[Show abstract][Hide abstract]ABSTRACT: To study a controversy that has been discussed for more than two decades: whether or not children with autism have abnormalities affecting the cochlear nerve or the auditory pathway in the brain stem and, if so, to describe these abnormalities.
A group of 153 children and adolescents with autistic disorder were included in an investigation of auditory brain stem responses (ABR). Two thirds of this group, 101 individuals (75 boys, 26 girls), had normal hearing and they were selected for an in-depth ABR study. The results from the study group were compared with those of an age-matched comparison group.
The III-V interpeak latency (IPL) was significantly prolonged in both boys and girls with autism, compared with the controls. The latencies of ABR waves I and V were also significantly lengthened in the study groups. The individual test results showed that more than half of this normal-hearing autistic disorder group (58%) had abnormalities of one or more of eight ABR parameters studied. The most common abnormalities were prolongation of wave V (38%), and of I-V IPL (28%). A lengthening of the I-V IPL was also recorded in 27% of 49 children who were difficult to test or who had hearing loss. Abnormal left-right differences of ABR latencies were found in 18% of autism cases with normal hearing.
Possible causes of the reported ABR abnormalities, observed here as well as in other studies, are discussed. Brain stem lesion, occult cochlear dysfunction, and involvement of the cochlear efferent system are probable factors that can explain the ABR findings
[Show abstract][Hide abstract]ABSTRACT: A group of 199 children and adolescents (153 boys, 46 girls) with autistic disorder was audiologically evaluated. Mild to moderate hearing loss was diagnosed in 7.9% and unilateral hearing loss in 1.6% of those who could be tested appropriately. Pronounced to profound bilateral hearing loss or deafness was diagnosed in 3.5% of all cases, representing a prevalence considerably above that in the general population and comparable to the prevalence found in populations with mental retardation. Hearing deficits in autism occurred at similar rates at all levels of intellectual functioning, so it does not appear that the covariation with intellectual impairment per se can account for all of the variance of hearing deficit in autism. Hyperacusis was common, affecting 18.0% of the autism group and 0% in an age-matched nonautism comparison group. In addition, the rate of serous otitis media (23.5%) and related conductive hearing loss (18.3%) appeared to be increased in autistic disorder. The study emphasizes the need for auditory evaluation of individuals with autism in order to refer those with pronounced to profound hearing loss for aural habilitation and to follow those with mild to moderate hearing loss because of the risk of deterioration.
Article · Nov 1999 · Journal of Autism and Developmental Disorders
[Show abstract][Hide abstract]ABSTRACT: Gangliosides are sialic acid-containing glycolipids found in all cells, especially abundant in nerve cells and mainly situated on outer-membrane surfaces. The aim of this study was to provide data on the concentration of gangliosides in the CSF of children and adolescents with autism spectrum disorders (ASD) - 66 with autistic disorder, and 19 with other autism spectrum disorders. The comparison group consisted of 29 children and adolescents, whose CSF had been sampled to exclude acute infectious CNS disorder. The concentrations of the gangliosides GM1, GD1a, GD1b, and GT1b were determined using a microimmunoaffinity technique. The ASD group had a significantly higher concentration of ganglioside GM1 compared with the comparison group. The GM1 increase could not be explained as secondary to other clinical factors. Mean ganglioside levels did not differentiate subgroups with autistic disorder and those with a more atypical clinical picture, nor subgroups with known medical disorders and those with idiopathic autism. Altered patterns of gangliosides in the CNS might reflect important correlates of pathogenesis in autism.
Article · Oct 1998 · Developmental Medicine & Child Neurology
[Show abstract][Hide abstract]ABSTRACT: The Childhood Autism Rating Scale (CARS) is an instrument for screening and diagnosis of autism. The present study was performed to assess the interrater reliability of a Swedish version of the CARS when used in a clinical setting. The procedure used mimicked a frequent form of consultation in neuropsychiatry and pediatric neurology. During a restricted time period, both an interview with the parents and observation of the child take place. Often this assessment is an important screening procedure and directs further investigation. CARS was used for rating autistic behavior by two investigators in 25 children. A variant of the weighted kappa statistic (correcting for chance and for degrees of disagreement) showed values between .53 and .75 (indicating fair to excellent agreement). Aspects of validity and reliability are discussed.
Article · Mar 1998 · Journal of Autism and Developmental Disorders
[Show abstract][Hide abstract]ABSTRACT: The majority of children with autism show deviance and socially or psychiatrically handicapping conditions throughout life. Only a small proportion of those with classical childhood autism lead independent adult lives. Others, particularly those with 'high-functioning' autism and so-called Asperger syndrome will improve enough to live an independent adult life. The level of mental retardation and other comorbid conditions (such as medical syndromes and other neuropsychiatric disorders, including epilepsy) is important in predicting outcome. An IQ below 50 around school age predicts severe restriction of social and adaptive functioning in adult life. The absence of communicative speech at 5-6 years of age is indicative of a poorer long-term overall outcome. There is a clear co-variation between IQ and level of communication, but probably there is some prognostic factor in language development apart from this. Measures of flexibility and cognitive shifting abilities tend to be good predictors of social outcome in a few studies. There is a continued need for prospective, longitudinal studies of children with autism spectrum disorders, particularly in Asperger syndrome. The role of interventions of various kinds needs to be addressed in such studies.
Article · Feb 1998 · Acta Psychiatrica Scandinavica
[Show abstract][Hide abstract]ABSTRACT: Autism and Asperger syndrome are disorders with early childhood onset. They are believed to exist on the same spectrum of impairments of reciprocal communication and social interaction restriction of imagination and behaviour. A number of screening and diagnostic tools have been developed in the field, and several of these are briefly reviewed here. It is concluded that autism may be screened around age 18 months and a diagnosis reliably be made around age 30 months, whereas a diagnosis of Asperger syndrome is not usually suspected, screened or made until into the child's school age.
Article · Jul 1996 · European Child & Adolescent Psychiatry
[Show abstract][Hide abstract]ABSTRACT: The prevalence of autism spectrum disorders was studied in all children with mental retardation and/or motor disability in a defined geographical region over a two-year follow-up period. In the general population, the prevalence of autistic disorder was 0.09% at the end of the follow-up period -a minimum estimate, as children with average intelligence were not screened. Autism spectrum disorders were found in 19.8% of children with mental retardation, including strictly defined autistic disorder (DSM-III-R criteria) in 8.9%; the two-year follow-up yielded a higher prevalence of 11.7% with autistic disorder. Among children with cerebral palsy, 10.5% had an autism spectrum disorder. Clear co-variation was found between mental retardation, epilepsy and autism spectrum disorders in this population of children with neurodevelopmental disorders.
Article · May 1996 · Developmental Medicine & Child Neurology
[Show abstract][Hide abstract]ABSTRACT: The Autism Behavior Checklist (ABC) was used as a screening instrument in a study of autism spectrum disorders in a population of children with mental retardation or physical disability or both. The ABC score clearly reflected behavioural problems found in children with mental retardation and not only behaviours typical of autism. If the cut-off score used was 45 (lower than recommended by the original investigators), children with autistic disorder without multiple other disabilities were reliably identified, with an acceptable rate of false positive cases. In order not to miss other autism spectrum disorders, all cases with several omitted items in their checklists were examined in more detail. The Childhood Autism Rating Scale (CARS) distinguished reasonably well between autistic disorder and other autism spectrum disorders.
Article · May 1996 · Developmental Medicine & Child Neurology
[Show abstract][Hide abstract]ABSTRACT: Of a population of 100 Swedish thalidomide embryopathy cases, at least four met full criteria for DSM-III-R autistic disorder and ICD-10 childhood autism. Thalidomide embryopathy of the kind encountered in these cases affects fetal development early in pregnancy, probably on days 20 to 24 after conception. It is argued that the possible association of thalidomide embryopathy with autism may shed some light on the issue of which neural circuitries may be involved in autism pathogenesis.
Autisme dans l'embryopathie thalidomide: une étude de population
Dans une population de 100 cas suédois d'embryopathie thalidomide, au moins quatre cas présentaient tous les critères du trouble autistique du DSM-III-R et de l'autisme infantile du ICD-10. L'embryopathie thalidomide du type recontré dans ces cas affecte le développement en début de grossesse, probablement entre le jour 20 et le jour 24 après la conception. Les auteurs pensent que l'association possible de l'embryopathie thalidomide avec I'autisme peut jetter quelques lumières sur la nature des circuits neuronaux impliqués dans la pathogenése de l'autisme.
Autismus bei Thalidomid Embryopathie: eine Populationssiudie
Von 100 schwedischen Thalidomid Embryopathiefällen erfüllten mindestens vier alle Krtiterien für die DSM-HI-R Form des Autismus und für den ICD-10 Autismus des Kindesalters. Die Thalidomid Embryopathie, die bei diesen Kindern vorlag, stört die fetale Entwicklung in der frühen Schwangerschaft, wahrscheinlich an den Tagen 20 bis 24 nach der Konzeption. Die Autoren denken, daβ die mögliche Beziehung zwischen Thalidomid Embryopathie und Autismus zur Klärung der Frage beitragen könnte, welche fetalen Verbindungen bei der Pathogenese des Autismus involviert sind.
A utismo en la embriopatia por talidomina. t'studio de una población
De una población de 100 casos en Suecia de embriopatia talidomínica, por lo menos cuatro cumplian los criterios establecidos por el DSM-III-R para una alteratión autistica y por el ICD-10 para el autismo infantil. La embriopatia talidominica del tipo encontrado en estos casos afecta el desarrollo prenatal precozmente en la gestation, probablemente en los dias 20 al 24 después de la conceptión. Se argumenta que la posible asociación de la embriopatia talidominica con el autismo pueda ser de alguna ayuda sobre el tema de cuales son los circuitos neuronales afectados en la patogenesis del autismo.
Article · May 1994 · Developmental Medicine & Child Neurology