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Tan C, Frewer V, Cox G, Williams K, Ure A. Prevalence and Age of Onset of Regression in Children with Autism Spectrum Disorder: A Systematic Review and Meta-analytical Update. Autism Res 2021; 14:582-598. [PMID: 33491292 DOI: 10.1002/aur.2463] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/10/2020] [Accepted: 12/05/2020] [Indexed: 01/22/2023]
Abstract
A systematic review published in 2013 reported 32% of children on the autism spectrum experience skill loss, known as autistic regression. However, the frequency varied depending on definition and measures used to capture skills. Retrospective parent report and prospective observation indicate loss of language and/or social skills, with motor skills typically unaffected. Our aim was to update the prevalence and age of onset of autistic regression through a meta-analysis of the literature to understand if there have been changes to the reported onset and prevalence since 2010. A systematic literature search was conducted using Medline, Embase, PsycINFO, and the Cochrane Library databases and included studies published from 2010 onward. Risk of bias assessment was performed on included studies. A random effects model was used to calculate the pooled prevalence and age of onset of autistic regression. Ninety-seven studies were included in the systematic review, of which 75 studies involving 33,014 participants had sufficient data for meta-analytic syntheses. The pooled proportion of autistic regression was 30% (95% confidence interval [CI]: 27-32%) but heterogeneity was high (I2 = 96.91) and did not reduce with sensitivity or subgroup analyses based on study design or clinical differences, respectively. Prevalence varied according to risk of bias (low: 27%) and definition of regression (language: 20%, language/social: 40%, mixed: 30%, and unspecified: 27%). Weighted average age of onset was 19.8 months. Findings from this meta-analysis highlight the importance of developing a standardized definition of autistic regression, and tools to measure this at multiple time points during early childhood development. LAY SUMMARY: About a third of children with Autism Spectrum Disorder experience loss of skills, which is also known as autistic regression. This paper provides an update of the rate of autistic regression in children and the age when they first experience loss of skills, based on current studies. The findings from this review contribute to our understanding of the onset patterns of autistic regression. Unfortunately, studies are not sufficiently similar, making it difficult to provide clear answers on the exact timing or type of regression seen in different children.
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Affiliation(s)
- Christine Tan
- Department of Paediatrics and Melbourne School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Veronica Frewer
- Department of Paediatrics and Melbourne School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Georgina Cox
- Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics & Education Research, Monash University, Clayton, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics and Melbourne School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics & Education Research, Monash University, Clayton, Victoria, Australia.,Developmental Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Alexandra Ure
- Department of Paediatrics and Melbourne School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Neurodisability & Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics & Education Research, Monash University, Clayton, Victoria, Australia.,Developmental Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
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Singh NN, Lancioni GE, Medvedev ON, Hwang YS, Myers RE. Real-Time Telehealth Treatment Team Consultation for Self-Injury by Individuals with Autism Spectrum Disorder. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2021; 5:170-182. [PMID: 33490369 PMCID: PMC7813971 DOI: 10.1007/s41252-021-00192-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Self-injurious behavior (SIB) refers to any repeated self-directed, non-suicidal, behavior that may cause or has the potential to cause physical harm to the person's body. Behavioral interventions provide the standard evidence-based treatments for SIB by people with autism spectrum disorder (ASD) and intellectual disabilities (ID). Translating the proven effectiveness of behavioral interventions to treatment of self-injury in community settings by clinicians and caregivers has not been totally successful. The aim of the present study was to advance translational research by providing real-time telehealth consultation to a treatment team at a community-based mental health agency that provided inpatient and outpatient services to individuals with ASD and ID. METHOD The participants of this single-case experimental study were three adolescents with ASD who had been referred for services because of their increasingly unmanageable SIB both at home and at school. The telehealth consultant provided real-time assistance to the treatment team within a translational model of care in the development and implementation of a behavior support plan and an informal mindfulness-based Soles of the Feet (SoF) program. RESULTS Both visual and statistical analyses demonstrated reductions in the frequency of SIB for all three adolescents, with overall clinically significant reductions only with the SoF intervention. CONCLUSION The results of this translational study suggest that telehealth consultation might be a viable technological alternative in situations which preclude face-to-face consultation. Telehealth consultation could be one method of supporting people with behavioral difficulties during pandemics, such as COVID-19.
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Affiliation(s)
- Nirbhay N. Singh
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA 30912 USA
| | - Giulio E. Lancioni
- Department of Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Oleg N. Medvedev
- School of Psychology, University of Waikato, Hamilton, New Zealand
| | - Yoon-Suk Hwang
- Centre for Disability Studies, University of Sydney, Camperdown, NSW 2050 Australia
| | - Rachel E. Myers
- WellStar School of Nursing, Kennesaw State University, Kennesaw, GA USA
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Derscheid DJ, Arnetz JE. Patient and Family Member Violent Situations in a Pediatric Hospital: A Descriptive Study. J Pediatr Nurs 2020; 55:241-249. [PMID: 32992261 PMCID: PMC7722004 DOI: 10.1016/j.pedn.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The intent of this study is to report on violent situations involving the pediatric patient and/or the patient's family member in the inpatient hospital setting. DESIGN AND METHODS This descriptive study used two independent samples: Behavioral Emergency Response Team (BERT) recipients and surveyed pediatric healthcare staff at a pediatric hospital within a large urban Midwestern academic hospital in the United States. RESULTS Per BERT recipients (N = 26) and staff survey respondents (N = 91), common physical patient behaviors were, respectively, hitting (60%, 77%) and kicking (53%, 82%). Fifteen (75%) patient BERT responses were for violent situations. The most common mental health condition among patients in violent situations was behavior dyscontrol (n = 8, 53%), which was absent among calls for non-violent situations (n = 5). Seizures, which was the most common medical condition among patients in BERT violent situations (n = 6, 40%), was proportionately slightly greater than among non-violent situations (n = 1, 20%). Staff who reported experience with violent situations (n = 64, 73%) were from general medical units (n = 48, 75%), and registered nurses (n = 53, 79%). CONCLUSIONS This study helped illuminate demographic, medical and mental health clues about violent situations with patients and family members on pediatric inpatient hospital units. PRACTICE IMPLICATIONS Pediatric patients and families may struggle to cope during hospitalization. Healthcare providers' knowledge about co-occurring conditions, stress related to hospitalization and use of BERT as a resource may help prevent violent situations.
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Affiliation(s)
| | - Judith E Arnetz
- Department of Family Medicine, Michigan State University, United States.
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4
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Boterberg S, Van Coster R, Roeyers H. Characteristics, Early Development and Outcome of Parent-Reported Regression in Autism Spectrum Disorder. J Autism Dev Disord 2020; 49:4603-4625. [PMID: 31463633 DOI: 10.1007/s10803-019-04183-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study explored regression patterns in 100 children with ASD (3-11 years) using several approaches to enhance the validity of retrospective parent report. Both early development and outcome were examined in regression groups defined by 36 months age cut-off and two underlying empirical patterns based on type and onset age. Results over regression groups were generally consistent. During early development, children with regression showed a similar amount of social atypicalities and stereotyped behaviour as compared to children without regression. However, parents indicated less communication skills which could be a valuable predictor of regression. Development after regression was characterised by early language delay and more restricted and repetitive behaviour. The findings provide insight into the diagnosis and prognosis of regression in ASD.
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Affiliation(s)
- Sofie Boterberg
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Rudy Van Coster
- Department of Paediatric Neurology and Metabolism, Faculty of Medicine and Health Sciences, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Herbert Roeyers
- Department of Paediatric Neurology and Metabolism, Faculty of Medicine and Health Sciences, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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Boterberg S, Charman T, Marschik PB, Bölte S, Roeyers H. Regression in autism spectrum disorder: A critical overview of retrospective findings and recommendations for future research. Neurosci Biobehav Rev 2019; 102:24-55. [PMID: 30917924 DOI: 10.1016/j.neubiorev.2019.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 11/16/2022]
Abstract
Historically, two onset patterns in autism spectrum disorder (ASD) were described: early onset of symptoms and regression in which one-third appear to show a loss of previously established skills in the second year of life. Since this phenomenon could represent a distinct ASD subtype and provide more insight into the etiology, diagnosis, and prognosis, many studies have compared these two groups. The present review discusses definitions, etiology, and methods used in research with a retrospective design and provides an overview of the results on early development and outcomes. However, retrospective research has not provided clear answers on regression as a distinct subtype of ASD and the historic division between early onset and regression does not seem to fit the empirical findings. Based on inconsistent results, future research on onset patterns in ASD needs to be more systematic on the definitions and methods used. Several recommendations to enhance the reliability of future retrospective results are discussed. The combination of a categorical and dimensional approach provides a new interesting framework.
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Affiliation(s)
- Sofie Boterberg
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium.
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter B Marschik
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany; iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research; Department of Women's and Children's Health, Karolinska Institutet & Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Herbert Roeyers
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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Soke GN, Rosenberg SA, Rosenberg CR, Vasa RA, Lee LC, DiGuiseppi C. Self-injurious behaviors in children with autism spectrum disorder enrolled in the Study to Explore Early Development. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 22:625-635. [PMID: 28635306 PMCID: PMC5912993 DOI: 10.1177/1362361316689330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We assessed potential factors associated with "current" or "ever" self-injurious behaviors, reported in the Autism Diagnostic Interview-Revised, among children with autism spectrum disorder (n = 692) from the Study to Explore Early Development. Data on factors examined were obtained from questionnaires, standardized clinical instruments, and birth certificates. We employed a log-binomial regression to assess these associations. Although most associations were quite similar for currently and ever exhibiting self-injurious behaviors, a few differences were noted. We documented previously unreported associations of current self-injurious behaviors with maternal age and cesarean delivery, and ever self-injurious behaviors with maternal age, child sex, gestational age, and maternal race. We also confirmed previously reported associations with adaptive skills, somatic conditions (sleep, gastrointestinal, and sensory abnormalities), and other behavioral problems. These findings are informative for clinical practice and future research.
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Affiliation(s)
- Gnakub Norbert Soke
- University of Colorado Denver, USA
- Centers for Disease Control and Prevention, USA
| | | | | | | | - Li-Ching Lee
- Johns Hopkins Bloomberg School of Public Health, USA
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Soke GN, Rosenberg SA, Hamman RF, Fingerlin T, Robinson C, Carpenter L, Giarelli E, Lee LC, Wiggins LD, Durkin MS, DiGuiseppi C. Brief Report: Prevalence of Self-injurious Behaviors among Children with Autism Spectrum Disorder-A Population-Based Study. J Autism Dev Disord 2017; 46:3607-3614. [PMID: 27565654 DOI: 10.1007/s10803-016-2879-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Self-injurious behaviors (SIB) have been reported in more than 30 % of children with an autism spectrum disorder (ASD) in clinic-based studies. This study estimated the prevalence of SIB in a large population-based sample of children with ASD in the United States. A total of 8065 children who met the surveillance case definition for ASD in the Autism and Developmental Disabilities Monitoring (ADDM) Network during the 2000, 2006, and 2008 surveillance years were included. The presence of SIB was reported from available health and/or educational records by an expert clinician in ADDM Network. SIB prevalence averaged 27.7 % across all sites and surveillance years, with some variation between sites. Clinicians should inquire about SIB during assessments of children with ASD.
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Affiliation(s)
- Gnakub N Soke
- Department of Epidemiology, Colorado School of Public Heath, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
| | - Steven A Rosenberg
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Richard F Hamman
- Department of Epidemiology, Colorado School of Public Heath, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Tasha Fingerlin
- Department of Epidemiology, Colorado School of Public Heath, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Cordelia Robinson
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Laura Carpenter
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Ellen Giarelli
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, 19102, USA
| | - Li-Ching Lee
- Departments of Epidemiology and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Lisa D Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Maureen S Durkin
- University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Carolyn DiGuiseppi
- Department of Epidemiology, Colorado School of Public Heath, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
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Factors Associated with Self-Injurious Behaviors in Children with Autism Spectrum Disorder: Findings from Two Large National Samples. J Autism Dev Disord 2017; 47:285-296. [PMID: 27830427 DOI: 10.1007/s10803-016-2951-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In this study, we explored potential associations among self-injurious behaviors (SIB) and a diverse group of protective and risk factors in children with autism spectrum disorder from two databases: Autism and Developmental Disabilities Monitoring (ADDM) Network and the Autism Speaks-Autism Treatment Network (AS-ATN). The presence of SIB was determined from children's records in ADDM and a parent questionnaire in AS-ATN. We used multiple imputation to account for missing data and a non-linear mixed model with site as a random effect to test for associations. Despite differences between the two databases, similar associations were found; SIB were associated with developmental, behavioral, and somatic factors. Implications of these findings are discussed in relation to possible etiology, future longitudinal studies, and clinical practice.
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Zhang J, Song J, Wang J. Adolescent self-harm and risk factors. Asia Pac Psychiatry 2016; 8:287-295. [PMID: 27224048 DOI: 10.1111/appy.12243] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/13/2015] [Accepted: 03/11/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aims to define the characteristics of adolescents who have engaged in self-harm behavior and ascertain the risk factors. METHODS From January 2013 to January 2014, 4,176 adolescents from senior middle schools in Linyi, China, were administered four questionnaire surveys to ascertain the following: incidence of self-harm behavior regarding the frequency of different self-harm behaviors by group (never/one to five times/greater than five times in the last 6 months) and then comparing the self-harm behavior of the different subgroups; symptom self-check, comparing the differences between the adolescents with self-harm behavior and without in nine subscales (somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, fear, paranoid, and psychosis); Adolescent Self-Rating Life Events Check List scores; and Egna Minnenav Barndoms Uppfostran (EMBU) scores. Multivariate logistic regression analysis was used to determine the risk factors of self-harm in adolescents. RESULTS The incidence of adolescent self-harm was 27.60%; the occurrence of adolescent self-harm was closely related to their mental health status, stressful life events, and EMBU. Being female, an urban student, or an only child; having poor school performance or experiences of stressful life events, harsh parenting styles, or excessive interference; and poor mental health were the risk factors for adolescent self-harm. CONCLUSIONS The incidence of adolescent self-harm was high, and their mental health status, stressful life events, and EMBU affected the occurrence of adolescent self-harm, which is an issue that needs greater attention.
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Affiliation(s)
- Jixiang Zhang
- Department of Clinical Psychology, Linyi Municipal People's Hospital, Linyi, China
| | - Jianwei Song
- Department of Neurosurgery, Linyi Municipal People's Hospital, Linyi, China.
| | - Jing Wang
- Department of Obstetrics and Gynecology, Linyi Municipal Chinese Medicine Hospital, Linyi, China
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De Giacomo A, Craig F, Terenzio V, Coppola A, Campa MG, Passeri G. Aggressive Behaviors and Verbal Communication Skills in Autism Spectrum Disorders. Glob Pediatr Health 2016; 3:2333794X16644360. [PMID: 27336016 PMCID: PMC4905127 DOI: 10.1177/2333794x16644360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 02/23/2016] [Accepted: 03/08/2016] [Indexed: 12/28/2022] Open
Abstract
Aggressive behavior is a common problem among children with autism spectrum disorder (ASD) and could negatively affect family functioning and school and social competence. The aim of the present study was to investigate the relationship between aggressive behavior, such as self-aggression and other-aggression, with verbal communication ability and IQ level in children with ASD. The sample examined in this study included 88 children with a diagnosis of ASD. For the purposes of our study, much attention was focused on individual items of the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview–Revised that were useful to evaluate the aggressive behavior. We have not found any association between aggressive behavior (other-aggression and self-aggression) and the absence of language or low IQ in children with ASD. Thus, the degree of severity of autism is probably the most important risk factor for this behavior.
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Sibling Death after Being Thrown from Window by Brother with Autism: Defenestration, an Emerging High-Risk Behavior. Case Rep Psychiatry 2015; 2015:463694. [PMID: 26339519 PMCID: PMC4539045 DOI: 10.1155/2015/463694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/16/2015] [Accepted: 07/21/2015] [Indexed: 11/25/2022] Open
Abstract
Children diagnosed with autistic spectrum disorders (ASD) may have serious behavioral problems such as aggression, self-injury, and violence. However, the literature on ASD either overrules any correlation between aggression and ASD or maintains the fact that the efforts to link them have so far been inconclusive. Although severe forms of violence are extremely rare in children with autism, there are a few cases reported in the literature with significant harm to siblings. We hereby report an 8-year-old boy with ASD who caused the death of his sibling by throwing her out of the window. Shared similarities of all defenestration cases indicate a pattern of high-risk behavior threatening the survival of minors. We recommend precautions against this high-risk behavior in children with ASD.
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