A follow-up study of infantile autism in Hong Kong

Transition Into Adulthood With Autism Spectrum Disorders: A Longitudinal Population Cohort Study of Socioeconomic Outcomes

This longitudinal population cohort study tracks the transition of 1,405 adolescents with autism spectrum disorders (ASDs) into adulthood, and highlights functional and social skills as core predictors of social outcomes (tertiary education, civic volunteering, and employment). Applying regression methods with sample selectivity to administrative data records obtained from Israel’s National Insurance Institute, we show that these outcomes are not highly correlated, suggesting that the high/low functioning dichotomy frequently used to categorize individuals with ASD is not supported by these data. We show that there is no causal relation between civic volunteering at an earlier stage and subsequent participation in tertiary education. This suggests that the traditional sequential model of developmental disability does not apply to ASD, and that the social-functional model of disability seems more applicable. We also show that functional and social severity vary inversely with year of diagnosis, due probably to the application of more liberal diagnostic standards. Disability among successive birth cohorts has been decreasing and is expected to decrease further in the future. Parents’ income has only a modest beneficial association with the transition into adulthood, and socioeconomic environments have no effect at all. Findings are discussed with respect to policy and practice.

Rationale and design for cognitive behavioral therapy for anxiety disorders in children with autism spectrum disorder: a study protocol of a randomized controlled trial

Background

Autism spectrum disorder (ASD) is found in approximately 1% of the population and includes core symptoms that affect general and social development. Beside these core symptoms, it is suggested that up to 60% of children with ASD suffer from comorbid anxiety disorders which may further affect educational, social and general development as well as quality of life. The main goal of this study is to examine the effectiveness of a manualized cognitive behavioral therapy (CBT) anxiety program adapted for children with ASD.

Methods

This study is a randomized controlled trial (RCT). Fifty children with ASD and anxiety, aged 7 to 13 years, will be randomly assigned to group CBT or a wait-list control (WL) condition. The design will follow a two (CBT and WL) by two (pre–post assessment) mixed between–within design. The control group will receive intervention after the waitlist period of 13 weeks. Primary outcomes are diagnostic status and severity of the anxiety disorders, measured with The Anxiety Disorder Interview Schedule for DSM-IV, Parent and Child Versions. Secondary outcomes are parent and child ratings on questionnaires on the child’s level of anxiety and impact on everyday life. Additional outcomes entail information gathered from parents, child and teachers on the child’s behavior and negative self-statements, together with social and adaptive skills. Follow-up data will be collected 3 months after intervention.

Discussion

This study aims to evaluate the effectiveness of a manualized CBT program in Danish children with ASD and anxiety within a mental health clinic setting. The hypothesis is that training anxiety reduction skills will decrease anxiety in children, as well as ensure better psychosocial development for the child in general.

Trial registration

https://ClinicalTrials.gov (NCT02908321). Registered 19th of September 2016.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2591-x) contains supplementary material, which is available to authorized users.

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.

Low rates of depressed mood and depression diagnoses in a clinic review of children and adolescents with autistic disorder

OBJECTIVES

The purpose of this study was to investigate the prevalence of depression diagnoses and related clinical data in an outpatient sample of youth with autistic disorder.

METHODS

Records of 123 psychiatrically referred children and adolescents with a Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR) diagnosis of autistic disorder were examined. Mood disorder diagnoses and chief complaints along with family mood disorder history were the primary variables analyzed.

RESULTS

Four subjects (3%) presented with depressed mood. Irritability complaints were frequent (n=78, 63%). Six subjects (5%) received a mood disorder diagnosis; all with mood disorder, not otherwise specified. No subjects received a depressive disorder diagnosis. Family history of mood disorders was common.

CONCLUSIONS

Findings raise questions about the appropriate characterization and potential misdiagnoses of depression in youth with autistic disorder.

Parental expectations regarding postschool social attainments of adolescents with autism spectrum disorders in Singapore

This study sought to understand the parental expectations of social attainments in the postschool years. The parents of 20 adolescents with autism spectrum disorders (ASD) attending special schools were interviewed. Most expected their children would be working in sheltered workshops or unemployed. All parents indicated that their children would live with them until they were unable to provide appropriate care, and nearly half expressed wishes for relatives to care for them thereafter. None expected any independent access to the community. Analysis of the interviews suggested that the adolescents' learning and behavior, parental concerns, availability of formal resources, and societal factors influenced parents' expectations. Implications for working with Asian populations and for service delivery in Singapore are discussed.

Parental coping with developmental disorders in adolescents within the ultraorthodox Jewish community in Israel

This preliminary study compares the coping strategies used by 100 ultraorthodox Jewish parents and 100 secular Jewish parents for dealing with adolescent children with developmental disorders. The parents completed two questionnaires on the sense of stress-related personal growth and the sense of coherence. The ultraorthodox parents reported a higher sense of growth and a higher sense of coherence than the secular parents. In addition, there were associations found between demographic characteristics. Gender differences between mothers and fathers in the sense of growth and community differences between ultraorthodox fathers and secular fathers in the sense of coherence are discussed. The study highlights the uniqueness of the religious point of view in dealing with adolescent children with developmental disorders.

Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis

There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.

The activities and participation of adolescents with autism spectrum disorders in Singapore: findings from an ICF-based instrument

BACKGROUND

This study sought to describe the activities and participation of adolescents with autism spectrum disorders (ASD) in Singapore and to examine the suitability of the Activity and Participation component of the International Classification of Functioning, Disability and Health for achieving this purpose. This information may guide the development of intervention programmes for adolescents and adults as well as the provision of a means to document meaningful outcomes.

METHODS

Parents of 20 adolescents with ASD attending special schools in Singapore were interviewed using the Vineland Adaptive Behavioural Scales - Second Edition and the Activities and Participation Rating Scale (APRS), which was developed for this study.

RESULTS

The adolescents with ASD were rated to have more difficulties with participation than with the engagement of activities. Individual domain analyses indicate no difficulties with mobility and mild difficulties with self-care. The performance of general tasks and demands were rated as less problematic than domestic, major life areas, communication and interpersonal interactions. The adolescents with ASD were rated to have more difficulties in communication and community environments than in at home. In addition, analysis of associations between the APRS and Vineland Adaptive Behavioural Scales - Second Edition reveal a pattern of strong relationships between sub-tests.

CONCLUSION

This study highlights the imperative for researchers and practitioners alike to develop a focus on strengths, generalisation and the quality of life of adolescents with ASD. The APRS also shows promise in helping document outcomes for adolescents with ASD in Asia and further development of this instrument is needed.

New-onset psychiatric disorders in individuals with autism

A follow-up study to at least the age of 21 years of 135 individuals with an autism spectrum disorder diagnosed in childhood and an IQ of over 30 was conducted. The study is distinctive in its large size, low attrition rate and use of systematic interviews to obtain clinical information. Questionnaires completed by caregivers asked about the development of new psychiatric disorders. For the 39 individuals with a possible new disorder, a detailed psychiatric assessment was undertaken through parental interview. Of all participants, 16 percent developed a definite new psychiatric disorder. A further 6 percent developed a possible new disorder. Five individuals developed an obsessive-compulsive disorder and/or catatonia; eight an affective disorder with marked obsessional features; three complex affective disorders; four more straightforward affective disorders; one a bipolar disorder; and one an acute anxiety state complicated by alcohol excess. There was no case of schizophrenia.

Examining the validity of autism spectrum disorder subtypes

The classification of autism spectrum disorders (ASDs) is a topic of debate among clinicians and researchers with many questioning the validity of the distinction among subtypes. This manuscript examines the validity of three ASD subtypes (Autism, Asperger's, and PDDNOS) by reviewing 22 studies published between 1994 and 2006. We reviewed studies that examined differences between the subtypes in terms of clinical and demographic characteristics, neuropsychological profiles, comorbidity, and prognosis. Results largely did not support differences between autism and Asperger's disorder based on current diagnostic criteria. Overall, the most salient group differences were noted when samples were categorized on IQ. Drawing definitive conclusions is difficult due to the inconsistent application of diagnostic criteria and circularity in methods.

A longitudinal study of pretend play in autism

This study describes a longitudinal design (following subjects described in Rutherford & Rogers [2003, Journal of Autism and Developmental Disorder, 33, 289-302]) to test for predictors of pretend play competence in a group of children with autism. We tested the hypothesis that developmental change in pretend play performance can be predicted by earlier measures of either executive function, intersubjectivity, imitation, or general development. Participants at the time of follow-up testing were 28 children with autistic disorder (mean chronological age (CA) 57.6 months), 18 children with other developmental disorders (mean CA 59.0 months), and 27 typically developing children (mean CA 30.1 months). Children with autism were profoundly delayed given both competence (prompted) measures as well as performance (spontaneous) measures. Joint attention at time 1 strongly and uniquely predicted pretend play development.

ADHD symptom subtypes in children with pervasive developmental disorder

OBJECTIVE

Compares DSM-IV ADHD subtypes in large samples of 3-to-5 and 6-to-12 year old children with pervasive developmental disorder (PDD) vs. nonPDD clinic referrals.

METHOD

Parents and teachers completed a DSM-IV-referenced rating scale.

RESULTS

ADHD subtypes were clearly differentiated from the nonADHD group and showed a differential pattern of co-occurring psychiatric symptoms (more pronounced for teacher- than parent-defined subtypes and older than younger children) that was similar in both PDD and nonPDD samples. The Combined type had more severe oppositional, aggressive, and PDD symptoms than Inattentive type and were from less advantaged homes than other subtypes. Hyperactive-Impulsive type was least impaired.

CONCLUSION

Findings support the notion that ADHD may be a clinically meaningful syndrome in children with PDD.

Comorbid Psychiatric Disorders in Children with Autism: Interview Development and Rates of Disorders

The Kiddie Schedule for Affective Disorders and Schizophrenia was modified for use in children and adolescents with autism by developing additional screening questions and coding options that reflect the presentation of psychiatric disorders in autism spectrum disorders. The modified instrument, the Autism Comorbidity Interview-Present and Lifetime Version (ACI-PL), was piloted and frequently diagnosed disorders, depression, ADHD, and OCD, were tested for reliability and validity. The ACI-PL provides reliable DSM diagnoses that are valid based on clinical psychiatric diagnosis and treatment history. The sample demonstrated a high prevalence of specific phobia, obsessive compulsive disorder, and ADHD. The rates of psychiatric disorder in autism are high and are associated with functional impairment.

Presentation of depression in autism and Asperger syndrome: a review

Depression is common in autism and Asperger syndrome, but despite this, there has been little research into this issue. This review considers the current literature on the prevalence, presentation, treatment and assessment of depression in autism and Asperger syndrome. There are diagnostic difficulties when considering depression in autism and Asperger syndrome, as the characteristics of these disorders, such as social withdrawal and appetite and sleep disturbance, are also core symptoms of depression. Impaired verbal and non-verbal communication can mask the symptoms of depression. Symptoms associated with autism and Asperger syndrome such as obsessionality and self-injury may be increased during an episode of depression. There is a clear need to develop specific tools both for diagnostic purposes and for measurement of depression in autism and Asperger syndrome in order to help alleviate the distress caused by this treatable illness.

Grappling with affliction: autism in the Jewish ultraorthodox community in Israel

In this essay we seek to examine the cultural tool kit employed in the Jewish ultraorthodox community to cope with autism, a predicament deemed resistant to massive cultural molding. Through 30 open-ended interviews with ultraorthodox mothers of children with autism we portray the mothers' emerging recognition of the disorder, their care seeking activities, and their construction of explanatory models. The health care system on which the ultraorthodox mothers rely is extremely diverse, including mainstream medical and educational services, various alternative therapies, therapies specific to autism, and spiritual and mystical interventions. The outcome of these endeavors is a dual system of illness perception in which bio-medical and spiritual-religious frames of references coexist. This duality cuts across all the facets of the explanatory system: etiology, pathophysiology, treatment, and prognosis. Metaphysical accounts, and especially the notion of the transmigration of souls, serve as meta-accounts, bridging the epistemological gap between God's mysterious intention and the specific bodily mechanisms underlying the disorder. The religious and moral theme of suffering is highlighted in the narratives as a salient constituent of the ultraorthodox mothers' attempts to understand and come to terms with their plight.

Improvement in cognitive and language skills from preschool to adolescence in autism

This paper reports on the developmental progression of a sample of 48 adolescents and young adults with autism who were previously assessed at preschool age and again in the mid-school period. In contrast to the earlier period when about one-third of the children made dramatic gains, cognitive and language skills tended to remain stable or decline over this time span. The gain in mental and language age of the non-retarded adolescents with autism was less than half the change in their chronological age. The mentally retarded adolescents with autism showed some gain in mental age over time but this was far less than their change in chronological age, and they showed almost no gain in language age. Early childhood predictors of language skills in adolescence were functional play skills, responsiveness to others' bids for joint attention, and the frequency of requesting behaviors.

Psychiatric symptoms in preschool children with PDD and clinic and comparison samples

OBJECTIVE

This study describes and compares the severity of DSM-IV symptoms in preschool children with diagnosed pervasive developmental disorder (PDD), clinic controls, and two community-based samples.

METHOD

Parents (/and teachers) completed the early child inventory-4 (ECI-4), a DSM-IV-referenced rating scale for four samples: PDD (n = 172/160) and nonPDD psychiatric clinic referrals (n=135/101) and youngsters in regular (n=507/407) and special (n =64/140) early childhood programs. Children ranged in age from 3 to 5 years old.

RESULTS

With the exception of conduct problems, the PDD group generally received higher symptom severity ratings than the regular early childhood group, but the pattern of differences compared with the other two groups often varied by type of symptom and informant. Teachers rated the PDD and nonPDD clinic groups as having equally severe ADHD and oppositional defiant disorder symptoms. Teachers rated the PDD group as having more severe anxiety and depression symptoms than parents. The Asperger group was rated by both informants as more oppositional than the autism and PDDNOS subgroups. Teachers rated males in the regular early childhood sample as having more severe ADHD and aggressive symptoms than females, but this was not the case for the PDD sample.

CONCLUSION

Preschoolers with PDD exhibit more severe DSM-IV psychiatric symptoms than children in regular and special early childhood programs, and to some extent nonPDD psychiatric referrals. The concept of comorbidity warrants further exploration, as does informant-specific syndromes as validators of diagnostic constructs.

Comparative study of early childhood high-function autism and developmental mixed receptive-expressive language disorder

Verbal cognitive profile and general social functioning were compared between two groups of children aged 5 to 7 years, one with high-function autism and the other with developmental mixed receptive-expressive language disorders. The two groups, totaling 50 children, were matched for age and non-verbal IQ (mean, 90). Both groups had impaired verbal cognitive profile and social adaptive functioning, with no statistically significant differences between the two groups. The implications of our findings are discussed. Current preschool and early childhood medical-educational intervention programs in Taiwan must design and implement curricula in which children with language delay, whether autistic or/not, can develop essential social skills.

Prospective long-term follow-up of patients with pervasive developmental disorders

We conducted a 12-year prospective study of children with pervasive developmental disorders from North Dakota. In a prospective longitudinal follow-up study, of 59 patients, we found 52 patients with pervasive developmental disorders (88%). Ten (17%) declined to participate. We collected data on 42 (71%) of the original cohort. Of the 42 subjects, 1 died (1.7%). The other 41 were followed up for 492 person-years. Severity scores for the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) declined 20% and for DSM-IV 23%. Global Assessment of Functioning improved 19%, and the average number of comorbidities decreased 45%. Thirty-seven percent of patients improved in all four measures, whereas only 5% improved in only one measure. Pervasive developmental disorders are developmental disorders with a long-term course of limited improvement for most patients. Male subjects demonstrated substantially more variability in improvement but, overall, demonstrated more improvement than female subjects.

Spatial orientation adjustments in children with autism in Hong Kong

Abnormal spatial orientation and body postures in children with autism often interfere with visual abilities to attend tasks and social interactions. Twenty-four children diagnosed with autism from Kowloon, Hong Kong were assessed for spatial orientation and spatial management abilities. Positive changes in spatial orientation were evident when the children wore ambient prism lenses and included changes in posture from slanted to erect. Adjustments in spatial management were evident in improved ball catching ability, a task requiring visual tracking and eye-hand coordination. The findings suggest that alterations to the sensory systems may lead to behavioral change in some children.

Epidemiology of autism in Singapore: findings of the first autism survey

The report describes the results of a survey conducted on 176 parents of children with autism in Singapore. The ages of the children ranged from 3 to 12 years. The survey focused on the child's background, behaviour problems and skill profile, the home and school situation as well as the linguistic and social background. It was noted that the Singapore population confirms the international distribution regarding a predominance of boys over girls and a low incidence of birth complications. A positive trend noted was the fact that 60% of the children were diagnosed before the age of 3 years. Discussion focuses on possible risk factors and psychosocial adversities for autism such as a high frequency of caregivers who are foreign maids, the use of multiple languages and the high level of punitive educational practices. The possible influence of psychosocial deprivation on child development is discussed.

Autism and developmental receptive language disorder--a follow-up comparison in early adult life. II: Social, behavioural, and psychiatric outcomes

This paper focuses on general social functioning in two groups of young men, one with autism and one with developmental receptive language disorders, who were first assessed at the ages of 7-8 years. At that time, although matched for nonverbal IQ (mean 92-93) and expressive language, the Language group showed significantly fewer social and behavioural problems. At follow-up, when aged on average, 23 to 24 years, the Autism group continued to show significantly more impairments in terms of stereotyped behaviour patterns, social relationships, jobs, and independence. However, problems in all these areas were also common in the Language group. Many still lived with their parents, few had close friends or permanent jobs, and ratings of social interaction indicated abnormalities in a number of different areas. On a composite measure of social competence only 10% of the Language group was assessed as having severe social difficulties compared to 74% of the Autism group. Nevertheless, 65% were rated as having moderate social problems and only 25% were rated as being of near/normal social functioning. Two individuals in the Language group, but none in the Autism group, had also developed a florid paranoid psychosis in late adolescence. As in the follow-up of cognitive and linguistic functioning (see Mawhood et al., 2000, this volume, pp. 547-559), discriminant function analysis, which had clearly distinguished between the groups as children, now showed much greater overlap between them. Regression analysis indicated that although early language ability appeared to be related to outcome in the Autism group, there was little association between any measures of childhood functioning and prognosis in the Language group. Theoretically, these findings have implications for our understanding of the nature of autism and other pervasive language disorders, and of the relationship between them. Practically, they demonstrate the very persistent problems experienced by individuals with developmental language disorders, and their need for much greater help and support than is presently available.

Anwendbarkeit der Child Behavior Checklist bei entwicklungsgestörten Kindern

Zusammenfassung: Frage: Die Child Behavior Checklist (CBCL) wird in großen, unausgelesenen Stichproben verwendet, um Verhaltensauffälligkeiten bei Kindern und Jugendlichen zu erfassen. In der hier vorgelegten Arbeit wird untersucht, inwieweit sich die CBCL eignet, um die bei einer Stichprobe entwicklungsgestörter Kinder typischerweise auftretenden Probleme zu erfassen. Methodik: Es wurden zwei Stichproben entwicklungsgestörter Kinder, bei denen Schwierigkeiten im Bereich der Sprache und der Kommunikation bestanden, untersucht. Es handelte sich um 34 Kinder mit einem frühkindlichen Autismus und 34 alters-, geschlechts- und intelligenzparallelisierte Kinder mit einer spezifischen Sprachentwicklungsstörung. Bei den zwei Stichproben wurde im Rahmen der routinemäßigen Abklärung der Symptomatik die CBCL ausgefüllt. Ergebnisse: Die Hälfte der sprachgestörten Kinder hatten im CBCL-Gesamtscore Werte im klinischen Bereich. Bei diesen Kindern sind die Probleme vor allem auf den Skalen «Aufmerksamkeitsstörungen», «Soziale Probleme» und «Zurückgezogenheit» anzutreffen. Etwa zwei Drittel der autistischen Kinder werden auf den oben genannten Syndromskalen als auffällig eingestuft. 32 der 34 autistischen Kinder erreichen auf der Skala V «Schizoid/Zwanghaft» auffällige Werte, während dies nur für ein sprachgestörtes Kind der Fall ist. Die Einzelitem-Analyse zeigt, daß in beiden Stichproben überdurchschnittlich häufig über entwicklungsbezogene Probleme (Sprechprobleme, Einnässen…) berichtet wird. Schlußfolgerungen: Die CBCL ist geeignet, um die bei entwicklungsgestörten Kindern charakteristischen Verhaltensauffälligkeiten zu erfassen. Diese Auffälligkeite n werden sowohl auf der Ebene der Syndromskalen wie auch durch Einzelitems erfaßt. Hohe Werte auf der Skala «Schizoid/Zwanghaft» sollten bei diesen Kindern Anlaß zu einer gezielten diagnostischen Abklärung eines frühkindlichen Autismus geben.

Prognosis in autism: do specialist treatments affect long-term outcome?

Many different treatments have been claimed to have a dramatic impact on children with autism. This paper reviews what is known about the outcome in adult life and examines the limitations and advantages of a variety of intervention approaches. It concludes that there is little evidence of any "cure" for autism, but appropriately structured programmes for education and management in the early years can play a significant role in enhancing functioning in later life.

Developing a Chinese version of the psychoeducational profile (CPEP) to assess autistic children in Hong Kong

The Psychoeducational Profile (PEP) has been used to assess the developmental functioning and behavior of autistic children in the West. To examine its suitability for assessing autistic children in Hong Kong, the PEP was translated into Chinese and certain items were adapted for local conditions. The Chinese version of the PEP (CPEP) was administered to 23 autistic children and 40 children with normal development, ranging in age from 3 to 7 years. Some of the children were also given the Merrill-Palmer Scale of Mental Tests. Results indicated that CPEP scores correlated significantly with Merrill Palmer scores, demonstrating criterion-related validity. Significant positive correlations were also found between age and CPEP scores for children with normal development, verifying that the CPEP has properties of a developmental scale. There was also a significant difference between children with normal development and children with autism on the Pathology scale, suggesting that the scale has discriminant validity.

Autism in northern Sweden. A population based follow-up study: Psychopathology

A follow-up study based on a population survey of children with infantile autism from a northern Swedish county is reported. The original survey was performed during 1977-1979. In the country of Västerbottens 39 cases of "childhood psychosis" were identified in the age group 0-20 years (prevalence 5.6/10,000). According to DSM-III-R, 38 children met the criteria of "autistic disorder". The follow-up study was performed in 1987-1988, after eight to nine years. Thirty-four individuals participated (20 males and 14 females). Each child was evaluated according to the Medical Research Council's Schedule of Handicaps, Behaviours and Skills, DSM-III-R symptom check-list, Lotter's modified Questionnaire and information about the academic and social situation. Most symptoms showed stability over time. The individuals had a poor outcome. A few, mostly males, improved in function. Only one boy had "grown out of" autism without showing any autistic-like symptoms at all. Four cases, the majority being females, showed a mildly deteriorating course. In one case symptoms of schizophrenia developed. In most children language and communication had improved. The few well-functioning individuals with autism in this study were males. The proportion of severe mental retardation was greater in the female group.

A follow-up study of 201 children with autism in Kyushu and Yamaguchi areas, Japan

A follow-up survey was conducted on 201 young adults with autism who were 18 or older (mean age, 21.5). All had participated previously in intensive therapeutic camping or had therapeutic involvement at medical consultation agencies to evaluate their outcome. Their social outcome was better than that previously reported in Japan. Although 31.5% had shown marked deterioration during adolescence, 43.2% had shown marked improvement during that period. Possible factors contributing to these results are discussed.

A follow-up study of high-functioning autistic children

Fifty-eight high-functioning autistic children were assessed during preschool and early school years and followed over a period of 8 years. Early and current psychometric and language tests, parent interviews concerning autistic symptomatology, and direct observations were examined as predictors of the Vineland Adaptive Behavior Scales and scores on standardized achievement tests. Verbal skills emerged as the strongest predictor of social-adaptive functioning. Clear, positive relationships also emerged between intellectual functioning, and academic attainment. Early non-verbal IQ also showed a positive relationship with outcome. Academic performance appeared considerably stronger than in earlier studies.