Children with autism spectrum disorders and selective mutism

Background: It has been suggested that autism spectrum disorder (ASD) might be a “comorbid” condition in selective mutism (SM). Methods: In this retrospective study, we examined medical records of children with SM diagnosis (n=97) at a medical center specializing in assessment of ASD. Results: Mean age for onset of SM symptoms was 4.5 years and mean age at SM diagnosis was 8.8 years. SM was more common among girls (boy:girl ratio=2.7:1). We found that 63% of the study group had an ASD (no gender difference). The SM group with combined ASD had later onset of symptoms, higher age at diagnosis, more often a history of speech delay, and a higher proportion of borderline IQ or intellectual disability. Conclusion: The results highlight the risk of overlap between ASD and SM

Dialogical Family Guidance (dfg)-Development and implementation of an intervention for families with a child with neurodevelopmental disorders

Aim: To describe the development and implementation of a Dialogical Family Guidance (DFG) intervention, aimed at families with a child with neurodevelopmental disorders (NDD). Design: The DFG components are presented and the content of a DFG training course. Professionals' experiences after the DFG training were evaluated. Methods: Dialogical Family Guidance development phases and implementation process are examined. The Revised Standards for Quality Improvement Reporting Excellence checklist (SQUIRE 2.0) was used to provide a framework for reporting new knowledge. Results: The DFG training course seemed to increase possibilities of a more independent role as a nurse to deliver the DFG family intervention. The project showed that the use of dialogue can be difficult for some professionals. Analysis of the questionnaire completed after DFG training reported a high level of satisfaction. DFG training offered a new approach to deliver knowledge and understanding to families using dialogue, including tailored psychoeducation and emotional and practical guidance.Peer reviewe

ESSENCE-Q- used as a screening tool for neurodevelopmental problems in public health checkups for young children in south Japan

Background: Screening for developmental disorders is an important task for Child Health Care. The concept of ESSENCE (early symptomatic syndromes eliciting neurodevelopmental clinical examinations) was created to cover all types of early developmental disorders and the ESSENCE-Questionnaire (ESSENCE-Q containing 12 questions with possible total scores ranging from 0 to 22) was developed as a tool for early detection of these disorders. The aim of this study was to perform a validation study in a public health situation in Japan. Methods: The psychometric properties of the ESSENCE-Q, completed by mothers, public health nurses (PHNs), and psychologists at 18-month (n=143 children) and 36-month (n=149 children) checkups were evaluated in a small city of Japan. Results were validated against clinical ESSENCE diagnoses. Receiver operating characteristic curves were generated and compared by using the area under the curve (AUC). Optimal cutoff values were explored. Results: At the 18-month checkup, AUC by mothers was 0.72, by PHNs 0.86, and by psychologists 0.82. An optimal cutoff was 3 with a high negative predictive value (NPV). At the 36-month checkup, AUC by mothers was 0.57, by PHNs 0.82, and by psychologists 0.87. Optimal cutoff was 2 with high NPV. Conclusion: The ESSENCE-Q completed by PHNs and psychologists had good diagnostic validity. The results suggested that almost all children scoring under cutoff would not have any ESSENCE problems/diagnoses

ESSENCE-Q – used as a screening tool for neurodevelopmental problems in public health checkups for young children in south Japan

Background: Screening for developmental disorders is an important task for Child Health Care. The concept of ESSENCE (early symptomatic syndromes eliciting neurodevelopmental clinical examinations) was created to cover all types of early developmental disorders and the ESSENCE-Questionnaire (ESSENCE-Q containing 12 questions with possible total scores ranging from 0 to 22) was developed as a tool for early detection of these disorders. The aim of this study was to perform a validation study in a public health situation in Japan. Methods: The psychometric properties of the ESSENCE-Q, completed by mothers, public health nurses (PHNs), and psychologists at 18-month (n=143 children) and 36-month (n=149 children) checkups were evaluated in a small city of Japan. Results were validated against clinical ESSENCE diagnoses. Receiver operating characteristic curves were generated and compared by using the area under the curve (AUC). Optimal cutoff values were explored. Results: At the 18-month checkup, AUC by mothers was 0.72, by PHNs 0.86, and by psychologists 0.82. An optimal cutoff was 3 with a high negative predictive value (NPV). At the 36-month checkup, AUC by mothers was 0.57, by PHNs 0.82, and by psychologists 0.87. Optimal cutoff was 2 with high NPV. Conclusion: The ESSENCE-Q completed by PHNs and psychologists had good diagnostic validity. The results suggested that almost all children scoring under cutoff would not have any ESSENCE problems/diagnoses

Offenders in emerging adulthood : School maladjustment, childhood adversities, and prediction of aggressive antisocial behaviors

Early psychosocial adversities and maladjustment, such as childhood maltreatment and school adjustment problems, have been linked to an increased risk of aggressive antisocial behaviors. Yet, clinical studies of subjects at the highest risk of persistence in such behaviors are rare, especially during the life-changing transition years of emerging adulthood. This study describes early predictors of aggressive antisocial behaviors in a large, nationally representative cohort of Swedish, male violent offenders in emerging adulthood (age range = 18-25 years; N = 270). First, data on psychosocial background characteristics and aggressive antisocial behaviors (including age at onset) are provided. Second, early predictors of aggressive antisocial behaviors are tested in bivariate and multivariate interactive models. The offenders demonstrated a diversity of early onset adversities and disruptive behaviors, in line with established risk factors for subsequent criminality and adverse outcomes in a variety of life domains. Severe school adjustment problems, especially bullying others and early onset truancy, were important and interrelated predictors of aggressive antisocial behaviors over the lifetime, whereas childhood adversities such as parental substance or alcohol abuse and repeated exposure to violence at home during childhood were interrelated predictors of aggressive antisocial behaviors, albeit with less statistical importance. The findings stress the importance of early identification of individuals in the risk zone of developing severe and persistent aggressive antisocial behaviors and of early preventive interventions directed toward families with high-risk profiles. The findings also provide initial guidelines on which psychosocial background risk factors that need to be considered first-hand in early interventions. (PsycINFO Database Recor

Randomized Clinical Trial Comparing Dialogical Family Guidance with Ordinary Clinical Treatment for Families with a Child with Neurodevelopmental Disorders

Objectives Previous studies have highlighted the need to offer targeted interventions to strengthen the wellbeing of family members in families with children with neurodevelopmental disorders (NDD). Interventions for this target group require research and development. The purpose of this study was to test a new family intervention: Dialogical Family Guidance (DFG). Methods Families of children with NDD were randomized into an intervention group that was delivered DFG and a comparison group provided with ordinary clinical treatment. The Family Functioning, Family Health and Social Support (FAFHES) and the DFG instrument were used to collect data at baseline and after 3 months. Repeated measure analysis of variance (ANOVA) was used as an analytical strategy. Results There was a significant within-subjects effect of time on family health and social support, indicating that family health and social support increased in both groups over time. There was also a significant between-subjects effect of group and interaction between time and group on social support, indicating that social support increased more in the intervention group than in the control group. Managing in daily life and the relationship between parents were associated with family functioning and family health. Conclusion DFG can strengthen parental experiences of social support. Managing in daily life, relationship between parents, practical guidance, psychoeducation, dialogue, and receiving positive feedback on parenting were strengthening factors during DFG. However, the results of this study must be considered as only preliminary, as they relate only to parental perceptions of the intervention effects.Peer reviewe

The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study

BACKGROUND: A subgroup of persons with anorexia nervosa (AN) have been proposed to have sociocommunicative problems corresponding to autism spectrum disorders [ASDs, i.e. DSM-IV pervasive developmental disorders (PDDs): autistic disorder, Asperger's disorder, PDD not otherwise specified (NOS)]. Here, clinical problems, personality traits, cognitive test results and outcome are compared across 16 subjects (32%) with teenage-onset AN who meet or have met ASD criteria (AN+ASD), 34 ASD-negative AN subjects and matched controls from a longitudinal Swedish study including four waves of independent assessments from the teens to the early thirties.MethodThe fourth wave included the Structured Clinical Interview for DSM-IV (SCID)-I and the SCID-II (cluster C, i.e. 'anxious' PDs) interviews, the Asperger Syndrome Diagnostic Interview, self-assessments by the Autism Spectrum Quotient and the Temperament and Character Inventory, neurocognitive tests by subscales from the Wechsler scales, continuous performance tests, Tower of London, and Happé's cartoons. RESULTS: The ASD assessments had substantial inter-rater reliability over time (Cohen's κ between 0.70 and 0.80 with previous assessments), even if only six subjects had been assigned a diagnosis of an ASD in all four waves of the study, including retrospective assessments of pre-AN neurodevelopmental problems. The AN+ASD group had the highest prevalence of personality disorders and the lowest Morgan-Russell scores. The non-ASD AN group also differed significantly from controls on personality traits related to poor interpersonal functioning and on neurocognitive tests. CONCLUSIONS: A subgroup of subjects with AN meet criteria for ASDs. They may represent the extreme of neurocognitive and personality problems to be found more generally in AN

Facets of Psychopathy, Intelligence, and Aggressive Antisocial Behaviors in Young Violent Offenders

Psychopathy continues to be a challenge in forensic contexts, and evidence of its association with destructive behaviors, such as aggressive antisocial behaviors, is extensive. However, the potential role of intelligence as moderator of the well-established association between psychopathy and aggressive antisocial behaviors has largely been neglected, despite intelligence having been independently related to both concepts. Increased knowledge of whether intelligence is relevant to this association is needed because of its possible implications on the assessment and treatment of individuals with psychopathic traits and aggressive antisocial behaviors. This study aimed to investigate the association between psychopathic traits, aggressive antisocial behaviors, and intelligence in young violent offenders and to test whether intelligence moderates the relationship between psychopathic traits and aggressive antisocial behaviors. Participants were 269 male violent offenders aged 18–25 years, assessed on the Psychopathy Checklist-Revised (PCL-R), the Life History of Aggression (LHA), and the General Ability Index from the Wechsler Adult Intelligence Scale, 3rd edition. Associations were tested with Spearman’s rho, and moderation analysis was performed through ordinary least squares regressions. The PCL-R four-facet structure was used for the analyses. We found a positive association between psychopathic traits and aggressive antisocial behaviors, and a small negative association between the Affective PCL-R facet and intelligence. In the moderation analyses, a small yet statistically significant moderation effect of intelligence on the association between the Interpersonal facet and LHA total scores was demonstrated. However, the amount of variance in the LHA total score explained by the model was very small: 2.9%. We suggest that intelligence, however, important for rehabilitation strategies and everyday functioning, is not necessarily pertinent to understanding aggressive antisocial behaviors in young offenders with psychopathic traits

Vitamin D in the general population of young adults with autism in the Faroe Islands

Vitamin D deficiency has been proposed as a possible risk factor for developing autism spectrum disorder (ASD). 25-Hydroxyvitamin D3 (25(OH)D3) levels were examined in a cross-sectional population-based study in the Faroe Islands. The case group consisting of a total population cohort of 40 individuals with ASD (aged 15–24 years) had significantly lower 25(OH)D3 than their 62 typically-developing siblings and their 77 parents, and also significantly lower than 40 healthy age and gender matched comparisons. There was a trend for males having lower 25(OH)D3 than females. Effects of age, month/season of birth, IQ, various subcategories of ASD and Autism Diagnostic Observation Schedule score were also investigated, however, no association was found. The very low 25(OH)D3 in the ASD group suggests some underlying pathogenic mechanism

Children with autism grow up. Use of the DISCO (Diagnostic Interview for Social and COmmunicative disorders) in population-based cohorts

Objectives: Examine the prevalence and outcome of autism in child and adult population cohorts using the Diagnostic Interview for Social and COmmunication disorders (DISCO). Method: The Faroe Islands school population aged 7-18 years (n=7689) was screened for autism and cases raising suspicion were examined and tested. Parents were interviewed using the DISCO. Clinical diagnoses were established on the basis of all available information. Prevalence rates for autistic disorder, atypical autism and Asperger syndrome were calculated. The autism outcome was looked at in 3 partly overlapping population cohorts of individuals (n=120) diagnosed in childhood as suffering from autism or atypical autism from the region of Göteborg, Sweden. They were re-examined at ages 17-40 years, 13-22 years after diagnosis. Parents and carers were interviewed using the DISCO. Strict operationalised criteria for outcome were used. Diagnostic stability over time was analysed. Symptom profiles on the basis of the DISCO were reviewed and background factors contributing to outcome in adult age were assessed. Aspects of Quality of Life were examined. Results: The prevalence of autism, atypical autism and Asperger syndrome in the Faroe Islands child population was 0.56%. The boy:girl ratio was 4.8:1. The DISCO was very useful in eliciting the information needed for a correct clinical diagnosis. The overall outcome of autism in the Göteborg population was psychosocially poor with few adults leading independent lives. Mortality was high (5%) and seemed to be associated with medical disorders including epilepsy. All but one of the individuals included in the follow-up study (n=108) still met criteria for autism or atypical autism. A small subgroup showed better psychosocial outcomes. They had all had some spoken language at age 3 years. Those with a childhood diagnosis of atypical autism tended to be diagnosed with autism at follow-up. The correspondence between clinical diagnoses and DISCO algorithm diagnoses was very good. The level of intellectual functioning showed a significant shift downwards. A subgroup deteriorated in adolescence. According to DISCO results, social, communication, and sensory impairment problems typical of the childhood period were still present at very high rates in late adolescence and adult life. Quality of Life seemed to be relatively good in some cases in spite of the poor overall psychosocial outcome. Early communication skills and IQ predicted aspects of outcome. Discussion: The DISCO is a useful instrument for diagnosis and follow-up of individuals with autism spectrum conditions. Combined with clinical examination of the individuals themselves, the DISCO yields important diagnostic and symptom information needed for appropriate diagnosis in childhood and for clinical review of diagnosis and symptom load in adolescence and adult life. The prevalence of autism in the Faroe Islands was very similar to that reported for autism in other parts of the world. The outcome of autism in the Göteborg cohort was psychosocially very poor, but life quality did not generally appear to be at a correspondingly low level. However, an important minority had very poor quality of life. The Faroe Islands cohort included relatively much higher functioning individuals than did the Göteborg group, which included cases diagnosed 15-30 years ago. The Faroe Islands cohort may have a very different prognosis, and the outcome findings from the Göteborg study can only be generalized, if at all, to other populations with autism diagnosed before the 1990s, when diagnostic concepts and criteria were more narrow than they are today. Conclusions: Autism is not a very rare disorder. Outcome in severe cases with intellectual impairment is psychosocially poor (with little or no independence in adult life), but life quality can be good even in such cases. The DISCO is a very helpful instrument for diagnosis in childhood and in adult life and can be used for follow-up of symptom profiles and problem assessment before and after adolescence