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PubMed2001

Autistic disorder versus other pervasive developmental disorders in young children: same or different?

Eighteen preschool children diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders Third Edition Revised (DSM III-R) as having Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS) were compared to 176 children with DSM III-R Autistic Disorder (AD), and to 311 non-autistic children with developmental language disorders (DLD) (N = 201) or low IQ (N = 110). All children were partitioned into "high" and "low" cognitive subgroups at a nonverbal IQ of 80. Within cognitive subgroups, the 18 PDD-NOS children did not differ significantly from either the DLD or the AD children in verbal and adaptive skills and obtained scores intermediate between those of these groups. The PDD-NOS did not differ from the AD children in maladaptive behaviors. Both the PDD-NOS and AD children had many more of these behaviors than the non-autistic comparison groups. Children in the "high" and "low" cognitive subgroups of AD, but not of PDD-NOS, differed substantially on most measures, with the children with lower cognitive scores significantly more impaired on all measures. Similarity of PDD-NOS children to AD children in maladaptive behaviors and an intermediate position between autistic and non-autistic groups on virtually all measures explains the difficulty clinicians encounter in classifying children with PDD and raises questions about the specificity of these diagnostic subtypes of the autistic spectrum.

Autistic Disorder↗
PubMed2005

Generalized reduction of problem behavior of young children with autism: building trans-situational interventions.

The effects of functional communication training on the generalized reduction of problem behavior with three 4- to 5-year-old children with autism and problem behavior were evaluated. Participants were assessed in primary teaching settings and in three secondary, generalization settings. Through baseline analysis, lower effort interventions in the secondary settings were documented as ineffective when implemented alone. Higher effort interventions incorporating functional communication training were documented within a multiple baseline design to reduce problem behavior in the primary setting, but not in secondary settings until the lower effort interventions were re-introduced. Results demonstrate the need for trans-situational interventions based on a common functional assessment hypothesis across settings and including intensive interventions that enhance the effects of lower intensity interventions.

Autistic Disorder↗
PubMed1998

Integrating qualitative and quantitative methods in the study of developmental psychopathology in context.

Qualitative methods are well suited to advance the understanding of the role of social context in the development of maladaptation and psychopathology. However, they have not been widely used by developmental psychopathologists, despite being utilized in related fields, particularly in the sociological study of crime and delinquency. This article assesses the potential for the increased use of qualitative methods in developmental psychopathology and addresses the challenges involved in integrating them with quantitative research strategies. The interplay of qualitative and quantitative methods in the study of juvenile delinquency is reviewed for relevant lessons about both the utility and the difficulties of integrating the two types of methods. The problem of assessing continuities and discontinuities over the life course in patterns of antisocial behavior is discussed as an example of the challenge of integrating methodological paradigms. Schools of thought about qualitative methods and their relationship to quantitative research paradigms are identified and compared. Examples are discussed of narrative life history interviewing and qualitative observational techniques and of recent research endeavors integrating these qualitative techniques with quantitative data analyses.

Adaptation, Psychological↗
PubMed1998

Pathways of risk for accelerated heavy alcohol use among adolescent children of alcoholic parents.

The current study examined two questions. First, do internalizing symptoms and externalizing behavior each mediate the relations between parent psychopathology (alcoholism, antisocial personality disorder, and affective disorder) and growth in adolescent heavy alcohol use? Second, are there gender differences in these mediated pathways? Using latent curve analyses, we examined these questions in a high-risk sample of 439 families (53% children of alcoholic parents; 47% female). Collapsing across gender, adolescent-reported externalizing behavior mediated both the relation between parent alcoholism and growth in heavy alcohol use and the relation between parent antisociality and growth in heavy alcohol use. Parent-reported externalizing behavior only mediated the relation between parent antisociality and growth in heavy alcohol use in males. No support was found for internalizing symptoms as a mediator of these relations. Avenues are suggested for further exploring and integrating information about different mediating processes accounting for children of alcoholics' risk for heavy alcohol use.

Adolescent↗
PubMed1990

Siblings of autistic children: their adjustment and performance at home and in school.

The research examined the adjustment of siblings of autistic children. The relationship between sex and family size of the siblings and the sibling's performance on achievement, self-concept, home behavior, and school behavior was examined. Six 2 x 2 analyses of variance were completed. Results indicated that there was little variance as a function of sex or family size. Overall the sibling's performance was not suggestive of needing special intervention. These results are discussed in terms of how they relate to previous findings and implications for clinical intervention and future research.

Achievement↗
PubMed1999

Identification of attentional and hyperactivity problems in primary care: a report from pediatric research in office settings and the ambulatory sentinel practice network.

OBJECTIVES: To 1) determine the frequency of identification of attentional and hyperactivity problems (AHPs) by clinicians, and 2) examine whether minority children or children from less well-educated, lower-income, or lower-functioning families would be more likely to be identified as having AHPs. DESIGN: Prospective cohort study of 22 059 consecutive children 4 to 15 years of age being seen for acute, chronic, and health supervision visits. SETTING: Practices of 401 pediatric and family practice clinicians in 44 states, Puerto Rico, and 4 Canadian provinces. METHODS: Parent questionnaires included demographic information and the Pediatric Symptom Checklist. Clinician questionnaires categorized psychosocial problems and addressed how assessment of problems was made. Analyses compared children with newly identified AHPs with those with other newly identified psychosocial problems. RESULTS: Clinicians identified behavior problems in 18.7% of children, with 9.2% of the entire sample identified as having AHPs. Among those with newly assessed AHPs, clinicians identified minority children and those from low-income or poorly functioning families as having AHPs at the same rate as other children. However, even after controlling for symptoms, males were more likely than females (odds ratio, 2.81) to be identified as having AHPs. Older clinicians were significantly more likely to identify children as having AHPs (odds ratio, 2.09). In assessing AHPs, clinicians used standardized tools such as behavioral questionnaires for only 36.9% of children, and Diagnostic and Statistical Manual criteria for 38.3% of children. CONCLUSIONS: AHPs are highly prevalent in primary care practice. Clinicians do not appear predisposed to label children from disadvantaged backgrounds as having AHPs. Primary care assessment of AHPs lacks standardization.

Adolescent↗
PubMed1993

Lack of cognitive impairment in first-degree relatives of children with pervasive developmental disorders.

OBJECTIVE: The objective of this study was to test the hypothesis that mild cognitive impairments aggregate in the unaffected first-degree relatives of probands with autism or pervasive developmental disorders (PDD). METHOD: The unaffected siblings and parents of 52 PDD probands and 33 Down syndrome and low birth weight controls were administered a battery of psychometric tests. The tests included measures previously found to be depressed in siblings of autistic children as well as cognitive deficits seen in PDD subjects of normal IQ. In addition, the Vineland Adaptive Behavior Scales were administered to siblings to measure the social-communication impairments found in PDD. RESULTS: Neither the siblings nor parents of the PDD probands demonstrated lower cognitive or adaptive behavior scores compared with controls. Developmental histories did not reveal greater rates of social, cognitive, or language delays, nor was there evidence to suggest that relatives of subgroups of PDD probands were different from each other. CONCLUSION: These findings indicate that, apart from relatives with PDD, cognitive and social impairments do not aggregate in the families of PDD probands.

Adolescent↗
PubMed2002

Double-blind placebo-controlled trial of secretin: effects on aberrant behavior in children with autism.

Secretin has been proposed as a treatment alternative for autistic spectrum disorders, but empirical support is lacking. A double-blind placebo-controlled study examined the effect of a single dose of synthetic human secretin on aberrant behavior. Parent and teacher data from the Aberrant Behavior Checklist for eight male children were analyzed for reliable change in a clinical replication series. By parent and teacher report, the majority of change occurred either on the placebo trial or reflected deterioration subsequent to secretin infusion. Repeated-measures multivariate analysis of variance results were similar. Results are consistent with other studies, suggesting that secretin may not be an effective treatment option.

Autistic Disorder↗
PubMed2000

Review: cognitive and psychological outcomes in pediatric heart transplantation.

OBJECTIVE: To review empirical literature investigating the cognitive and psychological effects of pediatric heart transplantation. METHODS: Electronic and library searches were used to identify empirical studies examining the cognitive and psychological effects of pediatric heart transplantation. Only studies investigating cognitive or psychological outcomes, either prospectively or cross-sectionally, were reviewed. RESULTS: Preliminary findings suggest that children and adolescents generally functioned within the normal range on most measures of cognitive functioning post-transplant. However, a complicated transplant course caused by infections or rejections may place these recipients at increased risk for cognitive difficulties post-transplant. Studies also suggested that approximately 20%-24% of pediatric heart transplant recipients experienced significant symptoms of psychological distress (e.g., anxiety, depression, behavior problems) during the first year post-transplant. CONCLUSIONS: Research suggests that some recipients are at risk for cognitive and psychological difficulties post-transplant and may require additional academic remediation and/or psychological intervention to address these challenges. Given the limited number of empirical studies available at this time, continued research investigating cognitive and psychological outcomes following pediatric heart transplantation is needed.

Anxiety Disorders↗
PubMed2006

The River Street Autism Program: a case study of a regional service center behavioral intervention program.

An urgent demand from Connecticut parents for behavioral intervention resulted in the development of the River Street Autism Program (RSAP). This research-to-practice program implements intervention service based on empirical research findings conducted with children diagnosed with autism and pervasive developmental disorders. RSAP is provided through a regional service center and provides services for children entering the program at 2 to 5 years old. Because of the diverse nature of the districts served by RSAP, the delivered services varied according to the needs of the districts, available funding, and family preferences. Program evaluation data were therefore examined with regard to outcomes for children who received programs with differing numbers of treatment components. Treatment components that varied across children were treatment intensity, duration, extent of family participation, staff training, and supervision. Outcome data revealed that families reported greater gains in child functioning and quality of life when children received programs with more treatment components.

Autistic Disorder↗
PubMed2006

Executive functions: a discussion of the issues facing children with autism spectrum disorders and related disorders.

The interest and attention devoted to executive functions has grown steadily in the last several decades. The concept and definitions of executive functions and their association with certain disorders such as autism spectrum disorders (ASD) and overall cognitive, social, emotional, and behavioral functioning are important knowledge areas for those working in education, health, and mental health-related fields. It is particularly important for providers to have an understanding of the basic issues related to assessment and remediation of executive dysfunction. This article briefly addresses the background, current definitions, research, and some intervention options associated with executive functions. The intent is to present a foundation for encouraging additional research on the issues relevant to this important topic.

Autistic Disorder↗
PubMed1995

Asperger's syndrome and autism: differences in behavior, cognition, and adaptive functioning.

OBJECTIVE: To determine whether subtypes of children with pervasive developmental disorder (PDD) differed on variables that were relatively independent of distinguishing criteria. METHOD: Higher-functioning children with PDD, 4 through 6 years of age, were differentiated into those with autism (n = 47) and those with Asperger's syndrome (n = 21) on the basis of delayed and deviant language development. The groups were then compared on a wide range of measures including PDD symptoms, adaptive behaviors in communication, socialization, and activities of daily living, and an assessment of verbal and nonverbal cognitive skills. RESULTS: Significant differences between the groups existed on many PDD symptoms, adaptive behaviors, and cognitive measures of language competence, but not on aspects of nonverbal communication, nonverbal cognition, or motor development. CONCLUSION: Subtypes of children with PDD can be identified that differ on variables relatively independent of defining characteristics. These findings should provide a firm foundation into research to determine whether children with autism and Asperger's syndrome also differ on outcome, etiology, and response to treatment.

Activities of Daily Living↗
PubMed2004

Choosing or being chosen by aggressive-disruptive peers: do they contribute to children's externalizing and internalizing problems?

The goal of this study was to investigate the extent to which aggressive-disruptive peers contribute to the development of externalizing and internalizing problems in children, while controlling for children's own behavior. We examined 2 sets of peers: (1) those that the child nominated as friends, and (2) those that nominated the child as a friend. The participants were 236 boys and girls attending 3rd to 5th grade at the beginning of the study, who were followed over a period of 2 years. Results showed that choosing more aggressive peers on the nomination procedure was associated with more externalizing problems and self-reported depressive symptomatology over time. On the other hand, being liked by more aggressive children generally was not associated with elevated externalizing or internalizing problems.

Aggression↗
PubMed2005

The CBCL predicts DSM bipolar disorder in children: a receiver operating characteristic curve analysis.

BACKGROUND: No clear consensus has been reached yet on how best to characterize children who suffer from pediatric bipolar disorder (PBD). The CBCL-PBD profile on the Child Behavior Checklist (CBCL) has been consistently reported showing deviant findings on the Attention Problems, Aggressive Behavior, and Anxious-Depressed subscales. AIM: To examine the sensitivity and specificity of the proposed CBCL-PBD profile for determining DSM diagnosis of PBD. METHODS: We applied receiver operating characteristic (ROC) curve analysis to data from 471 probands from two family studies of attention-deficit hyperactivity disorder and their 410 siblings. RESULTS: The CBCL-PBD score demonstrated an area under the curve (AUC) of 0.97 for probands and 0.82 for siblings for current diagnosis of PBD, suggesting that the CBCL-PBD provided a highly efficient way of identifying subjects with a current diagnosis of PBD in this sample. CONCLUSIONS: These findings suggest that the CBCL-PBD may provide a highly efficient way of screening for childhood bipolar disorder.

Adolescent↗
PubMed2000

Toward a developmental operational definition of autism.

Traditional approaches to diagnosing autism emphasize delays in communication and socialization. Traditional diagnostic schemes typically list symptoms (e.g., lack of eye contact), but provide little guidance on how to incorporate information about developmental level in making a diagnosis. Because standardized measures of adaptive behavior can provide information about children's communication, socialization, and other behavior relative to their age, they may be useful tools for diagnosing autism. This study investigated the ability of the Vineland Adaptive Behavior Scales to identify children with autism. Vineland scores and measures of intellectual functioning were obtained for children with autism, PDDNOS, and other developmental disorders (DD). Discriminant function analyses indicated that the autism and combined nonautism (PDDNOS and DD) groups could be differentiated on the basis of socialization, daily living skills, and serious maladaptive behaviors. Socialization alone accounted for 48% of the variance in diagnosis. Using regression analyses derived from a large normative sample, adaptive behavior scores were predicted from chronological age (CA) and mental age (MA). Socialization scores in the autism group were substantially below the level predicted from CA or MA. An index derived from the ratio of actual to predicted socialization scores correctly classified 86% of both autism and nonautism cases. Findings suggest that comparison of obtained Vineland socialization scores to those predicted by CA or MA may be useful in clarifying the diagnosis of autism.

Adaptation, Psychological↗
PubMed1988

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. The use of combined measures.

A two-stage epidemiologic survey was carried out on a probability sample of the population aged 4 through 16 years in Puerto Rico. The survey used the Child Behavior Checklist as a screening instrument, and prevalence rates were estimated on the basis of clinical diagnoses and other measures provided by child psychiatrists during the second stage. Maladjustment was operationally defined through the use of combined measures, including DSM-III diagnosis and a scale of functional impairment. Data were provided on the demographic correlates of maladjustment and on the comorbidity of DSM-III diagnostic domains. The prevalence rates obtained vis-à-vis the availability of mental health services on the island reflected a major public health problem.

Adjustment Disorders↗
PubMed2001

The behavioral phenotype in fragile X: symptoms of autism in very young children with fragile X syndrome, idiopathic autism, and other developmental disorders.

This study was designed to explore the behavioral phenotype of autism in a group of young children with fragile X syndrome (FXS). Twenty-four children with FXS, ages 21 to 48 months, were compared with two well-matched groups: 27 children with autism (AD) and 23 children with other developmental delays (DD), on two standardized autism instruments, as well as on measures of development and adaptive behavior. Two FXS subgroups emerged. One subgroup (n = 16) did not meet study criteria for autism. Their profiles on the autism instruments and the developmental instruments were virtually identical to the other DD group. The other FXS subgroup (n = 8, or 33% of the total FXS group) met study criteria for autism. Their profiles on the autism instruments were virtually identical to the group with autism. The finding of two FXS subgroups raises a hypothesis of additional genetic influences in the FXS autism group, warranting further genetic studies.

Autistic Disorder↗