Current level of technology use, health and eHealth literacy in older Canadians with a recent fracture-a survey in orthopedic clinics.

Among older adults who have recently sustained a fracture, there is substantial adoption of mobile technology. Furthermore, health and eHealth literacy level reported by participants supports the development of interactive eHealth interventions toward fostering better patient engagement in skeletal health management. INTRODUCTION: Electronic health resources are increasingly used in the self-management of medical conditions. We aimed to identify the current level of technology adoption, health, and eHealth literacy among older adults with a recent fracture, to determine if the use of electronic interventions would be feasible and acceptable in this population. METHODS: Adults ≥ 50 years with recent fractures were invited to complete a self-administered survey composed of 21 questions, including an 8-item perceived eHealth literacy scale. RESULTS: A total of 401 participants completed the survey (women, 64%; ≥ 65 years, 59%; university education, 32%). Most participants reported no difficulty in reading printed health material (67%) and felt confident in filling out medical forms (65%). Younger age and higher levels of education were associated with higher health literacy. Most respondents (81%) owned at least one mobile device (smartphone, 49%; tablet, 45%). eHEALS scores were similar among men (29, IQR 24-32) and women (29, IQR 25-33), and between younger age group categories (50-64 years, 30; IQR 26-33; and 65-74 years, 29; IQR 25-32), but lower in the oldest age group (≥ 75 years, 24; IQR 21-29; p < 0.05). Compared with the youngest group, those ≥ 75 years had higher odds of an eHEALS < 26 (odds ratio, 4.2; 95% confidence interval 2.0-8.9) after adjusting for sex and education level. CONCLUSION: There is significant adoption of mobile technology among older adults. Health and eHealth literacy reported by this study population supports the development of interactive eHealth interventions toward fostering better patient engagement in skeletal health management.

Challenging behaviours at early adulthood in autism spectrum disorders: topography, risk factors and evolution.

BACKGROUND: Challenging behaviours are highly prevalent in children and adolescents with autism spectrum disorders (ASD), but little is known about the prevalence and course of these behaviours during adulthood. The aims of this study were to describe the topography of challenging behaviours in a cohort of 106 young adults with ASD and to identify the risk factors for challenging behaviours. Our secondary objective was to study the changes in challenging behaviours from adolescence to early adult years. METHOD: The present study uses data from the EpiTED prospective follow-up study in France. The presence of challenging behaviours was assessed by the Aberrant Behaviour Checklist (ABC) completed by parent informants. Several dimensions of behaviour were studied: irritability, stereotypy, lethargy, hyperactivity and self-injury. Clinical variables were collected on ASD symptom severity, cognitive and language levels, adaptive behaviours and comorbid medical disorders. RESULTS: The presence of challenging behaviours at early adulthood was related to the young adult's cognitive and language level, ASD symptom severity and comorbid gastrointestinal and sleep disorders. The main risk factor for challenging behaviours was ASD symptom severity. The level of language impairment was a significant predictor of self-injury. Gastrointestinal disorders were a significant predictor of stereotypy. The change in behaviour topography from adolescence to early adult years corresponded with decreased parent report of hyperactivity, but no significant decrease in parent reports of irritability, stereotypy, lethargy and self-injurious behaviours. CONCLUSIONS: The challenging behaviours in individuals with ASD persist in early adulthood and are related to core symptom severity, levels of cognitive and language impairments and medical comorbidity. The results emphasise the importance of early interventions for children with ASD to target cognitive and language abilities and to alleviate the severity of ASD symptoms. They also underscore the need to enhance opportunities for individuals with ASD to better communicate discomforts and pain in the context of medical illness.

Measurement properties of screening and diagnostic tools for autism spectrum adults of mean normal intelligence: A systematic review.

BACKGROUND: The autism spectrum (AS) is a multifaceted neurodevelopmental variant associated with lifelong challenges. Despite the relevant importance of identifying AS in adults for epidemiological, public health, and quality of life issues, the measurement properties of the tools currently used to screen and diagnose adults without intellectual disabilities (ID) have not been assessed. OBJECTIVES: This systematic review addresses the accuracy, reliability, and validity of the reported AS screening and diagnostic tools used in adults without ID. METHODS: Electronic databases and bibliographies were searched, and identified papers evaluated against inclusion criteria. The PRISMA statement was used for reporting the review. We evaluated the quality of the papers using the COSMIN Checklist for psychometric data, and QUADAS-2 for diagnostic data. For the COSMIN assessment, evidence was considered to be strong when several methodologically good articles, or one excellent article, reported consistent evidence for or against a measurement property. For the QUADAS ratings, evidence was considered to be "satisfactory" if at least one study was rated with a low risk of bias and low concern about applicability. RESULTS: We included 38 articles comprising 32 studies, five reviews, and one book chapter and assessed nine tools (three diagnostic and six screening, including eight of their short versions). Among screening tools, only AQ-50, AQ-S, and RAADS-R and RAADS-14 were found to provide satisfactory or intermediate values for their psychometric properties, supported by strong or moderate evidence. Nevertheless, risks of bias and concerns on the applicability of these tools limit the evidence on their diagnostic properties. We found that none of the gold standard diagnostic tools used for children had satisfactory measurement properties. CONCLUSION: There is limited evidence for the measurement properties of the screening and diagnostic tools used for AS adults with a mean normal range of measured intelligence. This may lessen the validity of conclusions and public health decisions on an important fraction of the adult autistic population. This not only justifies further validation studies of screening and diagnostic tools for autistic adults, but also supports the parallel use of self-reported information and clinical expertise with these instruments during the diagnostic process.

Daily living pain assessment in children with autism: Exploratory study.

This study aims to broaden knowledge about pain expression and assessment in daily life situations in children with Autism Spectrum Disorder (ASD). The goals are to provide a description of the responses of the GED-DI, the French version of the NCCPC, and to test the internal structure validity of this scale. Thirty five children with ASD were included in this study (mean age=58months; mean developmental age=32months). The French version of the NCCPC was filled in by parents. Descriptive analysis of responses shows that children with ASD express pain through varied and common behaviours, related to different expressive markers (vocal, facial, activity, etc.). Behaviours more specific to the symptomology and disturbances of ASD are also displayed. A four-factor solution (negative emotional reaction, idiosyncratic expression, hyper-vigilance reaction, pain expression) emerges from an exploratory factor analysis that explains 54.4% of the total variance. Correlation coefficients show good psychometric qualities in terms of internal consistency, factorial validity and discriminant validity. This study provides new data about pain expression in daily life situations and shows that the French version of NCCPC adjusted to ASD children is relevant to assess pain in daily life situations.

[Children and adolescents' anxiety disorders]. / Les troubles anxieux de l'enfant et l'adolescent.

Anxiety disorders were long underestimated in children by healthcare professionals, but they are now better diagnosed. They account for the most frequent psychiatric diagnosis between 6 and 18 years of age, with differences in prevalence or risk factors related to the clinical forms. Different clinical subtypes of anxiety disorders are detailed in this article: separation anxiety, specific phobia, generalized anxiety, social anxiety, panic disorder, post-traumatic stress syndrome, and obsessional-compulsive disorder. The repercussions of anxiety are often major on the psychological, relational, and developmental dimensions, as well as academics. Refusing school for reasons of anxiety is one of the possible and severe consequences of anxiety disorders, possibly resulting in total removal from school and the risk of early and permanent cessation of schooling. Other frequent complications are depression, and substance abuse during adolescence, as well as chronification of the disorders until adulthood. Indeed, adults affected by anxiety disorders frequently place the onset of their disorders at the beginning of adolescence. It is therefore essential to diagnose these disorders as soon as possible to set up an adapted therapeutic strategy. The main first-line treatment currently recommended in the pediatric population is cognitive and behavioral therapy, the efficacy of which has been the most clearly demonstrated. Psychoactive drugs can be used as a complement in severe or resistant cases, mainly serotonin recapture inhibitors.

[Impact of anxiety disorders on quality of life of adolescents with autism spectrum disorder without intellectual disability]. / Impact des troubles anxieux sur la qualité de vie des adolescents avec un trouble du spectre autistique sans déficience intellectuelle.

INTRODUCTION: The prevalence of anxiety disorders has been recently estimated at 42 % in a population of adolescents with autism spectrum disorder without intellectual disability. This rate is more than two times higher than in adolescents without developmental disorders (around 20 %). Besides, according to recent studies, the quality of life of adolescents with ASD without mental retardation seems to be lower than adolescents with typical development. We guess that anxiety disorders may be responsible for a low quality of life in adolescents with ASD. OBJECTIVES: The aim of this study was to describe the relationship between quality of life and anxiety disorders. The first objective was to determine if anxiety disorders are a risk factor for having a low quality of life in adolescents with ASD. The second objective was to confirm this link with another comparison using a control group of adolescents with an anxiety disorder but without ASD. Our hypothesis was that anxiety disorder is a risk factor to decrease the quality of life of adolescents with ASD. METHODS: This research was a transversal descriptive and comparative study. Sixty-six adolescents aged between 11 and 18years old were included: 46 with ASD without mental retardation and 20 controls (with anxiety disorders without ASD). Among the ASD group, 20 patients were identified as having an anxiety disorder according to international classifications of mental diseases, and 26 adolescents had no psychiatric comorbidity. Quality of Life (QoL) was reported in five domains with the KIDSCREEN-27, for each patient in the three different groups. Diagnosis of anxiety disorders was assessed using the Kiddie-SADS-PL. The level of anxiety was measured with a self-report questionnaire (RC-MAS). We compared the anxiety rates and the QoL levels between the two groups of adolescents with ASD, one with anxiety disorders, the other without anxiety disorder. Comparisons were also made with QoL data from the general population. RESULTS: Quality of life in the two different groups of adolescents with ASD without mental retardation (with and without anxiety disorders) was significantly lower than in adolescents in the general population. Those rates were significantly lower in the group with ASD and anxiety disorders than in the group with ASD without anxiety disorders for the domain of "physical well-being" only. There was no significant difference between the groups regarding the four other domains of the Kidscreen-27. Moreover, there was no difference between adolescents with ASD and adolescents without ASD regarding the perceived level of anxiety. CONCLUSION: This study shows that anxiety disorders could be a risk factor for impairment of the "physical well-being" dimension of QoL in adolescents with ASD without intellectual disability. Results highlight the interest of a self-evaluation of anxiety level in a population of adolescents with ASD. Findings about self-report of QoL might be temper probably due to the insight difficulties that meet patients with ASD reported in literature review. Further research need to be done with larger samples of patients using self-evaluation coupled with hetero-evaluation such as parents' reports and clinicians' reports.

[How sociocultural aspects influence health and mental health care: A case study on a young gypsy girl with autism]. / Impact des aspects socio-culturels sur l'accès aux soins des sujets en situation de handicap mental : le cas particulier d'une enfant gitane autiste.

INTRODUCTION: In some cases, cultural and social aspects are important determinants in health care access. Some authors have found that bilingualism and loss of cultural markers due to immigration or misunderstanding of the institutions of another country result in patients losing the opportunity to receive good care. In this article, we analyze these cultural aspects through the description of an 11-year-old gypsy girl who had autism spectrum disorder (ASD) with mild intellectual disability. CASE REPORT: An 11-year-old girl lived with her mother, grandmother, and two brothers. She had ASD with mild intellectual disability. The diagnostic procedure was hard to initiate and contact with her mother had been lost twice. Then the mother received help from a psychologist, who played a key role in facilitating the healthcare procedures. During the follow-up, it appeared that each healthcare decision made for the patient (on treatment, type of care) led to a meeting of at least 20 members of the family, who discussed and debated the best decision to make. DISCUSSION: Taking into account gypsy cultural habits, the psychiatrist's intervention facilitated the initiation and follow-up of care for this patient. Her mother, assisted by the psychologist, better understood institutional procedures and could also change some of her habits to optimize care. Some other members of the family were included in the care procedure, because we understood that it was very important for the mother and to improve alliance and ongoing care. CONCLUSION: Taking into account cultural and social aspects is highly important for the management of care and the therapeutic alliance, especially in child and adolescent psychiatry.

Symptom severity as a risk factor for self-injurious behaviours in adolescents with autism spectrum disorders.

BACKGROUND: Self-injurious behaviours (SIB) are highly prevalent in individuals with autism spectrum disorders (ASD) and have deleterious effects on the individual and their environment. The aim of this study was to examine SIB prevalence and associated features in a population of 152 adolescents with ASD and to determine risk factors for SIB. METHODS: The present study uses a subset of data of a longitudinal follow-up of 152 children with ASD. The presence of a low or high level of self-injury was assessed at adolescence through the Aberrant Behaviour Checklist completed by parents. Clinical and social variables regarding severity of autism symptoms, psychological development, adaptive behaviours, parental quality of life and total intervention time were collected during childhood (mean age = 5 years, SD = 1.6) and at adolescence (mean age = 15 years, SD = 1.3). RESULTS: About 35.8% of adolescents with ASD in our sample displayed self-injury, which was frequently associated with other challenging behaviours and was related to severity of autism symptoms, adaptive skills, intellectual functioning and language level (P < 0.001). The main risk factor for SIB at adolescence was severity of autism symptoms (P = 0.04). Cognitive development during childhood was found to be a protective factor (P = 0.03) whereas at adolescence, the main protective factor was communicative abilities (P = 0.04). CONCLUSIONS: These data showed that SIB remained highly prevalent at adolescence and yielded risk and protective factors for developing SIB at this period of life. Limitations and perspectives for future research are discussed.

[Implementation of a French cohort of children or adolescents with autism spectrum disorders: ELENA cohort]. / Mise en place d'une cohorte française d'enfants et adolescents présentant des troubles du spectre autistique : cohorte ELENA.

BACKGROUND: Multidisciplinary cohort studies of children with autism spectrum disorders (ASD) followed from childhood to adulthood exist abroad but not in France. The objective of the ELENA French cohort is to study the developmental trajectories of children and adolescents with ASD and their risk or protective associated factors. METHODS: This is an open, prospective and multicenter cohort study, including children and adolescents under 16 years of age with ASD recruited from services specialized in the assessment of developmental disorders. The patients will be monitored every 18 months for at least 36 months and during a maximum of 10 years. Clinical, social, environmental, and genetic data, as well as data relating to the parental quality of life will be collected. The primary endpoint will be the adaptive level in three domains of the Vineland II (communication, socialization and daily living skills). The secondary endpoints will be parental quality of life, comorbidities, interventions and severity of ASD. EXPECTED RESULTS AND PERSPECTIVES: The inclusion of 1600 patients over a 10-year period is expected. This cohort should contribute to a better knowledge of the child developing an ASD, taking into account the physical, social and familial environment, the type of interventions and some genetic components. It should also lay the foundations for a national network of professionals working in the field of autism research by offering them a common tool for promoting translational studies.

Social skills improvement in children with high-functioning autism: a pilot randomized controlled trial.

High-functioning autism (HFA) is characterized by persistent impairment in social interaction despite the absence of mental retardation. Although an increasing number of group-based programs for the improvement of social skills have been described, randomized controlled trials are needed to evaluate their efficacy. To compare the effect of a Social Skills Training Group-based Program (SST-GP) and a Leisure Activities Group-based Program (LA-GP) on the perception of facial emotions and quality of life (QoL) in young people with HFA. Eligible patients were children and adolescents with HFA. Participants were randomized to the SST or LA group. The primary outcome was defined as an improvement of 2 points in error rates for facial emotion labeling (DANVA2) from baseline. After the 6-month training period, the SST Group made fewer errors in labeling anger on adult faces, whereas error rates in the LA Group remained stable. Progress in the ability to recognize anger in the SST Group was due to better recognition of low intensity stimuli on adult faces. QoL increased in the SST Group in the dimension of school environment, as a marker of the transfer of skills acquired in the treatment setting to their use in the community. The SST-GP had higher efficacy than the LA-GP. Data justify replication using larger samples.

[Anxiety in children and adolescents with pervasive developmental disorder without mental retardation: review of literature]. / Troubles anxieux dans les troubles envahissants du développement sans retard mental : état des lieux chez les enfants et les adolescents au travers d'une revue de la littérature.

OBJECTIVE: Anxiety is highly prevalent in Pervasive Developmental Disorder (PDD) without mental retardation but is too often misdiagnosed. The authors suggest a critical review of current data of the PDD without mental retardation in children and adolescents, in order to summarize research published in this field. After describing specific features, this article tackles the issue of prevalence of anxiety among this population, then deals with present-time assessment and treatments of comorbid anxiety. METHODS: This review was based on a systematic search of the main online databases (Science Direct, PsychInfo, Medline and Pubmed) in order to compile surveys published on Asperger syndrome and high-functioning autism-related anxiety among children and adolescents. This study focuses on papers published between 1995 and 2010, using strict diagnostic criteria for anxiety and PDD, and a controlled group, with the exception of pharmacological studies because none are controlled. We found seven studies assessing the prevalence of anxiety among children and adolescents with PDD, four assessment tools and 12 treatments. RESULTS: Anxiety disorders were shown in 42% of children and adolescents with PDD without mental retardation. This disorder is related to age and level of cognitive functioning and is likely to affect PDD without mental retardation as children and adolescents with anxiety disorder without PDD. This review highlights a major problem: assessment of anxiety in PDD without mental retardation. Actually, only two PDD adapted instruments have been found: the Autism Co-Morbidity Interview Present and Lifetime Version (ACI-PI) and the Stress Survey Schedule (SSS) for persons with autism. Such tools being methodologically limited, the diagnosis of anxiety disorder is all the more difficult to establish. Consequently, considering suitable treatment is not always proposed. Recent surveys show how profitable pharmacological treatment and behavioral intervention like Cognitive-Behavior Therapy (CBT) or psychosocial treatments are. However, important methodological limitations are evoked: there is no control study assessing the efficiency of a pharmacological treatment in Asperger syndrome and high-functioning autism. Besides, the research on how profitable cognitive and behavioral treatment is, gives heterogeneous results. Finally, social skills' training does not treat anxiety disorder directly, but skills abilities that are the most important disabilities in PDD without mental retardation. Therefore, authors advocate adapting treatment in order to treat anxiety disorder. CONCLUSION: The research revealed an important need to create new assessment instruments suitable to PDD without mental retardation in order to facilitate the co-morbidity diagnosis. This survey also underlines the necessity to develop controlled research testing the efficiency of such treatments as pharmacological ones, cognitive and behavioral therapies as well as social skills training.

What clinical characteristics of children with autism influence their inclusion in regular classrooms?

BACKGROUND: This study took place in the context of recent legislation enacted in several countries--including France--and aimed at promoting inclusion of children with intellectual disabilities. It focuses on young children with autism and examines the links between the children's characteristics and their weekly hours of regular-classroom inclusion and intervention in specialised setting. METHOD: Standardised clinical and sociodemographic data were collected for 77 children with autism, along with data about their interventional programmes. RESULTS: The study showed that the number of hours of inclusion at school was influenced by the children's behavioural and adaptive characteristics, as well as by the socioprofessional category of their parents, although these factors did not affect the number of hours spent in specialised setting. Moreover, the total amount of time per week spent in interventional services of any kind was very small for some of the children. CONCLUSION: The time spent in special-intervention services and regular classrooms combined did not add up to an adequate number of weekly hours for these children, particularly those exhibiting at least one of the following characteristics: low adaptation level, major behavioural problems or low socioprofessional category of parents.

[Asperger syndrome: evolution of the concept and current clinical data]. / Evolution du concept et actualité clinique du syndrome d'Asperger.

Although Asperger syndrome is described by international classifications as a category of pervasive developmental disorder (PDD), its validity as a specific entity distinct from autistic disorders remains controversial. The syndrome, first described by Hans Asperger, could not be distinguished from high functioning autism (onset, symptoms, outcome...). However, international classifications propose a distinction between the two syndromes based on a delayed onset, the absence of speech delay, the presence of motor disorders and a better outcome in Asperger syndrome. This categorical differentiation is not confirmed by current studies and in the absence of biological markers, no clinical, neuropsychological or epidemiological criteria makes it possible to distinguish high functioning autism from Asperger syndrome. From a clinical perspective, it is nevertheless of interest to isolate Asperger syndrome from other autistic disorders to propose specific assessment and therapy.

Autism: tactile perception and emotion.

BACKGROUND: For many years, and especially since Waynbaum and Wallon, psychology and psychopathology have dealt with cognitive perception, but have had little to do with the affective qualities of perception. Our aim was to study the influence of the sensory environment on people with autism. METHOD: Several experiments were carried out using different forms of tactile stimulation (passive and active subjects). RESULTS: Our data showed specific responses in children with autism and intellectual disability. These children displayed a strong (positive) valence to the stimulation provided. CONCLUSION: They were very attracted to the stimulation and were excited by it.

What happens to children with PDD when they grow up? Prospective follow-up of 219 children from preschool age to mid-childhood.

OBJECTIVE: To describe the psychological development of children with pervasive developmental disorders over a period of 3 years and to identify the factors linked to their developmental paths. METHOD: The study was a collaborative and prospective follow-up study of 219 preschoolers. Retrospective data and enrollment data were collected at the beginning of the study and 3 years later. RESULTS: We observed high variability in the short-term outcomes of preschoolers. In line with previous research, our results showed that intellectual, linguistic and adaptive functioning were useful for predicting outcome. The severity of a child's autistic symptoms appears to be related to his or her future development. These variables can therefore be used as predictors of outcome for preschoolers with autism. CONCLUSION: Developmental and symptom changes in young children with autism should not be overlooked and need to be assessed regularly in view of choosing suitable servicing programs.

[Clinical guidelines for the screening and the diagnosis of autism and pervasive developmental disorders]. / Recommandations pour la pratique clinique du dépistage et du diagnostic de l'autisme et des troubles envahissants du développement.

UNLABELLED: Autism is the best defined category among PDD. Its high prevalence, its onset in very young children and its persistence in adulthood arise many questions about early screening and early diagnosis. The aim of the study was to identify professional best practices about screening and diagnosis of autism in order to propose clinical guidelines and actions for the future. Scientific experts and parents take part to this procedure. Literature and previous guidelines were analyzed, experts in various fields were interviewed, a national study about the medical practices of the diagnosis of autism was made and questionnaires were send to 1600 psychiatrists and pediatricians. Guidelines built around 2 levels were proposed about screening and diagnosis. CONCLUSION: Diagnosis needs a multidisciplinary approach, validated instruments and more communication between professionals and parents. Finally one of the more important aims of the diagnosis of autism is to facilitate intervention program.

[Descriptive study of psychotropic use in the 20-35 age adults with autism in Languedoc-Roussillon]. / Etude descriptive de l'utilisation de psychotropes chez les personnes autistes de 20 à 35 ans en institution du Languedoc-Roussillon.

The Pervasive Developmental Disorders complications can lead to an important life long handicap. There is an important literature about autism, but in most cases, specifically concerning children and adolescents problems. We wished to focus our attention on adults, in order to describe, on one hand their socio-adaptive profile, and on the other hand, the necessity to resort to a psycho-active treatment. The geographic zone chosen in order to carry out this, was Languedoc-Roussillon, and the applied method was a descriptive study of psychotropic use in the 20-35 age adults with autism. The instruments used were standardized and validated. The diagnosis was confirmed using ICD 10 criteria checklist and individual characteristics including adaptive profile estimated on the Vineland scale, were collected. Moreover the prescriber's global impressions were collected on the CGI scale. Out of 165 case files collected, the sex-ratio was 3 men for 2 women, 45% showed associated somatic disorders (of which 24% epileptic), 66% -benefited from a psycho-active treatment; 85% had been admitted in institutions during childhood or adolescence. The admittance framework being respectfully, MAS 21.8%, community homes 35.2%, CAT 17.6% and psychiatric services 20.6%. Mean equivalent age, in the three Vineland adaptive domains, were from 21 months in Communication to 43 months in Autonomy in daily life Skills and 17 months in Socialization. The development quotient showed adaptive retardation in 100% of cases. The 110 persons benefiting from a medicinal treatment, were treated for aggressiveness in 62.7% of cases, agitation in 43.6% of cases and anxiety in 48.2% of cases. The therapeutic categories used were, in majority, antipsychotics in 85% of cases, anxiolitics in 40.2% of cases; hypnotics as well as anti-depressants or mood-regulators, each representing 10% of prescriptions. Associations of several molecules representing 83% of cases. The therapeutic effect was considered interesting in more than two-thirds of cases. Undesirable side-effects were reported in 50% of the patients under treatment; 50% of the persons treated had been administered the same treatment for more than 5 years. The adaptive-profile significantly varied, depending on the accommodation structures and also the presence or absence of a psycho-active treatment. The results of this study portrayed the level of social adaptation and the types of psychoactive treatment in adults with autism, who are severely limited in their adaptive functioning due to their handicaps.

The relationship between expressive language level and psychological development in children with autism 5 years of age.

The age of detection of autism varies and may be linked to differences in the severity of disturbance and any associated retardation. Symptom intensity, overall language level, age of recognition of first disturbances and level of psychological development were examined in 222 children with pervasive developmental disorder with a mean age of 5 years. Results showed a positive correlation between language level and psychological development as well as between language level and intensity of symptoms. The central position of language in psychological development is discussed.