Search PubMed⌕ Search

Biomedical subjects

M Rutter

Publications and source records attributed to M Rutter.

At least 55 records · Page 3Linked to original sources
PubMed1994

Field trial for autistic disorder in DSM-IV.

OBJECTIVE: This project focused on the development of the definition of autism for DSM-IV. METHOD: Multiple sites were involved in obtaining information regarding 977 patients with the following clinician-assigned diagnoses: autism (N = 454), other pervasive developmental disorders (N = 240), and other disorders (N = 283). A standard coding system was used, and the raters (N = 125) had a range of experience in the diagnosis of autism. Patterns of agreement among existing diagnostic systems were examined, as was the rationale for inclusion of other disorders within the class of pervasive developmental disorders. RESULTS: The DSM-III-R definition of autism was found to be overly broad. The proposed ICD-10 definition most closely approximated the clinicians' diagnoses. Inclusion of other disorders within pervasive developmental disorders appeared justified. Partly on the basis of these data, modifications in the ICD-10 definition were made; this and the DSM-IV definition are conceptually identical. CONCLUSIONS: The resulting convergence of the DSM-IV and ICD-10 systems should facilitate both research and clinical service.

Age of Onset↗
PubMed1993

Analyzing twin resemblance in multisymptom data: genetic applications of a latent class model for symptoms of conduct disorder in juvenile boys.

A model based on the latent class model is developed for the effects of genes and environment on multivariate categorical data in twins. The model captures many essential features of dimensional and categorical conceptions of complex behavioral phenotypes and can include, as special cases, a variety of major locus models including those that allow for etiological heterogeneity, differential sensitivity of latent classes to measured covariates, and genotype x environment interaction (G x E). Many features of the model are illustrated by an application to ratings on eight items relating to conduct disorder selected from the Rutter Parent Questionnaire (RPQ). Mothers rated their 8- to 16-year-old male twin offspring [174 monozygotic (MZ) and 164 dizygotic (DZ) pairs]. The impact of age on the frequency of reported symptoms was relatively slight. Preliminary latent class analysis suggests that four classes are required to explain the reported behavioral profiles of the individual twins. A more detailed analysis of the pairwise response profiles reveals a significant association between twins for membership of latent classes and that the association is greater in MZ than DZ twins, suggesting that genetic factors played a significant role in class membership. Further analysis shows that the frequencies of MZ pairs discordant for membership of some latent classes are close to zero, while others are definitely not zero. One possible explanation of this finding is that the items reflect underlying etiological heterogeneity, with some response profiles reflecting genetic categories and others revealing a latent environmental risk factor. We explore two "four-class" models for etiological heterogeneity which make different assumptions about the way in which genes and environment interact to produce complex disease phenotypes. The first model allows for genetic heterogeneity that is expressed only in individuals exposed to a high-risk ("predisposing") environment. The second model allows the environment to differentiate two forms of the disorder in individuals of high genetic risk. The first model fits better than the second, but neither fits as well as the general model for four latent classes associated in twins. The results suggest that a single-locus/two-allele model cannot fit the data on these eight items even when we allow for etiological heterogeneity. The pattern of endorsement probabilities associated with each of the four classes precludes a simple "unidimensional" model for the latent process underlying variation in symptom profile in this population. The extension of the approach to larger pedigrees and to linkage analysis is briefly considered.

Adolescent↗
PubMed1993

Cause and course of psychopathology: some lessons from longitudinal data.

Case-control studies of clinic samples constitute the usual research method for the investigation of the causes and course of psychiatric disorder. However, they carry substantial disadvantages and if causal hypotheses are to be tested in rigorous fashion, it is necessary to use longitudinal research strategies applied to epidemiologically based samples. Their advantages are reviewed with respect to the use of 'experiments of nature' for testing causal mechanisms through the study of within-individual change over time in relation to some prospectively measured alteration in the risk variable. Attention is drawn to the value of longitudinal data in studying the processes involved in 'escape' from risk; in examining differential vulnerability to risk experiences; in validating diagnostic categories; in investigating the timing of disorders; and in evaluating the role of variables that cannot be recalled. The data from a range of longitudinal studies are used to note some of the key implications for developmental and psychopathological concepts.

Adolescent↗
PubMed1993

Prevalence of the fragile X anomaly amongst autistic twins and singletons.

Early screening studies of autistic individuals suggested that up to one-quarter of cases were associated with the Fragile X anomaly. Recent studies find that the usual behavioural phenotype of the Fragile X anomaly is distinct from autism as usually defined, and that a variety of methodological factors contribute to the variability of the prevalence estimates. We report the prevalence of the Fragile X anomaly, using strict cytogenetic criteria, in a large sample of autistic individuals whose diagnosis was confirmed using a standardised diagnostic instrument. The anomaly was detected in 1.6% of tested autistic individuals from a combined sample of: autistic twins; clinic attenders; and, individuals from families multiplex for autism or related cognitive phenotypes. The anomaly was not detected in greater than 2.5% of any of the constituent samples and accounted for only a small proportion of the genetic influences amongst concordant twins and multiplex families. The anomaly was detected in 5% of the 40 tested autistic females, confirming reports that the prevalence of the anomaly is similar amongst autistic individuals of both sexes.

Adult↗
PubMed1993

Assessment of psychosocial experiences in childhood: methodological issues and some illustrative findings.

The development of a new standardised investigator-based interview, PACE (Psychosocial Assessment of Childhood Experiences), for the assessment of acute life events and long-term psychosocial experiences is described. An application of PACE to a sample of 84 children referred to psychiatric clinics and 22 general population controls, is presented. Reliability was assessed using a separate clinic sample of 15 child-parent pairs. The findings showed that PACE has satisfactory reliability and discriminant validity.

Adaptation, Psychological↗
PubMed1992

Classification of pervasive developmental disorders: some concepts and practical considerations.

Classifications have to meet a variety of purposes. Clinical and research needs are different and there is much to be said for separate clinical and research schemes. Care is needed to ensure that classifications provide an appropriate medium for teaching about diagnosis and do not cause difficulties when used as a "passport" to resources. Principles of classification are considered in relation to the need to take course, as well as symptomatology, into account, and with respect to the neuropsychiatric interface. The value of a multiaxial approach is noted. The pros and cons of autism and pervasive developmental disorders (PDD) as an overall descriptive term, of lumping or splitting, and of different choices with respect to PDD subcategories are discussed.

Autistic Disorder↗
PubMed1992

The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder.

The effect of conduct disorder on adult social functioning in the areas of work, sexual/love relationships, social relationships and criminality was studied in a sample of young adults who spent much of their childhoods in group-cottage children's homes and an inner-city comparison group. Most subjects with conduct disorder had pervasive (but not necessarily severe) social difficulties compared to peers without conduct disorder. Less than half of this group met DSM-III adult criteria for antisocial personality disorder and just over half were given a diagnosis of personality disorder on interviewer clinical ratings. A latent class model that used both the retrospective and contemporaneous indicators of conduct disorder confirmed the very high continuity with adult social difficulties. Current diagnoses did not adequately describe this group and conduct disorder appeared to be an almost necessary condition for multiple social disability in adults in these samples.

Adolescent↗
PubMed1992

Season of birth: issues, approaches and findings for autism.

Rates of birth in the general population show seasonal fluctuations for reasons that are ill understood. Variations from these general population patterns have been reported for several psychiatric conditions and used as the basis for aetiological hypotheses. In this paper, the evidence for alterations in the expected seasonal fluctuation in birth dates of autistic people is evaluated. A national sample of 1435 autistic individuals and a clinic sample of 196 subjects are compared to general population figures and to 121 sibling controls. Compared with the general population, the national sample showed significant deviations from the expected rate of birth by month. In the clinic sample, differences from the anticipated monthly pattern were only evident when this sample was compared to the sibling controls. A variety of models for seasonal trends, including year quarters, temperature and sine wave forms, were fitted to these variations but no consistent picture emerged.

Adolescent↗
PubMed1991

Childhood experiences and adult psychosocial functioning.

Various studies have shown statistically significant associations between adverse experiences in childhood and abnormal psychosocial functioning in early adult life. It should not be assumed that this finding necessarily means an enduring effect of early experience. Part of the explanation is that adverse environments tend to be persistent and, hence, that what is being reflected is simply continuity in risk factors. But even when such continuity is taken into account, substantial associations over time remain. Using data from two long-term longitudinal studies a variety of possible mediating mechanisms are considered and shown to be operative. These include: an immediate effect leading to emotional/behavioural disturbance in childhood that then persists into adult life (this mechanism may be more important than appreciated hitherto, because heterotypic continuity has concealed the strength of the persistence of disturbance); one risk environment increasing the likelihood of occurrence of a second, different risk environment; the establishment of patterns of behaviour that bring about later risk environments; and the development of an increased vulnerability to later risk environments.

Adult↗
PubMed1991

Reliability and validity of a psychosocial axis in patients with child psychiatric disorder.

The interrater reliability of a classification scheme of psychosocial stressors was assessed among 52 child psychiatrists in rating exercises with 28 case histories. Validity was evaluated in a field study of 377 cases rated by 39 of the same child psychiatrists. The impact of glossary descriptions on reliability and validity was also determined. Reliability was low with most Kappa values being in the range of 0.20 to 0.40. The glossary did not affect interrater reliability, but it significantly decreased the use of abnormal codes. The discriminant validity of the codes was supported in that the most commonly used codes were used with differential frequency in a pattern that conforms with the known psychosocial correlates of the different psychiatric conditions of childhood.

Child↗
PubMed1991

Adult outcomes of childhood and adolescent depression: II. Links with antisocial disorders.

Sixty-three child and adolescent patients meeting operational criteria for depression and 68 non-depressed child psychiatric controls were followed into adulthood. Twenty-one percent of the depressed group had had conduct disorder (CD) in conjunction with their index depression. Depressed children with comorbid CD did not differ from depressed children without conduct problems with respect to depressive symptom presentation or demographic characteristics. However, depressives with CD had a worse short-term outcome and a higher risk of adult criminality than depressed children without conduct problems. There was a strong trend for depressives with CD to have a lower risk of depression in adulthood than depressed children without conduct problems. The outcomes of depressives with CD were very similar to those of nondepressed children with CD. The findings are discussed in the context of current classification schemes.

Adolescent↗
PubMed1991

Comorbidity in child psychopathology: concepts, issues and research strategies.

Epidemiological data show that the co-occurrence of two or more supposedly separate child (and adult) psychiatric conditions far exceeds that expected by chance (clinic data cannot be used for this determination). The importance of comorbidity is shown and it is noted that it is not dealt with optimally in either DSM-III-R or ICD-9. Artifacts in the detection of comorbidity are considered in terms of referral and screening/surveillance biases. Apparent comorbidity may also arise from various nosological considerations; these include the use of categories where dimensions might be more appropriate, overlapping diagnostic criteria, artificial subdivision of syndromes, one disorder representing an early manifestation of the other, and one disorder being part of the other. Possible explanations of true comorbidity are discussed with respect to shared and overlapping risk factors, the comorbid pattern constituting a distinct meaningful syndrome, and one disorder creating an increased risk for the other. Some possible means of investigating each of these possibilities are noted.

Adult↗