Research Items (75)
- May 2018
Background Challenging behaviours are highly prevalent in children and adolescents with autism spectrum disorders (ASD), but little is known about the prevalence and course of these behaviours during adulthood. The aims of this study were to describe the topography of challenging behaviours in a cohort of 106 young adults with ASD and to identify the risk factors for challenging behaviours. Our secondary objective was to study the changes in challenging behaviours from adolescence to early adult years. Method The present study uses data from the EpiTED prospective follow‐up study in France. The presence of challenging behaviours was assessed by the Aberrant Behaviour Checklist (ABC) completed by parent informants. Several dimensions of behaviour were studied: irritability, stereotypy, lethargy, hyperactivity and self‐injury. Clinical variables were collected on ASD symptom severity, cognitive and language levels, adaptive behaviours and comorbid medical disorders. Results The presence of challenging behaviours at early adulthood was related to the young adult's cognitive and language level, ASD symptom severity and comorbid gastrointestinal and sleep disorders. The main risk factor for challenging behaviours was ASD symptom severity. The level of language impairment was a significant predictor of self‐injury. Gastrointestinal disorders were a significant predictor of stereotypy. The change in behaviour topography from adolescence to early adult years corresponded with decreased parent report of hyperactivity, but no significant decrease in parent reports of irritability, stereotypy, lethargy and self‐injurious behaviours. Conclusions The challenging behaviours in individuals with ASD persist in early adulthood and are related to core symptom severity, levels of cognitive and language impairments and medical comorbidity. The results emphasise the importance of early interventions for children with ASD to target cognitive and language abilities and to alleviate the severity of ASD symptoms. They also underscore the need to enhance opportunities for individuals with ASD to better communicate discomforts and pain in the context of medical illness.
- Jun 2017
The impact of ASD on parental QOL was evaluated in the EpiTED cohort study at early adulthood. Two-third of parents of young adults with ASD (66.7%) reported that their QoL was at least moderately altered. The perceived impact of ASD on parental QoL was related to the young adults' level of adaptive skills, as well as to symptom severity and the presence of challenging behaviors, which appeared to be the main risk factor. The study of change between adolescence and early adulthood showed that parents whose children had a decrease in challenging behaviors perceived a decreased impact on their QoL. These results argue for the importance to propose specific interventions to target associated challenging behaviors in ASD.
- May 2017
Background: The autism spectrum (AS) is a multifaceted neurodevelopmental variant associated with lifelong challenges. Despite the relevant importance of identifying AS in adults for epidemiological, public health, and quality of life issues, the measurement properties of the tools currently used to screen and diagnose adults without intellectual disabilities (ID) have not been assessed. Objectives: This systematic review addresses the accuracy, reliability, and validity of the reported AS screening and diagnostic tools used in adults without ID. Methods: Electronic databases and bibliographies were searched, and identified papers evaluated against inclusion criteria. The PRISMA statement was used for reporting the review. We evaluated the quality of the papers using the COSMIN Checklist for psychometric data, and QUADAS-2 for diagnostic data. For the COSMIN assessment, evidence was considered to be strong when several methodologically good articles, or one excellent article, reported consistent evidence for or against a measurement property. For the QUADAS ratings, evidence was considered to be "satisfactory" if at least one study was rated with a low risk of bias and low concern about applicability. Results: We included 38 articles comprising 32 studies, five reviews, and one book chapter and assessed nine tools (three diagnostic and six screening, including eight of their short versions). Among screening tools, only AQ-50, AQ-S, and RAADS-R and RAADS-14 were found to provide satisfactory or intermediate values for their psychometric properties, supported by strong or moderate evidence. Nevertheless, risks of bias and concerns on the applicability of these tools limit the evidence on their diagnostic properties. We found that none of the gold standard diagnostic tools used for children had satisfactory measurement properties. Conclusion: There is limited evidence for the measurement properties of the screening and diagnostic tools used for AS adults with a mean normal range of measured intelligence. This may lessen the validity of conclusions and public health decisions on an important fraction of the adult autistic population. This not only justifies further validation studies of screening and diagnostic tools for autistic adults, but also supports the parallel use of self-reported information and clinical expertise with these instruments during the diagnostic process.
- Feb 2017
Autism spectrum disorder (ASD) is defined as persistent deficits in social communication and social interaction, and restricted, repetitive patterns of behavior, interests or activities Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5; American Psychiatric Association, 2013). However, individuals with ASD show clearly atypical visual patterns. So far, indications of abnormal visual attention and oculomotor control concerning stimuli independent of social function in ASD have been found. The same findings have been shown in individuals suffering of other neurodevelopmental disorders (e.g., developmental coordination disorder and developmental dyslexia [DD]). Furthermore, visual attention processes and oculomotor control are supposed to be subserved by the magnocellular visual system, which has been found, in turn, to be dysfunctional in ASD and other neurodevelopmental disabilities (i.e., DD). The purpose of this article is to briefly review the link between oculomotor control and visual attention processes and ASD, and to discuss the specificity and overlap of eye movement findings between ASD and other neurodevelopmental disorders.
This study aims to broaden knowledge about pain expression and assessment in daily life situations in children with Autism Spectrum Disorder (ASD). The goals are to provide a description of the responses of the GED-DI, the French version of the NCCPC, and to test the internal structure validity of this scale. Thirty five children with ASD were included in this study (mean age = 58 months; mean developmental age = 32 months). The French version of the NCCPC was filled in by parents. Descriptive analysis of responses shows that children with ASD express pain through varied and common behaviours, related to different expressive markers (vocal, facial, activity, etc.). Behaviours more specific to the symptomology and disturbances of ASD are also displayed. A four-factor solution (negative emotional reaction, idiosyncratic expression, hyper-vigilance reaction, pain expression) emerges from an exploratory factor analysis that explains 54.4% of the total variance. Correlation coefficients show good psychometric qualities in terms of internal consistency, factorial validity and discriminant validity.
Autism spectrum disorder (ASD) is defined as persistent deficits in social communication and social interaction, and restricted, repetitive patterns of behavior, interests or activities (DSM-5; APA, 2013). However, individuals with ASD show clearly atypical visual patterns. So far, indications of abnormal visual attention and oculomotor control concerning stimuli independent of social function in ASD have been found. The same findings have been shown in individuals suffering of other neurodevelopmental disorders (e.g., developmental coordination disorder-DCD and developmental dyslexia-DD). Furthermore, visual attention processes and oculomotor control are supposed to be subserved by the magnocellular visual system, which has been found, in turn, to be dysfunctional in ASD and other neurodevelopmental disabilities (i.e. DD). The purpose of this paper is to briefly review the link between oculomotor control and visual-attention processes and autism spectrum disorder, and to discuss the specificity and overlap of eye movement findings between ASD and other neurodevelopmental disorders.
Anxiety disorders were long underestimated in children by healthcare professionals, but they are now better diagnosed. They account for the most frequent psychiatric diagnosis between 6 and 18 years of age, with differences in prevalence or risk factors related to the clinical forms. Different clinical subtypes of anxiety disorders are detailed in this article: separation anxiety, specific phobia, generalized anxiety, social anxiety, panic disorder, post-traumatic stress syndrome, and obsessional-compulsive disorder. The repercussions of anxiety are often major on the psychological, relational, and developmental dimensions, as well as academics. Refusing school for reasons of anxiety is one of the possible and severe consequences of anxiety disorders, possibly resulting in total removal from school and the risk of early and permanent cessation of schooling. Other frequent complications are depression, and substance abuse during adolescence, as well as chronification of the disorders until adulthood. Indeed, adults affected by anxiety disorders frequently place the onset of their disorders at the beginning of adolescence. It is therefore essential to diagnose these disorders as soon as possible to set up an adapted therapeutic strategy. The main first-line treatment currently recommended in the pediatric population is cognitive and behavioral therapy, the efficacy of which has been the most clearly demonstrated. Psychoactive drugs can be used as a complement in severe or resistant cases, mainly serotonin recapture inhibitors. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Les adolescents avec un trouble du spectre autistique sans déficience intellectuelle (TSA-SDI) ont une prévalence élevée de troubles anxieux (42 %). Par ailleurs, leur qualité de vie semble plus altérée que celle des sujets sans TSA. Nous pensons que les troubles anxieux pourraient être un facteur de risque d’altération de la qualité de vie dans cette population. Dans cette étude, la population est constituée de 66 adolescents âgés de 11 à 18 ans dont 46 avec un TSA-SDI (20 avec trouble anxieux et 26 sans trouble anxieux) et 20 témoins (avec troubles anxieux sans TSA). La qualité de vie, critère principal de jugement, a été mesurée dans cinq domaines à l’aide de l’échelle Kidscreen-27 (auto-questionnaire). L’anxiété a également été évaluée pour chaque sujet à l’aide d’outils validés et standardisés (KIDDIE-SADS et RCMAS-2). Les résultats montrent que tous les scores de qualité de vie sont significativement plus faibles que la moyenne dans le groupe avec TSA-SDI, que l’anxiété soit présente ou non. Ces scores sont significativement plus bas dans le groupe TSA-SDI anxieux par rapport au groupe TSA-SDI non anxieux dans le domaine « bien-être physique » uniquement. Par ailleurs, des questions se posent sur les limites d’une autoévaluation chez les sujets avec TSA, probablement en raison de leurs difficultés dans l’insight. Cette étude doit donc être complétée avec un échantillon plus grand, en couplant des procédures d’hétéro-évaluation afin de déterminer si les troubles anxieux sont un facteur de risque d’altération de la qualité de vie des sujets avec un TSA-SDI.
Résumé But de l’étude Dans la littérature, les travaux concernant l’efficacité des interventions à destination des enfants avec troubles du spectre autistique (TSA) portent principalement sur les approches comportementales intensives, et les études de cohorte réalisées dans des conditions plus écologiques sont encore peu fréquentes. Cette étude a pour objectif de décrire l’évolution des comportements adaptatifs d’une cohorte de jeunes enfants avec autisme. Patients et méthodes Cette étude prospective et multicentrique porte sur un échantillon de 77 enfants âgés de 3 à 5 ans. Les comportements adaptatifs, la durée hebdomadaire de prise en charge spécialisée et la durée hebdomadaire de scolarisation en milieu ordinaire sont recueillis tous les 3 mois sur une période de 12 mois. Résultats Les résultats indiquent que l’évolution des comportements adaptatifs est liée aux caractéristiques cliniques initiales des enfants, mais également à leurs durées de prise en charge. Ainsi, les enfants ayant bénéficié de davantage d’heures de scolarisation en milieu ordinaire connaissent une meilleure évolution dans le domaine de l’autonomie, alors que ceux qui ont bénéficié de davantage d’heures de prise en charge spécialisée (principalement en hôpital de jour) connaissent une meilleure évolution dans le domaine de la socialisation. Conclusion Ces résultats suggèrent l’influence des processus développementaux d’origine ontogénétique et celle des facteurs environnementaux relatifs à la prise en charge dans l’évolution des enfants. Ils témoignent de la nécessité de poursuivre la recherche sur l’efficacité des interventions au moyen d’études de suivi ou de cohorte.
- Mar 2016
- An Introduction to Pain and its Relation to Nervous System Disorders
People with autism spectrum disorders (ASD) are likely to experience pain in a large variety of contexts because of challenging behaviors, medical comorbidities or life conditions. The assessment and treatment of pain in people with ASD is for those reasons a major issue. In this chapter, studies regarding pain expression in people with ASD are reviewed. The results yield possible alterations of pain experience at several levels, namely the neurochemical, sensory and cognitive components of pain. Moreover, because of socio-communicative deficits, pain assessment is particularly challenging in this population and there is no specific assessment tool (self or proxy-report) for people with ASD at the moment. Studies also show that in this population and more generally in people with developmental disabilities, pain alleviation or management is still insufficient in current health care practice. The authors conclude that there is an urgent need to improve pain assessment and management in people with ASD, and to develop and adapt individualised tools and techniques in order to reduce anxiety and prevent challenging behaviors during painful medical procedures.
Autism Spectrum Disorder (ASD) is an etiologically and clinically heterogeneous group of neurodevelopmental conditions, characterized by impairments in communication, social interaction and restricted repetitive and stereotyped behaviors. Ehlers-Danlos Syndrome hypermobility-type (EDS-HT; also known as Joint Hypermobility Syndrome), is the most common hereditary disorder of the connective tissue. It is characterized by joint hypermobility and a wide range of articular and non-articular manifestations, including disturbances in different systems due to the widespread distribution of collagen in the body. The clinical presentations of ASD and EDS-HT share several similar features, and although literature that relates these two conditions is scarce, it suggests that a connective tissue disorder may contribute to autistic symptomatology. The present work reviews the similarities in the clinical presentation of both conditions. In addition, the case of a 12-year-old boy diagnosed with ASD in which autistic manifestations overlap and/or might be explained by the presence of EDS-HT is presented as illustration.
- Dec 2015
Résumé Objectif L’objectif de cette étude est d’évaluer les bénéfices de la participation à un groupe d’accompagnement parental sur le plan de la qualité de vie et du stress, chez des parents dont les enfants ont reçu récemment un diagnostic de TSA. Matériel et méthode Le programme comporte cinq séances d’une journée. Treize familles (18 parents au total) d’enfants âgés de moins de six ans y participent. Une évaluation avant et après le programme est effectuée à l’aide d’une échelle de qualité de vie (Par-DD-QoL) et de stress parental (PSI). Résultats Il est noté une diminution significative du score de stress parental à la fin du programme. Le score émotionnel de l’échelle de qualité de vie tend également à diminuer, alors que le score de vie quotidienne reste stable. La diminution du stress parental apparaît plus marquée chez les parents qui ont deux enfants que chez ceux n’ayant qu’un seul enfant. Conclusions Ces résultats suggèrent l’intérêt des programmes visant à accompagner les parents dans les suites immédiates de l’annonce du diagnostic de TSA et leur possible impact sur le stress parental.
- Apr 2015
Self-injurious behaviours (SIB) are highly prevalent in individuals with autism spectrum disorders (ASD) and have deleterious effects on the individual and their environment. The aim of this study was to examine SIB prevalence and associated features in a population of 152 adolescents with ASD and to determine risk factors for SIB. The present study uses a subset of data of a longitudinal follow-up of 152 children with ASD. The presence of a low or high level of self-injury was assessed at adolescence through the Aberrant Behaviour Checklist completed by parents. Clinical and social variables regarding severity of autism symptoms, psychological development, adaptive behaviours, parental quality of life and total intervention time were collected during childhood (mean age = 5 years, SD = 1.6) and at adolescence (mean age = 15 years, SD = 1.3). About 35.8% of adolescents with ASD in our sample displayed self-injury, which was frequently associated with other challenging behaviours and was related to severity of autism symptoms, adaptive skills, intellectual functioning and language level (P < 0.001). The main risk factor for SIB at adolescence was severity of autism symptoms (P = 0.04). Cognitive development during childhood was found to be a protective factor (P = 0.03) whereas at adolescence, the main protective factor was communicative abilities (P = 0.04). These data showed that SIB remained highly prevalent at adolescence and yielded risk and protective factors for developing SIB at this period of life. Limitations and perspectives for future research are discussed. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.
To the Editor, The heritable disorders of the connective tissue are a group of genetic disorders affecting connective tissue matrix proteins that classically include Marfan syndrome (MFS), Ehlers–Danlos Syndrome (EDS), benign joint hypermobility syndrome and osteogenesis imperfecta (Grahame 2000). As connective tissue is found throughout the body, the clinical manifestations of these disorders are varied, including disturbances in different systems (skeletal, ocular, cardiovascular, etc.). A common feature of the heritable disorders of the connective tissue is joint hypermobility (JH), which is a highly heritable condition characterized by an increased range of motion of the joints as a consequence of connective tissue involvement.We encountered a 7-year-old boy addressed by teachers due to school problems. His mother suffer from MFS such as his maternal grandmother who died by cardiac complications. Considering familial antecedents, his morphotype (long bone overgrowth), JH and ocular ...
- Oct 2014
Multidisciplinary cohort studies of children with autism spectrum disorders (ASD) followed from childhood to adulthood exist abroad but not in France. The objective of the ELENA French cohort is to study the developmental trajectories of children and adolescents with ASD and their risk or protective associated factors. This is an open, prospective and multicenter cohort study, including children and adolescents under 16 years of age with ASD recruited from services specialized in the assessment of developmental disorders. The patients will be monitored every 18 months for at least 36 months and during a maximum of 10 years. Clinical, social, environmental, and genetic data, as well as data relating to the parental quality of life will be collected. The primary endpoint will be the adaptive level in three domains of the Vineland II (communication, socialization and daily living skills). The secondary endpoints will be parental quality of life, comorbidities, interventions and severity of ASD. The inclusion of 1600 patients over a 10-year period is expected. This cohort should contribute to a better knowledge of the child developing an ASD, taking into account the physical, social and familial environment, the type of interventions and some genetic components. It should also lay the foundations for a national network of professionals working in the field of autism research by offering them a common tool for promoting translational studies. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
- Mar 2014
This study aims to identify Aberrant Behavioral (AB) patterns in adolescents with Autism Spectrum Disorders (ASD) and to examine if these patterns are associated to their adaptive behavior trajectories. The Aberrant Behavior Checklist (ABC) was used to assess problems behaviors in a sample of 152 adolescents with ASD, whose adaptive behavior trajectories were described based on the Vineland communication and socialization scores. Clustering analyses were performed to identify AB patterns and univariate analyses to evaluate the association between AB patterns and adaptive behavior trajectories. We identified four clusters or AB patterns: (1) low scores in the ABC four domains, (2) high scores in irritability and hyperactivity, (3) medium scores in the four domains, and (4) medium level of irritability and high scores in stereotypy, lethargy and hyperactivity. These patterns were significantly linked to the adolescents’ adaptive behavior trajectories. Most adolescents with a high trajectory (87%) were found in clusters 1 and 3, whereas adolescents with a low trajectory were equally distributed in the four clusters. Results suggest that while a high trajectory seems associated with a low level of AB, low trajectory is not necessarily associated with a high level of AB. Study limitations and clinical implications are discussed.
- Feb 2014
To study the impact of autism spectrum disorders (ASDs) on parental quality of life (QoL) at adolescence using the parental-developmental disorders-quality of life scale (Par-DD-QoL). One hundred and fifty-two mothers of adolescents with ASD completed Par-DD-QoL. This scale assesses the following dimensions: emotional, daily disturbance and global QoL. This cross-sectional study uses a subset of data collected at the final time of a follow-up study (EpiTED cohort). A polytomic regression identified an increase in aberrant behavior scores as the major independent risk factor for parental QoL. The identified protective factors were the increase in daily living, communication and object cognition scores and a higher number of siblings. Those results suggest that there is a negative effect of externalizing behaviors and a protective effect of adaptive skills, communication and object cognition on parental QoL. Study limitations and implications are discussed.
We examined the occurrence and timing of separation of parents raising children with Autism Spectrum Disorders followed over a 10-year period (n=119). We also compared the clinical characteristics of children and sociodemographic variables between parents who remained as a couple versus parents who separated. The results showed that after 10 years of follow-up 74.8% of the couples remained together (n=89), representing a separation rate of 25.2%. This rate remained stable over the study period. There was no significant difference in any of the clinical and sociodemographic variables between comparison groups. Our results suggest that raising a child with autism does not often lead to the dissolution of the parents' relationship, as is commonly believed. The occurrence of parental separation in children with Autism Spectrum Disorders does not appear to vary according to their stage of life (childhood or adolescence). Lastly, the clinical profile of children and sociodemographic variables do not seem to influence the relationship status of parents.
- Oct 2013
There is a lack of knowledge about pain reactions in children with autism spectrum disorders (ASD), who have often been considered as insensitive to pain. The objective of this study was to describe the facial, behavioral and physiological reactions of children with ASD during venipuncture and to compare them to the reactions of children with an intellectual disability and nonimpaired control children. We also examined the relation between developmental age and pain reactions. The sample included 35 children with ASD, 32 children with an intellectual disability, and 36 nonimpaired children. The children were videotaped during venipuncture and their heart rate was recorded. Facial reactions were assessed using the Child Facial Coding System (CFCS) and behavioral reactions were scored using the Noncommunicating Children's Pain Checklist (NCCPC). A linear mixed-effects model showed that children's reactions increased between baseline and venipuncture and decreased between the end of venipuncture and the recovery period. There was no significant difference between groups regarding the amount of facial, behavioral and physiological reactions. However, behavioral reactions seemed to remain high in children with ASD after the end of the venipuncture, in contrast with children in the 2 other groups. Moreover, we observed a significant decrease in pain expression with age in nonimpaired children, but no such effect was found regarding children with ASD. The data reveal that children with ASD displayed a significant pain reaction in this situation and tend to recover more slowly after the painful experience. Improvement in pain assessment and management in this population is necessary.
- Feb 2013
High-functioning autism (HFA) is characterized by persistent impairment in social interaction despite the absence of mental retardation. Although an increasing number of group-based programs for the improvement of social skills have been described, randomized controlled trials are needed to evaluate their efficacy. To compare the effect of a Social Skills Training Group-based Program (SST-GP) and a Leisure Activities Group-based Program (LA-GP) on the perception of facial emotions and quality of life (QoL) in young people with HFA. Eligible patients were children and adolescents with HFA. Participants were randomized to the SST or LA group. The primary outcome was defined as an improvement of 2 points in error rates for facial emotion labeling (DANVA2) from baseline. After the 6-month training period, the SST Group made fewer errors in labeling anger on adult faces, whereas error rates in the LA Group remained stable. Progress in the ability to recognize anger in the SST Group was due to better recognition of low intensity stimuli on adult faces. QoL increased in the SST Group in the dimension of school environment, as a marker of the transfer of skills acquired in the treatment setting to their use in the community. The SST-GP had higher efficacy than the LA-GP. Data justify replication using larger samples.
AimThis study is a component of the “French Autism Plan 2008–2010”. Its objective is to describe intervention and care practices proposed to people with pervasive developmental disorders (PDD) in three French regions (Île-de-France, Franche-Comté, Nord-Pas-de-Calais).Method Data were collected by a questionnaire adapted mailed to special education and health care services in three regions (quantitative data) and semi-structured interviews from a sample of professionals (qualitative data). A total of 254 questionnaires (163 from services for children and adolescents, 91 from services for adults) and 48 interviews (21 for children and adolescents, 27 for adults) were analyzed.ResultsIntervention and care practices described often lack of specificity and are not enough adapted to people with PDD, particularly in adults’ services. An improvement of practices is nevertheless evidenced, with the development of interventions centered on the development of communication or daily living skills and procedures to manage challenging behaviors, yet not generalized. Important efforts are made regarding training and partnership with ordinary settings. Professionals also wish to better take into account the person's and his family's point of view in the individualized program.Conclusion This study emphasizes lacks and improvement in intervention and care practices for people with PDD in France, and those data might be a useful basis to study the practices’ evolution in the future.
We examined the occurrence and timing of separation of parents raising children with Autism Spectrum Disorders followed over a 10-year period (n=119). We also compared the clinical characteristics of children and sociodemographic variables between parents who remained as a couple versus parents who separated. The results showed that after 10 years of follow-up 74.8 % of the couples remained together (n=89), representing a separation rate of 25.2 %. This rate remained stable over the study period. There was no significant difference in any of the clinical and sociodemographic variables between comparison groups. Our results suggest that raising a child with autism does not often lead to the dissolution of the parents’ relationship, as is commonly believed. The occurrence of parental separation in children with Autism Spectrum Disorders does not appear to vary according to their stage of life (childhood or adolescence). Lastly, the clinical profile of children and sociodemographic variables do not seem to influence the relationship status of parents.
- Oct 2012
This study focused on parents' satisfaction with the special education and care services proposed to their child with autism spectrum disorders (ASD). Data were collected in three regions of France, using a questionnaire designed for the purpose of this study. Among the 530 families contacted, 212 filled in the questionnaire (response rate = 40.8%). Results showed that parents were globally satisfied with providers' involvement and motivation, but they felt they were not involved enough in their childfelt they were nots individualized program, that communication with providers was insufficient and that the services lacked ASD's specific tools and interventions. Among all families interviewed, parents of adolescents were the most unsatisfied and we hypothesized that this could be due to the specific issues regarding developmental changes and concern about the future at this period of life. Congruently with the literature, variables related to parental overall satisfaction were a regular communication with professionals, a specific, regularly updated individual program in which parents are associated, and specialized tools and interventions. The implications of these findings are discussed as well as future directions for clinicians to improve service delivery and allow the persons with ASD and their families to be more involved in the services.
Anxiety is highly prevalent in Pervasive Developmental Disorder (PDD) without mental retardation but is too often misdiagnosed. The authors suggest a critical review of current data of the PDD without mental retardation in children and adolescents, in order to summarize research published in this field. After describing specific features, this article tackles the issue of prevalence of anxiety among this population, then deals with present-time assessment and treatments of comorbid anxiety. This review was based on a systematic search of the main online databases (Science Direct, PsychInfo, Medline and Pubmed) in order to compile surveys published on Asperger syndrome and high-functioning autism-related anxiety among children and adolescents. This study focuses on papers published between 1995 and 2010, using strict diagnostic criteria for anxiety and PDD, and a controlled group, with the exception of pharmacological studies because none are controlled. We found seven studies assessing the prevalence of anxiety among children and adolescents with PDD, four assessment tools and 12 treatments. Anxiety disorders were shown in 42% of children and adolescents with PDD without mental retardation. This disorder is related to age and level of cognitive functioning and is likely to affect PDD without mental retardation as children and adolescents with anxiety disorder without PDD. This review highlights a major problem: assessment of anxiety in PDD without mental retardation. Actually, only two PDD adapted instruments have been found: the Autism Co-Morbidity Interview Present and Lifetime Version (ACI-PI) and the Stress Survey Schedule (SSS) for persons with autism. Such tools being methodologically limited, the diagnosis of anxiety disorder is all the more difficult to establish. Consequently, considering suitable treatment is not always proposed. Recent surveys show how profitable pharmacological treatment and behavioral intervention like Cognitive-Behavior Therapy (CBT) or psychosocial treatments are. However, important methodological limitations are evoked: there is no control study assessing the efficiency of a pharmacological treatment in Asperger syndrome and high-functioning autism. Besides, the research on how profitable cognitive and behavioral treatment is, gives heterogeneous results. Finally, social skills' training does not treat anxiety disorder directly, but skills abilities that are the most important disabilities in PDD without mental retardation. Therefore, authors advocate adapting treatment in order to treat anxiety disorder. The research revealed an important need to create new assessment instruments suitable to PDD without mental retardation in order to facilitate the co-morbidity diagnosis. This survey also underlines the necessity to develop controlled research testing the efficiency of such treatments as pharmacological ones, cognitive and behavioral therapies as well as social skills training.
L’anxiété est un trouble associé très fréquent dans le trouble envahissant du développement sans retard mental (TED-SRM), mais demeure encore très souvent sous-diagnostiquée. Les auteurs proposent une lecture critique des données actuelles concernant l’anxiété chez les enfants et adolescents avec un TED-SRM. Après une description des particularités de cette population, cet article aborde dans un premier temps les études de prévalence de l’anxiété chez les personnes porteuses d’un TED-SRM, puis s’interroge dans un second temps sur la problématique de l’évaluation et des différents modes de prise en charge de l’anxiété. Cette revue de littérature a été effectuée à partir d’une recherche informatique sur les principales bases de données internationales et s’est limitée à la période 1995–2010. Les résultats montrent un besoin important de créer des outils d’évaluation adaptés à cette population pour faciliter le diagnostic de la comorbidité étudiée et soulignent également la nécessité de développer des recherches contrôlées testant l’efficacité des prises en charge telles que les traitements médicamenteux, les thérapies cognitives et comportementales (TCC) et les interventions pro-sociales.
Global Management of autistic people primarily requires behavioral and educational therapy. There is actually no psychopharmacological agent that is efficient on the core symptoms of autism, especially the social and communicative impairments.However psychotropic medications are widely prescribed in this population and as mush as 1 out 2 people with autism receives at least one medication. In this population, medications are mainly directed at the frequently associated behavioral symptoms such as aggression toward self or others, tantrums, hyperactivity, severe repetitive behaviors. The goal of this article is to provide a review of the existing controlled studies in this area. The presented studies aim the following therapeutic classes: atypical antipsychotics, selective serotonin reuptake inhibitors (SSRI), psychostimulants and antiepileptics. The studies and there mains results in terms of efficiency and safety are presented in tables. Atypical antipsychotics, especially risperidone and aripiprazole have been shown to be useful in the treatment of behavioral symptoms. SSRI seem to have limited interest for the management of repetitive behaviors. Stimulants can help in case of hyperactivity and attention deficit associated with Autism spectrum disorders. Antiepileptics show promising results, but the best indications for this class are not clear. For sleep disturbances, melatonin can be a safe and efficient option.Challenging behaviors requires careful investigation to understand their origin in order to provide the specific management. The first answer should be environmental and educational .Somatic or mental diseases should be carefully assessed.Medication use in this vulnerable population should carefully evaluate the benefit/risk balance. Medications should be prescribed at the minimum dose for the minimum duration.
Clinical work and prediction of development are closely linked in the practice of early detection, diagnosis and choice of modes of intervention in young children with autism. Variables are often defined in terms of risk factors or of development, and may refer to general or specific phenomena. The purpose of this paper was, using a generalized mixed model, to test ways of measuring development and its prediction regarding joint attention (that is to say, response to and initiation of joint attention) in children with autism. Over a period of one year, seventy-seven children were followed from the age of four and a half years upwards. The results show that it is possible to identify general risk factors, but much more difficult to pinpoint specific factors. In our current state of knowledge, prediction can only be of a global nature and therefore requires the use of general markers.
- Dec 2011
Cette recherche aborde au travers d’une étude de cas, la question du traitement des comportements de pica (ingestion de substances non comestibles et/ou consommation inappropriée de produites comestibles) résistants, observables chez un enfant porteur d’un syndrome de Pallister Killian associé à un autisme et à un retard mental profond. Les comportements de pica pouvant être envisagés comme remplissant des fonctions, nous avons procédé à une évaluation fonctionnelle, basée sur un recueil d’observations directes et indirectes. Suite à ces observations, nous avons pu élaborer quatre hypothèses fonctionnelles expliquant l’apparition ou le maintien de ces comportements : soulagement de douleurs dentaires ; compensation de carences en oligoéléments ; gestion de situations vécues comme stressantes ; autostimulations sensorielles. Sur cette base, nous avons ensuite développé une approche thérapeutique multimodale, qui a donné lieu à la disparition des troubles du comportement.
- Sep 2011
This study examines change in 152 children over an almost 10-year period (T1: 4.9 (± 1.3) years; T2: 8.1 (± 1.3) years; T3: 15(± 1.6) years) using a group-based, semi-parametric method in order to identify distinct developmental trajectories. Important deficits remain at adolescence in the adaptive abilities of children with Autism spectrum disorders, but changes in adaptive skills show two distinct growth rates. The univariate analysis reveals that low growth trajectories for both social and communication outcome are associated with the following characteristics at age 5: low cognitive and language skills, presence of epilepsy, and severity of autism. The multivariate analysis confirms that risk factors at age 5, were low language and severity of autism for both social and communication outcomes 10 years later, and that hours of early intervention was protective factor for communication.
- Jul 2011
Delays in language production in children with autism (ASD) are now well known. For parents and clinicians, the possibility of using the first vocal productions as prognostic indications has been tempting. However, such an approach implies questions of predictability and the development of language. To describe and analyze certain relationships between phonological and lexical development with the aim of determining a simple prognostic indicator, 60 children were observed twice, at 5 years of age (T1) and three years later (T2). Linguistic data were obtained in a semi-standardized situation (ADOS-G) and from parents (ADI-R, Item 19), and analyzed with CHILDES. At T1, the sample was distributed into a ‘verbal’ and a ‘non-verbal’ group. From T1 to T2, the sample replicated the four trajectories known from pathological development characterized by stability, progression and regression. A multiple regression analysis for predicting morpheme production at T2 showed that two general markers (CARS and DLS, being ‘risk factors’) and one specific marker (phoneme production, a ‘protection’ factor) were significantly related to lexical development.
Children with high functioning autism (HFA) is a pervasive developmental disorder without mental retardation with an important social skills deficit. The literature suggested that interventions targeting prosocial development of social skills could have a positive impact.
AimTo discuss the methodology of a descriptive study of intervention and care practices proposed to people with pervasive developmental disorders (PDD). This study is a component of the “French Autism Plan 2008–2010”.
The study aims were to identify developmental trajectories of young children with autism and investigate their prognostic factors. The participants were 208 children, assessed first at the age of 5 years, followed longitudinally, and reassessed 3 years later. The children's clinical characteristics and the interventions received were recorded. The results indicated two distinct outcome groups with more stability than change. When changes did occur, they pertained to symptom severity (which decreased) and speech level and adaptive behavior (which improved). A logistic regression analysis pointed out two main risk factors (symptom severity and speech level) and two main protection factors (communication skills and person-related cognition). Surprisingly, the amount of intervention (in terms of number of hours) was not related to outcome.
The purpose of the present article was to assess the available literature concerning pain and autism. First, authors summarized the published articles on pain reactivity in people with autism. Second, the hypotheses envisaged to explain the presence of expressive particularities in people with autism spectrum disorders were reviewed; these included endogenous opioid excess theory, sensorial abnormalities and sociocommunicative deficit. Finally, the present review dealt with the tools available to assess and manage pain in people with autism. In conclusion, the authors revealed the need for more research to obtain more consensual data and provided some recommendations in this domain that were under exploited by the scientific community. From a clinical point of view, more knowledge about pain in people with autism should enable the development of specific assessment tools and, consequently, better pain management in daily care.
The purpose of the present article was to assess the available literature concerning pain and autism. First, authors summarized the published articles on pain reactivity in people with autism. Second, the hypotheses envisaged to explain the presence of expressive particularities in people with autism spectrum disorders were reviewed; these included endogenous opioid excess theory, sensorial abnormalities and sociocommunicative deficit. Finally, the present review dealt with the tools available to assess and manage pain in people with autism. In conclusion, the authors revealed the need for more research to obtain more consensual data and provided some recommendations in this domain that were underexploited by the scientific community. From a clinical point of view, more knowledge about pain in people with autism should enable the development of specific assessment tools and, consequently, better pain management in daily care.
- Jan 2009
It is well established that language development in children with autism is disturbed in a number of ways, and evidence is accumulating that their emerging linguistic skills may be related to interactive competences such as joint attention, imitation and certain aspects of play as has been found in normally developing children. The present study examined developmental changes in expressive language in relation to these variables in 132 children of the autistic spectrum aged 5–8 years using standardized tools for language measurement and psychological assessment. The results corroborated reports on relationships between expressive language level and joint attention, interpersonal communication with and without the use of objects, and play but contradicted data on the importance of imitation. Play and language level were found to be firmly related suggesting that children with autism draw more on “conceptual understanding” than “symbolizing ability”—a possible contributing factor to their language deficits. An evaluation of expressive language and interactive abilities of the entire sample corroborated evidence on developmental pathways and developmental psychopathology.
- Oct 2008
This study took place in the context of recent legislation enacted in several countries--including France--and aimed at promoting inclusion of children with intellectual disabilities. It focuses on young children with autism and examines the links between the children's characteristics and their weekly hours of regular-classroom inclusion and intervention in specialised setting. Standardised clinical and sociodemographic data were collected for 77 children with autism, along with data about their interventional programmes. The study showed that the number of hours of inclusion at school was influenced by the children's behavioural and adaptive characteristics, as well as by the socioprofessional category of their parents, although these factors did not affect the number of hours spent in specialised setting. Moreover, the total amount of time per week spent in interventional services of any kind was very small for some of the children. The time spent in special-intervention services and regular classrooms combined did not add up to an adequate number of weekly hours for these children, particularly those exhibiting at least one of the following characteristics: low adaptation level, major behavioural problems or low socioprofessional category of parents.
- Jun 2008
Although Asperger syndrome is described by international classifications as a category of pervasive developmental disorder (PDD), its validity as a specific entity distinct from autistic disorders remains controversial. The syndrome, first described by Hans Asperger, could not be distinguished from high functioning autism (onset, symptoms, outcome...). However, international classifications propose a distinction between the two syndromes based on a delayed onset, the absence of speech delay, the presence of motor disorders and a better outcome in Asperger syndrome. This categorical differentiation is not confirmed by current studies and in the absence of biological markers, no clinical, neuropsychological or epidemiological criteria makes it possible to distinguish high functioning autism from Asperger syndrome. From a clinical perspective, it is nevertheless of interest to isolate Asperger syndrome from other autistic disorders to propose specific assessment and therapy.
SummaryBackground: Very few studies have been conducted on the impact of autistic problems on family quality of life. There are only studies on the stress of these families, the results of which are used to estimate the impact of autism on their quality of life.Aim: Study the impact of the weekly treatment recommended to autistic children on their parents’ quality of life.Methods: Our sample was composed of 77 young autistic children without significant mental retardation. The weekly treatments were monitored for each child over a one-year period. At the beginning and end of the study, parents filled in a questionnaire on the impact of autism on their quality of life (Par-DD-Qol).Results: It was difficult to reveal a significant effect of the children’s treatment duration on the family’s quality of life, even if some differences were observed between fathers and mothers. It was also noted that improvement in how the quality of life was perceived was not linked to treatment changes.Conclusion: There is apparently a positive emotional effect from any extra-familial time spent in group treatment.Prat Organ Soins 2008;39(1):53-60
- Sep 2007
For many years, and especially since Waynbaum and Wallon, psychology and psychopathology have dealt with cognitive perception, but have had little to do with the affective qualities of perception. Our aim was to study the influence of the sensory environment on people with autism. Several experiments were carried out using different forms of tactile stimulation (passive and active subjects). Our data showed specific responses in children with autism and intellectual disability. These children displayed a strong (positive) valence to the stimulation provided. They were very attracted to the stimulation and were excited by it.
- Aug 2007
Aim To explore the factors related to the outcome of self-injurious behaviour (SIB) in children with pervasive developmental disorders (PDD). Method Children with PDD were assessed on individual and environmental variables at time 1 and 3 years later. A questionnaire about the presence or absence of SIB was also administered at both times in order to examine the early course of SIB. Results Our findings suggest an association between a negative outcome and several aspects of the children’s behaviour. Children with a negative outcome differed from the others in having greater speech impairment, more cognitive and adaptive deficits, and more severe signs of autism. When these variables were entered into a multivariate model for predicting the outcome of SIB, only speech deficits (ORa 3.5, CI 95% 1.13–13.4) and autism severity (ORa 1.1, CI 95% 1.03–1.18) were significant risk factors. Discussion The importance of these findings for improving our understanding of SIB is discussed.
- Jun 2007
To describe the psychological development of children with pervasive developmental disorders over a period of 3 years and to identify the factors linked to their developmental paths. The study was a collaborative and prospective follow-up study of 219 preschoolers. Retrospective data and enrollment data were collected at the beginning of the study and 3 years later. We observed high variability in the short-term outcomes of preschoolers. In line with previous research, our results showed that intellectual, linguistic and adaptive functioning were useful for predicting outcome. The severity of a child's autistic symptoms appears to be related to his or her future development. These variables can therefore be used as predictors of outcome for preschoolers with autism. Developmental and symptom changes in young children with autism should not be overlooked and need to be assessed regularly in view of choosing suitable servicing programs.
- Mar 2007
This longitudinal study assessed multidisciplinary data on 219 children with autistic spectrum disorders from the median age of 5 (Time 1) to 8 years old (Time 2). The evolution of psychological and adaptive data was subjected to cluster analysis. Four clinically meaningful clusters emerged. The first group (21%) demonstrated the most important psychological transformations between the two times of the research. The second group (24%) made progress but less than group 1. The third and biggest group (30%) kept the same developmental slope. The fourth group (25%) showed no significant evolution between the two times of the research. This study highlights important differences among children with autism and the necessity of using a developmental view when considering the autistic syndrome.
- Oct 2006
Historically, the relationship between psychiatry and the mental handicap were organized around intellectual disabilities which were first considered as an alienation, then like as a maladjustment having to be treated. Education and therapeutic were generally considered in reciprocal exclusion or subordination one compared to the other in a competing delimitation of the professional categories. These oppositions were underlain by theoretical concepts, but also by economic considerations in contradiction with the stated principles. The major changes between the Law of 1975 “in favor of the people with a handicap” and the Law of 2005 on “the Right and Equal opportunity”, translation of the evolution of our society, imply adaptations of the functions and roles of the professionals whose width is not measured yet.
- May 2006
Autism is the best defined category among PDD. Its high prevalence, its onset in very young children and its persistence in adulthood arise many questions about early screening and early diagnosis. The aim of the study was to identify professional best practices about screening and diagnosis of autism in order to propose clinical guidelines and actions for the future. Scientific experts and parents take part to this procedure. Literature and previous guidelines were analyzed, experts in various fields were interviewed, a national study about the medical practices of the diagnosis of autism was made and questionnaires were send to 1600 psychiatrists and pediatricians. Guidelines built around 2 levels were proposed about screening and diagnosis. CONCLUSION: Diagnosis needs a multidisciplinary approach, validated instruments and more communication between professionals and parents. Finally one of the more important aims of the diagnosis of autism is to facilitate intervention program.
- Apr 2006
Autism is the best defined category among PDD. Its high prevalence, its onset in very young children and its persistence in adulthood arise many questions about early screening and early diagnosis. The aim of the study was to identify professional best practices about screening and diagnosis of autism in order to propose clinical guidelines and actions for the future. Scientific experts and parents take part to this procedure. Literature and previous guidelines were analyzed, experts in various fields were interviewed, a national study about the medical practices of the diagnosis of autism was made and questionnaires were send to 1600 psychiatrists and pediatricians. Guidelines built around 2 levels were proposed about screening and diagnosis.Conclusion. – Diagnosis needs a multidisciplinary approach, validated instruments and more communication between professionals and parents. Finally one of the more important aims of the diagnosis of autism is to facilitate intervention program.
- Jul 2005
Mental retardation is defined now by attitudes based on a mental deficiency associated with a social unskill. In the current classification (DSM IV-TR, 2003) it is located in Axis II, the axis dealing with permanent 'personality disorders'. The autistic syndrome is located in Axis I, the axis that tackles mental disorders occurring at childhood. It is therefore a developmental syndrome whose symptoms may undergo a considerable change during the ontogenesis. The association of the mental retardation with the autistic syndrome is worth studying. The cognitive and adaptive system of 210 children with autism was assessed. The assessment first focused on children at 5 (median age) then on children at 8 (median age). The cluster analysis show that the children may be divided into four groups - between these two periods the psychological evolutions of the four groups are completely different. The association of mental retardation with autism changes a lot in the four groups (the mental retardation was defined in terms of intensity). The results are commented on from the viewpoint of developmental psychology and they raise the issue of « a transitional mental retardation ».
The Pervasive Developmental Disorders complications can lead to an important life long handicap. There is an important literature about autism, but in most cases, specifically concerning children and adolescents problems. We wished to focus our attention on adults, in order to describe, on one hand their socio-adaptive profile, and on the other hand, the necessity to resort to a psycho-active treatment. The geographic zone chosen in order to carry out this, was Languedoc-Roussillon, and the applied method was a descriptive study of psychotropic use in the 20-35 age adults with autism. The instruments used were standardized and validated. The diagnosis was confirmed using ICD 10 criteria checklist and individual characteristics including adaptive profile estimated on the Vineland scale, were collected. Moreover the prescriber's global impressions were collected on the CGI scale. Out of 165 case files collected, the sex-ratio was 3 men for 2 women, 45 % showed associated somatic disorders (of which 24 % epileptic), 66 % benefited from a psycho-active treatment ; 85 % had been admitted in institutions during childhood or adolescence. The admittance framework being respectfully, MAS 21.8 %, community homes 35.2 %, CAT 17.6 % and psychiatric services 20.6 %. Mean equivalent age, in the three Vineland adaptive domains, were from 21 months in Communication to 43 months in Autonomy in daily life Skills and 17 months in Socialization. The development quotient showed adaptive retardation in 100 % of cases. The 110 persons benefiting from a medicinal treatment, were treated for aggressiveness in 62.7 % of cases, agitation in 43.6 % of cases and anxiety in 48.2 % of cases. The therapeutic categories used were, in majority, antipsychotics in 85 % of cases, anxiolitics in 40.2 % of cases ; hypnotics as well as anti-depressants or mood-regulators, each representing 10 % of prescriptions. Associations of several molecules representing 83 % of cases. The therapeutic effect was considered interesting in more than two-thirds of cases. Undesirable side-effects were reported in 50 % of the patients under treatment ; 50 % of the persons treated had been administered the same treatment for more than 5 years. The adaptive-profile significantly varied, depending on the accommodation structures and also the presence or absence of a psycho-active treatment. The results of this study portrayed the level of social adaptation and the types of psychoactive treatment in adults with autism, who are severely limited in their adaptive functioning due to their handicaps.
The age of detection of autism varies and may be linked to differences in the severity of disturbance and any associated retardation. Symptom intensity, overall language level, age of recognition of first disturbances and level of psychological development were examined in 222 children with pervasive developmental disorder with a mean age of 5 years. Results showed a positive correlation between language level and psychological development as well as between language level and intensity of symptoms. The central position of language in psychological development is discussed.
- May 2005
The Pervasive Developmental Disorders complications can lead to an important life long handicap. There is an important literature about autism, but in most cases, specifically concerning children and adolescents problems. We wished to focus our attention on adults, in order to describe, on one hand their socio-adaptive profile, and on the other hand, the necessity to resort to a psycho-active treatment. The geographic zone chosen in order to carry out this, was Languedoc-Roussillon, and the applied method was a descriptive study of psychotropic use in the 20-35 age adults with autism. The instruments used were standardized and validated. The diagnosis was confirmed using ICD 10 criteria checklist and individual characteristics including adaptive profile estimated on the Vineland scale, were collected. Moreover the prescriber's global impressions were collected on the CGI scale. Out of 165 case files collected, the sex-ratio was 3 men for 2 women, 45% showed associated somatic disorders (of which 24% epileptic), 66% -benefited from a psycho-active treatment; 85% had been admitted in institutions during childhood or adolescence. The admittance framework being respectfully, MAS 21.8%, community homes 35.2%, CAT 17.6% and psychiatric services 20.6%. Mean equivalent age, in the three Vineland adaptive domains, were from 21 months in Communication to 43 months in Autonomy in daily life Skills and 17 months in Socialization. The development quotient showed adaptive retardation in 100% of cases. The 110 persons benefiting from a medicinal treatment, were treated for aggressiveness in 62.7% of cases, agitation in 43.6% of cases and anxiety in 48.2% of cases. The therapeutic categories used were, in majority, antipsychotics in 85% of cases, anxiolitics in 40.2% of cases; hypnotics as well as anti-depressants or mood-regulators, each representing 10% of prescriptions. Associations of several molecules representing 83% of cases. The therapeutic effect was considered interesting in more than two-thirds of cases. Undesirable side-effects were reported in 50% of the patients under treatment; 50% of the persons treated had been administered the same treatment for more than 5 years. The adaptive-profile significantly varied, depending on the accommodation structures and also the presence or absence of a psycho-active treatment. The results of this study portrayed the level of social adaptation and the types of psychoactive treatment in adults with autism, who are severely limited in their adaptive functioning due to their handicaps.
Stability and change of mental retardation by young children with autistic disorders Mental retardation is defined now by attitudes based on a mental deficiency associated with a social unskill. In the current classification (DSM IV-TR, 2003) it is located in Axis II, the axis dealing with permanent ‘personality disorders’. The autistic syndrome is located in Axis I, the axis that tackles mental disorders occurring at childhood. It is therefore a developmental syndrome whose symptoms may undergo a considerable change during the ontogenesis. The association of the mental retardation with the autistic syndrome is worth studying. The cognitive and adaptive system of 210 children with autism was assessed. The assessment first focused on children at 5 (median age) then on children at 8 (median age). The cluster analysis show that the children may be divided into four groups – between these two periods the psychological evolutions of the four groups are completely different. The association of mental retardation with autism changes a lot in the four groups (the mental retardation was defined in terms of intensity). The results are commented on from the viewpoint of developmental psychology and they raise the issue of « a transitional mental retardation ».
- Sep 2004
This study focuses on the organization of the socio-cognitive skills and abilities of autistic children under 7 years of age. The psychological development of 193 children with autism was assessed in five functional areas: object-related cognitions, person-related cognitions, mastery of social communication tools, daily living skills, and degree of socialization. Two very contrasting groups of children were constituted by crossing three variables: developmental age, presence or lack of linguistic activity, and disorder severity. A “low severity autism” group (n = 44; CA = 60 months and DA = 39 months) and a “high severity autism” group (n = 36; CA = 63 months and DA = 15 months) were compared to two control groups of typical children. Control groups were assessed in the same functional areas as autistic children: a group with a CA of 40 months (n = 46) and a group with a CA of 15 months (n = 52). The autistic children of the “low severity” group and the typical children, aged 40 months are characterized by an “undifferentiated organization”. Factor analyses highlight for each of these two groups one general factor. The two other groups (autistic children of the “high severity” group and typical children, aged 15 months) are characterized by a differentiation of their skills; factor analyses highlight for each of these groups a bifactorial structure. These results allow a distinction to be made between a developmental differentiation and an autistic dissociation.
- Jan 2004
Autism is now thought to be present right from birth. Although usually not officially diagnosed until after the child’s second birthday, parents often report disturbances before then. The age of detection of disturbances varies and may be linked to differences in the severity of the autism and its associated retardation. This study evaluates the developmental characteristics of 193 children with pervasive developmental disorder, using the same standard procedures for all subjects. Our goal was to determine the relationship between age of parental recognition of disturbances and disorder severity. The results indicated mainly a link between early abnormalities, associated medical condition and severity measured on cognitive tests. They suggest systematic screening for signs of autism in very young children.
- Dec 2003
The aim of this study was to identify risk factors for self-injurious behaviours (SIBs) in children with autistic disorders. The occurrence of SIB was examined in comparison with the following variables: chronological age, sex, adaptive skills, speech level, associated medical condition, degree of autism and parental social class. The subjects were 222 children aged under 7 years and all of them fulfilled the ICD-10 criteria for infantile autism. Retrospective data were collected on demographic characteristics and medical condition. Children were assessed in terms of speech, degree of autism and adaptive skills in communication, socialization and daily living skills domains. Results indicated that 50% of the children experienced SIB and 14.6% had severe SIBs. Lower chronological age, associated perinatal condition, a higher degree of autism and a higher daily living skills delay were risk factors of SIBs but parental class, sex and epilepsy were not.
- Jul 2003
Autism is now thought to be present right from birth. Although usually not officially diagnosed until after the child's second birthday, parents often report disturbances before then. The age of detection of disturbances varies and may be linked to differences in the severity of the autism and its associated retardation. This study evaluates the developmental characteristics of 193 children with pervasive developmental disorder, using the same standard procedures for all subjects. Our goal was to determine the relationship between age of parental recognition of disturbances and disorder severity. The results indicated mainly a link between early abnormalities, associated medical condition and severity measured on cognitive tests. They suggest systematic screening for signs of autism in very young children.
- May 2002
Autism is an early developmental disorder. It leads to severe and durable disturbances. Given this problem, no treatment can be excluded a priori. Thus, many approaches are used to deal with autistic disorders. In France, pharmacological treatments are, for instance, largely and mostly used in adults. In the USA, these treatments concern 50% of persons with autism of any age. Nevertheless, they are rarely based on controlled studies. At the present, however, prescriptions and expected effects appear to be hard to localize. Furthermore, only few controlled studies validate their use. Aim - We offer a review of studies about medical treatments used in adolescents and adults with autism. They are classified in 3 categories: the first (category I) includes drugs used for their neurochemical effects focusing on autistic signs. The second (category II) covers drugs used for treatment of behavioural disorders frequently associated with autism. The third (category III) corresponds to a wide range of drugs or vitamins for wich only few case studies exist reporting irregular positive effects. The main hypothesis of this review is that autism involves a dysfunction of the neuromediation systems. This hypothesis opens new perspectives in the research of medical treatments in autism by focusing on molecules, which are supposed to have an effect on neuromediation systems. Method - Our review is based on studies, which have been published during the past twenty years. For many studies, data are limited to adolescents and adults. So we expanded our review to data available in children. The data bases that we have used are medline and psyclit. Keywords have been chosen according to: pharmacological considerations (psychotropic, psychoactive drugs, psychopharmacology) and clinical symptoms (autism, automutilations, aggressive behavior, and hyperactivity). Hypothesis of a dysfunction in the neuromediation systems in autism - Many studies exist about biochemical abnormalities in autism. As in schizophrenia and mental retardation, dysfunctions of the neuromediation systems are considered to be etiological factors. In 30% of people with autism the most regular dysfunction is the increase of serotonine. This led to the serotoninergic hypothesis in autism and to the use of active drugs in the serotonine system. However, the presence of other neurometabolic abnormalities also motivates the use of drugs, supposed to be active in other neuromediation systems. Pharmacological treatments in autism - Category I section sign 1 Active drugs in the dopamine system. Haloperidol (Dopamine antagonist): The effects of this molecule have been broadly studied in autism. Results indicate high efficiency in some symptoms of autism (lack in social behaviour, stereotypical behaviour) and in behavioural impairments that may be associated with autism (aggressive behaviour, hyperactivity). Its side effects, particulary the risk of late dyskinesy, make atypical antipsychotics preferable because of their lower risks. Risperidone (Dopamine and serotonine antagonist): Among several studies only few have been controlled. They indicate that Risperidone has positive effects on the behaviour and is quite well tolerated. section sign 2 Active drugs in the serotonine system. Clomipramine: after promising results, the medium-term efficiency has decreased and severe side effects have limited its use. Fluvoxamine, Fluoxétine, Sertraline (Specific serotonine drugs): Their efficiency has been mainly tested through open studies and their results are contrasted. In some cases, social behaviours have improved and aggressiveness and stereotyped behaviours have decreased. Fenfluramine: At present, this drug is removed from the market. Yet, some studies have suggested that it improves behavioural disturbances as well as performances in autism. section sign 3 Active drugs in the opiate system. Naltrexone: Several controlled studies have indicated an improvement in social and aggressive behaviours. Nevertheless, these studies have used small size sample and have not been replicated. Category II. This category correspond to drugs supposed to be active on neurochemical disturbances found in autism but their target symptoms are not autism specific signs as defined by the ICD 10. Buspirone: This serotonine agonist may have a good impact on emotional disorders and sleeping confusions. Methylphenidate: Most of the current studies about this noradrenergic drug concern children. The results are variable. Paradoxical effects may exist in children with severe mental retardation. Propanolol: Some isolated studies habe reported its efficiency on behavioural disturbances. Clonidine: This adrenergic drug treats efficiently some cases of aggressive behaviour and hyperactivity. Category III. This category contains a wide range of drugs, vitamins or method used in autism after sporadic observations of their positive effects. Secretine: An important improvement has been reported in isolated cases. However, controlled studies in children do not confirm these results. Vitamines B6, B12 and Magnesium: An improvement in socialization and in behavioural disorders have been reported in some cases, but these results are not yet confirmed. Lithium, Carbamazépine, Valproate: Results of some case studies have found it to be efficient in cyclic disorders. Gluten and casein free diet: An improvement of social behaviour have been reported by some parents after these diets. No controlled study has validated this observation. Conclusion - There is no consensus on the use of psychopharmacological treatments in autism. Although there exist many clinical observations, only few controlled studies have validated the efficiency and safety of these treatments. At the present time and until having sufficient studies, drugs are generally limited to severe disorders, for which usual psycho-educational approaches are insufficient.
Benefits and shortcomings of follow-up studies to measure developmental changes in children with autism This paper discusses the interests and the limits of the follow-up studies on the outcome of the children and adolescent with infantile autism until the adulthood. These studies not only seek to describe the changes of symptomatology but also to establish if the individual characteristics observed in childhood are correlated with those observed at the adulthood in order to establish if it exists, possible prognostic factors for whole or part of the disorders. They finally aim at evaluating the effects of environmental factors likely to intervene in the course of trajectory. These studies allow the report of the diversity of the evolutions in infantile autism but in the absence of sufficient cognitive or cerebral maps they do not make it possible to understand what explains the individual differences in the evolution and what could support it.
This paper discusses the interests and the limits of the follow-up studies on the outcome of the children and adolescent with infantile autism until the adulthood. These studies not only seek to describe the changes of symptomatology but also to establish if the individual characteristics observed in childhood are correlated with those observed at the adulthood in order to establish if it exists, possible prognostic factors for whole or part of the disorders. They finally aim at evaluating the effects of environmental factors likely to intervene in the course of trajectory. These studies allow the report of the diversity of the evolutions in infantile autism but in the absence of sufficient cognitive or cerebral maps they do not make it possible to understand what explains the individual differences in the evolution and what could support it.
- Jun 2001
Currently the diagnostis of autism takes place towards the 3rd year, however, when parents are questioned concerning the first signs, they had become concerned very much earlier. Paediatricians and general practitioners, who saw these children after the parents had observed problems, tended to reassure them, due to the fact that they lacked the necessary elements enabling them to give greater depth to their diagnostic questioning (decision tree lacked branches). The objective of this work is to specify age of the observation of the first signs by parents, age at initial paedopsychiatric consultation, age at the initial acceptance of care and the analyse factor wich influence those ages.
- Mar 2001
In autism, individual and environmental factors lead to heterogeneous outcomes. Some individual and environmental factors such as intellectual and speech level in childhood are well known. Others — gender, age of onset or association of medical disease — are controversial. The influence of environmental factors and of interventions is less known.The aim of this collaborative and prospective study is to identify the relationship between the individual and environmental factors.The relationship between the differences as regards the two assessments realised at intervals of three years and interventions will be studied.In this paper, we present, retrospective data, social features and assessment results (diagnosis, intensity of autistic behavior, cognitive and speech profiles) in 193 autistic children with a mean age of five years.