[Screening interview for early detection of high-functioning autism spectrum disorders]

OBJECTIVE

Various different questionnaires are available for the screening of autism spectrum disorders (ASD). These screening instruments show high sensitivity and are able to identify a large number of individuals with ASD, but they lack the specificity to differentiate individuals with ASD from those children and adolescents with other complex neurobehavioural disorders (such as attention-deficit/hyperactivity disorder, emotional disorders, and others), especially for those without intellectual disabilities.

METHOD

The present study evaluates the data of 309 individuals (153 with high-functioning ASD, 156 with other psychiatric disorders, IQ > 70) to find out whether selected items of the ADI-R can be used for an economic and sensitive screening of high-functioning ASD.

RESULTS

The results show that 8 items of the ADI-R can be used to discriminate high-functioning ASD and other psychiatric disorders. A cutoff of 5 led to a sensitivity of 0.93 and a cutoff of 6 to a specificity of 0.74.

CONCLUSION

The combination of early onset, serious abnormalities in social contact with stereotyped or compulsive-ritualized behaviour or interests can be detected with few interview questions for screening of ASD. Nevertheless, a more detailed and specific assessment in an expert setting should follow the screening process.

[The German Competence Analysis Questionnaire (KANN): Autism-spectrum-disorders and/or ADHD Compared]

The German Competence Analysis Questionnaire (KANN): Autism-spectrum-disorders and/or ADHD Compared. Due to the frequent comorbidity of autism spectrum disorders (ASD) and attention-deficit hyperactivity disorders (ADHD) the investigation of similarities and differences between these two syndromes has been the focus of research in recent years. The main objective of the present paper is to compare the three clinical groups "ASD", "ADHD" and "ASD+ADHD" as well as a control group on the basis of competencies relevant to everyday and social life by using the German Competence Analysis Questionnaire (Kompetenzanalyseverfahren, KANN). The KANN is an external assessment tool used to determine observable personal resources (competencies) in children and adolescents. A total of n = 205 children and adolescents under the care of child and youth welfare services are analyzed. The results show that the clinical group "ADHD" is superior to the groups "ASD" (in this case statistically significant) and "ASD+ADHD" at the KANN-scale "Leisure Behavior & Peer Groups" and "Independence in Everyday Life". The similar KANN-profiles of the two autistic groups do not support - contrary to the additionally collected data of behavior disorders (CBCL/4-18) - the hypothesis of an additive symptom effect within the meaning of the loss of competencies for the combined diagnoses group "ASD+ADHD". Furthermore, the ability of the KANN scales to differentiate between a clinical and a non-clinical child and youth welfare group underlines the validity of the KANN.

[High-functioning autism spectrum disorders in adulthood]

The prevalence of autism spectrum disorders in the general population is approximately 1 %. Some individuals with high-functioning autism graduate from regular schools without autism having been diagnosed and problems only occur when the demands for social competence increase. Then patients often present with secondary psychiatric symptoms, such as depression, anxiety or interpersonal problems. At this time, typical autistic features, such as social interaction deficits, restricted interests and stereotypic behavior can be camouflaged by high compensatory skills, particularly in highly intelligent patients. Therefore, missed or wrong diagnoses are frequent. Interviews, questionnaires and neuropsychological tests might be used to support the diagnosis. In cases where there is evidence for a secondary cause of autistic symptoms, somatic disorders should be excluded. Pharmacological treatment should be symptom-oriented. Individualized psychotherapeutic approaches are becoming increasingly more available; however, pragmatic solutions often need to be deployed.

Autistische Störungen – State-of-the-Art und neuere Entwicklungen

Der vorliegende Überblicksartikel baut auf dem «State-of-the-Art»-Vortrag zu tiefgreifenden Entwicklungsstörungen bei der 32. Jahrestagung der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP) im März 2011 in Essen auf und fasst die neuesten Erkenntnisse bezüglich epidemiologischer Studien (Komorbidität, Risikofaktoren), Frühdiagnose, Klassifikation und evidenzbasierter Therapieverfahren im Bereich medikamentöser Therapie sowie Autismus-spezifischer Frühförderung und Verhaltenstherapie zusammen. In allen diesen Bereichen hat die Forschung in den letzten Jahren zu einem besseren Verständnis und zu einer effektiveren Therapie von Autism Spectrum Disorders beigetragen.