Claudine Dietz’s research while affiliated with Nederlands Jeugd Instituut and other places

Om bij kinderen al op zeer jonge leeftijd ASS op te kunnen sporen, heeft het Landelijk Netwerk Autisme Jonge Kind (LNAJK) de krachten gebundeld. Niet alleen kinderen zijn gebaat bij een vroege diagnose en behandeling; ouders kan het veel zorgen en stress besparen. Maar wat komt er zoal kijken bij zo’n vroege diagnose?

In order to understand typical and atypical developmental trajectories it is important to assess how strengths or weaknesses in one domain may be affecting performance in other domains. This study examined longitudinal relations between early fine motor functioning, visuospatial cognition, exploration, and language development in preschool children with ASD and children with other developmental delays/disorders. The ASD group included 63 children at T1 (Mage = 27.10 months, SD = 8.71) and 46 children at T2 (Mage = 45.85 months, SD = 7.16). The DD group consisted of 269 children at T1 (Mage = 17.99 months, SD = 5.59), and 121 children at T2 (Mage = 43.51 months, SD = 3.81). A subgroup nested within the total sample was randomly selected and studied in-depth on exploratory behavior. This group consisted of 50 children, 21 children with ASD (Mage = 27.57, SD = 7.09) and 29 children with DD (Mage = 24.03 months, SD = 6.42). Fine motor functioning predicted language in both groups. Fine motor functioning was related to visuospatial cognition in both groups and related to object exploration, spatial exploration, and social orientation during exploration only in the ASD group. Visuospatial cognition and all exploration measures were related to both receptive and expressive language in both groups. The findings are in line with the embodied cognition theory, which suggests that cognition emerges from and is grounded in the bodily interactions of an agent with the environment. This study emphasizes the need for researchers and clinicians to consider cognition as emergent from multiple interacting systems.

Background: Although delays and deficits in language development are diagnostic criteria for Autism Spectrum Disorder (ASD), little is known about the pre-clinical signs related to these deficits. Various researchers have noted delays and deficits in the motor skills of young children with ASD, little attention has been paid however to the role of motor development in the acquisition of language in children with ASD. From an embodied cognition perspective it is proposed that motor functioning and language development are related, and that exploratory behavior and visuospatial cognition are possible mediators of this relationship. This perspective may be fruitful to study the language acquisition in ASD. Objectives: The objectives of this study were to examine whether (1) early motor functioning can predict later receptive and expressive language development in children with ASD and children at risk for ASD, (2) the relationship between motor functioning and language is mediated by exploration and visuospatial cognition, (3) the relationship between motor functioning and language is moderated by severity of autism. Methods: Longitudinal relations between early finemotor functioning and language in the fourth year of life were examined in two groups of preschool children: 50 with ASD, confirmed by ADI-R and the ADOS-G, and 120 at high risk for developing ASD. The high risk children failed 3 or more items on the Early Screening of Autistic Traits (ESAT) but had no ASD at the moment of assessment. Motor functioning, visuospatial cognition and language abilities were assessed with the Mullen Scales of Early Learning (MSEL). An observation coding scheme was applied to score several aspects of exploration. Results: Finemotor functioning predicted language in the ASD and the high risk group. This relationship was mediated by visuospatial cognition in both groups and by exploration in the ASD group. Severity of autism moderated the strength of some of the relations with stronger effects in the ASD group compared to the high risk group. Conclusions: Early motor functioning, exploration, and visuospatial cognition appear to be predictors of later language development in children with autism. These findings are in support of the embodied cognition theory. The current study emphasizes the importance of motor assessment for children with ASD and the need for clinicians to consider cognition in general, and language specifically as emergent from multiple interacting systems. Future longitudinal studies are needed to examine the developmental trajectories of ASD and the interrelations between different domains of functioning.

To study brain volumes in children with ASD as compared to children with a mental retardation or a language delay (developmentally delayed). In addition, to study the association of intellectual functioning on brain volumes in children with ASD or developmental delay. Thirty-four children with ASD and 13 developmentally delayed children without ASD, between 2 and 7 years old, matched on age and developmental level, participated in a MRI study. Volumes of cranium, total brain, cerebellum, grey and white matter, ventricles, hippocampus and amygdala were measured. No significant differences in volumes of intracranium, total brain, ventricles, cerebellum, grey or white matter or amygdala and hippocampus between the ASD group and the developmentally delayed group were found. In the developmentally delayed group, a significant correlation (0.73) was found between intellectual functioning and total brain volume after partialling out intracranial volume. In the ASD group, the correlation between intellectual functioning and brain volume corrected for intracranial volume was not significant. No evidence was found for overall differences in brain volumes in children with ASD compared to developmentally delayed children between 2 and 7 years. The finding that higher intellectual functioning was not associated with a relative larger brain volume in children with ASD may suggest that a relative enlargement of the brain may not be beneficial to patients with autism.

To examine the inter-rater reliability and stability of autism spectrum disorder (ASD) diagnoses made at a very early age in children identified through a screening procedure around 14 months of age. In a prospective design, preschoolers were recruited from a screening study for ASD. The inter-rater reliability of the diagnosis of ASD was measured through an independent assessment of a randomly selected subsample of 38 patients by two other psychiatrists. The diagnoses at 23 months and 42 months of 131 patients, based on the clinical assessment and the diagnostic classifications of standardised instruments, were compared to evaluate stability of the diagnosis of ASD. Inter-rater reliability on a diagnosis of ASD versus non-ASD at 23 months was 87% with a weighted kappa of 0.74 (SE 0.11). The stability of the different diagnoses in the autism spectrum was 63% for autistic disorder, 54% for pervasive developmental disorder, not otherwise specified (PDD-NOS), and 91% for the whole category of ASD. Most diagnostic changes at 42 months were within the autism spectrum from autistic disorder to PDD-NOS and were mainly due to diminished symptom severity. Children who moved outside the ASD category at 42 months made significantly larger gains in cognitive and language skills than children with a stable ASD diagnosis. In conclusion, the inter-rater reliability and stability of the diagnoses of ASD established at 23 months in this population-based sample of very young children are good.

Several instruments have been developed to screen for autism spectrum disorders (ASD) in high-risk populations. However, few studies compare different instruments in one sample. Data were gathered from the Early Screening of Autistic Traits Questionnaire, Social Communication Questionnaire, Communication and Symbolic Behavior Scales-Developmental Profile, Infant-Toddler Checklist and key items of the Checklist for Autism in Toddlers in 238 children (mean age = 29.6 months, SD = 6.4) at risk for ASD. Discriminative properties are compared in the whole sample and in two age groups separately (8-24 months and 25-44 months). No instrument or individual item shows satisfying power in discriminating ASD from non-ASD, but pros and cons of instruments and items are discussed and directions for future research are proposed.

Veel ouders/verzorgers ervaren, net als de ouders van Imar, al vroeg problemen in de ontwikkeling van hun kind. ‘Hij is zo stil en maakt nauwelijks geluidjes’; ‘Ze reageert zo weinig op wat er om haar heen gebeurt’ en ‘Mijn kind begint maar niet met praten’. Dit zijn zomaar een paar zorgen die ouders/verzorgers kunnen uiten bij een bezoek aan, bijvoorbeeld, het consultatiebureau.

Kinderen kunnen al vroeg in hun leven signalen vertonen die kunnen wijzen op aan ASS gerelateerde problemen in de ontwikkeling. In dit hoofdstuk zal uitleg gegeven worden over het signaleren van risico’s op dergelijke ontwikkelingsproblemen. Daarvoor zullen onder meer de zogenoemde ‘Alarmsignalen’ worden geïntroduceerd.

Autisme is een ernstige neuropsychiatrische ontwikkelingsstoornis, waarbij problemen en afwijkingen in de ontwikkeling van wederkerig sociaal contact centraal staan. Deze stoornis komt al vroeg in de ontwikkeling tot uiting en beperkt het functioneren tot in de volwassenheid.