Wiggins LD, Rice CE, Baio J. Developmental regression in children with an autism spectrum disorder identified by a population-based surveillance system
Centers for Disease Control and Prevention, Atlanta, USA.Autism (Impact Factor: 3.5). 08/2009; 13(4):357-74. DOI: 10.1177/1362361309105662
This study evaluated the phenomenon of autistic regression using population-based data. The sample comprised 285 children who met the autism spectrum disorder (ASD) case definition within an ongoing surveillance program. Results indicated that children with a previously documented ASD diagnosis had higher rates of autistic regression than children who met the ASD surveillance definition but did not have a clearly documented ASD diagnosis in their records (17-26 percent of surveillance cases). Most children regressed around 24 months of age and boys were more likely to have documented regression than girls. Half of the children with regression had developmental concerns noted prior to the loss of skills. Moreover, children with autistic regression were more likely to show certain associated features, including cognitive impairment.These data indicate that some children with ASD experience a loss of skills in the first few years of life and may have a unique symptom profile.
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- "The reason for this is that our primary focus is skill loss associated with ASD, and we cannot be assured that regressions occurring after age three are truly associated with the child's ASD. Furthermore, large-scale studies report an average age of regression in ASD around 21–24 months (Barger et al., 2013; Wiggins et al., 2009). Therefore, we chose to present the data separately so as to be inclusive of all regressions in the SSC while at the same time presenting the information in ways that may be more meaningful to other investigators. "
ABSTRACT: Studies using varied methods report that developmental regression occurs in a sizeable proportion of children with autism spectrum disorder (ASD). Findings are equivocal as to whether regression is associated with poorer cognitive and adaptive functioning. This study examined retrospective parent report in 2105 Simons Simplex Collection participants with ASD. Children were classified as having “full” or “subthreshold” losses on language and/or other skills using items from the Autism Diagnostic Interview-Revised (ADI-R) and a supplemental interview to capture more subtle regressions. Overall, 36.9% of children had some type of regression (27.8% language, 27.0% other-skill loss), with the supplemental interview capturing 11.7% of losses that would have been missed using the ADI-R alone. This figure is consistent with previous parent-report studies but lower than clinician-observed rates in prospective investigations. Early language losses—either full or subthreshold—and full other-skill losses appear to be associated with more deleterious outcomes by middle childhood. Findings may signify the need for more immediate and/or intense therapies for children who have even minor skill losses, particularly in language skills. Results further demonstrate the utility of an expanded set of additional queries with slightly modified criteria to capture such early, subtle losses.
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- "Além disso, um estudo realizado com 36 crianças com TEA e 20 controles, com desenvolvimento típico, e seus pais, encontrou que de 20 a 30% dos cuidadores descrevem padrões de regressão de linguagem, envolvendo a perda de palavras previamente adquiridas (Werner & Dawson, 2005). De fato, investigações recentes acerca do tema têm demonstrado que a regressão é um fenômeno fidedigno, que afeta uma parcela importante das crianças com TEA (Backes, Zanon, & Bosa, 2013; Wiggins, Rice, & Baio, 2009). Por exemplo, Backes et al. 2013; Backes, Zanon, Endres, Meimes, & Bosa, 2012, em um estudo realizado com 30 crianças americanas com Transtorno Autista, conforme critérios diagnósticos da Autism Diagnostic Interview-Revised (ADI-R), encontraram que 20% delas apresentaram regressão das habilidades de linguagem. "
ABSTRACT: Dificuldades no desenvolvimento social são os indicadores mais prováveis de um futuro diagnóstico de autismo, entretanto o atraso da fala parece ser o motivo que mais mobiliza os pais na busca por assistência. Neste estudo foram investigados os primeiros sintomas percebidos pelos pais de crianças com autismo e a idade da criança na ocasião. Participaram 32 pré-escolares e o instrumento utilizado foi a Autism Diagnostic Interview-Revised. Comprometimentos no desenvolvimento da linguagem foram os sintomas mais frequentemente observados, porém os da socialização foram os mais precocemente identificados. No geral, a idade média em que os primeiros sintomas foram percebidos foi 15,2 meses. Os resultados corroboram achados de outros estudos, ressaltando a importância dos comprometimentos sociais para a identificação precoce do autismo.
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- "By far the most provocative evidence for a putative environmental postnatal precipitating factor in autism is the unexplained regression or stagnation of behavior and language development at 15–30 months reported by some third of parents of toddlers [Kurita, 1985; Rogers, 2004; Wilson, Djukic, Shinnar, Dharmani, & Rapin, 2003]. There is sparse information about sex ratio among these children, although one study reports that the proportion of boys was marginally higher (90%) in those who regressed than in those who did not (84%) [Wiggins, Rice, & Baio, 2009]. If regression is indeed more prevalent in boys and is in some way environmentally–influenced, which has not been documented, it might indicate that some genetically susceptible boys are more vulnerable than girls to some environmental factors such as common-place potentially triggering events like infections or immunologic factors. "
ABSTRACT: We offer a neurobiologic theory based on animal work that helps account for the conspicuous male predominance in autism spectrum disorders (ASD). In young male animals, testosterone (TST) binds to androgen receptors (AR) in brainstem neurons responsible for enhancing brain arousal. As a consequence, arousal-related neurotransmitters bombard the amygdala hypersensitized by TST acting though AR. Arousal-related inputs are known to prime amygdaloid mechanisms for fear and anxiety, with resultant social avoidance. We hypothesize that similar mechanisms contribute to autism's male predominance and to its defining impaired social skills. The theory rests on two key interacting factors: the molecular effects of TST in genetically vulnerable boys in combination with environmental stresses they experienced in utero, neonatally, or during the first years. We postulate that higher TST levels and, therefore, higher amounts of arousal-related inputs to the amygdala sensitize these genetically vulnerable male infants to very early stresses. In sharp contrast to boys, girls not only do not have high levels of TST-facilitated arousal-causing inputs to the amygdala but they also enjoy the protection afforded by estrogenic hormones, oxytocin, and the oxytocin receptor. This theory suggests that novel technologies applied to the molecular endocrinology of TST's actions through AR will offer new avenues of enquiry into ASD. Since the high male preponderance in autism is important yet understudied, we offer our theory, which is based on detailed neurobehavioral research with animals, to stimulate basic and clinical research in animals and humans and hopefully help develop novel more effective medical treatments for autism.
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