Article

Autism and Diagnostic Substitution: Evidence from a Study of Adults with a History of Developmental Language Disorder

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Rates of diagnosis of autism have risen since 1980, raising the question of whether some children who previously had other diagnoses are now being diagnosed with autism. We applied contemporary diagnostic criteria for autism to adults with a history of developmental language disorder, to discover whether diagnostic substitution has taken place. A total of 38 adults (aged 15-31y; 31 males, seven females) who had participated in studies of developmental language disorder during childhood were given the Autism Diagnostic Observation Schedule--Generic. Their parents completed the Autism Diagnostic Interview--Revised, which relies largely on symptoms present at age 4 to 5 years to diagnose autism. Eight individuals met criteria for autism on both instruments, and a further four met criteria for milder forms of autistic spectrum disorder. Most individuals with autism had been identified with pragmatic impairments in childhood. Some children who would nowadays be diagnosed unambiguously with autistic disorder had been diagnosed with developmental language disorder in the past. This finding has implications for our understanding of the epidemiology of autism.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Studies suggest up to one-quarter of the increase in autism/ASD diagnoses correlates with the gradual elimination of the term mental retardation. 19,[31][32][33][34] Developmental language disorders are complex and regularly overlap autism/ASD. 35 The new DSM-5 diagnosis social (pragmatic) communication disorder is a good example of diagnostic substitution. ...
... The distribution and range of disorder severity in autism/ASD is similar to the continuum of diagnoses with intellectual disability, where profound, severe, moderate, and mild disabilities affect about 2%, 4%, 10%, and 85% of the intellectual disabilities population, respectively. 34,44 There is an unsettled obligation to reconcile the spectrum of needs among individuals with autism/ASD that range from severe autism with comorbid intellectual disabilities to the larger group of disorders and developmental differences generally now described by the colloquial phrase "on the spectrum." ...
Article
Full-text available
Classic autism has gradually evolved into the concept of a larger "spectrum disorder." The rising prevalence of autism and autism spectrum disorder (autism/ASD) diagnoses can be largely attributed to broader diagnostic criteria, adoption of dimensional assessment strategies, increased awareness, linking of services to diagnosis, and the inclusion of milder neurodevelopmental differences bordering on normality. The spectrum disorder diagnosis raises numerous bioethical issues for individuals and society. Three groups of caregivers have important ethical, legal, and social obligations to individuals with autism/ASD: (1) families and advocates of individuals with autism/ASD; (2) health care and other professionals; and (3) governments. Each group may have different views of autism/ASD diagnostic criteria, screening, testing, and the effectiveness of various interventions. All see timely diagnosis as desirable, but earlier diagnosis may not be better, morally or practically. The growing practice of genetic testing in milder ASD raises ethical questions because of its uncertain scientific validity and limited clinical utility. Individuals with autism/ASD have various kinds of needs but all want acceptance and most deserve better accommodations. Governments struggle to provide a fair allocation of appropriate special education and supportive services. This article examines the evolving dimensions of the autism/ASD diagnosis, outlines certain bioethics principles related to its evaluation and management, reviews relevant laws and disability rights, and emphasizes the societal obligation to recognize neurodevelopmental variation and human neurodiversity. Future directions in the evaluation and care of autism/ASD should attempt to integrate the roles and responsibilities of all agents caring for each unique autistic individual.
... There is also evidence that, during a period of stability for diagnostic criteria, there was a reduction in the behavioural severity of individuals diagnosed with an autistic disorder [13]. Further, diagnostic substitution has been identified in autism [14] and, in the USA between 1994 and 2003, a decrease in the prevalence of intellectual disabilities has occurred in conjunction with an increase in the prevalence of autism [15]. Changes in diagnostic criteria over the past three decades may play a role in the increased prevalence rate of autism, although its causes remain controversial. ...
... The aim of the evaluation phase is to ascertain the dimensional constructs that characterise the unique profile of an individual using NAS in a cohort of 100 participants with neurodevelopmental disorders. The participants will be of homogenously distributed age groups preschool (ages 2-6), primary school (ages 5-13), and secondary school (ages [13][14][15][16][17][18]. The results from the NAS assessment will be superimposed on the clinician assessment of diagnostic categories to understand the overlap. ...
Article
Full-text available
Neurodevelopmental disorders are a heterogeneous group of conditions with overlapping symptomatology and fluctuating developmental trajectories that transcend current diagnostic categorisation. There is a need for validated screening instruments which dimensionally assess symptomatology from a holistic, transdiagnostic perspective. The primary aim is to co-design a Neurodevelopment Assessment Scale (NAS), a user-friendly transdiagnostic assessment inventory that systematically screens for all signs and symptoms commonly encountered in neurodevelopmental disorders. Our first objective is to undertake development of this tool, utilising co-design principles in partnership with stakeholders, including both those with lived experience of neurodevelopmental disorders and service providers. Our second objective is to evaluate the face validity, as well as the perceived utility, user-friendliness, suitability, and acceptability (i.e., ‘social validity’), of the NAS from the perspective of parents/caregivers and adults with neurodevelopmental disorders, clinicians, and service providers. Our third objective is to ascertain the psychometric properties of the NAS, including content validity and convergent validity. The NAS will provide an efficient transdiagnostic tool for evaluating all relevant signs, symptoms, and the dimensional constructs that underpin neurodevelopmental presentations. It is anticipated that this will maximise outcomes by enabling the delivery of personalised care tailored to an individual’s unique profile in a holistic and efficient manner.
... Otros autores se refieren al mismo fenómeno como 'sustitución diagnóstica' (King & Bearman, 2009). Este fenómeno se ha atribuido mayoritariamente a la modificación de criterios de los principales manuales de clasificación (Bishop et al., 2008;Coo et al., 2008;Howlin, 2008;King & Bearman, 2009;Newschaffer, 2006;Shattuck, 2006) y ha sido ampliamente estudiado para entender las causas del reciente aumento de prevalencia en el diagnóstico de TEA, ya que podría explicar un alto porcentaje del auge de casos de autismo en las últimas décadas (Cardinal & Griffiths, 2016;Coo et al., 2008;Howlin, 2008;King & Bearman, 2009;Newschaffer, 2006;Özerk, 2017;Shattuck, 2006). Asimismo, este concepto justificaría que un elevado número de individuos originalmente diagnosticados con TEL en sus diferentes subtipos pudieran ser incluidos en la categoría TEA en la adultez según los criterios diagnósticos actuales (Bishop et al., 2008). ...
... Este fenómeno se ha atribuido mayoritariamente a la modificación de criterios de los principales manuales de clasificación (Bishop et al., 2008;Coo et al., 2008;Howlin, 2008;King & Bearman, 2009;Newschaffer, 2006;Shattuck, 2006) y ha sido ampliamente estudiado para entender las causas del reciente aumento de prevalencia en el diagnóstico de TEA, ya que podría explicar un alto porcentaje del auge de casos de autismo en las últimas décadas (Cardinal & Griffiths, 2016;Coo et al., 2008;Howlin, 2008;King & Bearman, 2009;Newschaffer, 2006;Özerk, 2017;Shattuck, 2006). Asimismo, este concepto justificaría que un elevado número de individuos originalmente diagnosticados con TEL en sus diferentes subtipos pudieran ser incluidos en la categoría TEA en la adultez según los criterios diagnósticos actuales (Bishop et al., 2008). ...
Article
Full-text available
Trastorno específico del lenguaje (TEL) y trastorno del espectro autista (TEA) son trastornos del neurodesarrollo muy similares a edades tempranas, lo que dificulta el diagnóstico diferencial temprano. El fenómeno ‘migración diagnóstica’ alude al cambio diagnóstico por evolución del trastorno o modificación de criterios diagnósticos, instrumentos o técnicas de evaluación. El objetivo de este estudio fue analizar la incidencia y el impacto del fenómeno en los centros de atención infantil temprana (CAITs) de la provincia de Córdoba. A través de un cuestionario en formato online habilitado desde marzo a mayo de 2020, los responsables de los CAITs proporcionaron datos cuantitativos sobre este fenómeno y su valoración del impacto en la intervención, el pronóstico y las familias de población infantil de 0 a 6 años. Diez CAITs con financiación pública respondieron al cuestionario. Los resultados arrojaron una alta incidencia del fenómeno migración diagnóstica, principalmente desde TEA hacia TEL. También se observó una diferencia significativa en el número de casos diagnosticados en ambos trastornos, siendo TEA el diagnóstico mayoritario. El impacto de este fenómeno sobre el pronóstico del niño y la familia se estimó positivo, ya que generalmente suponía una evolución hacia un trastorno más leve. Estos resultados ofrecen una aproximación hacia un tema de importancia y escasa investigación hasta la fecha. Continuar esta línea de investigación ampliando la muestra de centros, la información sociodemográfica de los mismos e incluyendo la perspectiva de las familias mejoraría el conocimiento de estos trastornos y favorecería la práctica clínica en el ámbito de la atención temprana.
... This is due to a lack of good-quality evidence for screening methods and effective interventions in these ages and also whether there are beneficial effects for the child in the longer term. However, there is agreement that these children should be identified, because late talkers and DLD, in particular, in pre-schoolers are often markers of other neurodevelopmental disorders (3)(4)(5)22,32,33). ...
... Of these 30 children, 13 (43%) were diagnosed with ASD five years later. This figure corresponded to findings from a follow-up study of 38 individuals who had been diagnosed with language disorders in childhood, with 13 (34%) meeting the criteria for ASD (32). It also agreed with our previous study, which showed that 90% of children who attended a special preschool with DLD as a referral criterion, had other definite developmental problems (33). ...
Article
Full-text available
Aim This study identified whether children who had screened positive for either developmental language disorder (DLD) or autism spectrum disorder (ASD) at the age of 2.5 years had neurodevelopmental assessments five years later. Methods Our study cohort were 288 children born from 1 July 2008‐20 June 2009 who screened positive for DLD and, or, ASD at 2.5 years. Of these, 237 children were referred to, and assessed, at the Paediatric Speech and Language Pathology clinic (n=176) or the Child Neuropsychiatry Clinic (n=61) at the Queen Silvia Children's Hospital, Gothenburg, Sweden. Clinical registers covering all relevant outpatient clinics were reviewed five years later with regard to established diagnoses. Results When the 237 were followed up five years later, 96 (40%) had established neurodevelopmental disorders or problems, often beyond DLD and ASD. Co‐existing problems were common in this cohort and multidisciplinary assessments were indicated. The other 60% did not appear in subsequent clinic records. It is likely that this 40% was a minimum rate and that more children will be referred for developmental problems later. Conclusion Five years after they had been screened positive for DLD and, or autism at 2.5 years, 40% of our cohort had remaining or other developmental problems. This article is protected by copyright. All rights reserved.
... The number with ASD in the population increased by 2.8 per cent from 2002 to 2012. 2 Research from the Autism and Developmental Disabilities Monitoring Network, US showed an increase from one per 165 in 2002 to one per 68 children in 2012 diagnosed with autism spectrum disorder. 3 Both improved clinical diagnoses of developmental conditions and heightened awareness of the symptoms among parents and public are posited as contributors to the reported increase in ASD prevalence. 3 The new (DSM-5) diagnostic criteria include all subgroups defined by DSM-IV and intellectual disability (ID) disorders under one umbrella, which may serve to facilitate access to appropriate services and supports for individuals who have ASD in addition to intellectual disability. ...
... 3 Both improved clinical diagnoses of developmental conditions and heightened awareness of the symptoms among parents and public are posited as contributors to the reported increase in ASD prevalence. 3 The new (DSM-5) diagnostic criteria include all subgroups defined by DSM-IV and intellectual disability (ID) disorders under one umbrella, which may serve to facilitate access to appropriate services and supports for individuals who have ASD in addition to intellectual disability. 4 There is a great debate in the scientific community as to how much of the increase is real and how much is reclassification. ...
Article
Full-text available
Studies have shown considerable evidence of visual dysfunction in autism spectrum disorders. Anomalies in visual information processing can have a major effect on the life quality of individuals with autism spectrum disorders. We summarise the hypotheses and theories underlying neural aetiologies and genetic factors that cause these disorders, as well as the possible influences of unusual sensory possessing on the communications and behaviour characterised by the autistics. In particular, we review the impact of these dysfunctions on visual performance.
... There has been considerable debate regarding the basis for the significant increase in the diagnosis of autism over the past 20 years. Some possible explanations have included: changes in the environment that have led to genetic mutations (Herbert et al. 2006;Herbert 2010), increased awareness among pediatric professionals who refer children for diagnosis and the type of measures used to make a diagnosis of autism (Rutter 2005;Bishop et al. 2008, Taylor 2006Fombonne 2005;Lundström et al. 2015). Inconsistencies in the application of Autism spectrum disorder diagnoses and nomenclature, e.g., Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Autism, and Asperger's Disorder, have led to eliminating these terms and subsuming these disorders under the term Autism Spectrum Disorder (ASD) in the latest Diagnostic and Statistical Manual of Mental Disorders, fifth Edition manual (DSM-5) (First 2013). ...
Article
Full-text available
To compare community diagnoses of Autism Spectrum Disorder (ASD) reported by parents to consensus diagnoses made using standardized tools plus clinical observation. 87 participants (85% male, average age 7.4 years), with reported community diagnosis of ASD were evaluated using the Autism Diagnostic Observation Schedule) (ADOS-2), Differential Ability Scale (DAS-II), and Vineland Adaptive Behavior Scales (VABS-II). Detailed developmental and medical history was obtained from all participants. Diagnosis was based on clinical consensus of at least two expert clinicians, using test results, clinical observations, and parent report. 23% of participants with a reported community diagnosis of ASD were classified as non-spectrum based on our consensus diagnosis. ASD and non-spectrum participants did not differ on age at evaluation and age of first community diagnosis. Non-verbal IQ scores and Adaptive Behavior Composite scores were significantly higher in the non-spectrum group compared to the ASD group (104.5 ± 21.7 vs. 80.1 ± 21.6, p < .01; 71.1 ± 15 versus 79.5 ± 17.6, p < .05, respectively). Participants enrolled with community diagnosis of PDD-NOS were significantly more likely to be classified as non-spectrum on the study consensus diagnosis than Participants with Autism or Asperger (36% versus 9.5%, Odds Ratio = 5.4, p < .05). This study shows suboptimal agreement between community diagnoses of ASD and consensus diagnosis using standardized instruments. These findings are based on limited data, and should be further studied, taking into consideration the influence of DSM 5 diagnostic criteria on ASD prevalence.
... This article argues that a change in the definition of autism can account for the increase of this disorder. (Bishop, 2008). ii. ...
... It is well recognised, for example, that during the 1990s there was an 'epidemic' of autism diagnoses (Eyal et al., 2010, p. 2) with prevalence rates increasing from around 4:10,000 in 1978 (Wing and Potter, 2002, p. 151) to approximately 1:100 in 2009 ( Baron-Cohen et al., 2009, p. 500). Yet there is little agreement on the cause of this increase and assortative mating (Baron-Cohen, 2006), diagnostic substitution (Bishop et al., 2008), and environmental risk factors (Weintraub, 2011) have all been proposed as possible factors. Similarly lacking in explanation is the 4:1 male-to-female ratio in diagnoses (Fombonne, 2009) a finding which, again, has been attributed to basic biology (Baron-Cohen et al., 2011) and more complex social factors (Cheslack-Postava and Jordan-Young, 2011). ...
Article
Full-text available
Autism is a highly uncertain entity and little is said about it with any degree of certainty. Scientists must, and do, work through these uncertainties in the course of their work. Scientists explain uncertainty in autism research through discussion of epistemological uncertainties which suggest that diverse methods and techniques make results hard to reconcile, ontological uncertainties which suggest doubt over taxonomic coherence, but also through reference to autism?s indeterminacy which suggests that the condition is inherently heterogeneous. Indeed, indeterminacy takes two forms ? an inter-personal form which suggests that there are fundamental differences between individuals with autism and an intra-personal form which suggests that no one factor is able to explain all features of autism within a given individual. What is apparent in the case of autism is that scientists put uncertainty and indeterminacy into discussion with one another and, rather than a well policed epistemic-ontic boundary, there is a movement between, and an entwinement of, the two. Understanding scientists? dialogue concerning uncertainty and indeterminacy is of importance for understanding autism and autistic heterogeneity but also for understanding uncertainty and ?uncertainty work? within science more generally.
... For example, although recent U.S. figures have suggested rates of more than 1% for ASD (3) and a South Korean study reported prevalence estimates of 0.9% for AD and 2.6% for ASD (24), an epidemiological study in Norway (25) found rates of only 0.14% for AD and 0.5% for ASD. Some researchers argue that increased prevalence rates are influenced by "diagnostic substitution": in recent years, children with intellectual disability, attention-deficit/hyperactivity disorder, or language disorder have been more likely to be diagnosed with AD or ASD in addition to these other conditions rather than intellectual disability, attentiondeficit/hyperactivity disorder, or language disorder alone (6,26,27). Overshadowing has also been described in relation to coexisting attentiondeficit/hyperactivity disorder and ASD, which suggests that an initial ADHD diagnosis may be associated with a delayed ASD diagnosis (28). The increased frequency of the occurrence of ASD with other medical, developmental, and behavioral disorders increases the possibility of "overshadowing" in that all additional problems are attributed to the medical condition (7,28,29). ...
Article
Full-text available
Nevertheless, it also suffers from a number of methodological problems that limit the conclusions that can be drawn. First, the sample size is small. Although there was no evidence of substantial changes in diagnostic practice over time, standardized diagnostic instruments (e.g., the Autism Diagnostic Observation Schedule) were used to confirm diagnoses in only 14 cases. Second, the study compares two clinically referred samples, but children with high levels of autistic traits may have received educational services without being referred to specialized services for a possible diagnosis. Third, the use of the DSM-III-R criteria in Cohort 1 and the ICD-10 criteria in Cohort 2 may be related to the change in diagnostic frequency. However, this would be expected to lead to a decrease in diagnostic rates (42). Fourth, the results relate only to children residing in Nordland County at the two time points examined and thus may not be generalizable to other counties or other time periods. Finally, the ICD-10 classification of children into subgroups within the autism spectrum can be problematic (45) and can lead to misclassification. This might have influenced the number of registered children with AD in Nordland County. However research has shown relatively high agreement for the diagnosis of AD specifically (46).
... We proposed a simple schema for coding disfluency type, applicable to studies of disfluency more generally, and using this schema, we found that children with ASD have different patterns of disfluency than peers with SLI or typical development, including a higher rate of content maze use and a lower rate of filler use. The patterns of disfluency investigated here are easily quantified features of pragmatic language that may differentiate ASD and SLI, a challenging differential diagnosis [90][91][92]. We recommend that future studies quantify disfluency patterns in longitudinal studies of the same populations, similar to a recent longitudinal study of disfluency in typically developing children [93]. ...
Article
Full-text available
Deficits in social communication, particularly pragmatic language, are characteristic of individuals with autism spectrum disorder (ASD). Speech disfluencies may serve pragmatic functions such as cueing speaking problems. Previous studies have found that speakers with ASD differ from typically developing (TD) speakers in the types and patterns of disfluencies they produce, but fail to provide sufficiently detailed characterizations of the methods used to categorize and quantify disfluency, making cross-study comparison difficult. In this study we propose a simple schema for classifying major disfluency types, and use this schema in an exploratory analysis of differences in disfluency rates and patterns among children with ASD compared to TD and language impaired (SLI) groups. 115 children ages 4–8 participated in the study (ASD = 51; SLI = 20; TD = 44), completing a battery of experimental tasks and assessments. Measures of morphological and syntactic complexity, as well as word and disfluency counts, were derived from transcripts of the Autism Diagnostic Observation Schedule (ADOS). High inter-annotator agreement was obtained with the use of the proposed schema. Analyses showed ASD children produced a higher ratio of content to filler disfluencies than TD children. Relative frequencies of repetitions, revisions, and false starts did not differ significantly between groups. TD children also produced more cued disfluencies than ASD children.
... A review of the "rising autism" figures compared to other disabilities in schools shows a corresponding drop in findings of mental retardation [23]. The reported increase is largely attributable to changes in diagnostic practices, referral patterns, availability of services, age at diagnosis, and public awareness [24][25][26][27]. A widely cited 2002 pilot study concluded that the observed increase in autism in California cannot be explained by changes in diagnostic criteria [28], but a 2006 analysis found that special education data poorly measured prevalence because so many cases were diagnosed, and that the 1994-2003 U.S. increase was associated with declines in other diagnostic categories, indicating that diagnostic substitution had occurred [29]. ...
... In this study, we were able to minimize the impact of changes in case-finding and clinical broadening of case definition over time by using the same multi-source case ascertainment methodology and uniformly applying the same ASD research definitions (ASD-R I and ASD-R N ) to abstracted signs and symptoms throughout the study period. Clinical diagnosis rates (ASD-C), but not ASD-R I or ASD-R N , could be impacted by diagnostic substitution, which is diagnostic recategorization toward ASD and away from other diagnoses (e.g., intellectual disability or language disorder) when ASD became increasingly familiar to health care and education professionals and/or when access to better services was facilitated by having the ASD diagnosis (Elsabbagh et al. 2012;Bishop et al. 2008;Coo et al. 2008;Miller et al. 2013;Polyak et al. 2015). ...
Article
Full-text available
We retrospectively identified autism spectrum disorder (ASD) incident cases among 31,220 individuals in a population-based birth cohort based on signs and symptoms uniformly abstracted from medical and educational records. Inclusive and narrow research definitions of ASD (ASD-RI and ASD-RN, respectively) were explored, along with clinical diagnoses of ASD (ASD-C) obtained from the records. The incidence of ASD-RI, ASD-RN, and ASD-C increased significantly from 1985 to 1998, then ASD-RI and ASD-RN plateaued while the rate of ASD-C continued to increase during 1998–2004. The rising incidence of research-defined ASD may reflect improved recognition and documentation of ASD signs and symptoms. Although the frequency of threshold ASD symptoms stabilized, the rate of ASD-C continued to increase, narrowing the gap between clinical ascertainment and symptom documentation.
... There is substantial evidence that non-etiological factors, such as ''diagnostic substitution'' [i.e., intellectual disability (ID) diagnoses decreased at the same time ASD diagnoses increased], have played a role. However, not all of the ''autism epidemic'' can be explained by these factors, and research efforts continue to investigate genetic, environmental, and other potential contributors [17][18][19][20][21][22]. ...
Article
Full-text available
Purpose of review: Psychiatry is steadily moving toward a new conceptualization of brain disorders that blurs long-held diagnostic distinctions among neurodevelopmental and psychiatric conditions, including autism. Genomic discoveries are driving these changing perceptions, yet there has so far been minimal impact on traditional genetic counseling practices that continue to view autism through the lens of a dichotomous, all-or-none risk model. Recent findings: High rates of comorbidity exist across autism spectrum disorder, schizophrenia, intellectual disability, and other brain-based disorders. Recent epidemiological studies have shown that co-occurrence of neurodevelopmental and psychiatric disorders is the rule, rather than the exception, in affected individuals and within families. Moreover, studies of chromosomal microarray analysis and whole exome sequencing have now detected many of the same pathogenic copy number and sequence-level variants across cohorts with different clinical presentations. Summary: Going forward, the genetic counseling field will need to significantly adapt its approaches to pedigree interpretation, variant analysis, and patient education to more precisely describe both the chance and the nature of autism recurrence in terms of a continuum of brain dysfunction. These efforts will have implications for multiple practice areas and require philosophical changes for experienced practitioners and for the training of new genetic counselors. Resetting entrenched dichotomous notions about autism and other brain-based manifestations of genetic conditions will require a strategic educational effort on the part of the genetic counseling profession.
... The improved health services enabled individuals who previously were not considered as having ASD to receive a second diagnosis by ASD specialists. For example, Bishop et al. (2008) found that 66% of adults who received an initial diagnosis of developmental language disorder were later diagnosed as having PDD, a mild form of ASD. Third, the prevalence rates were influenced by the methods used in identifying ASD cases. ...
Thesis
Full-text available
The most recent estimates of the prevalence rates of Autism Spectrum Disorder reveal that 1 in 68 children in the US are diagnosed with ASD. However, although the awareness of ASD has been increasing around the world, most studies of the prevalence rates and diagnosis of ASD originate in developed countries, and little is known about the situation in developing countries. Indonesia is the fourth most populated country in the world. However, as is the case in most developing countries, disability still receives limited attention from the Indonesian Government. In terms of ASD, there is no recent estimate of the prevalence rate of ASD in Indonesia following the estimates released 22 years ago which suggested that 1 in 833 children in Indonesia were being as diagnosed with ASD. Currently studies on ASD are still lacking and almost 500 cities and regencies in Indonesia are unable to identify and provide appropriate support services for people with ASD. As a starting point to understanding the situation relating to ASD in developing countries, the first study in this thesis aimed to investigate the application of best practice guidelines in Indonesia. A survey was developed and undertaken with 67 practitioners with experience in assessing ASD. It was found that, similar to situations in developed countries, the three best practice components relating to ASD diagnosis were challenging to apply in the Indonesian context. Further, having more validated and culturally sensitive tools to assess ASD in Indonesian language was found to be one of the crucial needs of ASD specialists in Indonesia. As a response to this finding, an Indonesian version of ADEC (ADEC-IND) was developed and evaluated for its psychometric properties and cultural appropriateness. The ADEC is an observation tool that has been shown to be effective in detecting ASD in children as young as 12 months. The tool has been validated within Australian and in Mexican children. In comparison to the gold standard measurement tools, the use of ADEC is more affordable, less time consuming in administration, and does not require lengthy and expensive training for its use. Considering these benefits and as a response to the first study results, the second and third studies that comprise this thesis were conducted in order to translate and validate the use of ADEC within the Indonesian context. The ADEC was translated into the Indonesian language and then pilot tested with eight Indonesian children (Mage = 31.8 months, SD = 11.36) in Brisbane and Melbourne. In the translation process, after being translated, the first Indonesian version of ADEC (ADEC-IND) was reviewed independently by two reviewers and a revised draft was made based on the reviewers’ feedback. Subsequently, the revised draft was then pilot tested with each testing session videotaped and given an English subtitle. Each participant was tested using ADEC-IND and their parents interviewed using the ADI-R. All of the sessions were videotaped and given English subtitles. The study found that the revised and translated draft of ADEC-IND is ready for use in a large scale study, as the participants in the pilot study had no problem in understanding the instructions of ADEC-IND, and no difficulties were experienced with either the implementation or scoring. Following the pilot testing and review, the revised version of ADEC-IND was tested with 82 children in Indonesia. The children were aged between 14 and 72 months (M=45.23 months, SD=14.51) who were classified within three diagnostic groups (typical developing children, children with ASD, and children with other disabilities). The participants were recruited from clinics and schools in five major cities in Indonesia (Jakarta, Bogor, Depok, Tangerang, and Bekasi). Similar to the pilot study, the children were assessed using the ADEC-IND and the parents were interviewed using the ADI-R. All sessions were videotaped. For investigating the inter-rater reliability, fifty videotaped sessions were given English subtitles and re-scored by a second assessor who was blind to the original scores, using the English version of the ADEC. The results showed that ADEC-IND possessed good sensitivity (.92 to .96), good specificity (.85 to .92), and high inter-rater reliability (r = .94, p < .001). ADEC-IND also showed good concurrent validity and good agreement (82.92%) with the ADI-R in classifying children into ASD and non-ASD groups. The implications of these findings are discussed in relation to the assessment and diagnosis of ASD in Indonesia.
... In combination with epidemiological studies (Durkin et al. 2010;Durkin et al. 2008), these investigations provide a rich store of knowledge about how meso-and-macro-level processes have resulted in the contemporary autism "epidemic" (Bishop et al. 2008). However, with the rare exception (Rossi 2012), there are virtually no studies of how the diagnosis is applied to patients "on the ground" (Duneier 2007)-due, no doubt, to the paucity of data. ...
Article
Full-text available
Recent decades have witnessed a dramatic upsurge in the prevalence of autism spectrum disorder (ASD). As researchers have investigated the responsible sociohistorical conditions, they have neglected how clinicians determine the diagnosis in local encounters in the first place. Articulating a position “between Foucault and Goffman,” we ask how the interaction order of the clinic articulates with larger-scale historical forces affecting the definition and distribution of ASD. First, we show how the diagnostic process has a narrative structure. Second, case data from three decades show how narrative practices accommodate to different periods in the history of the disorder, including changing diagnostic nomenclatures. Third, we show how two different forms of abstraction—Type A, which is categorical, and Type B, which is concrete and particular—inhabit the diagnostic process. Our analysis contributes to the sociology of autism, the sociology of diagnosis, the sociology of abstraction, and social theory.
... individuals previously diagnosed with schizophrenia, psychosis, emotional disturbance, traumatic brain injury, and other forms of mental illness, disability and developmental delay (Shattuck 2006;Mandell et al. 2012). On the higher end of the spectrum, individuals with language disorders (Bishop et al. 2008), ADHD, and OCD would be included (Gillberg and Billstedt 2000;Liu, King and Bearman 2010). Cases of autism can also be linked to or are associated with tuberous sclerosis complex 16 , epilepsy, and Fragile X Syndrome, among other conditions (Newschaffer et al. 2007). ...
Article
Over the last several decades, the clinical prevalence of autism has increased considerably, as has the amount of popular and scientific attention directed towards the condition. However, discussions of autism tend to focus on children and finding a cause and a cure, while the growing numbers of adults diagnosed with autism have received relatively little attention. This dissertation begins with the argument that popular representations of autism are shaped by the idealism of modern medicine, and its overriding search to discover etiologies and treatments for all forms of biological difference that fall within its purview. And yet, for those responsible for adults with autism, management, care, and support are more relevant concerns to everyday experience than are cause and cure. In order to describe and analyze this everyday experience, this dissertation features a three-year ethnographic study of thirteen families with adult members with severe forms of autism. After reviewing pertinent historical and demographic information, the body of the manuscript explores: 1) the process by which caretakers negotiate between different definitions of problem behavior in the face of persistent situational complexity and ambiguity; 2) the contextual dynamics that make it possible for caretakers to perceive as innocent and/or humorous behaviors that are often viewed as atypical by others; and 3) the ways in which the experience of continued atypicality and dependency comes into conflict with popular representations of autism while at the same time highlighting the reality of the ever-looming future and the care and support required after primary caretakers are gone. At the end of the dissertation, I return to the argument that modern medical idealism discourages popular recognition that, in the case of autism, continued atypicality and dependency constitute the condition's usual prognosis. I conclude with a short consideration of how the themes explored in this thesis resonate with the experiences of those living with or alongside other forms of biological difference (e.g. disability, mental illness, Alzehemier's) that are currently incurable.
... b) The other related factors are the diagnostic substitution, changing, and expanding of diagnostic criteria in DSM III-R in 1987 and DSM IV-TR in 1994. Due to the changes in these manuals, children with developmental language disorder or pragmatic language impairments could get diagnosed as having autism/ASD (Baird et.al., 2006;Bishop et al., 2008). Furthermore, modifications in ICD 10 in the 1990s or later could have impacted the prevalence rates as well (Howlin, 2008). ...
Article
Full-text available
From a purely educationist perspective, gaining a deeper understanding of several aspects related to the prevalence of autism/ASD in a given population is of great value in planning and improving educational and psychological intervention for treatment, training, and teaching of children with this disorder. In this article, I present and discuss numerous facets of prevalence studies, beginning with assessing the changes in diagnostic manuals (DSM and ICD) over time. Based on the existing available research literature and empirical studies published during 2000 to 2016, I address the geographical-dimension and age-dimension of prevalence of autism/ASD. Over 50 studies from 21 countries reveals that prevalence rates of autism/ASD among children are on rise. There are international and intra-national, regional/territorial variations with regard to prevalence rates, and I present and discuss possible factors/factor-groups that can explain these variations. Regardless of their geographic location, children with autism/ASD can be treated, trained, and taught, but to do so effectively requires reliable prevalence studies that can properly inform policy makers and higher institutions about the steps that must be taken in the field in order to improve the learning conditions of these children with special needs. Moving forward, it's essential that studies of geographical dimension and age dimension of prevalence of autism/ASD must be supplemented by other (i.e. gender, socioeconomic , ethnic, cultural, and language) dimensions to help give us the perspective we need to grapple with this increasingly common disorder.
... Um exemplo bastante claro sobre a melhoria no protocolo de diagnóstico do TEA é dado por um estudo realizado por Bishop et al. (2008), no qual os investigadores concluíram que, se, na época em que os 38 adultos diagnosticados como possuidores de transtorno da linguagem que eles investigaram (situados entre 15 e 31 anos de idade), fossem submetidos ao protocolo que eles estavam testando quando tinham entre 4 e 5 anos de idade, muitos deles certamente teriam sido tipificados como possuidores de TEA, indicando-se, assim, uma das possíveis fontes do incremento no número de pessoas com autismo que têm sido observadas. ...
Chapter
Full-text available
O transtorno do espectro do autismo (TEA) parece ser, em um primeiro momento, uma condição quase que intransponível para os professores de Educação Física que se sentem despreparados quando têm de lidar, pela primeira vez, com esse público. O objetivo deste texto foi discutir as principais dificuldades que os docentes de Educação Física encontram para incluir seus alunos diagnosticados no transtorno do espectro do autismo (TEA), além de apresentar possibilidades para a realização deste trabalho com sucesso.
... The prevalence of neurodevelopmental disorders, and in particular, autism spectrum disorder, is increasing worldwide (Landrigan et al., 2012;Baio et al., 2018), and several studies have documented that this is not due solely to increased awareness and expanded diagnostic criteria (Bishop et al., 2008;Coo et al., 2008;Hertz-Picciotto and Delwiche, 2009). The rapid rise in the prevalence of autism spectrum disorder coupled with evidence that single genetic factors alone account for only a percentage of cases (El-Fishawy and State, 2010;Herbert, 2010;Hallmayer et al., 2011;Weintraub, 2011;Landrigan et al., 2012) strongly support a role for environmental factors in determining individual risk and/or severity of these and other neurodevelopmental disorders (Sealey et al., 2016;Lyall et al., 2017). ...
Article
Full-text available
Polychlorinated biphenyls (PCBs) are putative environmental risks for neurodevelopmental disorders. Here, we tested two hypotheses: (1) developmental exposure to a human-relevant PCB mixture causes behavioral phenotypes relevant to neurodevelopmental disorders; and (2) expression of human mutations that dysregulate neuronal Ca ²⁺ homeostasis influence sensitivity to behavioral effects of developmental PCB exposures. To test these hypotheses, we used mice that expressed a gain-of-function mutation (T4826I) in ryanodine receptor 1 ( RYR1 ), the X-linked fragile X mental retardation 1 ( FMR1 ) CGG repeat expansion or both mutations (double mutant; DM). Transgenic mice and wildtype (WT) mice were exposed to the MARBLES PCB mix at 0, 0.1, 1, and 6 mg/kg/day in the maternal diet throughout gestation and lactation. The MARBLES PCB mix simulates the relative proportions of the 12 most abundant PCB congeners found in the serum of pregnant women at increased risk for having a child with a neurodevelopmental disorder. We assessed ultrasonic vocalizations at postnatal day 7 (P7), spontaneous repetitive behaviors at P25-P30, and sociability at P27-P32. Developmental PCB exposure reduced ultrasonic vocalizations in WT litters in all dose groups, but had no effect on ultrasonic vocalizations in transgenic litters. Developmental PCB exposure significantly increased self-grooming and decreased sociability in WT males in the 0.1 mg/kg dose group, but had no effect on WT females in any dose group. Genotype alone influenced ultrasonic vocalizations, self-grooming and to a lesser extent sociability. Genotype alone also influenced effects of PCBs on sociability. PCB levels in the brain tissue of pups increased in a dose-dependent manner, but within any dose group did not differ between genotypes. In summary, developmental PCB exposure phenocopied social behavior phenotypes observed in mice expressing human mutations that modify intracellular Ca ²⁺ dynamics, and expression of these mutations alleviated PCB effects on ultrasonic vocalizations and repetitive behavior, and modified the dose-response relationships and sex-dependent effects of PCB effects on social behavior. These findings suggest that: (1) developmental PCB exposure causes behavioral phenotypes that vary by sex and genotype; and (2) sex-specific responses to environmental factors may contribute to sex biases in the prevalence and/or severity of neurodevelopmental disorders.
... Crucially, use of um is not associated with language impairment within the group of children diagnosed with ASD, and children with SLI use um at a similar rate as their TD peers. Filler use is an easily quantified feature of pragmatic language that, in concert with other behavioral features, may distinguish ASD and SLI, a notoriously difficult differential diagnosis [Bishop and Norbury, 2002;Bishop et al., 2008;Cox et al., 1999]. We believe that this general approachusing contextualized natural language samples to quantify features of pragmatic language-will provide muchneeded conceptual precision and complement existing methods of diagnosis and phenotypic characterization based on clinical observation or structured assessment. ...
Article
Full-text available
Atypical pragmatic language is often present in individuals with autism spectrum disorders (ASD), along with delays or deficits in structural language. This study investigated the use of the "fillers" uh and um by children ages 4-8 during the autism diagnostic observation schedule. Fillers reflect speakers' difficulties with planning and delivering speech, but they also serve communicative purposes, such as negotiating control of the floor or conveying uncertainty. We hypothesized that children with ASD would use different patterns of fillers compared to peers with typical development or with specific language impairment (SLI), reflecting differences in social ability and communicative intent. Regression analyses revealed that children in the ASD group were much less likely to use um than children in the other two groups. Filler use is an easy-to-quantify feature of behavior that, in concert with other observations, may help to distinguish ASD from SLI. Autism Res 2016. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
... There is evidence that the broadening of diagnostic criteria from DSM-III to DSM-IV has played a role in the increasing numbers of individuals diagnosed with an ASD over the past three decades [Bishop, Whitehouse, Watt, & Line, 2008;King & Bearman, 2009;Leonard et al., 2010;Miller et al., 2012;Shattuck, 2006]. In a systematic review of prevalence studies, Williams and colleagues found that epidemiological studies using DSM-IV criteria led to prevalence estimates three times those of studies using previous diagnostic criteria [Williams, Higgins, & Brayne, 2006]. ...
Article
The increasing prevalence of Autism Spectrum Disorders (ASD) may in part be due to a shift in the diagnostic threshold that has led to individuals with a less severe behavioral phenotype receiving a clinical diagnosis. This study examined whether there were changes over time in the qualitative and quantitative phenotype of individuals who received the diagnosis of Autistic Disorder. Data were from a prospective register of new diagnoses in Western Australia (n = 1252). From 2000 to 2006, we examined differences in both the percentage of newly diagnosed cases that met each criterion as well as severity ratings of the behaviors observed (not met, partially met, mild/moderate and extreme). Linear regression determined there was a statistically significant reduction from 2000 to 2006 in the percentage of new diagnoses meeting two of 12 criteria. There was also a reduction across the study period in the proportion of new cases rated as having extreme severity on six criteria. There was a reduction in the proportion of individuals with three or more criteria rated as extreme from 2000 (16.0%) to 2006 (1.6%), while percentage of new cases with no "extreme" rating on any criteria increased from 58.5% to 86.6% across the same period. This study provides the first clear evidence of a reduction over time in the behavioral severity of individuals diagnosed with Autistic Disorder during a period of stability in diagnostic criteria. A shift toward diagnosing individuals with less severe behavioral symptoms may have contributed to the increasing prevalence of Autistic Disorder diagnoses. Autism Res 2017. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.
... NDDs, TBI and ACEs are also highly co-occurrent (Cleaton and Kirby, 2018) and symptoms of one may be misdiagnosed as another (e.g. Bishop et al., 2008). Furthermore, low literacy, leading to less ability to access support is a complicating factor in the identification of NDD, compounding under-diagnosis or misidentification. ...
Article
Purpose This paper aims to examine the relationship between patterns of functioning in four domains (attention and concentration; social and communication; coordination and organisation; and literacy and numeracy) in women in prison. Also, to consider potential associations between functioning and previous Neurodevelopmental Disorder (NDD) diagnoses, previous mental health diagnoses and history of head injury, self-harm and attempted suicide. Design/methodology/approach Women in one Scottish prison were invited to participate; 87 consented. Women were screened for functional difficulties and asked about their relevant educational and medical history. Findings Half of participants reported difficulties in one or more domains. All possible combinations of functional difficulties were found. Only eight women reported previous NDD diagnoses. Functional difficulties were significantly associated with history of self-harm, history of attempted suicide and mental health diagnoses. In total, 32% of women reported at least one head injury, but this was not significantly associated with functional difficulties. Research limitations/implications The sample was comparatively small and questions were self-report. Analyses were based on within-cohort comparisons due to a lack of appropriate general population data. Practical implications There is a clear need for timely, practical and comprehensive profiling of females in the Justice System. Current systems do not appear to adequately identify women with functional difficulties or other adversity. Greater use of interdisciplinary working and shared training is indicated, as is a move from categorical diagnostic systems towards dimensional approaches. Originality/value This study is the first to investigate associations between difficulties associated with NDDs, mental health difficulties and head injury in women in prison.
... Moreover, the core symptoms of children originally diagnosed with DLD frequently change with age; in many children the diagnosis in adulthood is an ADHD-type disorder (see Yew & O'Kearney, 2013;Curtis, Frey, Watson, Hampton, & Roberts, 2018) or a form of autism (see e.g. Bishop, Whitehouse, Watt, & Line, 2008;Roy & Chiat, 2014;Conti-Ramsden, Simkin, & Botting, 2006). Thus, it is certainly not the case that DLD of itself provides evidence in support of linguistic nativist theories of language development, a là Pinker's (1999) original claim. ...
Chapter
Full-text available
Usage-based theories explain language development in terms of the specific characteristics of language input in combination with a child’s own inherent ability to engage in shared intentionality and statistical learning. In this chapter, I discuss these mechanisms in relation to evidence from Developmental Language Disorders (DLD) and Autism. First, there is evidence for the role of language input in both conditions. The specific patterns of morpho-syntax impairments in DLD are clearly affected by the relative perceptual salience, frequency and complexity of morpho-syntax in the specific language a child is acquiring. Regarding autism, the grammatical complexity of parental child-directed utterances predicts child vocabulary and morpho-syntactic skills at later time-points. Nonetheless, both conditions are highly heritable, raising questions about the child-internal mechanisms leading to language learning difficulties. Impairments in statistical learning could potentially account for morpho-syntactic difficulties in DLD. However, any firm conclusions await assessments of statistical learning which have good test – retest reliability. Autistic children might plausibly tend to have difficulties with - or lack motivation for - engaging in shared intentionality. If verified, this could account for patterns of relatively spared nuts-and-bolts (structural, core) language in the face of pragmatic language difficulties. However, to date studies of autistic difficulties with shared intentionality have not stringently ruled out alternative explanations. Both DLD and autism are likely to exist on a continuum with the neuro-typical population. Future research needs to move towards designs which can more fully accommodate the vast heterogeneity that exists within both DLD and autism.
... Adults with Dravet syndrome (Berkvens et al., 2015) and agenesis of the corpus callosum (Paul, Corsello, Kennedy, & Adolphs, 2014) had higher autism prevalence than the general population. Preliminary evidence from longitudinal studies suggests an overlap between developmental language disorder (DLD) and autism, as people diagnosed with DLDs in childhood have a higher rate (2.1%) of receiving an autism diagnosis in adolescence and adulthood (Mouridsen & Hauschild, 2009), and 34% of a sample of 38 adults with DLD diagnoses were found to meet autism criteria (Bishop et al., 2008). ...
Article
Full-text available
More adults are undergoing autism assessment due to recent changes in awareness, diagnostic criteria and professional practices. This scoping review aimed to summarise research on autism diagnosis in adulthood and identify any gaps for future study. The authors searched for studies involving first-time assessment and diagnosis of autism in adults, which identified 82 studies from 13 countries using various methodologies. Six themes of (1) prevalence, (2) diagnostic pathways and processes, (3) gender, (4) psychosocial characteristics, (5) co-occurring conditions and (6) experiences of diagnosis were identified across the studies. Findings suggest that receiving an autism diagnosis has a significant emotional impact on adults, but accessibility and processes are inconsistent, and formal support services are lacking. More research is needed on autism diagnosis in adults with intellectual disability, consequences of the timing of diagnosis, and support after diagnosis. Lay abstract More adults are getting assessed for possible autism. Here, we give an overview on what is already known about autism diagnosis in adulthood and find areas that need more research. We divided results from the studies we found into six topics of (1) rates of autism in different groups; (2) the process of getting an autism diagnosis in adulthood; (3) gender; (4) personality traits, abilities and behaviours of diagnosed adults; (5) mental and physical health conditions that occur together with autism; and (6) how adults think and feel about being assessed and diagnosed. We found that adults often have strong emotions after being diagnosed, the process of getting a diagnosis can be unclear and different for everyone, and not many support services are available for adults. More research on diagnosing adults with intellectual disability, differences between early and late-diagnosed adults, and support after diagnosis would be useful.
Chapter
Autism is a neurodevelopmental disorder characterised by socio-communicative impairments and restricted interests and repetitive behaviours. While autism is today diagnosed in approximately 1 in 100 children, and retrospectively observed throughout history, it was described for the first time only in the 1940s and seen only rarely until more recently still. Some of the broad social, and specific scientific, developments which led to the contemporary form and shape of autism are here outlined. Social developments include the advent of psychology, the onset of compulsory education, and the widespread deinstitutionalisation which occurred in the 1960s. Consideration of scientific change is centred on the move away from psychoanalytic concepts and towards the methods of biology and cognitive psychology. These changes are placed into dialogue with the self-advocacy movement and consideration of the ethical and conceptual challenges that these movements have ushered in.
Chapter
Access to early intervention services often depends on early in life diagnosis. The average age a child receives an Autism Spectrum Disorder (ASD) diagnosis varies widely internationally and nationally. A number of obstacles often dissuade or preclude an accurate ASD diagnosis and current research-based approaches capable of diagnosing ASD very early in life (i.e., less than 18 months old) are rarely available. We first present the diagnostic characteristics of ASD per the DSM-5, briefly discusses the factors hypothesized to be contributing to the rising ASD prevalence and obstacles to obtaining an accurate ASD diagnosis (e.g., access to services, pediatricians without necessary experience, and so on). We then describe the most common ASD diagnostic procedures and present the pros and cons, as well as the available psychometric data that enables comparison across approaches. Recent research investigating novel approaches that facilitate earlier in life diagnosis is then reviewed. The chapter concludes with suggestions for future research and guidance for practitioners.
Chapter
The medical home was proposed by the American Academy of Pediatrics in 1967 as a model of care for children with special health-care needs-children with chronic health conditions who required care from pediatric subspecialists and mental health and child development professionals. In the medical home model, the primary care provider (PCP) is responsible for coordination of services from within the health care system and from community-based agencies including schools, to ensure that the child’s complex needs are comprehensively met. As the medical home model evolved, there was an increasing focus on primary care management of chronic health conditions like diabetes, cardiovascular disease, and asthma. The emphasis remained on providing care that is comprehensive, coordinated, continuous, and patient centered. In pediatrics, this means care that meets the needs of the child and family. Because services from diverse providers are integral to the model, it has also become known as the health home or health care home. Variations have been developed, including a mental health home in which the mental health professional is the care coordinator for individuals with a primary psychiatric diagnosis.
Article
Résumé Le DSM5 a plus d’un an dans sa version anglo-saxonne, et vient d’être publié en français. Des changements, issus de la pratique clinique et des avancées de la recherche, ont été opérés dans la rubrique des troubles de la communication, concernant les troubles du langage. Afin d’appréhender la façon dont le DSM5 traite des troubles spécifiques du langage oral (TSLO), une revue de littérature ciblant l’analyse des évolutions conceptuelles dans les critères d’exclusion et d’inclusion, et dans la sous-catégorisation de ces troubles a été menée et confrontée à la comparaison : DSM-IV–DSM5. On peut résumer les principaux changements du DSM5 : les troubles mixtes et expressifs du langage sont regroupés, le critère de dissociation avec les performances intellectuelles non verbales n’est plus retenu, le trouble du spectre autistique n’est plus un critère d’exclusion. Le DSM5 intègre une perspective « life-span », c’est-à-dire tout au long de la vie, indispensable à la compréhension des troubles développementaux. Les éléments de la littérature qui n’ont pas été intégrés sont analysés. Le DSM 5 est comme tout test ou manuel nosographique soumis au principe de précaution. La distanciation par l’expérience de la pratique (clinique et recherche) en termes de validité et de fiabilité diagnostique, associée à une démarche critique éclairée par les avancées scientifiques, permettra une utilisation prudente et critique de l’outil pour servir la description du réel. On évitera ainsi l’écueil inverse dans le champ des troubles spécifiques du langage.
Article
Full-text available
Jocul: Participarea la joc, cu scopul de a câştiga bani. Oricând se mizează pe bani sau pe alte valori în cazul unui eveniment cu consecinţe incerte, cu speranţa de a câştiga mai mult. Practicarea jocurilor devine o problemă atunci când afectează relaţiile interpersonale, familia, prietenii, sănătatea fi zică şi mintală, performanţele şcolare, serviciul sau situaţia fi nanciară. Jocul de noroc: Rezultatul jocului se datorează hazardului, neexistând nici o modalitate de a prezice cu certitudine rezultatul. Jocul responsabil: Practicarea jocurilor în scop de divertisment, nu ca o modalitate de a câştiga bani; există un echilibru între practicarea jocurilor şi alte activităţi distractive; alocarea unor sume limitate de bani, neincluzând banii de cheltuieli zilnice; fi xarea unui buget; fi xarea unei limite de timp; neapelarea la împrumuturi de bani pentru a juca; întreruperea frecventă a jocului şi conştientizarea faptului că riscul creşte o dată cu pierderile şi instalarea depresiei. Jocul patologic: Este conceptualizat ca fi ind preocuparea faţă de joc, cu pierderea controlului adecvat asupra oricărui comportament de joc. Se acompaniază de sentimente de vinovăţie şi izolare atunci când jucătorul încearcă să reducă sau să înceteze această activitate, precum şi difi cultăţi în relaţionarea socială, ca o consecinţă a jocului excesiv (Derevensky & Gupta, 2000). Jucătorii patologici suferă de un eşec cronic şi progresiv în a rezista impulsului de a juca. Ei prezintă consecinţe personale semnifi cative datorită continuării jocului. Existã un continuum în privinţa apariţiei şi dezvoltãrii jocului problemã ,aşa dupã cum se observã în fi g.1. SEMNELE JOCULUI PROBLEMĂ LA ADOLESCENŢI Psiholog Dr. Ramona Lupu, profesor logoped – Şcoala “Iuliu Haţieganu“ Cluj-Napoca, Conf. Dr. Viorel Lupu – Disciplina de Psihiatrie şi Psihiatrie pediatricã UMF “Iuliu Haţieganu“, Cluj-Napoca Fig. 1 Con􀆟 nuum în apariția și dezvoltarea jocului problemă (Schaff er & Hall, 1996) 0-------------------------1------------------------------2---------------------------3-----------------------------4 Absenţa jocului Joc recreaţional Simptome de tranziţie Jocul problemă Jocul problemă spre jocul-problemă care necesită tratament Studiile de prevalenţă efectuate în Europa , America de Nord şi pe alte continente au indicat că cel puţin 50% dintre adolescenţi practică ocazional jocuri de noroc, în unele regiuni acest procent apropiindu-se de 85% (Gupta ,Derevensky&Martin, 2006). Adolescenţa este o perioadă a experimentelor pe toate planurile, care presupune apariţia unor comportamente de căutare de senzaţii tari. Alături de consumul de alcool şi/sau de droguri, participarea la jocurile de noroc reprezintă un alt comportament de mare risc la care participă frecvent adolescenţii. La fel ca în cazul consumului de alcool sau de droguri, majoritatea adolescenţilor şi adulţilor tineri care participă ocazional la activităţi de joc nu vor ajunge să dezvolte o dependenţă de acestea (Lupu, 2008).
Article
Full-text available
This article builds on Hacking’s framework of “dynamic nominalism” to show how knowledge about biological etiology can interact with the “kinds of people” delineated by diagnostic categories in ways that “loop” or modify both over time. The authors use historical materials to show how “geneticization” played a crucial role in binding together autism as a biosocial community and how evidence from genetics research later made an important contribution to the diagnostic expansion of autism. In the second part of the article, the authors draw on quantitative and qualitative analyses of autism rates over time in several rare conditions that are delineated strictly according to genomic mutations in order to demonstrate that these changes in diagnostic practice helped to both increase autism’s prevalence and create its enormous genetic heterogeneity. Thus, a looping process that began with geneticization and involved the social effects of genetics research itself transformed the autism population and its genetic makeup.
Article
Full-text available
Aim: To identify a hypothesis on: Supine sleep, sudden infant death syndrome (SIDS) reduction and association with increasing autism incidence. Methods: Literature was searched for autism spectrum disorder incidence time trends, with correlation of change-points matching supine sleep campaigns. A mechanistic model expanding the hypothesis was constructed based on further review of epidemiological and other literature on autism. Results: In five countries (Denmark, United Kingdom, Australia, Israel, United States) with published time trends of autism, change-points coinciding with supine sleep campaigns were identified. The model proposes that supine sleep does not directly cause autism, but increases the likelihood of expression of a subset of autistic criteria in individuals with genetic susceptibility, thereby specifically increasing the incidence of autism without intellectual disability. Conclusion: Supine sleep is likely a physiological stressor, that does reduce SIDS, but at the cost of impact on emotional and social development in the population, a portion of which will be susceptible to, and consequently express autism. A re-evaluation of all benefits and harms of supine sleep is warranted. If the SIDS mechanism proposed and autism model presented can be verified, the research agenda may be better directed, in order to further decrease SIDS, and reduce autism incidence.
Article
Autism spectrum disorders (ASDs) are neurodevelopmental disorders whose core features of impaired social communication and atypical repetitive behaviors and/or restrictions in range of interests emerge in toddlerhood and carry significant implications at successive stages of development. The ability to reliably identify most cases of the condition far earlier than the average age of diagnosis presents a novel opportunity for early intervention, but the availability of such an intervention is disparate across US communities, and its impact is imperfectly understood. New research may transform the clinical approach to these conditions in early childhood.
Article
Full-text available
The prevalence of autism/autism spectrum disorder (ASD) has been increasing across the world. Previous studies in Norway reported, that the prevalence rate for 0-10-year-old children is 1 in 166, and in the case of 11-year-old children it is 1 in 125. Moreover, another nationwide study discovered that 1 in 192 males and 1 in 695 females between the ages of 1-16 years had autism in Norway in the year 2016. This study is underpinned by the data from the National Patient Registry (NPR) for registered incidences of autism/ASD (ICD-10: F84.0 Childhood autism and F84.5 Asperger syndrome). The results show that the prevalence rates of autism/ASD in the capital city of Oslo increased from 2012 to 2016 and the number of children with autism/ASD doubled during this period. Furthermore, in 2016 the results revealed that that 1 in 349 males and 1 in 1594 fe-males between the ages of 1-5 years old had Autism/ASD. Similarly, among the age group of 6-16 years, 1 among 157 males and 1 among 544 females had autism/ASD in the capital city of Oslo in 2016. These findings suggest a ‘school-age-effect’ in the increase of prevalence rates among the school-age children compared to the preschool-age children. In the following study, the results are presented and discussed along with some suggestions for the educational and healthcare authorities.
Chapter
Currently, there is much discussion in print, online and television media across the world about the “autism epidemic”. Although the rates of diagnoses of autism spectrum disorder (ASD) have increased, it could not accurately be described as an “epidemic”. This chapter begins with an examination of the origins of this myth and an overview of studies, which have measured the prevalence of autism spectrum diagnoses. It then explores current theories surrounding the increasing numbers of individuals who have received a diagnosis of ASD, with specific attention to the changing diagnostic criteria and greater awareness of the autism spectrum among parents, teachers and healthcare professionals including paediatricians and psychologists. The impact of this myth for the autistic community will be explored, and the implications of a neurodiversity paradigm on revising perceptions around the autism epidemic myth will be discussed. The chapter will conclude with an exploration of the benefits of shifting current thinking from viewing the increasing prevalence of autism as an “epidemic” to be stopped, to developing a consciousness of autistic individuals as comprising part of the natural variation of society who encompass a range of strengths and needs.
Technical Report
Full-text available
Rapporti ISTISAN 16/24 ISTITUTO SUPERIORE DI SANITÀ Strumenti per sorveglianza e presa in carico di bambini con disturbo dello spettro autistico: il ruolo dei pediatri nel riconoscimento precoce A cura di
Article
Research has indicated that educational diagnoses can differ from clinical diagnoses of autism spectrum disorder (ASD). This brief report provides an updated analysis using 2014–2015 IDEIA data compared to the contemporary CDC prevalence rate (1 in 59). Additionally, the variable of sex was analysed, which was omitted from the previous study. Results show a greater discrepancy in educational diagnoses for girls versus boys as compared to the clinical diagnoses. For race/ethnicity, only Asian American children were more likely to have an educational diagnosis versus a clinical diagnosis of ASD.
Chapter
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder generally manifesting in the first few years of life and tending to persist into adolescence and adulthood. It is characterized by deficits in communication and social interaction and restricted, repetitive patterns of behavior, interests, and activities. It is a disorder with multifactorial etiology. In this chapter, we will focus on the most important and common epidemiological studies, pathogenesis, screening, and diagnostic tools along with an explication of genetic testing in ASD.
Article
This article describes the current understanding of the identification, classification, and diagnosis of autism spectrum disorder (ASD) as it relates to the practice of primary care providers. In addition, the most updated information regarding risk factors, as well as effective treatment strategies are provided. Although primary care providers are not typically the experts in ASD treatment, they constitute a critical component of the care team responsible for early identification and intervention initiation for patients with ASD.
Article
Full-text available
Pathways to diagnosis in adulthood are poorly understood. Even less is known about undiagnosed adults who believe they may be autistic. This mixed-methods online survey examined adults’ journeys from initial concern to receiving the diagnosis. Quantitative findings showed the diagnostic process to be highly heterogeneous. Qualitative analysis identified desires for explanation and support as motives for seeking diagnosis. Cost and fear of not being taken seriously were major barriers, echoed by qualitative responses that described the process as confusing, expensive and time-consuming. While most participants were satisfied with the diagnosis, their emotional reactions were complex. Findings support the need for thoroughly implementing national guidelines, and for improved knowledge and communication in mainstream clinicians encountering clients with possible autism characteristics.
Chapter
Full-text available
Due to the heterogeneity of ASD population, many difficulties emerge when it comes to diagnosis of the disorder and even more difficulties regarding early detection. Specifically, early detection enables diagnosis to be made before the span of 24-30 months, the age where the official diagnosis is usually made. As it is known, earlier diagnosis is very crucial as children with ASD can benefit more from programs of early intervention. Taking all these into account, a brief review of the most popular approaches for early detection of ASD would be elaborated in order to raise awareness to health care professionals, clinicians, and parents. Moreover, in this chapter, the pros and the cons of each approach would be elaborated, and in the final part, some recommendations would be made concerning the process of early detection.
Article
Full-text available
The Autism Diagnostic Observation Schedule—Generic (ADOS-G) is a semistructured, standardized assessment of social interaction, communication, play, and imaginative use of materials for individuals suspected of having autism spectrum disorders. The observational schedule consists of four 30-minute modules, each designed to be administered to different individuals according to their level of expressive language. Psychometric data are presented for 223 children and adults with Autistic Disorder (autism), Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) or nonspectrum diagnoses. Within each module, diagnostic groups were equivalent on expressive language level. Results indicate substantial interrater and test—retest reliability for individual items, excellent interrater reliability within domains and excellent internal consistency. Comparisons of means indicated consistent differentiation of autism and PDDNOS from nonspectrum individuals, with some, but less consistent, differentiation of autism from PDDNOS. A priori operationalization of DSM-IV/ICD-10 criteria, factor analyses, and ROC curves were used to generate diagnostic algorithms with thresholds set for autism and broader autism spectrum/PDD. Algorithm sensitivities and specificities for autism and PDDNOS relative to nonspectrum disorders were excellent, with moderate differentiation of autism from PDDNOS.
Article
Full-text available
An influential theory attributes developmental disorders of language and literacy to low-level auditory perceptual difficulties. However, evidence to date has been inconsistent and contradictory. We investigated whether this mixed picture could be explained in terms of heterogeneity in the language-impaired population. In Experiment 1, the behavioural responses of 16 people with specific language impairment (SLI) and 16 control listeners (aged 10 to 19 years) to auditory backward recognition masking (ABRM) stimuli and unmasked tones indicated that a subgroup of people with SLI are less able to discriminate between the frequencies of sounds regardless of their rate of presentation. Further, these people tended to be the younger participants, and were characterised by relatively poor nonword reading. In Experiment 2, the auditory event-related potentials (ERPs) of the same groups to unmasked tones were measured. Listeners with SLI tended to have age-inappropriate waveforms in the N1-P2-N2 region, regardless of their auditory discrimination scores in Experiment 1. Together, these results suggest that SLI may be characterised by immature development of auditory cortex, such that adult-level frequency discrimination performance is attained several years later than normal.
Article
Full-text available
Independent raters scanned transcribed conversations from 57 language-impaired children and 67 control children aged from 4 to 12 years and identified instances where the normal flow of conversation appeared to be disrupted because the child's utterance was in some way inappropriate. It was found that adequate inter-rater reliability could be obtained using this procedure. Furthermore, test-retest correlations for inappropriacy were significant, indicating that this is a stable conversational characteristic. The measure of inappropriacy decreased with age in control children, and it distinguished language-impaired from control children. Those identified as having 'semantic-pragmatic disorder' obtained particularly high scores. In a subsidiary analysis, inappropriate responses were subcategorised. A wide range of semantic, syntactic and pragmatic peculiarities was identified as leading to a sense of inappropriacy. Some instances of inappropriacy appeared to indicate cognitive rather than linguistic difficulties. Children with semantic-pragmatic disorder resembled younger normal children in that they frequently misunderstood the literal or implicit meaning of adult utterances and they violated normal rules of exchange structure. In other respects, however, the semantic-pragmatic group did not resemble normally developing children of any age. In particular, they tended to provide the listener with too much or too little information.
Article
Full-text available
The diagnostic criteria for autism have been refined and made more objective since Kanner first described the syndrome, so there is now reasonable consistency in how this diagnosis is applied. However, many children do not meet these criteria, yet show some of the features of autism. Where language development is impaired, such children tend to be classed as cases of developmental dysphasia (or specific language impairment) whereas those who learn to talk at the normal age may be diagnosed as having Asperger's syndrome. It is argued that rather than thinking in terms of rigid diagnostic categories, we should recognise that the core syndrome of autism shades into other milder forms of disorder in which language or non-verbal behaviour may be disproportionately impaired.
Article
Full-text available
Six language-impaired children fitting the clinical picture of semantic-pragmatic disorder (mean age 11 years) engaged in conversations with adults in four situations varying in terms of familiarity of the interlocutor (familiar or unfamiliar) and type of setting (interview or toy exploration). These children did not produce more utterances or longer utterances than normally developing children of similar age or ability, but they were more likely to produce utterances that served the conversational function of initiating, rather than responding or acknowledging. This tendency was most pronounced in the toy setting. There was a nonsignificant trend for control children to initiate more with a familiar than with an unfamiliar adult, but no such tendency in the semantic-pragmatic group. A high rate of initiations in children with semantic-pragmatic disorder cannot be regarded as an unusual behavior provoked by the demands of the interview setting, as it is even more apparent during toy exploration, where the child is under less pressure to respond to adult questions.
Article
Full-text available
Eighteen children with specific language impairment (SLI), from 6 to 8 years of age, were compared with 9 control children matched on age and nonverbal ability (CA controls) and with 9 younger control children of comparable language level (LA controls). Half of the SLI group were rated on a teacher checklist as having pragmatic difficulties: these were referred to as the pragmatic language impairment (PLI) group; the remainder were the typical (SLI-T) group. Children's responses to adult soliciting utterances were compared. All children usually responded to conversational solicitations, but children in the PLI group were more likely than control children to give no response, and they also made very little use of nonverbal responses, such as nodding. Nonverbal responding was closely related to the quality of children's responses. Children who failed to use nonverbal responses also had a relatively high level of pragmatically inappropriate responses that were not readily accounted for in terms of limited grammar or vocabulary. This study lends support to the notion that there is a subset of the language-impaired population who have broader communicative impairments, extending beyond basic difficulties in mastering language form, reflecting difficulty in responding to and expressing communicative intents. The analytic methods developed for this project have promise for the study of pragmatic difficulties in other clinical groups.
Article
According to some lay groups, the nation is experiencing an autism epidemic—a rapid escalation in the prevalence of autism for unknown reasons. However, no sound scientific evidence indicates that the increasing number of diagnosed cases of autism arises from anything other than purposely broadened diagnostic criteria, coupled with deliberately greater public awareness and intentionally improved case finding. Why is the public perception so disconnected from the scientific evidence? In this article we review three primary sources of misunderstanding: lack of awareness about the changing diagnostic criteria, uncritical acceptance of a conclusion illogically drawn in a California-based study, and inattention to a crucial feature of the “child count” data reported annually by the U.S. Department of Education.
Article
The Children's Communication Checklist (CCC) was developed to assess aspects of communicative impairment that are not adequately evaluated by contemporary standardised language tests. These are predominantly pragmatic abnormalities seen in social communication, although other qualitative aspects of speech and language were also included. Some items covering social relationships and restricted interests were incorporated, so that the relationship between pragmatic difficulties and other characteristics of pervasive developmental disorders could be explored. Checklist ratings were obtained for 76 children aged 7 to 9 years, all of whom had received special education for language impairment. In 71 cases, 2 raters (usually a teacher and speech-language therapist) independently completed the checklist, making it possible to establish inter-rater reliability. From an initial pool of 93 items, 70 items, grouped into 9 scales, were retained. Five of the subscales were concerned with pragmatic aspects of communication. A composite pragmatic impairment scale formed from these subscales had inter-rater reliability and internal consistency of around .80. This composite discriminated between children with a school diagnosis of semantic-pragmatic disorder and those with other types of specific language impairment (SLI). The majority of children with pragmatic language impairments did not have any evidence of restricted interests or significant difficulties in the domains of social relationships.
Article
Two studies were conducted to test claims that pragmatic language impairment (PLI - previously referred to as semantic-pragmatic disorder) is simply another term for autistic disorder or pervasive developmental disorder not otherwise specified (PDDNOS). In Study 1, 21 children aged from 6 to 9 years with language impairments were subdivided on the basis of the Children's Communication Checklist into 13 cases of pragmatic language impairment (PLI) and eight cases of typical specific language impairment (SLI-T). Parents completed the Autism Diagnostic Interview - Revised (ADI-R) and the Social Communication Questionnaire (SCQ), and the children were given the Autism Diagnostic Observation Schedule - Generic (ADOS-G). In Study 2, a further 11 children with SLI-T and 18 with PLI were assessed using the SCQ and ADOS-G. In addition, six children diagnosed with high-functioning autism and 18 normally developing children were assessed. There was good agreement between ADI-R and SCQ diagnoses, but poor agreement between diagnoses based on these parental report measures and those based on ADOS-G. In many children, symptom profiles changed with age. Four PLI children from Study 1 and one from Study 2 met criteria for autistic disorder on both parental report (ADI-R or SCQ) and ADOS-G. Many of the others showed some autistic features, but there was a subset of children with pragmatic difficulties who were not diagnosed as having autism or PDDNOS by either instrument. These children tended to use stereotyped language with abnormal intonation/prosody, but they appeared sociable and communicative, had normal nonverbal communication, and showed few abnormalities outside the language/social communication domains. Presence of pragmatic difficulties in a child with communication problems should prompt the clinician to evaluate autistic symptomatology, but it is dangerous to assume that all children with pragmatic difficulties have autism or PDDNOS.
Article
Background: Recent reports have suggested that the prevalence of autism and related spectrum disorders (ASDs) is substantially higher than previously recognised. We sought to quantify prevalence of ASDs in children in South Thames, UK. Methods: Within a total population cohort of 56 946 children aged 9–10 years, we screened all those with a current clinical diagnosis of ASD (n=255) or those judged to be at risk for being an undetected case (n=1515). A stratified subsample (n=255) received a comprehensive diagnostic assessment, including standardised clinical observation, and parent interview assessments of autistic symptoms, language, and intelligence quotient (IQ). Clinical consensus diagnoses of childhood autism and other ASDs were derived. We used a sample weighting procedure to estimate prevalence. Findings: The prevalence of childhood autism was 38·9 per 10 000 (95% CI 29·9–47·8) and that of other ASDs was 77·2 per 10 000 (52·1–102·3), making the total prevalence of all ASDs 116·1 per 10 000 (90·4–141·8). A narrower definition of childhood autism, which combined clinical consensus with instrument criteria for past and current presentation, provided a prevalence of 24·8 per 10 000 (17·6–32·0). The rate of previous local identification was lowest for children of less educated parents. Interpretation: Prevalence of autism and related ASDs is substantially greater than previously recognised. Whether the increase is due to better ascertainment, broadening diagnostic criteria, or increased incidence is unclear. Services in health, education, and social care will need to recognise the needs of children with some form of ASD, who constitute 1% of the child population.
Article
The literature on children with language disorders that are characterized by semantic and pragmatic impairments is reviewed and the conclusion is drawn that some of these conditions may stem from the same fundamental cognitive and interpersonal difficulties that are found in early childhood autism. A summary is presented of recent relevant research and theory in the field of autism and suggestions are offered on how these ideas might be applied to children showing semantic and pragmatic difficulties.
Article
Describes the Autism Diagnostic Interview-Revised (ADI-R), a revision of the Autism Diagnostic Interview, a semistructured, investigator-based interview for caregivers of children and adults for whom autism or pervasive developmental disorders is a possible diagnosis. The revised interview has been reorganized, shortened, modified to be appropriate for children with mental ages from about 18 months into adulthood and linked to ICD-10 and DSM-IV criteria. Psychometric data are presented for a sample of preschool children.
Article
This paper reports on the results of a large project involving 7-year-old children attending language units in England. A group of 242 children with specific language impairment (SLI) were assessed on a battery of psychometric tests. In addition, teacher interviews were carried out to ascertain teachers' opinions of the children's difficulties. Cluster analysis revealed six robust subgroups of children with language difficulties. The findings are discussed in the context of other approaches to the classification of language impairment in children with special reference to the work of Rapin and Allen (1987).
Article
The Children's Communication Checklist (CCC) was developed to assess aspects of communicative impairment that are not adequately evaluated by contemporary standardised language tests. These are predominantly pragmatic abnormalities seen in social communication, although other qualitative aspects of speech and language were also included. Some items covering social relationships and restricted interests were incorporated, so that the relationship between pragmatic difficulties and other characteristics of pervasive developmental disorders could be explored. Checklist ratings were obtained for 76 children aged 7 to 9 years, all of whom had received special education for language impairment. In 71 cases, 2 raters (usually a teacher and speech-language therapist) independently completed the checklist, making it possible to establish inter-rater reliability. From an initial pool of 93 items, 70 items, grouped into 9 scales, were retained. Five of the subscales were concerned with pragmatic aspects of communication. A composite pragmatic impairment scale formed from these subscales had inter-rater reliability and internal consistency of around .80. This composite discriminated between children with a school diagnosis of semantic-pragmatic disorder and those with other types of specific language impairment (SLI). The majority of children with pragmatic language impairments did not have any evidence of restricted interests or significant difficulties in the domains of social relationships.
Article
This paper focuses on general social functioning in two groups of young men, one with autism and one with developmental receptive language disorders, who were first assessed at the ages of 7–8 years. At that time, although matched for nonverbal IQ (mean 92–93) and expressive language, the Language group showed significantly fewer social and behavioural problems. At follow-up, when aged on average, 23 to 24 years, the Autism group continued to show significantly more impairments in terms of stereotyped behaviour patterns, social relationships, jobs, and independence. However, problems in all these areas were also common in the Language group. Many still lived with their parents, few had close friends or permanent jobs, and ratings of social interaction indicated abnormalities in a number of different areas. On a composite measure of social competence only 10% of the Language group was assessed as having severe social difficulties compared to 74% of the Autism group. Nevertheless, 65% were rated as having moderate social problems and only 25% were rated as being of near/normal social functioning. Two individuals in the Language group, but none in the Autism group, had also developed a florid paranoid psychosis in late adolescence.
Article
To review the recent literature on possible causes of the increase in frequency of diagnosed autism reported from three countries, and to compare the medical diagnoses and drug therapy from a new series of autistic boys and their mothers with that of comparable nonautistic boys and their mothers. Case-control evaluation. Members of over 250 general practices in the United Kingdom. Frequency of exposure to drugs and presence of preexisting clinical illnesses in autistic children and their mothers were compared with nonautistic children and their mothers over time. According to published studies, the incidence of boys diagnosed with autism rose dramatically in the 1990s. Numerous published studies have concluded that the measles-mumps-rubella vaccine is not responsible for the large rise in diagnosed autism. In our study, boys diagnosed with autism had medical and drug histories, such as vaccines, before diagnosis, that were closely similar to those of nonautistic boys, except that developmental and sensory disorders were far more common in autistic boys. No material differences during pregnancy were found between the mothers of autistic boys and those of nonautistic boys in relation to illness or drug therapy. In the early 1990s, boys with diagnosed developmental disorders were infrequently diagnosed with autism. In the later 1990s, such boys more often were diagnosed with autism. A major cause of the recent large increase in the number of boys diagnosed with autism probably is due to changing diagnostic practices.
Article
The Children's Communication Checklist (CCC 1998) was revised in 2003 (CCC-2) to provide a general screen for communication disorder and to identify pragmatic/social interaction deficits. Two validation studies were conducted with different populations of children with language and communication impairments. In Study 1, the questionnaire was given to families of 87 children attending full-time special education for specific language impairment, pragmatic language impairments or autistic spectrum disorders. In addition, the teachers of half the sample completed CCC-2 forms for the same children, providing evidence for interrater agreement. In Study 2, the sample was increased to include 24 children with similar diagnoses in educational contexts in Scotland and 27 children referred for clinical evaluation at a neurodevelopment centre. The CCC-2 distinguished children with communication impairments from non-impaired peers. Furthermore, the social-interaction deviance composite (SIDC) of the CCC-2 identified children with disproportionate pragmatic and social difficulties in relation to their structural language impairments. This measure also had good interrater agreement (r=0.79). CCC-2 provides a useful screening measure for communication impairment and can be helpful in identifying children who should be referred for more detailed assessment of possible autistic spectrum disorder. However, the present data highlight substantial overlap amongst groups with 'distinct' diagnoses. It is suggested that it is unrealistic to use the CCC-2 to make categorical distinctions on this continuum of disorder.
Article
Little is known on the adult outcome and longitudinal trajectory of childhood developmental language disorders (DLD) and on the prognostic predictors. Seventeen men with a severe receptive DLD in childhood, reassessed in middle childhood and early adult life, were studied again in their mid-thirties with tests of intelligence (IQ), language, literacy, theory of mind and memory together with assessments of psychosocial outcome. They were compared with the non language disordered siblings of the DLD cohort to control for shared family background, adults matched to the DLD cohort on age and performance IQ (IQM group) and a cohort from the National Child Development Study (NCDS) matched to the DLD cohort on childhood IQ and social class. The DLD men had normal intelligence with higher performance IQ than verbal IQ, a severe and persisting language disorder, severe literacy impairments and significant deficits in theory of mind and phonological processing. Within the DLD cohort higher childhood intelligence and language were associated with superior cognitive and language ability at final adult outcome. In their mid-thirties, the DLD cohort had significantly worse social adaptation (with prolonged unemployment and a paucity of close friendships and love relationships) compared with both their siblings and NCDS controls. Self-reports showed a higher rate of schizotypal features but not affective disorder. Four DLD adults had serious mental health problems (two had developed schizophrenia). A receptive developmental language disorder involves significant deficits in theory of mind, verbal short-term memory and phonological processing, together with substantial social adaptation difficulties and increased risk of psychiatric disorder in adult life. The theoretical and clinical implications of the findings are discussed.
Article
Several reviews have noted a huge increase in the rate of diagnosed autism spectrum disorders. The main aims of this paper are: 1) to use published empirical findings to consider whether the rise reflects a true increase in incidence, as distinct from the consequences of better ascertainment and a broadening of the diagnostic concept; and 2) to consider how epidemiological data may be used to test hypotheses about possible causal influences, using MMR and thimerosal as examples. Search of the literature for studies with a large epidemiological base population, systematic standardized screening, a focus on an age group for which diagnostic assessments are reliable and valid, and diagnosis by trained professionals using high-quality research assessments. Also, search of a broader literature to consider the evidence from all epidemiological studies with respect to the hypothesized causal effect of MMR and thimerosal on autism spectrum disorders. The true incidence of autism spectrum disorders is likely to be within the range of 30-60 cases per 10 000, a huge increase over the original estimate 40 years ago of 4 per 10000. The increase is largely a consequence of improved ascertainment and a considerable broadening of the diagnostic concept. However, a true risk due to some, as yet to be identified, environmental risk factor cannot be ruled out. There is no support for the hypothesis for a role of either MMR or thimerosal in causation, but the evidence on the latter is more limited. Progress in testing environmental risk hypotheses will require the integration of epidemiological and biological studies.
Article
To quantitatively examine the influence of study methodology and population characteristics on prevalence estimates of autism spectrum disorders. Electronic databases and bibliographies were searched and identified papers evaluated against inclusion criteria. Two groups of studies estimated the prevalence of typical autism and all autism spectrum disorders (ASD). The extent of variation among studies and overall prevalence were estimated using meta-analysis. The influence of methodological factors and population characteristics on estimated prevalence was investigated using meta-regression and summarised as odds ratios (OR). Forty studies met inclusion criteria, of which 37 estimated the prevalence of typical autism, and 23 the prevalence of all ASD. A high degree of heterogeneity among studies was observed. The overall random effects estimate of prevalence across studies of typical autism was 7.1 per 10,000 (95% CI 1.6 to 30.6) and of all ASD was 20.0 per 10,000 (95% CI 4.9 to 82.1). Diagnostic criteria used (ICD-10 or DSM-IV versus other; OR = 3.36, 95% CI 2.07 to 5.46), age of the children screened (OR = 0.91 per year, 95% CI 0.83 to 0.99), and study location (e.g. Japan versus North America; OR = 3.60, 95% CI 1.73 to 7.46) were all significantly associated with prevalence of typical autism. Diagnostic criteria, age of the sample, and urban or rural location were associated with estimated prevalence of all ASD. Sixty one per cent of the variation in prevalence estimates of typical autism was explained by these models. Diagnostic criteria used, age of children screened, and study location may be acting as proxies for other study characteristics and require further investigation.
Article
Growing administrative prevalence of autism has stirred public controversy and concern. The extent to which increases in the administrative prevalence of autism have been associated with corresponding decreases in the use of other diagnostic categories is unknown. The main objective of this study was to examine the relationship between the rising administrative prevalence of autism in US special education and changes in the use of other classification categories. The main outcome measure was the administrative prevalence of autism among children ages 6 to 11 in US special education. Analysis involved estimating multilevel regression models of time-series data on the prevalence of disabilities among children in US special education from 1984 to 2003. The average administrative prevalence of autism among children increased from 0.6 to 3.1 per 1000 from 1994 to 2003. By 2003, only 17 states had a special education prevalence of autism that was within the range of recent epidemiological estimates. During the same period, the prevalence of mental retardation and learning disabilities declined by 2.8 and 8.3 per 1000, respectively. Higher autism prevalence was significantly associated with corresponding declines in the prevalence of mental retardation and learning disabilities. The declining prevalence of mental retardation and learning disabilities from 1994 to 2003 represented a significant downward deflection in their preexisting trajectories of prevalence from 1984 to 1993. California was one of a handful of states that did not clearly follow this pattern. Prevalence findings from special education data do not support the claim of an autism epidemic because the administrative prevalence figures for most states are well below epidemiological estimates. The growing administrative prevalence of autism from 1994 to 2003 was associated with corresponding declines in the usage of other diagnostic categories.
Article
Traditionally, autism and specific language impairment (SLI) have been regarded as distinct disorders but, more recently, evidence has been put forward for a closer link between them: a common set of language problems, in particular receptive language difficulties and the existence of intermediate cases including pragmatic language impairment. The present study aimed to examine the prevalence of autism spectrum disorders in a large sample of adolescents with a history of SLI. The presence of autism spectrum disorders was examined in seventy-six 14-year-olds with a confirmed history of SLI. A variety of instruments were employed, including the Autism Diagnostic Interview-Revised (ADI-R), the Autism Diagnostic Observation Schedule (ADOS) and the Family History Interview (FHI). The prevalence of autism spectrum disorders in young people with SLI was found to be 3.9%, about 10 times what would be expected from the general population. In addition, a much larger number of young people with a history of SLI showed only some autism spectrum symptoms or showed them in a mild form. Young people with SLI have an increased risk of autism. The magnitude of this risk is considerable. In addition, a larger proportion (a quarter of individuals) present with a number of behaviours consistent with autism spectrum disorders.
Article
Recent reports have suggested that the prevalence of autism and related spectrum disorders (ASDs) is substantially higher than previously recognised. We sought to quantify prevalence of ASDs in children in South Thames, UK. Within a total population cohort of 56 946 children aged 9-10 years, we screened all those with a current clinical diagnosis of ASD (n=255) or those judged to be at risk for being an undetected case (n=1515). A stratified subsample (n=255) received a comprehensive diagnostic assessment, including standardised clinical observation, and parent interview assessments of autistic symptoms, language, and intelligence quotient (IQ). Clinical consensus diagnoses of childhood autism and other ASDs were derived. We used a sample weighting procedure to estimate prevalence. The prevalence of childhood autism was 38.9 per 10,000 (95% CI 29.9-47.8) and that of other ASDs was 77.2 per 10,000 (52.1-102.3), making the total prevalence of all ASDs 116.1 per 10,000 (90.4-141.8). A narrower definition of childhood autism, which combined clinical consensus with instrument criteria for past and current presentation, provided a prevalence of 24.8 per 10,000 (17.6-32.0). The rate of previous local identification was lowest for children of less educated parents. Prevalence of autism and related ASDs is substantially greater than previously recognised. Whether the increase is due to better ascertainment, broadening diagnostic criteria, or increased incidence is unclear. Services in health, education, and social care will need to recognise the needs of children with some form of ASD, who constitute 1% of the child population.
Article
Standard case criteria are proposed for combined use of the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule to diagnose autism and to define the broader category of autism spectrum disorders. Single and combined Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule algorithms were compared to best estimate diagnoses in four samples: U.S. (n = 960) and Canadian (n = 232) participants 3 years and older, U.S. participants younger than 36 months (n = 270), and U.S. participants older than 36 months with profound mental retardation (n = 67). Sensitivities and specificities of 80% and higher were obtained when strict criteria for an autism diagnosis using both instruments were applied in the U.S. samples, and 75% or greater in the Canadian sample. Single-instrument criteria resulted in significant loss of specificity. Specificity was poor in the sample with profound mental retardation. Lower sensitivity and specificity were also obtained when proposed criteria for broader spectrum disorders were applied. The Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule make independent, additive contributions to the judgment of clinicians that result in a more consistent and rigorous application of diagnostic criteria.
North American usage: mental retardation
  • Child
344 Developmental Medicine & Child Neurology 2008, 50: 341–345 *North American usage: mental retardation.
Why and when do some language impaired children seem talkative?
  • Dvm Bishop
  • J Hartley
  • F Weir
Bishop DVM, Hartley J, Weir F. Why and when do some language impaired children seem talkative? J Autism Dev Disord 1994; 24: 177-97.
Why and when do some language impaired children seem talkative?
  • Bishop