Trend study of autistic spectrum disorders at Queen Sirikit National Institute of Child Health.

BACKGROUND: Increases in the incidence and prevalence of autistic spectrum disorders have been reported recently in the United States and Europe, but there are only a few reports on the trend of this problem in Thailand. OBJECTIVES: To study trend in autistic spectrum disorder patients and to find the factors that correlate with the incidence of this disorder at Queen Sirikit National Institute of Child Health. MATERIAL AND METHOD: A hospital-based prospective trend study was conducted in patients aged less than 12 years old, who attended the Child and Adolescent Department, Queen Sirikit National Institute of Child Health, Bangkok, form January 1998 to December 2002. Autistic spectrum disorders were defined as autistic disorder pervasive developmental disorder-not otherwise specified (PDD-NOS), and Asperger's disorder Related factors were recorded and analyzed Aged-adjusted incidence rate in both sexes and proportion rates of related factors were calculated by using the direct method Standard t-test and correlation coefficient were performed to test for statistically significant difference in the prevalence rate in each group. RESULTS: There were 610 new patients aged less than 12 years who displayed behavior consistent with autistic spectrum disorders. The increasing trend in the incidence of autistic spectrum disorder is observed (r = 0. 935, p = 0. 02). The incidence rate of autistic spectrum disorders among out patients less than 12 years has increased from 1.43 per 10, 000 in 1998 to 6.94 per 10, 000 in 2002. The correlation factors "an only one child in the family" is observed (r = 0.9, p = 0.038). CONCLUSION: During the 5 years of the study, a significant increase in the incidence of autistic spectrum disorders was observed at Queen Sirikit National Institute of Child Health. Increase in the incidence of ASD in this center cannot explain by any solid evidence from the present study.

Predicting outcome in pediatric near-drowning.

BACKGROUND: Near-drowning is common in children and has a high mortality rate. Some survivors remain in a vegetative state after the accident and are a great burden to their family and society. OBJECTIVES: To find out whether outcomes on near drowning can be reliably identified early in the course of illness. METHOD: Medical records of 72 children admitted to Queen Sirikit National Institute of Child Health, Bangkok, Thailand, for treatment of near drowning from January 1993 to December 2001 were retrospectively studied. Stepwise multivariate discriminant analysis was used to identify the power of variables achieving highest overall accuracy in minimizing errors for predicting poor outcome in intact survivors. RESULTS: The patients were identified into three groups: functionally intact, vegetative and dead groups, it was found that a combination of physical examination in the emergency department (ED), the need for cardiopulmonary (CPR) in the ED, amount of adrenaline given during CPR, and high blood sugar achieved an overall accuracy of 83 per cent. When categorizing patients into good outcome versus poor outcome (the combination of the vegetative and dead group were the poor outcome group). The variables mentioned above achieved an overall accuracy of 98 per cent. Good outcome survivors could be correctly predicted with no error, but error occurred when poor outcome survivors were predicted to be good outcome in 3 per cent. Glasgow coma score > or = 5, the need for CPR in the ED and blood sugar > 300 mg/dl were selected clinical variables found to have optimum predictive abilities with an overall accuracy of 96 per cent, but showed an error of 6 per cent in predicting poor outcome from functional intact survivors (unpredicted good outcome). CONCLUSION: From the present study discrimination analysis cannot accurately separate all intact survivors from the vegetative groups, but can prospectively differentiate unpredicted good outcome from vegetative or dead groups. When using only simple clinical classification systems, unpredicted good outcome patients are detected. Since outcome cannot be accurately predicted in the ED, all near drowning victims should receive vigorous and aggressive treatment in the early course of illness and need close monitoring for respiratory complications and neurological signs.

Human figure drawing test: validity in assessing intelligence in children aged 3-10 years.

BACKGROUND: Human-figure-drawing abilities are related with cognitive development in children. As cognitive skills progress, drawing abilities also improve in details and sex differentiation. The Goodenough-Harris (G-H) drawing test was developed to score human figure drawing with separate norms for males and females. OBJECTIVES: To evaluate whether the Goodenough-Harris human drawing test is valid to classify intelligence in children aged 3-10 years. MATERIAL AND METHOD: Record files of 528 children aged between 3-10 years who had attended the Child and Adolescent Unit at Queen Sirikit National Institute of Child Health (Children's Hospital), Bangkok, Thailand from January 1999 to December 2001 were retrospectively reviewed. Inclusion criteria included: 1) performing the human figure drawing test and standard intelligence tests on the same day and 2) diagnoses were addressed. RESULTS: The ages of the children ranged from 3 10/12 years to 10 11/12 years with a mean age of 7 9/12 years, 49.5 per cent were males and 50.5 per cent were female. The study group was diagnosed as pervasive development disorder 17 per cent, attention deficit hyperactivity disorder 13 per cent, and mental retardation 11.3 per cent. Overall correlation of full scale intellectual quotient (FSIQ) from the standard intelligence test and standard scores on the Goodenough-Harris system was 0.813 (p < 0.01). The overall validity of the human figure drawing test in classified correct intellectual level was 60.8 per cent but in children with an intellectual quotient (IQ) less than 70, the correct classification was 69.2 per cent. After stratification by age, it was found that the human figure drawing test had validity in predicting IQ below 70 in 88.7 per cent and 68.8 per cent of children aged < 6 years and aged > 6 years respectively. CONCLUSION: The human figure drawing test can be used as an additional measure of assessing intelligence in young children but it should not be substituted for standard tests. The test is not complicated, therefore, trained personnel can use it in combination with other screening tests for cognitive development in children.