Autism and pervasive developmental disorders: concepts and diagnostic issues

What is autism?

The term "Autism spectrum disorder" (ASD), in vogue at present, has evolved after continual substantial developments taking place over more than a century. ASD is a heterogeneous, multi-factorial, developmental disability in which an unusual pattern of development takes place during infant and toddler years. As per DSM-5, Autism spectrum disorder is a combined phrase for a family of complex developmental disabilities inclusive of "Autistic Disorder, Pervasive Developmental Disorder not Otherwise Specified (PDD-NOS), and Asperger's Disorder". "ASD is characterized not only by persistent impairments in reciprocal social communication and social interactions, but is also manifested by restricted, repetitive patterns of behavior, interests, or activities". The classical clinical signs that exist in two major domains, viz. the 'social domain' and the 'behavioral domain' for the precise diagnosis of ASD have been tabulated and major differences between DSM-5 and DSM-4 are depicted with the help of a figure in this basic review article. A sharp rise in the incidence of ASD cases has been observed worldwide owing to various risk factors such as genetic predisposition coupled with adverse environmental conditions, gynecological interventions, etc. Two official manuals viz. the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) (published by the American Psychiatric Association), and the "International Classification of Diseases" (ICD) (published by the World Health Organization) is being regularly updated to facilitate diagnosis of ASD. ICD-11 guidelines being prospectively implemented with effect from January 2022 have attracted global attention.

Examining criterion-oriented validity of the Repetitive Behavior Scales for Early Childhood (RBS-EC) and the Video-Referenced Rating of Reciprocal Social Behavior (vrRSB)

Improved characterization of quantitative traits and dimensionally distributed complex behaviors during toddlerhood may improve early identification of autism spectrum disorder and related neurodevelopmental disorders. Parents of 205 community-ascertained toddlers (age: mean = 20.2, SD = 2.6 months) completed the Repetitive Behavior Scales for Early Childhood (RBS-EC) and the Video-Referenced Rating of Reciprocal Social Behavior (vrRSB), with longitudinal follow-up of behavioral assessments and/or another round of parent-report questionnaires. Criterion validity was examined both concurrently and longitudinally using the Infant Toddler Social Emotional Assessment (ITSEA) as a criterion anchor. Reciprocal social behavior as measured by the vrRSB was significantly associated with social competence as measured by the ITSEA, longitudinally and concurrently. Reciprocal social behavior was not associated with the externalizing subscale on the ITSEA, providing evidence of discriminant validity. Higher-order repetitive behaviors (restricted interests; rituals and routines) as measured by RBS-EC subscales were associated with the dysregulation and internalizing subscales of the ITSEA, longitudinally and concurrently. All RBS-EC subscales (excepting repetitive motor) were associated concurrently and longitudinally with the dysregulation subscale of the ITSEA. We report evidence of criterion-oriented and discriminant validity for the constructs/domains captured by the RBS-EC and vrRSB. These instruments may be particularly useful in characterizing dimensional variability across the typical-to-atypical continuum.

Comprehension of presupposition triggers in Cantonese-speaking children with and without autism spectrum disorders

Built on a previous finding that children with autism spectrum disorders (ASD) had difficulty comprehending presuppositions, a domain of knowledge which is crucial for successful communication, the present study investigated the comprehension of seven types of presupposition trigger - namely definite descriptions, factive predicates, change-of-state verbs, implicative verbs, iteratives, temporal clauses, and counterfactual conditionals - in Cantonese-speaking children with and without ASD. Twenty-seven children with ASD (mean age 9.07) were compared with 23 typically developing (TD) children matched on chronological age and 21 TD children matched on language ability (LA). Knowledge of presupposition triggers was evaluated on the basis of children's ability to judge whether a given utterance was a correct presupposition of a preceding utterance. Children with ASD were found to perform significantly worse than TD children matched on chronological age in comprehending the seven types of presupposition trigger, but they performed similarly to TD children matched on language ability. After the effects of chronological age, language ability, and non-verbal intelligence were controlled for, children with ASD were still found to show a deficit in comprehending the presupposition triggered by a temporal clause, relative to the two groups of TD children. Future studies should investigate the factors contributing to this specific deficit in children with ASD, such as executive functioning and theory of mind.

[The prevalence of autism: genuine and imaginary]

In this review, the authors analyze the causes of the high prevalence of autism spectrum disorders (ASD) in recent decades. It is shown that the expansion of the boundaries of the 'autistic spectrum' concept led to a significant spread of data on its prevalence, depending on the time, diagnostic criteria, country and region. Stability of the diagnosis of ASD is not high and depends on the age of the child. Diagnostic practice in comorbid psychiatric disorders unfairly shifted toward ASD. At the same time, the hypothesis on the uniqueness of autistic manifestations in infancy is not convincingly confirmed. The practical aspect of the problem of the epidemiology of autism does not exclude, but on the contrary, presupposes early detection of nonspecific mental disorders followed by medical-psychological-pedagogical correction.

Childhood disintegrative disorder and autism spectrum disorder: a systematic review

AIM

In an attempt to clarify the debate surrounding the diagnostic validity of childhood disintegrative disorder (CDD), we systematically reviewed its characteristics and compared it with autism spectrum disorder (ASD).

METHOD

Four databases were searched (PubMed, PsycINFO, Embase, and Web of Science). Included articles had participants with CDD, as defined by symptoms present in the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and the International Classification of Diseases, 10th Revision. Comparison groups were those with ASD and ASD with regression. Case studies were excluded.

RESULTS

Twenty articles, comprising 96 participants with CDD (80 males, 16 females), were included. Most studies were cross-sectional. The prevalence of CDD was 1.1 to 9.2 per 100 000, with a mean age at regression of 3 years 2 months (SD 1y 1mo), with a range of 2 years to 7 years. In addition to core CDD symptoms, most had intellectual impairment, anxiety, challenging behaviours, and regressed in toileting skills. Participants with CDD and ASD shared core diagnostic and extra-diagnostic features. However, participants with CDD seemed to have more severe symptoms and a different symptom profile, including apparently typical development before regression, faster regression, more affective symptoms, and more global developmental deficit. Possible genetic and autoimmune neurobiological mechanisms were identified.

INTERPRETATION

There is limited high-quality evidence describing the aetiology and outcomes of CDD. However, given the qualitative and prognostic differences between ASD and CDD, we recommend that future diagnostic criteria should distinguish late-onset regression.

Comprehension of presuppositions in school-age Cantonese-speaking children with and without autism spectrum disorders

While an enormous amount of research has been done on the deficient conversation skills in individuals with autism spectrum disorders (ASD), little is known about their performance on presuppositions, a domain of knowledge that is crucial for successful communication. This study investigated the comprehension of four types of presupposition, namely existential, factive, lexical and structural presuppositions, in school-age Cantonese-speaking children with and without ASD. A group of children with ASD (n = 21), mean age 8.8, was compared with a group of typically developing children (n = 106). Knowledge of presuppositions was evaluated based on children's ability to judge whether a given utterance was a correct presupposition of a preceding utterance. Children with ASD were found to show a deficit in the comprehension of presuppositions, even after controlling for differences in general language ability and non-verbal intelligence. The relative difficulty of the four types of presupposition did not differ between the two groups of children. The present findings provide new empirical evidence that children with ASD have a deficit in the comprehension of presuppositions. Future research should explore whether the deficit in the comprehension of presuppositions is related to the development of theory of mind skills in children with ASD.

Students with Higher Functioning Autistic Disorder

This study focused on identifying the characteristics of children and youth identified as having higher functioning autistic disorder (H-F AD). Teachers of 29 children and youth previously identified as having H-F AD completed a common autism assessment measure on their students, the Autism Behavior Checklist. Review of teachers' ratings of the 29 subjects failed to reveal a common set of characteristics of students with H-F AD. Thus, even though the evaluators identified a variety of exceptional characteristics, including a number that are common to other students with mild disabilities, there was not a consistent image of students with H-F AD. These results are discussed relative to their implications for educational and clinical planning and practice.

Making Sense in a Fragmentary World

The communicative capabilities of people with autism are impaired and limited in significant ways. The problems are characterized by a lack of intentionality and symbol formation, which indicates that the deviant development of communication in autism is associated with a specific cognitive style. The central coherence theory can offer insight into the specific communication problems of people with autism, since a weaker drive for central coherence leads to problems in sense-making and, consequently, in communication. In the case of the comorbidity of autism and learning disability, the communication problems are aggravated. The crucial point is the determination of the level of sense-making, taking this comorbidity into account. Assessment and intervention have to be tuned to individual needs, in order to increase the communicative competence of people with autism and learning disability.

Greek Teachers’ Perceptions of Autism and Implications for Educational Practice

The general aim of this study was to examine perceptions about autism in regular education ( n35) and special education ( n29) teachers attending the second year of their in-service training. Data were collected through a series of written questions covering four areas of interest (general information, aetiology, behavioural characteristics, treatment). The analysis of findings revealed some confusion in regard to the causes of the syndrome in both groups of teachers. However, special education teachers were more likely to identify correctly the specific characteristics of autism. Regular and special education teachers also identified different instructional priorities in the treatment of autism. The practical implications of these findings for in-service training are discussed.

Detecting Features of Autism in Thousand Oaks and New Delhi, Children with Severe Learnin Difficulties: A Brief Report

The aim of this study was to develop a questionnaire to identify specific behaviours that differentiate children with severe learning difficulties with autism from children with severe learning difficulties without autism. Using teachers' reports of current behaviour, the results showed that six behaviours significantly differentiated these two groups of children. Children in the autism group showed less joint attention (pointing for interest and showing) and less eye gaze (in general and to clarify ambiguity). In addition, they showed less functional and imaginative play and more unusual or restricted interests and stereotyped motor behaviours.

Imitation, Theory of Mind and Related Activities in Autism

Systematic naturalist observations of imitation, theory of mind and other related activities (play and social contact) were conducted for five groups of subjects. The groups comprised children with autism, adults with autism, children with mixed learning disabilities, and normally developing 3- to 4-year-olds and 5- to 6-year-olds. Very little imitation was observed in any group other than the 3- to 4-year- old normal children, making it difficult to draw any conclusion about the specificity and universality of a deficit in spontaneous imitation. However, autistic subjects showed less interaction with peers, more manipulative activity, less symbolic play and less evidence of understanding mental states. The quality of these behaviours, when they did occur, also differed between groups. Comparisons across school and play situations indicated no major situational differences. The implications of the results are discussed with regard to Rogers and Pennington’s intersubjectivity theory of autism.

Autism

International school psychologists play an important professional role in providing early diagnostic, consultative and treatment-planning services for autistic children and their families. Recent advances in our understanding of this complex disorder necessitates updating professionals in the etiology and treatment of autism. The article describes components of making a differential diagnosis of autism from developmental language/speech disorders, mental retardation and schizophrenia. Etiological theories based on recent neurobiological data are outlined and the psychometric properties of cognitive ability and behavioral rating instruments frequently used with this population are delineated. Specific innovative educational and pharmacological treatment approaches are reviewed.

Behaviour Profiles within a Population of 145 Children with Autism Using the Behaviour Summarized Evaluation Scale

Clinicians and researchers have observed a degree of heterogeneity within the autistic syndrome which suggests different pathophysiological mechanisms. Greater understanding of this heterogeneity was sought by studying more homogeneous subpopulations according to developmental age (DA) within a large population of children with autism. The sample consisted of 145 children with autism (population P), and two subpopulations were determined according to DA criteria: DA < 2 years, population PDA-; DA? 2 years, population PDA+. An original multivariate descriptive statistical method, correspondence analysis, was applied to 13 behavioural data, followed by a classical hierarchical clustering method. In population P, four behaviour profiles were distinguished on the basis of three main functions: auditory perception, imitation and sensorimotility. The study of more homogeneous subpopulations according to DA revealed differences in the factorial structure of both subpopulations. In population PDA+ the main relevant behaviours defining profiles in autism were first abnormal reactivity to auditory stimuli, followed by imitation deficiences. However in population PDA-the main relevant behaviours were first stereotypies, followed by abnormal reactivity to auditory stimuli. Modification of the organization of behaviours in autism according to developmental age is clarified; unlike the auditory perception dimension, imitation and sensorimotor dimensions may be dependent on development. These results thus support the heterogeneity of the autistic syndrome and clarify some aspects of change and continuity in the expression of the disorders contained in this syndrome.

Facilitated Communication

This study examined types of support in Facilitated Communication with 12 non-verbal individuals with autism. Literacy tasks of graduated difficulty that included letter identification, word comprehension, labelling and sentence completion were employed to address the possible presence of literacy under three conditions of support: physical, emotional and mental. Although full facilitator support resulted in high performance levels on all tasks, emotional and physical support alone yielded unintelligible or minimal output. Thus, contrary to proponents' claims as to the importance of physical and emotional support, facilitated output hinges crucially on facilitator-provided mental support. In this study this was true regardless of task difficulty and motor requirement complexity, arguing against the technique's relevance to overcoming motor or emotional problems and demonstrating literacy in individuals with autism.

Dopaminergic variants in siblings at high risk for autism: Associations with initiating joint attention

Younger siblings of children with autism spectrum disorder (ASD; high-risk siblings) exhibit lower levels of initiating joint attention (IJA; sharing an object or experience with a social partner through gaze and/or gesture) than low-risk siblings of children without ASD. However, high-risk siblings also exhibit substantial variability in this domain. The neurotransmitter dopamine is linked to brain areas associated with reward, motivation, and attention, and common dopaminergic variants have been associated with attention difficulties. We examined whether these common dopaminergic variants, DRD4 and DRD2, explain variability in IJA in high-risk (n = 55) and low-risk (n = 38) siblings. IJA was assessed in the first year during a semi-structured interaction with an examiner. DRD4 and DRD2 genotypes were coded according to associated dopaminergic functioning to create a gene score, with higher scores indicating more genotypes associated with less efficient dopaminergic functioning. Higher dopamine gene scores (indicative of less efficient dopaminergic functioning) were associated with lower levels of IJA in the first year for high-risk siblings, while the opposite pattern emerged in low-risk siblings. Findings suggest differential susceptibility-IJA was differentially associated with dopaminergic functioning depending on familial ASD risk. Understanding genes linked to ASD-relevant behaviors in high-risk siblings will aid in early identification of children at greatest risk for difficulties in these behavioral domains, facilitating targeted prevention and intervention. Autism Res 2016, 9: 1142-1150. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Recognition of face and non-face stimuli in autistic spectrum disorder

The ability to remember faces is critical for the development of social competence. From childhood to adulthood, we acquire a high level of expertise in the recognition of facial images, and neural processes become dedicated to sustaining competence. Many people with autism spectrum disorder (ASD) have poor face recognition memory; changes in hairstyle or other non-facial features in an otherwise familiar person affect their recollection skills. The observation implies that they may not use the configuration of the inner face to achieve memory competence, but bolster performance in other ways. We aimed to test this hypothesis by comparing the performance of a group of high-functioning unmedicated adolescents with ASD and a matched control group on a "surprise" face recognition memory task. We compared their memory for unfamiliar faces with their memory for images of houses. To evaluate the role that is played by peripheral cues in assisting recognition memory, we cropped both sets of pictures, retaining only the most salient central features. ASD adolescents had poorer recognition memory for faces than typical controls, but their recognition memory for houses was unimpaired. Cropping images of faces did not disproportionately influence their recall accuracy, relative to controls. House recognition skills (cropped and uncropped) were similar in both groups. In the ASD group only, performance on both sets of task was closely correlated, implying that memory for faces and other complex pictorial stimuli is achieved by domain-general (non-dedicated) cognitive mechanisms. Adolescents with ASD apparently do not use domain-specialized processing of inner facial cues to support face recognition memory.

Nosology and epidemiology in autism: classification counts

Since its initial description by Kanner in 1943, the criteria by which a diagnosis of autism or autism-like disorders was made--and their alleged etiologies portrayed--have undergone manifold changes, from a psychiatric disorder engendered by "refridgerator" parents to a neurodevelopmental disability produced in the main by genetic abnormalities. In addition, the behavioral characterization of autism has also entered the public consciousness and professional domains increasingly in the past 30 years, the effects of which we are continually coming to terms. A diagnosis of autism that once seemed quite unusual is now considered almost epidemic. Increasing numbers of individuals diagnosed with autism and related pervasive developmental disabilities will, in turn, affect the calculated prevalence of the disorder. In this essay, I attempt to account for the increasing prevalence of autism and autism-related disorders by examining its changing criteria, the individuals and instruments used to make the diagnosis, the reliability and validity of same, and the sample sizes and other aspects of the methodology needed to make an accurate estimate of its prevalence.

Stereotyped behaviour in children with autism and intellectual disability: an examination of the executive dysfunction hypothesis

BACKGROUND

Increasing attention has been paid to the executive dysfunction hypothesis argued to underpin stereotyped behaviour in autism. The aim of this study is to investigate one component of this model, that stereotyped behaviours are related to impaired generativity and compromised behavioural inhibition, by examining whether episodes of these behaviours terminate naturally without external intervention.

METHODS

Using a naturalistic observational methodology the stereotyped behaviours of six participants with autism were recorded in real time over periods ranging from 3.59 to 9.20 h. Data were also recorded for teaching staff interactions with participants and environmental settings (one-to-one, group and freetime).

RESULTS

In comparison with one-to-one settings stereotyped behaviours were more frequent when participants were in freetime settings with the exception of one participant. For the termination of stereotyped behaviours these behaviours stopped with no ongoing physical or verbal adult contact being evident for a median of 73.25% of the time. Additionally, for a median of 89.40% of the time stereotyped behaviour stopped without the initiation of adult contact.

DISCUSSION

The termination of bouts of stereotyped behaviour was frequently not associated with any adult contact and thus this form of external intervention. This finding warrants explanation by extending the hypothesis that compromised impaired generativity and behavioural inhibition offers a complete explanation of stereotyped behaviours.

Child Behavior Checklist Scores for School-Aged Children with Autism: Preliminary Evidence of Patterns Suggesting the Need for Referral

The Child Behavior Checklist (CBCL) is a widely used questionnaire to assess behavioral and emotional problems. It is often used as a diagnostic screener, but autism spectrum disorders (ASD) are not included in the CBCL for school-aged children. This study investigated patterns of CBCL scores in 108 children with high-functioning ASD from two independent samples, and 67 IQ- and age-matched controls. Scores on the CBCL Thought and Social Problems scales significantly differentiated children with ASD from controls. Both independent ASD samples had the same pattern of elevations, with mean scores over two standard deviations above the mean for Social, Thought, and Attention Problems. The Withdrawn/Depressed scale was elevated to at least the borderline clinical range for half of the ASD sample. This pattern of elevations is consistent with two prior studies of the CBCL with school-aged children with ASD, and therefore may warrant follow-up assessment to rule out an ASD.

Social perception and WAIS-IV Performance in adolescents and adults diagnosed with Asperger's Syndrome and Autism

Previous research using the Wechsler scales has identified areas of cognitive weaknesses in children, adolescents, and adults diagnosed with Autism or Asperger's syndrome. The current study evaluates cognitive functioning in adolescents and adults diagnosed with Autism or Asperger's syndrome using the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and the Social Perception subtest from the Advanced Clinical Solutions. Deficits in social perception, verbal comprehension, and processing speed were found in the Autism sample. Additionally, they exhibited inconsistent performance on auditory working memory and perceptual reasoning tasks. The Asperger's syndrome group had better overall cognitive skills than the Autism group, but compared with controls, they had weaknesses in processing speed, social perception, and components of auditory working memory. Both groups had relatively low scores on the WAIS-IV Comprehension subtest compared with the other verbal comprehension subtests. Clinical application and utility of the WAIS-IV and Social Perception in Autism Spectrum Disorders are discussed.

How parents perceive and feel about participation in community activities. The comparison between parents of preschoolers with and without Autism Spectrum Disorders

The present study compared how parents of preschoolers with and without Autism Spectrum Disorders (ASD) perceived and felt about participation in community activities. A questionnaire survey was conducted with 380 Hong Kong parents of preschoolers with ASD and 214 Hong Kong parents of preschoolers without ASD. The two groups were not different in their willingness and frequency of participation in community activities. However, the psychological processes underneath their willingness were very different. Among the parents of preschoolers with ASD, their willingness was associated with how they perceived the difficulty and importance of the participation and what emotions they experienced during the activities. This pattern of association was not evident among the parents of preschoolers without ASD.

Qualitative or quantitative differences between Asperger's disorder and autism? Historical considerations

The histories of autism and Asperger's Disorder (AD), based on original contributions by Kanner and Asperger, are reviewed in relation to DSM-IV diagnostic criteria. Their original articles appear to have influenced the distinction between AD and autism made in the DSM-IV. Based on up-to-date empirical research, however, it appears that AD and autism are not qualitatively distinct disorders, but are different quantitative manifestations of the same disorder. The differences between AD and autism may be a function of individual variability in these areas, not the manifestation of qualitatively distinct disorders. The DSM-IV criteria for AD and autism need to be considered with their historical developments, and based on empirical evidence, the DSM-IV diagnostic criteria may be subject to critical review.

On the origins of self and the case of autism

This article examines what it means to have a self. My focus is on the essential components of self-experience, the kind of psychological architecture required to construct a self, rather than on the configurations or qualities of individual “selves.” I adopt a developmental perspective and indicate how early childhood autism may afford unique insights into the role of perceptual-affective and interpersonal experience in determining the normal child's developing awareness of self.

Variability in adaptive behavior in autism: evidence for the importance of family history

Adaptive behavior in autism is highly variable and strongly related to prognosis. This study explored family history as a potential source of variability in adaptive behavior in autism. Participants included 77 individuals (mean age = 18) with average or better intellectual ability and autism. Parents completed the Family History Interview about the presence of broader autism phenotype symptoms and major psychiatric disorders in first degree relatives. Adaptive behavior was assessed via the Vineland Adaptive Behavior Scales (VABS). Based on family history variables, age, and intelligence quotient (IQ), 87% of participants were correctly classified as having impaired or average VABS scores. Family history of depression and shyness accounted for the most variance in VABS scores, and they had the greatest influence on VABS Socialization scores in particular. Possible underlying mechanisms include genetics, psychosocial factors, and social resources. This study provides initial evidence of the importance of family history to adaptive behavior in autism and has implications for genetics and treatment.

A case of pervasive developmental disorder with chromosomal translocation 1-4

We describe a 5-year-old girl with pervasive developmental disorder associated to chromosome 1-4 translocation, an association that has not been described in specialized literature until this moment.

Trends in Special Education Code Assignment for Autism: Implications for Prevalence Estimates

There is considerable controversy over reasons for observed increases in the prevalence of autism spectrum disorders. We examined trends in British Columbia education database coding of children with autism from 1996 to 2004. There was a significant linear increase in autism prevalence. The proportion of children identified by age 6 increased significantly from 1996 to 1999. When we calculated prevalence assuming onset prior to age 3, previously unidentified cases, particularly among girls in 1996 and 1997, accounted for substantial increases in estimated prevalence. The magnitude of under-identification decreased from 1996 to 2000, and rose slightly in 2001. Analyses of prevalence trends must take into account effects of earlier age at identification and inclusion of previously undetected cases on prevalence estimates.

The relationship of Asperger's characteristics and schizotypal personality traits in a non-clinical adult sample

The study examines the relationship between Asperger's Disorder (AD) and Schizotypal Personality Disorder (SPD), mutually exclusive but similar diagnoses [DSM-IV-TR; American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders. Washington, DC: Author]. The literature and comparison of diagnostic criteria suggest that the two disorders may overlap: AD social impairment with SPD interpersonal problems and AD communication deficits with SPD disorganized features. Questionnaire measures of AD and SPD were administered to a large non-clinical adult sample. Consistent with expectations, the Asperger's and Schizotypal questionnaires were positively correlated. Further, the social-interpersonal and communication-disorganized areas were positively correlated, though the relationship between social-interpersonal areas is particularly strong. Future research should continue to explore the relationship between AD and schizotypy to confirm current findings and improve understanding of distinctions between the disorders.

Intellectual Ability, Self-perceived Social Competence, and Depressive Symptomatology in Children with High-functioning Autistic Spectrum Disorders

Although social competence deficits in children with high-functioning autistic spectrum disorders (HFASD) are well documented, there is little research investigating self-perceptions of social limitations. This study replicated research showing a negative association between self-perceived social competence and intellectual ability and investigated associations between self-perceived social competence and depressive symptomatology. Participants were 22 children with HFASD, aged 7-13 years with intelligence quotient (IQ) scores of 82-141. Parent- (N = 18) and teacher- (N = 17) rated social competence was lower for children with HFASD compared with a normative sample. Higher age and IQ predicted lower levels of self-perceived social competence, and low self-perceived social competence predicted higher levels of depressive symptomatology. Almost a third of children rated themselves for depression; parent ratings suggested even higher levels.

Neuropsychologic functioning in children with autism: further evidence for disordered complex information-processing

A wide range of abilities was assessed in 56 high-functioning children with autism and 56 age- and IQ-matched controls. Stepwise discriminant analyses produced good group discrimination for sensory-perceptual, motor, complex language, and complex memory domains but lower agreement for the reasoning domain than previously obtained for adults. Group discrimination did not occur for attention, simple language, simple memory, and visuospatial domains. Findings provide additional support for a complex information-processing model for autism, previously based on adult data, demonstrating a pattern across domains of selective impairments on measures with high demands for integration of information and sparing when demands were low. Children as compared to adults with autism exhibited more prominent sensory-perceptual symptoms and less pronounced reasoning deficits reflecting brain maturation.

Autism and the development of face processing

Autism is a pervasive developmental condition, characterized by impairments in non-verbal communication, social relationships and stereotypical patterns of behavior. A large body of evidence suggests that several aspects of face processing are impaired in autism, including anomalies in gaze processing, memory for facial identity and recognition of facial expressions of emotion. In search of neural markers of anomalous face processing in autism, much interest has focused on a network of brain regions that are implicated in social cognition and face processing. In this review, we will focus on three such regions, namely the STS for its role in processing gaze and facial movements, the FFA in face detection and identification and the amygdala in processing facial expressions of emotion. Much evidence suggests that a better understanding of the normal development of these specialized regions is essential for discovering the neural bases of face processing anomalies in autism. Thus, we will also examine the available literature on the normal development of face processing. Key unknowns in this research area are the neuro-developmental processes, the role of experience and the interactions among components of the face processing system in shaping each of the specialized regions for processing faces during normal development and in autism.

The profile of memory function in children with autism

A clinical memory test was administered to 38 high-functioning children with autism and 38 individually matched normal controls, 8-16 years of age. The resulting profile of memory abilities in the children with autism was characterized by relatively poor memory for complex visual and verbal information and spatial working memory with relatively intact associative learning ability, verbal working memory, and recognition memory. A stepwise discriminant function analysis of the subtests found that the Finger Windows subtest, a measure of spatial working memory, discriminated most accurately between the autism and normal control groups. A principal components analysis indicated that the factor structure of the subtests differed substantially between the children with autism and controls, suggesting differing organizations of memory ability.

Early features of autism: Repetitive behaviours in young children

This study examined whether repetitive behaviours were a differentiating feature of autism in children aged less than 51 months. The study also examined the relationship between age (chronological and developmental) and repetitive behaviours in young children with autism. Standardised developmental and diagnostic assessments were conducted on 55 children aged between 22 and 51 months, consisting of 40 developmentally delayed children with DSM-IV-TR Autistic Disorder and 15 developmentally delayed children without Autistic Disorder. Results indicated that several measures of repetitive behaviour, particularly more complex high-level ones, were significantly positively associated with the probability of receiving a diagnosis of autism. No significant relationships were found between developmental age and the presence of repetitive behaviours in children with autism, but younger chronological age was associated more with simple or low-level repetitive behaviours.

Molecular mimicry: anti-DNA antibodies bind microbial and nonnucleic acid self-antigens

Although cells of the innate immune response have a variety of pattern recognition receptors that are triggered by blood classes of markers, a critical feature of the adaptive immune response is antigenic specificity. Yet it is becoming increasingly clear that the specificity of lymphocyte receptors admits of some laxity. Cross-reactivity may, in fact, be necessary for lymphocyte survival as antigen receptor signaling maintains cellular viability in the absence of antigen activation. Studies of molecular mimicry have revealed many instances in which antibodies to microbial antigens bind also to self-antigens; in some cases, this cross-reactivity has pathogenic potential. In this chapter, we describe cross-reactivity between two self-antigens, DNA and NMDA receptors, and how antibodies with specificity for DNA in patients with splenic lupus may cause central nervous system damage by virtue of binding also to neuronal receptors. This example serves as a reminder that cross-reactivity may exist among self-antigens as well as between foreign and self-antigens.

The Importance of Catatonia and Stereotypies in Autistic Spectrum Disorders

Motor disturbances are often observed in individuals with autistic spectrum disorders (ASDs) and recognized as diagnostic features of these disorders. The movement disorders characteristically associated with autism include stereotypies and self-injurious behavior. Yet, individuals with ASD may also be at the risk for catatonia. Although not as frequent as stereotypies, up to 17% of older adolescents and adults with autistic disorder may have severe catatonic-like symptoms. Catatonia may be a comorbid risk factor of autism that warrants further empirical and clinical evaluations. Clinicians may need to be attentive to more subtle signs of catatonic-like symptoms in individuals diagnosed with ASDs, especially as they enter adolescence and young adulthood. Stress has been implicated as a possible precursor for symptoms; however, its role has not been empirically proven as a potential risk factor. Clinicians might also need to assess for signs of significant declines in motor movements, as this appears to be a useful diagnostic indicator of catatonic-like symptoms. The literature on stereotypies and autism is more extensive than for catatonia and ASDs, probably because of the higher rate of stereotypies with autism. Explanations for the occurrence of stereotypies range from genetic to behavioral contingencies, with evidence for a multifactor explanation. Assessment measures often include items that assess for stereotypies to aid with diagnosing these symptoms in individuals with autism. Treatment for stereotypies is largely behavioral at the present time and requires consistent reinforcement of treatment gains to manage the symptoms successfully. An important area of future research in autism is the relation among different types of motor abnormalities, including stereotypies and catatonia.

Chronomics of autism and suicide

We examine whether autism may be influenced by non-photic environmental factors, among others, in a California database consisting of the number of cases added quarterly to the system between 1993 and 2004. Instead of a precise calendar (1.0)-year-long spectral component, we detect unseen primarily helio- and geomagnetic signatures, including a newly discovered near-transyear of 1.09-year length. In this case, it overrides any undetected seasonal effects, the topic of much previous unrewarding research, also analyzed herein without overcoming the limitation by stacking. Since we could not get additional data on autism, data on suicides, the final "detachment" and failure to bond, were also analyzed, again revealing a spectrum of non-photic signatures. What we do not see and do not anticipate can exist and can override the seasons, as resolved time-microscopically by chronomics, the study of chronomes (time structures). Just as spatial microscopy and electron microscopy resolved infectious agents, so does microscopy in time resolve the signature of environmental agents in human behavior in health and disease.

The PDD-MRS: an instrument for identification of autism spectrum disorders in persons with mental retardation

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.