of dysregulation of cognitive activity and a general delay in communication ability in autistic children compared to the other two groups. Moreover, although the intensity of some of these disorders decreased in relation to the developmental levels of social interaction and joint attention in normal children, they were related to both high and low levels of development of social interaction only in autistic children. These findings raise the hypothesis of a relationship between a disorder of disengaging from an activity and developmental levels of social interaction noted at two transitory periods of early development (12 and 24 months) only in children with autism. Developmental and neuropsychological interpretations of this particular pattern are proposed.
The article reviews the empirical evidence relating to the development of early solitary object and parent-infant play in typical infants and children diagnosed with autism. Whilst, collectively, the findings indicate that there may be both qualitative and quantitative differences in the early play of children with autism, relative to that of other children, it is also clear that significant gaps exist in our current knowledge. It is proposed that longitudinal studies, which make a detailed examination of the form and developmental trajectory of early play, are needed if we are to devise the most effective content, design and outcome measures for intervention programmes using play as a therapeutic medium.
The Scale of Pervasive Developmental Disorder in Mentally Retarded Persons (PDD-MRS) is described. The PDD-MRS is a simple classification and screening instrument devised for identification of autistic disorders (of the entire spectrum) in persons with mental retardation from mild to profound levels, age-range 2-55 years. The norms of the scale are based on the research protocols of 1230 Dutch persons with mental retardation. The scale's sensitivity for the entire normative sample was found to be 92.4%; calculated separately for persons at all levels of mentally retarded functioning, male and female persons, speaking and non-speaking persons and five age categories, the sensitivity figures range between 87.0 and 100.0%. The specificity of the scale is also 92.4%; for the aforementioned subgroups separately, the specificity figures range between 84.6 and 95.5%. Roughly similar values for sensitivity and specificity were found when using the scale with severely visually impaired/blind persons; severely hearing-impaired/deaf persons; persons with Down syndrome; male persons with fragile X syndrome. The original version of the PDD-MRS dates from 1990; since then the scale has been widely used in the Netherlands and Belgium. The PDD-MRS should be regarded as a useful instrument for identifying PDD in persons with mental retardation.
The three main methodological issues faced by clinical and basic scientists conducting research on the syndrome of autism are absence of objective diagnostic criteria, absence of objective normative behavioral data, and difficulty establishing adequate comparison groups. The theoretical framework for a systematic Behavior Observation Scale (BOS) which codes behaviors that are objectively defined, independent of any theoretical model of pathological development, is presented. The BOS was designed to be an easily learned and highly reliable instrument that can be applied to normal children as well as to those with developmental disabilities such as autism and mental retardation. Data obtained from a sample of 89 children (36 autistic, 30 mentally retarded, 23 normal) are presented.
The Behavioral Observation System (BOS) is intended to objectively differentiate autistic, normal and mentally retarded children. Procedures for measuring 67 behaviors are described and data on 118 children presented. Session to session stability of each behavior was assessed by means of intraclass correlations derived from variance component analyses, and by means of reoccurrence of a behavior within a child. The recognizability of each behavior was examined utilizing exact percentage interobserver agreement. Methodological problems encountered when attempting to establish diagnostic data are discussed.
L'autisme de l'enfant a été individualisé par Kanner en 1943 [1] et décrit comme une difficulté à établir des relations normales avec les personnes, un isolement qui fait négliger, ignorer, rejeter tout ce que l'enfant peut recevoir de l'extérieur, enfin un désir que tout reste inchangé.
The design, administration, and scoring of the first edition of the Children's Handicaps, Behavior & Skills (HBS) structured interview schedule, intended to elicit information concerning mentally retarded or psychotic children, are described. A high level of reliability was achieved with experienced interviewers and good informants. In a study of 104 such children, the levels of overall agreement between parent and professional informants on the 62 sections of the schedule were, in general, 7O% or above. Agreement was better for rating absence of skills or behavioral abnormalities than for rating their presence. This tendency was particularly marked for the behavioral abnormalities. Parents, when compared with professional workers, tended to describe their children as having higher developmental skills, more social contact but also more repetitive and difficult behavior.
This paper explores the possible pathophysiologic mechanisms which might underlie the unusual motility disturbances which occur in autistic children. These motor behaviors are in some way related to the faulty modulation of sensory input which is also a significant feature of the autistic syndrome. Psychologic experiments have revealed that autistic children learn through manipulation and position cues rather than through normal perceptual processes. It is therefore suggested that their spontaneous abnormal motility may be the autistic children's way of making sense out of both exogenous and endogenous sensations through kinesthetic (sensorimotor) feedback. Experimental demonstrations of a deficient oculomotor response to vestibular and visual stimulation parallel clinical observations of the hypomotility also seen in response to sensory stimulation. Review of the neurophysiology of the vestibular system reveals that the vestibular nuclei modulate motor output at the time of sensory input and sensory input at the time of motor output. It is suggested that a dysfunction of the central connections of the vestibular system with the cerebellum and the brain stem may be responsible for the strange sensorimotor behavior observed in autistic children and may also have implications for understanding the manner in which autistic children learn, since clinical studies point toward a strong motor component to their perceptual processes.
Autistic children with an IQ below 70 and with an IQ above 70 were systematically compared. The two groups differed somewhat in the pattern of symptoms, but were closely similar in terms of the main phenomena specifically associated with autism. However, the low IQ and high IQ autistic children differed more substantially in terms of other symptoms such as self-injury and stereotypies and there were major differences in outcome. The possibility that the nature of the autistic disorder may differ according to the presence or absence of associated mental retardation needs to be taken into account in planning studies of etiology.
A sample of 74 young autistic children was selected and defined by direct observation of specific behaviors and clinical assessment of the presence or absence of associated pathological conditions. Retrospective developmental data on these children and 38 age-matched normal children were gathered by means of a written inventory completed by the parents when the children were relatively young (mean age less than 4 years). The autistic children were reported to have had significant delays in the development of motor abilities, speech, communication, comprehension, and, to a lesser extent, perception during their 1st and 2nd years.
The prevalence, in children aged under 15, of severe impairments of social interaction, language abnormalities, and repetitive stereotyped behaviors was investigated in an area of London. A "socially impaired" group (more than half of whom were severely retarded) and a comparison group of "sociable severely mentally retarded" children were identified. Mutism or echolalia, and repetitive stereotyped behaviors were found in almost all the socially impaired children, but to a less marked extent in a minority of the sociable severely retarded. Certain organic conditions were found more often in the socially impaired group. A subgroup with a history of Kanner's early childhood autism could be identified reliably but shared many abnormalities with other socially impaired children. The relationships between mental retardation, typical autism, and other conditions involving social impairment were discussed, and a system of classification based on quality of social interaction was considered.
-35 autistic and 30 mentally retarded children matched for both mean chronological and mental age were observed in a playroom. The frequencies of occurrence of 67 objectively defined behaviors were coded on the Behavior Observation Scale. Implication for determining the objective diagnosis of autism is discussed. Since the syndrome of autism was first described by Kanner (1943), there have been many attempts to specify objectively the behaviors which a child must exhibit in order to receive the diagnosis. However, before objective
The design, administration, and scording of the first edition of the Children's Handicaps, Behavior & Skills (HBS) structural interview schedule, intended to elicit information concerning metally retarded or psychotic children, are described. A high level of reliability was achieved with experienced interviewers and good informants. In a study of 104 such children, the levels of overall agreement between parent and professional informants on the 62 sections of the schedule were, in general, 70% or above. Agreement was better for rating absence of skills or behavioral abnormalities than for rating their presence. This tendency was particularly marked for the behavioral abnormaliteis. Parents, when compared with professional workers, tended to describe their children as having higher developmental skills, more social contact but also more repetitive and difficult behavior.
Autistic children with an IQ below 70 and with an IQ above 70 were systematically compared. The two groups differed somewhat in the pattern of symptoms, but were closely similar in terms of the main phenomena specifically associated with autism. However, the low IQ and high IQ autistic children differed more substantially in terms of other symptoms such as self-injury and stereotypies and there were major differences in outcome. The possibility that the nature of the autistic disorder may differ according to the presence or absence of associated mental retardation needs to be taken into account in planning studies of etiology.
Neurophysiologic hypotheses of infantile autism fall into two broad categories. One is a caudally directed sequence of pathophysiologic influence originating in telencephalic structures. The other is a rostrally directed sequence of pathophysiologic influence originating in brainstem and diencephalic structures. This paper relates each hypothesis to relevant aspects of autistic behavior, reviews neurophysiologic research relevant to each hypothesis, and describes recently completed studies of vestibular nystagmus, relating these new findings to the brainstem-diencephalic hypothesis. Those studies that delineate subgroups of autistic children are distinguished from those that characterize the entire group of autistic children. Those results that point toward maturational delays are distinguished from those that characterize deviant neurophysiologic abnormalities.
The author describes his Form E-2 checklist method for the diagnosis of early infantile autism and differentiation of other childhood psychoses. Data on 2,218 psychotic children, 1,652 boys and 556 girls, are presented. The checklists showed 9.7% of the children to have early infantile autism, thus providing a confirmation of Kanner's 1962 estimate that only 10% of his patients called “autistic” by others were correctly diagnosed. Also presented are data showing that among 445 psychotic children seen by two different diagnosticians, only 55 had been assigned the same diagnosis twice. Laboratory studies and other sources are cited to show that Form E-2 is effective in differentiating truly autistic from autistic-type children. Other aspects of the problem of diagnosing psychotic children are discussed.
Many investigators have attempted to study evoked potentials (EPs) in autistic children. In most of their studies, EPs were found to be smaller and less frequently elicited in autistic than in normal children. Very few studies have concerned the P3 component. The authors attempted to apply to autistic children a method derived from Pavlovian conditioning in which two different stimuli were presented to the subject who was not required to participate actively.
En rupture avec les conceptions initiales proposees de l'autisme, l'auteur soutient que ce trouble ne consiste pas dans un trouble d'abord affectif, ni ne se limite a un deficit du registre du langage, ni ne se definit par les handicaps sociaux qui affectent le sujet, mais que l'autisme est fonction d'un deficit crucial dans le domaine cognitif. Ce deficit cognitif est fondamental au double sens du terme, dans le mœsure ou il n'est pas secondaire aux autres traits qui caracterisent l'autisme et ou il est sous-jacent aux autres handicaps qui accompagnent l'autisme. Considerant cette definition comme un acquis des recherches les plus recentes, l'auteur pose la question des relations de cette dimension cognitive fondamentale dans l'autisme aux dimensions du desir et de l'affect
This review examines five measures specifically designed to assess autistic symptomatology: Rimland's Diagnostic Checklist for Behavior-Disturbed Children, the Behavior Rating Instrument for Autistic and Atypical Children, the Behavior Observation Scale for Autism, the Childhood Autism Rating Scale, and the Autism Behavior Checklist. Available studies of reliability and validity issues are discussed. Reliability indices for all scales, except Rimland's Diagnostic Checklist, are at acceptable levels. Each scale has been found to suffer from a lack of demonstrated discriminant and/or content validity. Recommendations for future research are provided.
In an open trial, a heterogeneous group of 44 children with autistic symptoms were treated with large doses of vitamin B6 and magnesium. Clinical improvement with worsening on termination of the trial was observed in 15 children. Thirteen responders and 8 nonresponders were retested in a 2-week, crossover, double-blind trial, and the responses to the open trial were confirmed.
An autism checklist was developed with behaviors selected from a variety of checklists and instruments used to identify autism. Content validity of the behaviors was established, and 3000 of the checklists were sent throughout the United States and Canada to professionals acquainted with handicapped children. 1049 checklists completed on individuals 18 months to 35 years old were returned. A chi-square analysis indicated that 55 of the 57 behaviors listed were significant predictors of autism (P<0.001) when compared to severe mental retardation. A weighted score, determined by statistics (4 indicating the highest predictor of autism, 1 the lowest), was assigned to each other.
The authors are developing the Behavior Observation Scale to objectively differentiate autistic, normal, and mentally retarded children aged 30--60 months. They describe operational definitions and procedures and report data on the frequency of selected behaviors among 114 children. Prior studies have revealed that to assess the clinical significance of behaviors in autistic children, both frequency of occurrence per subject and the number of children exhibiting the behaviors must be considered concurrently. This study confirms the hypothesis that it is critical to consider the IQ of the child when assessing the clinical significance of individual behaviors and groups of behaviors.
The schizophrenic child characteristically presents a remarkable array of symptoms. Indeed, the breadth of symptomatology and the extreme degree of divergence from normality in virtually all regulative and coordinative activities are almost diagnostic signs in themselves. Widespread disturbances seemingly occur at all levels of integration and affect all psychic functions. A proper delineation of the disorder, therefore, will emerge eventually from investigation of all dimensions of behavior.
Receptor processes, however, are of special interest. Through these processes, the child attains an understanding of his internal and external worlds. They also form the foundation for responding to these worlds. For some time, it has appeared that one of the major trends contributing to the globally bizarre picture of the childhood schizophrenic is a deviant pattern of receptor activity. In the past two and one-half years at Ittleson Center, therefore, a systematic and focused clinical interest has been in the receptor behavior
Behavior rating instrument for autistic and other atypical children. Philadelphia: Developmental Center for Autis-tic Children
- B A Ruttenberg
- B I Kalish
- C Wenar
- E G Wolf
Ruttenberg, B. A., Kalish, B. I., Wenar, C., & Wolf, E. G. (1977). Behavior rating instrument for autistic and other atypical children. Philadelphia: Developmental Center for Autis-tic Children.
Psychomotor Development Scale in Infancy
- O Brunet
- I Lezine
Brunet, O., & Lezine, I. (1976). Psychomotor Development Scale in Infancy. In Le ddveloppe-ment psychomoteur de la premiere enfance (4th ed.). Paris. P.U.F.
The early symptoms of childhood autism
- E M Ornitz
- D Guthrie
- A Farley
- E. M. Ornitz
Ornitz, E. M., Guthrie, D., & Farley, A. (1978). The early symptoms of childhood autism.
ln G. Serban (Ed.), Cognitive defects in the development of mental illness (pp. 24-42).
New-York: Brunner /Mazel.
Diagnostic and statistical manual of mental disorders Washington, DC: Author. Behaviors Associated with Differences between mentally retarded and normally intelligent autistic children
- American Psychiatric
- L Rutter
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author. Behaviors Associated with Infantile Autism 415 Bartak, L., & Rutter, M. (1976). Differences between mentally retarded and normally intelligent autistic children. Journal of Autism and Childhood Schizophrenia, 6, 109-120.
Autisme du nourrisson et du jeune enfant (0?3 ans). Signes précoces et diagnostic
- D Sauvage
- D. Sauvage
Sauvage, D. (1984). Autisme du nourrisson et du jeune enfant (0-3 arts). Signes prdcoces et diagnostic. Paris: Masson.
Psychomotor Development Scale in Infancy. InLe développement psychomoteur de la première enfance
- O Brunet
- I Lezine
- O. Brunet
Brunet, O., & Lezine, 1. (1976). Psychomotor
Development Scale in Infancy. ln Le développement psychomoteur de la première enfance (4th ed.). Paris. P.U.F.
Behavior rating instrument for autistic and other atypical children
- B A Ruttenberg
- B I Kalish
- C Wenar
- E G Wolf
- B. A. Ruttenberg