Reactive Attachment Disorder of Infancy or Early Childhood

Since its introduction into DSM-Ill, reactive attachment disorder has stood curiously apart from other diagnoses for two reasons: it remains the only diagnosis designed for infants, and it requires the presence of a specific etiology. This paper describes the pattern of disturbances demonstrated by some children who meet DSM-Ill-R criteria for reactive attachment disorder. Three suggestions are made: (1) the sensitivity and specificity of the diagnostic concept may be enhanced by including criteria detailing the developmental problems exhibited by these children; (2) the etiological requirement should be discarded given the difficulties inherent in obtaining complete histories for these children, as well as its inconsistency with ICD-10; and (3) the diagnosis arguably is not a disorder of attachment but rather a syndrome of atypical development. J.Am. Acad. Child Adolesc. Psychiatry,1994, 33, 3: 328-332. Key Words: reactive attachment disorder, maltreatment, DSM-Ill-

Assessing Pragmatic Language in Autism Spectrum Disorder: The Yale in vivo Pragmatic Protocol

Purpose: This study compared pragmatic language in youths (9–17 years) with autism spectrum disorder (ASD) and those with typical development (TD) on the Yale in vivo Pragmatic Protocol (YiPP), a semistructured, dynamic conversational assessment. Method: Participants (n = 118) were divided into groups based on age and diagnosis. Each completed the YiPP, which included 4 pragmatic domains (discourse management, communicative functions, conversational repair, presupposition). The participant’s response to each probe was scored correct or incorrect; incorrect scores elicited cues from the examiner, and level of cue required for a correction was also scored. Results: The YiPP showed high reliability and internal consistency, with moderate concurrent validity, sensitivity, and specificity. The group with ASD performed worse overall on YiPP probes compared to their TD counterparts on both error (d = 0.96) and cue (d = 0.91) scores. Item analyses revealed greater gaps between older students with ASD and their TD peers than between the 2 younger groups. Conclusions: These data suggest that a probe measure designed to assess pragmatic abilities in children with ASD within a conversational context has some validity for contributing to diagnostic classification and can identify specific areas of pragmatic vulnerabilities as part of a clinical assessment

Asperger syndrome

Asperger syndrome (AS) is a chronic neurodevelopmental disorder of social interaction, communication, and a restricted range of behaviors or interests. Although not generally associated with intellectual disability, the severe social disability and, in many cases, associated mental health and other medical problems, result in disability throughout life. The diagnosis is often delayed, sometimes into adulthood, which is unfortunate because there are now a range of interventions available, and the current evidence supports intervention starting as early in childhood as possible. The aim of this review is to present a description of AS, an up to date synopsis of the literature pertaining to its etiology, co-morbidity and intervention options, and a discussion of current nosological controversies

Irritability in Autistic Children Treated with Fenfluramine

Letter to the Editor in response to a report by Geller et al. The article presented preliminary results suggesting the possible usefulness of fenfluramine (a substituted phenylethylamine widely used as an appetite suppressant) in the treatment of infantile autism (July 15, 1982, issue). The rationale for the use of this agent rests on its ability to lower peripheral-blood levels of serotonin and on the observation that a substantial minority of autistic persons have elevated peripheral-blood serotonin levels. The report emphasized the preliminary nature of the results in a small sample of three young autistic boys with elevated serotonin levels

Production of Syllable Stress in Speakers with Autism Spectrum Disorders

This paper reports a study of the ability to reproduce stress in a nonsense syllable imitation task by adolescent speakers with autism spectrum disorders (ASD), as compared to typically developing (TD) age-mates. Results are reported for both raters’ judgments of the subjects’ stress production, as well as acoustic measures of pitch range and duration during stressed and unstressed syllable production. Results reveal small but significant differences between speakers with ASD and typical speakers in both perceptual ratings of stress and instrumental measures of duration of syllables. The implications of these findings for understanding prosodic deficits in ASD are discussed

Conversational Behaviors in Youth with High-functioning ASD and Asperger Syndrome

Twenty-nine youth with autism spectrum disorders and 26 with typical development between 12 and 18 years of age were engaged in structured interviews (ADOS). The interviews were videotaped and rated for atypical conversational behaviors by trained raters, using the Pragmatic Rating Scale (Landa et al. Psychol Med 22:245–254, 1992). The ASD group was divided into AS and HFA/PDD-NOS subgroups. Significant differences were found among groups on approximately one-third of the PRS items. These items involved primarily the management of topics and information, reciprocity, intonation, and gaze management. The only differences to reach significance between the AS and HFA/PDD-NOS group were a greater tendency for overly formal speech on the part of the AS group, and more difficulty with gaze management on the part of the group with HFA/PDD-NOS. The implications of these findings for understanding and treating conversational deficits in ASD are discussed

Pragmatic Assessment in Autism Spectrum Disorders: A Comparison of a Standard Measure with Parent Report

The purpose of this study was to investigate the concurrent validity of subtests on the Comprehensive Assessment of Spoken Language (CASL) by comparing them with the assessment of communication and social skills on the Vineland Adaptive Behavior Scales (Vineland). The participants were 35 children and adolescents with higher functioning autism spectrum disorders (ASD) who had received both the CASL and the Vineland. Results of the study suggest that the Pragmatic Judgment and Inferences subtests of the CASL appeared to document the difficulties that individuals with ASD had in adaptive use of language for communication

Adaptive Behavior in Autism and Pervasive Developmental Disorder-Not Otherwise Specified: Microanalysis of Scores on the Vineland Adaptive Behavior Scales

The purpose of this study is to provide a microanalysis of differences in adaptive functioning seen between well-matched groups of school-aged children with autism and those diagnosed as having Pervasive Developmental Disorder-Not Otherwise Specified, all of whom functioned in the mild to moderate range of intellectual impairment. Findings indicate that the major area of difference between children with autism and those with Pervasive Developmental Disorder-Not Otherwise Specified, was expressive communication; specifically, the use of elaborations in syntax and morphology and in pragmatic use of language to convey and to seek information in discourse. Linear discriminant function analysis revealed that scores on just three of these expressive communication item sets correctly identified subjects in the two diagnostic categories with 80% overall accuracy. Implications of these findings for both diagnosis and intervention with children with Autism Spectrum Disorders will be discussed

Speech and Prosody Characteristics of Adolescents and Adults With High-Functioning Autism and Asperger Syndrome

Speech and prosody-voice profiles for 15 male speakers with High-Functioning Autism (HFA) and 15 male speakers with Asperger syndrome (AS) were compared to one another and to profiles for 53 typically developing male speakers in the same 10- to 50-years age range. Compared to the typically developing speakers, significantly more participants in both the HFA and AS groups had residual articulation distortion errors, uncodable utterances due to discourse constraints, and utterances coded as inappropriate in the domains of phrasing, stress, and resonance. Speakers with AS were significantly more voluble than speakers with HFA, but otherwise there were few statistically significant differences between the two groups of speakers with pervasive developmental disorders. Discussion focuses on perceptual-motor and social sources of differences in the prosody-voice findings for individuals with Pervasive Developmental Disorders as compared with findings for typical speakers, including comment on the grammatical, pragmatic, and affective aspects of prosody

Enhancing the Understanding of Clinically Meaningful Results: A Clinical Research Perspective

Published research often address aspects related to “statistical significance” but fail to address the clinical and practical importance and meaning of results. Our main objectives in this article are to investigate the merit of common measures of Effect Size in statistical research and to highlight the importance of the simple Relative Risk ratio. In this article we present data where we consider two widely utilized effect size measures (Cohen's d and Pearson's r) in relations to relative risk. We conclude that probability analyses of risk surpass the most commonly used statistical approach used in clinical trials today and should thus be the preferred compared to the misuse and misunderstanding of reporting for instance p-values alone.publishedVersio