Kiddie-SADS Reveals High Rates of DSM-IV Disorders in Children and Adolescents with Autism Spectrum Disorders

Prevalence of current comorbid DSM-IV disorders was assessed in a special school population of children and adolescents with ASD (N = 71, age 6.0–17.9 years), representing all cognitive levels and main ASD subgroups. Symptoms were assessed through parent interview and association to child characteristics was explored. Seventy-two percent was diagnosed with at least one comorbid disorder. Anxiety disorders (41%) and attention deficit/hyperactivity disorder (31%) were most prevalent. Obsessive–compulsive disorder was more common in older children, and oppositional defiant disorder/conduct disorder more prevalent in pervasive developmental disorder, not otherwise specified. Our results show high rates of comorbid DSM-IV disorders and underscore the importance of such evaluation in children ASD. However, diagnostic challenges are present and future research on the diagnostic validity of comorbid psychiatric disorders is needed

Preoperative 18F-FDG PET/CT tumor markers outperform MRI-based markers for the prediction of lymph node metastases in primary endometrial cancer

Objectives To compare the diagnostic accuracy of preoperative 18F-FDG PET/CT and MRI tumor markers for prediction of lymph node metastases (LNM) and aggressive disease in endometrial cancer (EC). Methods Preoperative whole-body 18F-FDG PET/CT and pelvic MRI were performed in 215 consecutive patients with histologically confirmed EC. PET/CT-based tumor standardized uptake value (SUVmax and SUVmean), metabolic tumor volume (MTV), and PET-positive lymph nodes (LNs) (SUVmax > 2.5) were analyzed together with the MRI-based tumor volume (VMRI), mean apparent diffusion coefficient (ADCmean), and MRI-positive LN (maximum short-axis diameter ≥ 10 mm). Imaging parameters were explored in relation to surgicopathological stage and tumor grade. Receiver operating characteristic (ROC) curves were generated yielding optimal cutoff values for imaging parameters, and regression analyses were used to assess their diagnostic performance for prediction of LNM and progression-free survival. Results For prediction of LNM, MTV yielded the largest area under the ROC curve (AUC) (AUC = 0.80), whereas VMRI had lower AUC (AUC = 0.72) (p = 0.03). Furthermore, MTV > 27 ml yielded significantly higher specificity (74%, p  10 ml (58%, 62%, and 9.7, respectively). MTV > 27 ml also tended to yield higher sensitivity than PET-positive LN (81% vs 50%, p = 0.13). Both VMRI > 10 ml and MTV > 27 ml were significantly associated with reduced progression-free survival. Conclusions Tumor markers from 18F-FDG PET/CT outperform MRI markers for the prediction of LNM. MTV > 27 ml yields a high diagnostic performance for predicting aggressive disease and represents a promising supplement to conventional PET/CT reading in EC.publishedVersio

MRI-assessed tumor-free distance to serosa predicts deep myometrial invasion and poor outcome in endometrial cancer

Objectives To explore the diagnostic accuracy of preoperative magnetic resonance imaging (MRI)-derived tumor measurements for the prediction of histopathological deep (≥ 50%) myometrial invasion (pDMI) and prognostication in endometrial cancer (EC). Methods Preoperative pelvic MRI of 357 included patients with histologically confirmed EC were read independently by three radiologists blinded to clinical information. The radiologists recorded imaging findings (T1 post-contrast sequence) suggesting deep (≥ 50%) myometrial invasion (iDMI) and measured anteroposterior tumor diameter (APD), depth of myometrial tumor invasion (DOI) and tumor-free distance to serosa (iTFD). Receiver operating characteristic (ROC) curves for the prediction of pDMI were plotted for the different MRI measurements. The predictive and prognostic value of the MRI measurements was analyzed using logistic regression and Cox proportional hazard model. Results iTFD yielded highest area under the ROC curve (AUC) for the prediction of pDMI with an AUC of 0.82, whereas DOI, APD and iDMI yielded AUCs of 0.74, 0.81 and 0.74, respectively. Multivariate analysis for predicting pDMI yielded highest predictive value of iTFD <  6 mm with OR of 5.8 (p < 0.001) and lower figures for DOI ≥ 5 mm (OR = 2.8, p = 0.01), APD ≥ 17 mm (OR = 2.8, p < 0.001) and iDMI (OR = 1.1, p = 0.82). Patients with iTFD < 6 mm also had significantly reduced progression-free survival with hazard ratio of 2.4 (p < 0.001). Conclusion For predicting pDMI, iTFD yielded best diagnostic performance and iTFD < 6 mm outperformed other cutoff-based imaging markers and conventional subjective assessment of deep myometrial invasion (iDMI) for diagnosing pDMI. Thus, iTFD at MRI represents a promising preoperative imaging biomarker that may aid in predicting pDMI and high-risk disease in EC.publishedVersio

Intensive behavioural interventions based on applied behaviour analysis for young children with autism : an international collaborative individual participant data meta-analysis

This individual participant data meta-analysis is the most intensive possible evaluation of the effectiveness of early intensive applied behaviour analysis?based interventions for pre-school autistic children compared with treatment as usual/eclectic interventions. Data from 491 participants (originally collected in 10 studies) were included. Children receiving early intensive applied behaviour analysis?based interventions improved more on the Vineland adaptive behaviour scale (MD?=?7.00; 95% confidence interval?=?1.95?12.06) and cognitive ability (intelligence quotient) (MD?=?14.13; 95% confidence interval?=?9.16?19.10) relative to comparators at 2?years; though effects varied considerably across studies. Evidence for other outcomes was inconclusive due to insufficient evidence and there were few data on longer-term effects. All studies were at risk of bias across several domains, often due to the lack of randomisation or blinding of outcome assessors. Given the emerging evidence of modest, albeit short term, effects of a range of pre-school autism interventions and the limitations of the quality of evaluation studies to date, future research should investigate which supports and interventions are most effective for children and families prioritising outcomes measures that are meaningful for the autism community and longer-term follow-up. Further systematic reviews of the existing evidence are unlikely to add to the findings presented here.Lay abstractEarly intensive applied behaviour analysis?based interventions are designed to support young autistic children?s learning and development. Unfortunately, the available evidence about the effectiveness of these interventions remains unclear. Several reviews have focused on the published findings rather than contacting the authors to collect and analyse data about the individual participants in the original studies. Also, most of the studies were carried out by groups involved in delivering the interventions leading to the potential bias in interpreting the results. Our research team (supported by an international advisory group) carried out an independent individual patient data review by collecting the original participant data from the authors of the studies, to examine the effectiveness of these interventions. The results suggested that early intensive applied behaviour analysis?based interventions might lead to some changes in children?s cognitive ability (intelligence quotient) and everyday life skills after 2?years, compared with standard treatments. However, all the studies had problems with the way they were designed. Also, few of the studies looked at outcomes that have been described as most important to autistic people or followed children beyond 2?years. We think that further systematic reviews of the existing evidence are unlikely to add to the findings of our review. Furthermore, we recommend that future research should investigate which types of supports and interventions are most effective for children and families, prioritising outcomes measures that are meaningful for the autism community and include, wherever possible, longer-term follow-up

Behavioural early interventions for children with autism or intellectual disabilities

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Atferdsanalyse og Fysioterapi

Mange barn med utviklingsforstyrrelser har motoriske vanskeligheter. Dette kan gi ytterligere begrensninger i lek, fysisk aktivitet, og selvstendighet. I denne studien undersøkte vi om prosedyrer basert på anvendt atferdsanalyse kan brukes for å få gjennomført fysioterapi. Deltakeren var en tre år gammel gutt med muskelsvakheter, utviklingshemming og autisme. Opplæringsformatet discrete trial trening (DTT), positiv forsterkning, og prosedyrer for prompt og prompt fading ble brukt for å øke hastighet og selvstendighet i gjennomføringen av øvelser som var anbefalt av fysioterapeut. Effekten av treningen ble målt i en multippel basislinje design over tre ulike øvelser. Resultatene viste at den gjennomsnittlige hastigheten på de tre øvelsene økte, sammen med guttens evne til å gjennomføre øvelsene selvstendig. Resultatene tyder på at atferdsanalytiske prosedyrer som positiv forsterkning, prompt og prompt fading kan brukes for å hjelpe fysioterapeuter til å få gjennomført øvelser for barn hvor dette ellers er svært vanskelig

Reduction in Restraints Following a Functional Analysis of Severe Problem Behavior and Communication Training

We combined a functional analysis of precursors and problem behavior with subsequent communication training to reduce time spent in restraint. The patient was a man in his thirties with autism and life-long severe problem behaviors resulting in restraint. The highest frequencies of both problem behavior and precursors were observed in the demand conditions of the functional analysis. However, the precursors were observed across all conditions. Based on these findings we introduced functional communication training to establish an alternative functional response. He was taught to ask for a break when demands where presented, first in an analog setting and later in natural settings throughout his daily life. This resulted in a significant reduction in problem behavior and what followed was a significant reduction in the time spent in restraints. The much-reduced level of restraint was maintained in the patient’s natural environment at a 12-month follow-up assessment. Our findings suggest that a functional analysis and functional communication training may be an approach to consider when the ultimate goal is to reduce the time spent in restraint. These findings need to be replicated with a better experimental design

Generalized use of past tense verbs in children with autism following a sufficient exemplar training procedure

The purpose of this study was to validate a procedure for sufficient exemplar training that can potentially lead to generalized responding. Based on this procedure, we taught four children with autism, generalized use of regular past tense verbs. We applied a non-concurrent multiple baseline design across the participants. The dependent variable was the number of verbs that needed to be trained for generalization to untrained verbs to occur. The number of verbs that needed to be trained varied considerably across participants as did the number of trials. We concluded that the procedure was validated and that it was easy to implement and it allows for individualization. We discuss the practical implications of our findings for teaching a wide range of skills using the same type of training procedure and data display strategies we provided in this study

Opplæring i å Følge Beskjeder i Barnehagen hos et Barn med Autisme ved «Errorless Compliance Training»

Barn med autisme har ofte utfordringer med å følge enkle beskjeder i hverdagen. I samarbeid med foreldre og barnehagen ønsket vi å lære et barn med autisme å følge beskjeder. Vi baserte det på «Errorless Compliance Training». Seks instruksjoner ble delt i 3 nivåer basert på hvor ofte barnet fulgte instruksjonene i baseline. Vi startet å trene to instruksjoner i nivå 1 som var instruksjoner barnet fulgte i 75-100% av tiden. Deretter gikk vi over til nivå to som var to instruksjoner som barnet fulgte 50-75% av tiden, og til slutt to instruksjoner barnet kun fulgte 25-50 % av tiden. Resultatet viste at barnet fulgte 6 av 6 instruksjoner ved test etter treningsperioden. Tre av seks instruksjoner ble fulgt også når en annen person ga dem, mens alle instruksjonene ble fulgt i andre omgivelser. Kombinasjonen av «Errorless Compliance training» og tegnøkonomi ser ut til å være en lovende prosedyre for å lære å følge beskjeder for barn med autisme. Prosedyren fremstår som lett gjennomførbar og en sosialt akseptabel måte å etablere det å følge beskjeder