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PubMed1990

Using signal detection methodology to revise DSM-III-R: re-analysis of the DSM-III-R national field trials for autistic disorder.

Signal detection theory which takes into account the relative prevalence, sensitivity, and specificity of each of a set of criterion symptoms is used to determine an algorithm optimally predictive of a clinical diagnoses of autistic disorder using the data from the DSM-III-R national field trials. Findings support inclusion of one diagnostic criterion (marked lack of awareness of others) as mandatory, and four more (impaired imitation, abnormal social play, abnormal nonverbal communication, and abnormal speech) as alternate, associated criteria. Advantages of signal detection over other statistical methods for empirically deriving diagnostic standards are given, and implications for DSM-IV are discussed.

Algorithms↗
PubMed1981

Sex ratios in early childhood autism and related conditions.

Children aged 0-14 on a specified census day, with impairments of verbal and nonverbal communication, social interaction and imaginative play, and with repetitive, stereotyped activities, were identified in an epidemiological study carried out in an area of southeast London. Sociable moderately, severely, and profoundly retarded children were included for comparison. An overall male:female ratio of 2.6:1 was found in those with language and social impairments, but, in the children of this group who were moderately, severely, or profoundly retarded, the ratio was 2.1:1, closely similar to that found in children in the same IQ range with Down's syndrome or cerebral palsy. The excess of males was much more marked in language and socially impaired children who were of higher ability, or who had a history of typical early childhood autism. The findings were linked to hypotheses of genetically greater variability in males, and to male-female differences in visuo-spatial and language skills.

Adolescent↗
PubMed2006

Amygdala activation at 3T in response to human and avatar facial expressions of emotions.

Facial expressions of emotions are important in nonverbal communication. Although numerous neural structures have been identified to be involved in emotional face processing, the amygdala is thought to be a core moderator. While previous studies have relied on facial images of humans, the present study is concerned with the effect of computer-generated (avatar) emotional faces on amygdala activation. Moreover, elicited activation patterns in response to viewing avatar faces are compared with the neuronal responses to human facial expressions of emotions. Twelve healthy subjects (five females) performed facial emotion recognition tasks with optimized 3T event-related fMRI. Robust amygdala activation was apparent in response to both human and avatar emotional faces, but the response was significantly stronger to human faces in face-sensitive structures, i.e. fusiform gyri. We suggest that avatars could be a useful tool in neuroimaging studies of facial expression processing because they elicit amygdala activation similarly to human faces, yet have the advantage of being highly manipulable and fully controllable. However, the finding of differences between human and avatar faces in face-sensitive regions indicates the presence of mechanisms by which human brains can differentiate between them. This mechanism merits further investigation.

Acoustic Stimulation↗
PubMed2006

Intervention for autistic spectrum disorders.

A comprehensive approach to the assessment of any child with autism must be matched specifically to each individual child and family. This premise holds for medical therapies and special education services as well as psychopharmacologic interventions. Behavioral, as opposed to pharmacologic, treatment is the hallmark of effective intervention for autism. Physicians involved in the care of children with autism need to become familiar with educational law and intervention recommendations. Goals should include improved functional verbal and nonverbal communication and social skills, increased engagement in developmentally appropriate activities, improved fine and gross motor skills, and the development of independent academic and organizations skills, as well as replacement of problem behaviors with developmentally appropriate behaviors.. Medicating children with autism is difficult, but is often necessary for chronic behavioral difficulties. In the absence of clear and present guidelines, we have attempted to use evidence and clinical experience to suggest an algorithm based on symptom clusters. Although children with autism may be responsive to medications at lower doses and more susceptible to side effects than other children, medical intervention can produce a significant improvement in the quality of life for the child and family. Careful thought leading to correct identification of target behaviors can appropriately direct better alternatives for medication. Although these approaches are costly and time-consuming endeavors, the expenditure of such efforts is the only available pathway to improve the potential outcomes for individuals with autism as well as decrease the lifetime societal costs for each individual.

Autistic Disorder↗
PubMed1998

Discrimination of facial identity and of emotions in Alzheimer's disease.

OBJECTIVE: To investigate processing of human faces identity and of emotional expressions in patients with Alzheimer's Disease (AD). BACKGROUND: Mechanisms responsible for discriminating facial identity may be dissociated from those involved in discriminating facial expressions. Patients with prosopagnosia often have preserved capacities for processing emotional facial expressions and occasionally, patients with focal lesions may recognize human faces without being able to recognize their facial expression. Such a dissociation has not been clearly shown in groups of AD patients. METHODS: Thirty-one probable AD patients and 14 control subjects were administered tasks of discrimination of faces and of emotions. RESULTS: AD patients were significantly impaired in discriminating facial identities and in naming and pointing to named emotions, but were comparable to controls in discriminating facial expressions of emotion. The deficits of facial discrimination and of identification of emotions were, on the whole, correlated with the MMS and Raven scores. Discrimination of emotions was not correlated to either test, suggesting that this ability is based on cognitive processes different from those underlying the MMS and the PM47. CONCLUSIONS: This dissociation implies two separate systems, one dedicated to discrimination of facial identities and the other to discrimination of emotions. This is compatible with the modular organization of cognitive deficits in AD and may explain the well known experience that nonverbal communication often remains effective even in patients with severe dementia.

Alzheimer Disease↗
PubMed2002

The amygdala and related structures in the pathophysiology of autism.

Autism is a neurodevelopmental disorder that is defined behaviorally by severe deficiencies in reciprocal social interaction, verbal and nonverbal communication, and restricted interests. The amygdala is involved in the regulation of social behaviors and may be an important site of pathology for the social dysfunction seen in autism. This review focuses on lesion, postmortem, and neuroimaging studies that investigate the amygdala and related structures in this disorder. Other brain regions potentially involved in the neuropathology of autism are also briefly discussed. Although supportive evidence exists for amygdala dysfunction in autism, the currently available data are inconsistent and additional research is needed.

Amygdala↗
PubMed2002

Cultural factors in preventive care: African-Americans.

In summary, the implications for healthcare practitioners in caring for African American patients in a culturally sensitive manner include: Gaining trust, and understanding the historical distrust of the health care system Understanding and employing the kinship web in decisions regarding screening and treatment Involving the church in developing and delivering prevention and care messages Asking patients about the meaning of words or phrases Asking patients about the use of alternative medicines and herbs Tailoring messages about prevention to depictions of real life situations Paying attention to body language and other nonverbal communication.

Black or African American↗
PubMed1995

Interpersonal support among 8-year-old girls who have lost their parents or siblings to AIDS.

It has been estimated that 18,500 children and adolescents have been orphaned by the AIDS epidemic. A review of the literature reveals very little about the psychosocial needs of these children. This report discusses themes in group therapy gleaned from transcripts of 16 tape-recorded sessions. To supplement the content analysis of the sessions, notes were made after each session, documenting nonverbal communication among the girls. The findings showed that 8-year-old girls were extremely sensitive to one another's needs and able to offer interpersonal support in a group setting.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Developmental regression in autism: maternal perception.

Developmental regression among children with autism is a common phenomenon of unknown origin. The purpose of this study was to identify the differences between children with autism who reportedly regressed with those who did not regress. A representative group of 39 mothers were interviewed (40 children--1 pair of twin girls) about familial, pregnancy, perinatal, as well as medical history and developmental milestones. The study focused on mothers' perceptions of developmental regression. Nineteen children (47.5%) regressed in verbal and nonverbal communication and social but not in motor abilities. Mean age of regression was 24 months, with 11 children who regressed before and 8 after this age. No significant differences were reported by mothers of children who did or did not regress. More mothers of children who regressed, than those of children who did not, expressed guilt feelings regarding the development of autism, and almost all of them had an "explanation" for the possible mechanisms that might have influenced their children's developmental course. In conclusion, developmental regression in our population appears to be a typical event in the natural course of autism. There is little difference between those children who regressed and those who did not regress in maternal perceptions and reports of development, family, and medical history.

Autistic Disorder↗
PubMed1997

A practical approach to developing cases for standardized patients.

This article outlines a process for developing standardized patient cases. The initial step in the process is to define the educational goals of the exercise. Following this step the patient characteristics, setting for the interaction and clinical information are developed. Clinical information, in addition to history, may include elements of nonverbal communication, actual or simulated abnormal physical findings, and laboratory results. Guidelines for the standardized patient regarding disclosure of information to the student and providing feedback to the student enhance the value of the case. If the case is to be used as part of an examination, a grading system must be developed. Issues of cost, validity, and reliability are briefly addressed.

Journal Article↗
PubMed1999

Research on screening and diagnosis in autism: a work in progress.

In June 1998, the National Institutes of Health Autism Coordinating Committee (NIH/ACC) invited representatives of 13 major medical and other professional academies and associations and six national autism parent research organizations to review research data on screening and diagnosis of autism spectrum disorders. Ten review papers and more than 4,000 publications were consulted in this effort. This paper highlights some promising areas for research identified in this process. One of the highest priorities is the search for the ultimate diagnostic indicator, a biological marker(s), for example, genetic, metabolic, immunologic, neurologic, that will distinguish autism unequivocally from other developmental disabilities. In the interim, research on infant screening and diagnosis might lower the threshold age for diagnosis to 8-12 months. The role of sensory-motor disorders in early diagnosis needs further research. Earlier and better diagnosis of co-occurring, potentially treatable disorders, including epileptic and epileptiform disorders, has implications both for diagnosis and treatment. Pharmacogenetic and pharmacogenomic research strategies could help diagnose subtypes and responders versus nonresponders to potential treatments. Better endpoints and outcome measures are needed, including improved procedures for cognitive and neuropsychological testing, more knowledge about verbal and nonverbal communication milestones, and less invasive and more sensitive neuroimaging measures. Critical questions remain regarding regression after apparently normal development, and about possible environmental precipitants. Finally, field trials of the reliability and validity of screening and diagnosis using the newly developed practice guidelines are needed.

Autistic Disorder↗
PubMed1997

Validation of the Revised Behavior Summarized Evaluation Scale.

The Behavioral Summarized Evaluation scale (BSE), previously published and validated, was developed for the evaluation for the autistic behavior in developmentally disorder children. A revised version of this scale, the Revised Behavior Summarized Evaluation Scale (BSE-R) completed the 20-item BSE scale with the most relevant items extracted from a similar evaluation carried out with very young children. Thus 9 items were added to the original scale concerning nonverbal communication, emotional, and perception areas. This paper reports the reliability and validity studies of this new scale. In addition to confirming the previously published findings concerning the first version of the BSE, new items were extracted from the BSE-R content validity study. They involve fundamental functions such as intention and imitation which open new perspectives for a physiopathological approach to developmental disorders. The BSE-R is a useful tool for progressive recording of the evolution of patients both treated over long periods and included in short-term controlled therapeutic studies.

Autistic Disorder↗
PubMed1999

Existential hazards of the multicultural individual: defining and understanding "cultural homelessness".

Cultural homelessness (CH) is the authors' term to describe unique experiences and feelings reported by some multicultural individuals. Ethnically related concepts found in the cross-cultural and multiethnic literature (e.g., marginality, intercultural effectiveness, ethnic enclaves, reference group) are used to explain how CH may arise from cross-cultural tensions within the ethnically mixed family and between the family and its culturally different environment, especially due to geographic moves. CH is conceptualized as a situationally imposed developmental challenge, forcing the child to accommodate to contradictory and changing norms, values, verbal and nonverbal communication styles, and attachment processes. Culturally homeless individuals may enjoy a broader, stronger cognitive and social repertoire because of their multiple cultural frames of reference. However, code-switching,complexities may lead to emotional and social confusion, which, if internalized, may result in self-blame and shame. Culturally encoded emotion labeling may be disrupted, leading to alexithymia.

Adult↗
PubMed2005

Behavioral alterations in rats prenatally exposed to valproic acid: animal model of autism.

Autism is a severe behavioral disorder characterized by pervasive impairments in social interactions, deficits in verbal and nonverbal communication, and stereotyped, repetitive patterns of behaviors and interests. Recently, a new rodent model of autism was created by exposure of rat fetuses to valproic acid (VPA) on the 12.5th day of gestation (VPA rats). The model has striking anatomical, pathological, and etiological similarities to human data; however, it has not been characterized behaviorally. In order to determine if VPA rats present behavioral aberrations observed in autism, their behavior was extensively evaluated in a battery of tests. The results of the present experiments demonstrate that VPA rats exhibit: (1) lower sensitivity to pain and higher sensitivity to nonpainful stimuli, (2) diminished acoustic prepulse inhibition, (3) locomotor and repetitive/stereotypic-like hyperactivity combined with lower exploratory activity, and (4) decreased number of social behaviors and increased latency to social behaviors. In addition, VPA rats showed delayed maturation, lower body weight, delayed motor development, and attenuated integration of a coordinated series of reflexes, delayed nest-seeking response mediated by olfactory system, and normal negative geotaxis. Interestingly, all behavioral aberrations described in this paper appear before puberty, which could distinguish the VPA rat model of autism from other animal models of neurodevelopmental disorders, especially rodent models of schizophrenia. Our results bring further support to validity of the proposed VPA animal model of autism, suggesting similarities between the observed pattern of behavioral alterations in VPA rats and features of disturbed behavior in autistic patients.

Acoustic Stimulation↗
PubMed1984

Learning of Blissymbols and manual signs.

Blissymbols and manual signs are two representational systems widely used as alternatives to spoken communication for persons unable to speak understandably. They were compared to determine if there is any advantage of one over the other in ease of learning or in retention. Immediate and 1-day posttest measures were obtained from 20 7- and 8-year-old children engaged in a paired-associate transfer-of-training task using manual signs and Blissymbols. Results showed no overall difference between signs and symbols in number of correct responses on either the immediate or 1-day posttest.

Child↗
PubMedDate not supplied

Cross-cultural issues in the disclosure of cancer.

PURPOSE: To increase awareness of cultural differences in the disclosure of a cancer diagnosis or prognosis, the author reviews several surveys of patients and physicians from around the world. OVERVIEW: The Western medical community is increasingly emphasizing full truthful disclosure of cancer diagnoses or prognoses and respect for autonomy as necessary prerequisites to ethical practice. However, surveys of European, Japanese, Native American, and various ethnic American (including Korean, Chinese, Mexican, Hispanic, African, and European American) cancer patients and physicians reveal that many cultures consider complete and accurate disclosure of cancer undesirable. Cultural differences in the rates of disclosure of a cancer diagnosis or prognosis; the physician's use of euphemisms to give a true or false diagnosis; as well as considerations of how to disclose a cancer diagnosis are described. CLINICAL IMPLICATIONS: Developing an awareness about cross-cultural practices regarding cancer disclosure issues allows the clinician to become more sensitive to the expectations of culturally and individually diverse cancer patients. To this end, all healthcare professionals should be informed about how the patient would like to be informed of a diagnosis and how involved he or she would like family members to be. In addition, an awareness of the use of nonverbal communication in some cultures and the psychosocial impact of certain terms, such as "cancer," is essential. Often, phrases such as "malignant tumor" or "growth" are less inflammatory and are more readily accepted. In ascertaining a knowledge of various cultural preferences and developing a sensitivity to these preferences, clinicians are better able to provide effective care to individuals from a variety of cultural and individual backgrounds.

Attitude to Health↗
PubMed2003

The role of eyebrows in face recognition.

A fundamental challenge in face recognition lies in determining which facial characteristics are important in the identification of faces. Several studies have indicated the significance of certain facial features in this regard, particularly internal ones such as the eyes and mouth. Surprisingly, however, one rather prominent facial feature has received little attention in this domain: the eyebrows. Past work has examined the role of eyebrows in emotional expression and nonverbal communication, as well as in facial aesthetics and sexual dimorphism. However, it has not been made clear whether the eyebrows play an important role in the identification of faces. Here, we report experimental results which suggest that for face recognition the eyebrows may be at least as influential as the eyes. Specifically, we find that the absence of eyebrows in familiar faces leads to a very large and significant disruption in recognition performance. In fact, a significantly greater decrement in face recognition is observed in the absence of eyebrows than in the absence of eyes. These results may have important implications for our understanding of the mechanisms of face recognition in humans as well as for the development of artificial face-recognition systems.

Adult↗
PubMed1999

A familial factor in the development of face recognition deficits.

The face is probably the single most important visual object. It is the main cue for identifying familiar people and crucial in nonverbal communication. Face recognition can be demonstrated in newborn babies, suggesting that face recognition is to some degree 'hard-wired' in the brain. Also, neurological disease can selectively disrupt the ability to recognize faces. Apart from acquired face recognition deficits, developmental cases have been reported. This study presents a family in which the father and two of his daughters are very poor at recognizing faces, demonstrating for the first time a familial factor in developmental face recognition deficit.

Adult↗