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The autistic-spectrum disorders.
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Neurodevelopmental disorders following thimerosal-containing childhood immunizations: a follow-up analysis.
The authors previously published the first epidemiological study from the United States associating thimerosal from childhood vaccines with neurodevelopmental disorders (NDs) based upon assessment of the Vaccine Adverse Event Reporting System (VAERS). A number of years have gone by since their previous analysis of the VAERS. The present study was undertaken to determine whether the previously observed effect between thimerosal-containing childhood vaccines and NDs are still apparent in the VAERS as children have had a chance to further mature and potentially be diagnosed with additional NDs. In the present study, a cohort of children receiving thimerosal-containing diphtheria-tetanus-acellular pertussis (DTaP) vaccines in comparison to a cohort of children receiving thimerosal-free DTaP vaccines administered from 1997 through 2000 based upon an assessment of adverse events reported to the VAERS were evaluated. It was determined that there were significantly increased odds ratios (ORs) for autism (OR = 1.8, p < .05), mental retardation (OR = 2.6, p < .002), speech disorder (OR = 2.1, p < .02), personality disorders (OR = 2.6, p < .01), and thinking abnormality (OR = 8.2, p < .01) adverse events reported to the VAERS following thimerosal-containing DTaP vaccines in comparison to thimerosal-free DTaP vaccines. Potential confounders and reporting biases were found to be minimal in this assessment of the VAERS. It was observed, even though the media has reported a potential association between autism and thimerosal exposure, that the other NDs analyzed in this assessment of the VAERS had significantly higher ORs than autism following thimerosal-containing DTaP vaccines in comparison to thimerosal-free DTaP vaccines. The present study provides additional epidemiological evidence supporting previous epidemiological, clinical and experimental evidence that administration of thimerosal-containing vaccines in the United States resulted in a significant number of children developing NDs.
The Brief Infant-Toddler Social and Emotional Assessment: screening for social-emotional problems and delays in competence.
OBJECTIVE: To examine the reliability and validity of the 42-item Brief Infant-Toddler Social and Emotional Assessment (BITSEA), a screener for social-emotional/behavioral problems and delays in competence. METHOD: Parents in a representative healthy birth cohort of 1,237 infants aged 12 to 36 months completed the Infant-Toddler Social and Emotional Assessment (ITSEA)/BITSEA, the Child Behavior Checklist (CBCL)/1.5-5, the MacArthur Communication Developmental Inventory vocabulary checklist, and worry questions. In a subsample, independent evaluators rated infant-toddler behavior. RESULTS: Test-retest reliability was excellent and interrater agreement (mother/father and parent/child-care provider) was good. Supporting validity, BITSEA problems correlated with concurrent evaluator problem ratings and CBCL/1.5-5 scores and also predicted CBCL/1.5-5 and ITSEA problem scores one year later. BITSEA measures of competence correlated with concurrent observed competence and predicted later ITSEA competence measures. Supporting discriminant validity, only 23% of high BITSEA problem scorers had delayed vocabulary. Moreover, the combined BITSEA problem/competence cutpoints identified 85% of subclinical/clinical CBCL/1.5-5 scores, while maintaining acceptable specificity (75%). CONCLUSIONS: Findings support the BITSEA as a screener for social-emotional/behavioral problems and delays in social-emotional competence.
The group of hypotonic schizophrenics.
The physical and psychological characteristics of hypotonic schizophrenic children are described. It is hypothesized that hypotonic schizophrenia constitutes a homogeneous subgroup within the schizophrenic spectrum. The criteria for diagnosing hypotonic schizophrenia are stated. By selecting a homogeneous subgroup of schizophrenic patients, investigators may improve the probability of identifying a common biochemical etiology within this subgroup.
Treasured object use--a cognitive and developmental marker.
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An examination of social typologies in autism.
A system proposed by Wing and coworkers for subtyping autistic individuals on the basis of social interaction is examined in 78 autistic, 39 atypical, and 32 nonautistic, developmentally disordered individuals. Clinical ratings and questionnaire data based on the proposed subtypology were employed. Clinicians were able to reliably group both autistic and nonautistic cases into the three subtypes; these subtypes were strongly related to IQ. Issues relating to the validity and utility of this subtypology are discussed.
Autism and Asperger's: same or different?
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Outcome in autism and autistic-like conditions.
Autism carries a very variable prognosis; there might be a slight increase in mortality in the first 30 years of life. A small, but not negligible, minority of people with autism lead productive, self-supporting adult lives, but about two-thirds will remain dependent on others throughout life. The risk of epilepsy is very high, both in early childhood and adolescence. An important minority deteriorate in adolescence. Outcome in autistic-like conditions is even more variable, ranging from excellent in many cases of so-called Asperger syndrome to gloomy in most cases of so-called disintegrative disorders.
Magnetic resonance imaging of severely disturbed children--a preliminary study.
This study investigates the relationship between brain pathology and psychiatric disturbance in 37 psychiatric inpatients between 5 and 14 years of age referred for magnetic resonance imaging (MRI). Of 37 images, 13 were categorized as abnormal by neuroradiologists who were blind to the diagnoses of subjects. Three of six children with schizophrenia-related diagnoses had abnormal scans. In contrast, only one of 15 children with a primary disruptive behavior disorder diagnosis had an abnormal magnetic resonance image. A greater proportion of children with schizophrenia spectrum diagnoses had greater left than right frontal horns of the lateral ventricles than children with other diagnoses.
Psychopharmacology in child and adolescent psychiatry: a review of the past seven years. Part I.
OBJECTIVE: To present a critical overview of the literature published in the past 7 years on the efficacy and safety of psychoactive agents in mental retardation with associated psychiatric disorders, autistic disorder, Tourett's disorder, and attention-deficit/hyperactivity disorder. METHOD: Double-blind and placebo-controlled clinical trials and open studies were reviewed and selected reports presented. RESULTS: The literature review reveals that progress has been made in the psychopharmacological treatment of the above conditions. This is partly because more studies use larger sample sizes and a narrower age range of diagnostically homogeneous patients and use a more sophisticated methodology than in previous years. Greater attention is being paid to a critical assessment of psychoactive agents and to their safety, to the efficacy as well as to the effectiveness of drugs. The 5-year National Plan for Research on Child and Adolescent Mental Disorders (1991) based on the Institute of Medicine Report (1989) already has had a significant impact on psychophamacology research. CONCLUSIONS: Advances in methodology, initiatives of the National Institute of Mental Health, and the advent of DSM-IV should continue to enhance research and improve pharmacotherapy in clinical practice.
Misdiagnosed ADD/ADHD; rediagnosed PDD.
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Practice parameters for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. AACAP.
These practice parameters describe the assessment and treatment of obsessive-compulsive disorder based on a detailed literature review and expert consultation. Obsessive-compulsive disorder is a disorder of heterogeneous origin characterized by intrusive thoughts or compulsive urges or behaviors that are distressing, time-consuming, or functionally impairing. In children and adolescents, the disorder often is accompanied by a wide range of comorbidity, including mood, anxiety, attentional, and learning difficulties, and/or tic disorder. These parameters describe the relevant areas of assessment, especially symptomatology, onset, and course, other associated psychopathology, and developmental, family, and medical history (including postinfectious onset or exacerbations). Two modalities have been systematically assessed and empirically shown to ameliorate core symptoms: cognitive-behavioral therapy (primarily exposure/response prevention) and serotonin reuptake inhibitor medication. Data regarding the indications, efficacy, and implementation of these modalities are reviewed. Because OCD frequently occurs in the context of other psychopathology and adaptive difficulties, additional individual and family psychotherapeutic, pharmacological, and educational interventions often are necessary. Treatment planning guidelines are provided.
OCD symptoms in a young child.
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Risperidone treatment for juvenile bipolar disorder: a retrospective chart review.
OBJECTIVE: To investigate the effectiveness and tolerability of the atypical neuroleptic risperidone in the treatment of juvenile mania. METHOD: This is a retrospective chart review of outpatients with the diagnosis of bipolar disorder (DSM-IV) treated with risperidone at a university center. Response to treatment was evaluated using the Clinical Global Impression Scale (CGI) with separate assessments of mania, psychosis, aggression, and attention-deficit/hyperactivity disorder (ADHD). RESULTS: Twenty-eight youths (mean +/- SD age, 10.4 +/- 3.8 years) with bipolar disorder (25 mixed and 3 hypomanic) who had been treated with risperidone were identified. These children received a mean dose of 1.7 +/- 1.3 mg over an average period of 6.1 +/- 8.5 months. Using a CGI Improvement score of < or = 2 (very much/much improved) to define robust improvement, 82% showed improvement in both their manic and aggressive symptoms, 69% in psychotic symptoms, but only 8% in ADHD symptoms. CONCLUSIONS: Although limited by its retrospective nature, this study suggests that risperidone may be effective in the treatment of manic young people and indicates the need for controlled clinical trials of risperidone and other atypical neuroleptics in juvenile mania.
Olanzapine versus haloperidol in children with autistic disorder: an open pilot study.
OBJECTIVES: Conventional neuroleptics ameliorate symptoms in children with autistic disorder; however, they are known to cause dyskinesias. Atypical neuroleptics, including olanzapine, may have less risk for dyskinesia, but their efficacy in autistic disorder is not established. This study was designed to investigate the safety and effectiveness of open-label olanzapine as a treatment for children with autistic disorder by using haloperidol as a standard comparator treatment. METHOD: In a parallel groups design, 12 children with DSM-IV autistic disorder (mean age 7.8+/-2.1 years) were randomized to 6 weeks of open treatment with olanzapine or haloperidol. Mean final dosages were 7.9+/-2.5 mg/day for olanzapine and 1.4+/-0.7 mg/day for haloperidol. Outcome measures included the Clinical Global Impressions (CGI) and the Children's Psychiatric Rating Scale (CPRS). RESULTS: Both groups had symptom reduction. Five of six in the olanzapine group and three of six in the haloperidol group were rated as responders according to the CGI Improvement item. Subjects showed improvement on the CPRS Autism Factor (F1,9 = 24.4, p = .0008). Side effects included drowsiness and weight gain. CONCLUSIONS: The findings suggest that olanzapine is a promising treatment for children with autistic disorder. Further placebo-controlled and long-term studies of olanzapine in autistic disorder are required.
The family with a handicapped child: a review of the literature.
Research is reviewed on the impact of a handicapped child on the family. While most authors agree that the presence of such a child is a family stressor, there have been few studies using control groups, analytical methods, representative samples, or adequate numbers. The wide age range of the children within and across studies and the diversity of populations confuse some issues and leave others unresolved. In addition, no instrument has been designed to measure specifically the stress in families of a handicapped child. Most authors have not taken into account the dynamic process of rearing a handicapped child, nor have they addressed the problems of having a mildly handicapped child.