Identical triplets with infantile autism and the fragile-X syndrome

In a continuing twin study of autism in Scandinavia and Finland, moderately mentally retarded triplets fulfilling Rutter's criteria for infantile autism were reported. Judging by physical appearance the triplets were identical. Behaviourally they were extremely similar though one was intellectually slightly better than the other two. All three showed the physical stigmata characteristic of the fragile-X syndrome, in spite of their overall appearance being non-conspicuous. The triplets had between 8 and 12 per cent of fragile-X positive cells and showed a distinct pattern of urinary excretion of substances yielding absorbency at 280 nM. Their mother and sister also had a high count of fragile-X positive cells.

Autistic children's hand preferences: results from an epidemiological study of infantile autism

Twenty-six autistic children, constituting a total population sample of children diagnosed in accordance with Rutter's criteria as suffering from infantile autism, were assessed with regard to handedness and certain associated factors. They were compared with 52 age-, sex-, and IQ-matched controls. Sixty-two percent of the autistic children were non-right-handed compared with 37% of the controls. Left-handedness in autism was associated with an abundance of delayed echolalia. Heredity for left-handedness in some cases, and assumed brain damage and immature patterns of lateralization in others, were considered the cause of non-right-handedness in the autistic children. Computed tomographic (CT) brain scans and other neurobiological examinations did not provide evidence indicating clear-cut unilateral left hemisphere dysfunction in autism. Rather, a slight trend in the opposite direction (i.e., an association with right hemisphere dysfunction) was seen in the left-handed autistic children. The result points toward the need for further studies of handedness in autism.

Three-year follow-up at age 10 of children with minor neurodevelopmental disorders. I: Behavioural problems

Sixty-one children selected from a total population study of six-year-old children in Gothenburg and diagnosed as suffering from minimal brain dysfunction (MBD), motor perception dysfunction (MPD) or attention deficit disorder (ADD), and 51 normal control children were followed up at age 10 for behavioural problems. According to teachers', parents' and self-rating questionnaires, the index children, especially those with MBD, showed extremely high rates of severe behavioural/experiential problems at follow-up. None had been treated with stimulants or other drugs directed at alleviating the symptoms of the neurodevelopmental disorder. It is argued that the high rates of disturbances according to the questionnaire ratings are a true reflection of the psychiatric ill-health in these children.

Perceptual, motor and attentional deficits in Swedish primary school children. Some child psychiatric aspects

One hundred and forty-one seven-year-old children took part in an extensive neuropsychiatric study. Eight-two of these children had been selected and sampled from a group of 3448 children for whom questionnaires concerning motor control, perception and attention/behaviour had been completed by pre-school teachers. They all showed pre-school signs of both attention deficit and motor/perception dysfunction. The fifty-nine remaining children had been randomly sampled from the group of 3448 children to serve as controls. The study was carried out in a blind fashion. The present paper reports on results of the neuropsychiatric study with special regard to psychiatric disorders in so-called MBD syndromes, defined in accordance with operational criteria. Prevalence figures for marked psychiatric abnormality in MBD were shown to be higher than for psychiatric abnormality in children with 'neuroepileptic' disorders in the Isle of Wight study. Psychotic behaviour was found to be specifically associated with MBD. Hereditary and neuropathogenic factors singly or together possibly caused the 'MBD handicap'. Non-optimal psychosocial factors appear to interact with the MBD syndrome in the moulding of psychiatric disorders.

Auditory brainstem responses in childhood psychosis

Auditory brainstem responses were compared in 24 autistic children, 7 children with other childhood psychoses, and 31 normal children. One-third of the autistic children showed abnormal ABR indicative of brainstem dysfunction and correlating with muscular hypotonia and severe language impairment. The children with other psychoses and the normal children showed normal results.

Perceptual, motor and attentional deficits in seven-year-old children: neurological and neurodevelopmental aspects

This study presents the results of neurological assessments of a representative sample of seven-year-old Swedish children with perceptual, motor and attentional deficits and their controls (N = 141). Among those children diagnosed as suffering from minimal brain dysfunction (MBD), the majority showed neurodevelopmental deviations indicative of the "clumsy child syndrome'. However, 20 per cent had slight signs of choreoathetosis, diparesis, hemiparesis or ataxia. Other associated neurodevelopmental deviations are considered. The correlation between neurological findings and background factors is discussed: the MBD group had higher scores for various "organic' background factors than the comparison children, and the children with neurological syndromes had somewhat higher scores than the remaining children with MBD. The difficulties in distinguishing MBD from mental retardation, cerebral palsy and childhood psychoses is clearly illustrated. Long-term follow-up will indicate the prognostic significance of these findings.

Infantile autism: a total population study of reduced optimality in the pre-, peri-, and neonatal period

Twenty-five autistic children, constituting a total population sample of children with infantile autism, were compared with 25 sex- and maternity-clinic-matched controls for occurrence of reduced optimality in the pre-, peri, and neonatal period, as noted in medical records. Autistic children showed greatly increased scores for reduced optimality, especially with regard to prenatal factors. The findings are at odds with early reports that children with autism had not suffered potential brain injury. The reasons for the discrepancy are discussed.

Hyperkinetic disorders in seven-year-old children with perceptual, motor and attentional deficits

One hundred and forty-one seven-year-old Swedish children took part in an extensive neuropsychiatric study involving total population samples of children who had shown perceptual, motor and attentional deficits in pre-school, and blindly examined comparison children. The present paper reports on generalized hyperkinesis, i.e. hyperactivity in the child in all of three different assessment settings. About a third of children diagnosed according to strict criteria as suffering from 'Minimal Brain Dysfunction' showed generalized hyperkinesis. In children without perceptual-motor deficits, hyperkinesis was very much rarer. A total population frequency for generalized hyperkinesis in the range of 1-3% is reported as probable. Heredity for delayed maturation, non-optimal pre-, peri- and neonatal factors and adverse psychosocial factors were found to interact in the shaping of the disorder.

Childhood psychosis and computed tomographic brain scan findings

Twenty-seven infantile autistic children, nine children with other kinds of childhood psychoses, 23 children with mental retardation, and 16 normal children were examined with computerized tomography of the brain. Gross abnormalities were seen in 26% of the autism cases. It was also estimated that about the same proportion of a total population of infantile autistic children show gross changes of CT brain scan. Abnormalities in the region of the frontal horns of the ventricular system tended to be more common in the psychosis groups than in the normal group. Clear-cut right occipital protuberation was rather common in the small group of other psychoses cases but was only marginally more common in the autism than in the normal group. Evans' ratio was significantly higher in all three abnormal groups than in the normal group.

Mental retardation in Swedish urban children: some epidemiological considerations

The total population of children born in 1971 and living in Gothenburg, Sweden, by the end of 1977 was screened in order to estimate prevalence figures for various neurodevelopmental disorders. Ninety-four percent of all children assessed attended public preschools. Questionnaires aimed at detecting perceptual, conceptual, motor, and attentional deficits were completed by preschool teachers for 72% of children in these schools. Samples of children with and without problems on the questionnaire were given neuropsychiatric examinations. National registers were searched to identify mentally retarded children not in public preschools. The total population frequency figure for unequivocal mental retardation was almost 1% with an additional 1% of the total population deemed to be of borderline intelligence.

Perceptual, motor and attentional deficits in seven-year-old children. Paediatric aspects

42 children representative of Swedish urban seven-year-olds with a combination of various minor neurodevelopmental deficits in the form of so-called minimal brain dysfunction (MBD) syndromes were compared with 51 children of the same age without such problems as regards general health data from parents' interviews and questionnaires and from paediatric examinations. The findings at the physical examination revealed only few and small differences concerning minor physical anomalies that, in part, is dealt with in a separate report. Children with MBD had experienced simple febrile convulsions significantly more often than controls, and an abnormal EEG was a common finding in these cases. So-called psychosomatic complaints were not overrepresented in the MBD group, but enuresis and encopresis was somewhat more common. The parents' answers to a set of 6 questions (concerned with late speech development, late motor development, gross motor clumsiness, fine motor clumsiness, "shuffling" and difficulties to concentrate) were found to have a high discriminating capacity detecting for MBD syndromes. The possibility of a clinical application of this finding is discussed.

Perceptual, motor and attentional deficits in seven-year-old children. Neurological screening aspects

In an extensive neuropsychiatric study of seven-year-old children, operational criteria for diagnosing minimal brain dysfunction (MBD) syndrome were used. Detailed behavioural assessment and meticulous neurological examination provided the basis for the MBD diagnosis. The time-consuming specialist examination by the child neurologist was considered too sophisticated for use in everyday clinical practice. Therefore, the results obtained at a short neurodevelopmental screening assessment performed by a child psychiatrist were analysed with the aim of finding a limited set of neurological examination items with high discriminating capacity detecting for MBD syndromes. A set of six such items (diadochokinesis, hopping on one leg, standing on one leg, cutting out a paper circle, associated movements when walking on lateral sides of feet and the labyrinth test of the WISC) produced a minimal rate of misclassified cases. It is argued that this discriminant set may be useful in everyday child psychiatric and pediatric assessment of children who raise suspicion of suffering from MBD.

Parental age in child psychiatric clinic attenders

Parental age was detailed from medical records of all children treated or observed as inpatients at the Child and Youth Psychiatric University Clinic of Gothenburg, Sweden, in 1975, and compared with corresponding figures for parental age of children in the general population. Psychotic children and psychotic adolescents tended to have mothers (and fathers) who were older than average. Sixty per cent of mothers of psychotic children were 30 years or older at the time of birth of the child compared with 27% of children in the general population. Children with emotional disorders showed the same mean maternal age as average children in the population. It is suggested that children and adolescents with psychotic disorders have a higher level of "organic" background factors than children with other kinds of child psychiatric disorders.

Social class and infantile autism

Twenty infantile autistic children, constituting what is likely to be the majority of the total population of autistic children born in the years 1962 through 1973 and living in Göteborg, Sweden, by the end of 1978, were compared with a random population sample of 59 7-year-old Göteborg children with regard to social class. Two different social classification systems were used, one that takes account only of the father's occupation and one that includes several other parameters. The distributions of social class were almost identical in the infantile autism group and in the random group. With respect to some other social circumstances the two groups were very similar. Thus, the present results lend no support for the view that autistic children tend to come from high social classes.

Minor neurodevelopmental disorders in children born to older mothers

In order to test the hypothesis that rates of motor and perceptual deficits in children tend to increase with maternal age, 65 children aged five and six years born to mothers with a mean age of 39.4 years were compared with 55 age-matched children born to mothers with a mean age of 27.9 years. The hypothesis was supported in that fine-motor problems were five times more common among the children born to older mothers than among those born to younger mothers. Visuo-perceptual dysfunction and attentional deficit signs also were much more common among the children of older mothers. The contribution of various associated factors to these results is discussed.

Perceptual, motor and attentional deficits in six-year-old children. Epidemiological aspects

A total population study of 4797 six-year-old children attending the public preschools in the city of Göteborg (Gothenburg) has been carried out. A questionnaire with 34 questions about MBD-related problems was distributed to all pre-school teachers. Three thousand four hundred and forty-eight questionnaires were completed. Factor analysis of the questionnaire and empirical results from a pilot study provided the basis for selecting for further study children with pre-school signs and symptoms suggestive of MBD. Neurological, psychiatric and psychological assessment of 82 children with, and 59 children without, pre-school symptoms of MBD revealed that in the index groups 41% of the children, and in the control group 3% of the children, had MBD. Extrapolation procedures gave a total population frequency of 1.2% with severe MBD and a further 5.9% with mild-moderate MBD. A very large questionnaire refusal rate (28%) is discussed. The relevance of the calculated frequency figures, especially as regards the mild-moderate MBD category, cannot be properly evaluated until long-term follow-up has been completed.

Long-term follow-up of children born after amniocentesis

Paediatric and neurodevelopmental examinations were made of 122 children between the ages of 5 and 7 years. The mothers of 62 of these children had undergone amniocentesis for prenatal chromosome determination. The other 60 children were controls, matched for time of birth and maternal age. The fact that no difference between the groups was revealed in respect of paediatric and neurodevelopmental disorders, orthopaedic abnormalities, or respiratory problems during the neonatal period indicates that the risk for developmental complications is not increased in children born after amniocentesis in the second trimester.

Perceptual, motor and attentional deficits in six-year-old children. Screening procedure in pre-school

3 448 six-year-old Swedish children were screened for perceptual, motor and attentional deficits with the help of a questionnaire containing 34 yes-no questions. Epidemiological aspects of single symptoms and of groups of symptoms are presented. Boys displayed many more problems than girls. Children attending day nurseries had more problems than part-time pre-school children, particularly as regards attention and behaviour. 141 of the children- 82 with and 59 without questionnaire symptoms suggestive of so-called MBD-had been examined in an extended neuro-psychiatric study. A discriminant analysis of the questionnaire was performed for these 141 children which demonstrated that a set of 6 questions had a high discriminating capacity detecting for MBD-syndromes.