ABSTRACT
A group of 199 children and adolescents (153 boys, 46 girls) with autistic disorder was audiologically evaluated. Mild to moderate hearing loss was diagnosed in 7.9% and unilateral hearing loss in 1.6% of those who could be tested appropriately. Pronounced to profound bilateral hearing loss or deafness was diagnosed in 3.5% of all cases, representing a prevalence considerably above that in the general population and comparable to the prevalence found in populations with mental retardation. Hearing deficits in autism occurred at similar rates at all levels of intellectual functioning, so it does not appear that the covariation with intellectual impairment per se can account for all of the variance of hearing deficit in autism. Hyperacusis was common, affecting 18.0% of the autism group and 0% in an age-matched nonautism comparison group. In addition, the rate of serous otitis media (23.5%) and related conductive hearing loss (18.3%) appeared to be increased in autistic disorder. The study emphasizes the need for auditory evaluation of individuals with autism in order to refer those with pronounced to profound hearing loss for aural habilitation and to follow those with mild to moderate hearing loss because of the risk of deterioration.
Subject(s)
Autistic Disorder/epidemiology , Deafness/epidemiology , Hearing Loss, Conductive/epidemiology , Hearing Loss, Sensorineural/epidemiology , Adolescent , Adult , Autistic Disorder/diagnosis , Child , Child, Preschool , Comorbidity , Deafness/diagnosis , Female , Hearing Loss, Conductive/diagnosis , Hearing Loss, Sensorineural/diagnosis , Hearing Tests , Humans , Hyperacusis/diagnosis , Hyperacusis/epidemiology , Intellectual Disability/diagnosis , Intellectual Disability/epidemiology , Male , Otitis Media with Effusion/diagnosis , Otitis Media with Effusion/epidemiologyABSTRACT
Gangliosides are sialic acid-containing glycolipids found in all cells, especially abundant in nerve cells and mainly situated on outer-membrane surfaces. The aim of this study was to provide data on the concentration of gangliosides in the CSF of children and adolescents with autism spectrum disorders (ASD) - 66 with autistic disorder, and 19 with other autism spectrum disorders. The comparison group consisted of 29 children and adolescents, whose CSF had been sampled to exclude acute infectious CNS disorder. The concentrations of the gangliosides GM1, GD1a, GD1b, and GT1b were determined using a microimmunoaffinity technique. The ASD group had a significantly higher concentration of ganglioside GM1 compared with the comparison group. The GM1 increase could not be explained as secondary to other clinical factors. Mean ganglioside levels did not differentiate subgroups with autistic disorder and those with a more atypical clinical picture, nor subgroups with known medical disorders and those with idiopathic autism. Altered patterns of gangliosides in the CNS might reflect important correlates of pathogenesis in autism.
Subject(s)
Autistic Disorder/cerebrospinal fluid , Gangliosides/cerebrospinal fluid , Adolescent , Adult , Autistic Disorder/diagnosis , Autistic Disorder/genetics , Child , Child, Preschool , Diagnosis, Differential , Female , G(M1) Ganglioside/cerebrospinal fluid , Humans , Infant , Male , Neurologic Examination , Neuropsychological Tests , Reference ValuesABSTRACT
The Childhood Autism Rating Scale (CARS) is an instrument for screening and diagnosis of autism. The present study was performed to assess the interrater reliability of a Swedish version of the CARS when used in a clinical setting. The procedure used mimicked a frequent form of consultation in neuropsychiatry and pediatric neurology. During a restricted time period, both an interview with the parents and observation of the child take place. Often this assessment is an important screening procedure and directs further investigation. CARS was used for rating autistic behavior by two investigators in 25 children. A variant of the weighted kappa statistic (correcting for chance and for degrees of disagreement) showed values between .53 and .75 (indicating fair to excellent agreement). Aspects of validity and reliability are discussed.
Subject(s)
Autistic Disorder/diagnosis , Cross-Cultural Comparison , Neuropsychological Tests/statistics & numerical data , Autistic Disorder/psychology , Child , Child, Preschool , Female , Humans , Intellectual Disability/diagnosis , Intellectual Disability/psychology , Male , Observer Variation , Patient Care Team/statistics & numerical data , Reproducibility of Results , SwedenABSTRACT
The majority of children with autism show deviance and socially or psychiatrically handicapping conditions throughout life. Only a small proportion of those with classical childhood autism lead independent adult lives. Others, particularly those with 'high-functioning' autism and so-called Asperger syndrome will improve enough to live an independent adult life. The level of mental retardation and other comorbid conditions (such as medical syndromes and other neuropsychiatric disorders, including epilepsy) is important in predicting outcome. An IQ below 50 around school age predicts severe restriction of social and adaptive functioning in adult life. The absence of communicative speech at 5-6 years of age is indicative of a poorer long-term overall outcome. There is a clear co-variation between IQ and level of communication, but probably there is some prognostic factor in language development apart from this. Measures of flexibility and cognitive shifting abilities tend to be good predictors of social outcome in a few studies. There is a continued need for prospective, longitudinal studies of children with autism spectrum disorders, particularly in Asperger syndrome. The role of interventions of various kinds needs to be addressed in such studies.
Subject(s)
Activities of Daily Living/psychology , Autistic Disorder/diagnosis , Social Adjustment , Adolescent , Adult , Autistic Disorder/psychology , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Intelligence , Language Development Disorders/diagnosis , Language Development Disorders/psychology , Male , SyndromeABSTRACT
Autism and Asperger syndrome are disorders with early childhood onset. They are believed to exist on the same spectrum of impairments of reciprocal communication and social interaction restriction of imagination and behaviour. A number of screening and diagnostic tools have been developed in the field, and several of these are briefly reviewed here. It is concluded that autism may be screened around age 18 months and a diagnosis reliably be made around age 30 months, whereas a diagnosis of Asperger syndrome is not usually suspected, screened or made until into the child's school age.
Subject(s)
Autistic Disorder/diagnosis , Psychiatric Status Rating Scales , Adolescent , Age Factors , Child , Child, Preschool , Diagnosis, Differential , Humans , Infant , Infant, NewbornABSTRACT
The prevalence of autism spectrum disorders was studied in all children with mental retardation and/or motor disability in a defined geographical region over a two-year follow-up period. In the general population, the prevalence of autistic disorder was 0.09% at the end of the follow-up period -a minimum estimate, as children with average intelligence were not screened. Autism spectrum disorders were found in 19.8% of children with mental retardation, including strictly defined autistic disorder (DSM-III-R criteria) in 8.9%; the two-year follow-up yielded a higher prevalence of 11.7% with autistic disorder. Among children with cerebral palsy, 10.5% had an autism spectrum disorder. Clear co-variation was found between mental retardation, epilepsy and autism spectrum disorders in this population of children with neurodevelopmental disorders.
Subject(s)
Autistic Disorder/epidemiology , Autistic Disorder/physiopathology , Intellectual Disability/epidemiology , Adolescent , Adult , Child , Child, Preschool , Epilepsy/epidemiology , Female , Humans , Male , Prevalence , Sweden/epidemiologyABSTRACT
The Autism Behavior Checklist (ABC) was used as a screening instrument in a study of autism spectrum disorders in a population of children with mental retardation or physical disability or both. The ABC score clearly reflected behavioural problems found in children with mental retardation and not only behaviours typical of autism. If the cut-off score used was 45 (lower than recommended by the original investigators), children with autistic disorder without multiple other disabilities were reliably identified, with an acceptable rate of false positive cases. In order not to miss other autism spectrum disorders, all cases with several omitted items in their checklists were examined in more detail. The Childhood Autism Rating Scale (CARS) distinguished reasonably well between autistic disorder and other autism spectrum disorders.
Subject(s)
Autistic Disorder/epidemiology , Autistic Disorder/psychology , Disabled Persons/psychology , Mental Disorders/psychology , Adolescent , Child , Child, Preschool , Female , Humans , Male , Mental Disorders/epidemiology , Psychiatric Status Rating ScalesABSTRACT
Of a population of 100 Swedish thalidomide embryopathy cases, at least four met full criteria for DSM-III-R autistic disorder and ICD-10 childhood autism. Thalidomide embryopathy of the kind encountered in these cases affects fetal development early in pregnancy, probably on days 20 to 24 after conception. It is argued that the possible association of thalidomide embryopathy with autism may shed some light on the issue of which neural circuitries may be involved in autism pathogenesis.
Subject(s)
Autistic Disorder/chemically induced , Prenatal Exposure Delayed Effects , Thalidomide/adverse effects , Adult , Autistic Disorder/diagnosis , Deafness/chemically induced , Female , Humans , Intellectual Disability/chemically induced , Male , PregnancyABSTRACT
Craniopharyngiomas are situated in immediate vicinity of sleep regulating structures in the basal forebrain area, and the tumor and its treatment might influence the regulation of sleep and wakefulness. In 10 patients treated for craniopharyngioma nighttime sleep quality and daytime vigilance were examined with polygraphic sleep records and multiple sleep latency tests (MSLT). Two girls and 8 boys, 7.1-22.9 years of age, were studied after a follow-up time of 1.5-16.1 years postoperatively. The results were compared to those of 18 normal children. The regulation of the ultradian sleep rhythm was normal but the ability to maintain nighttime sleep was severely disturbed. The patients had an increased number of awakenings and spent long time awake during two recorded nights. Two patients had excessive daytime somnolence during this examination, one after severe sleep disturbance, the other without any known cause. The pattern of sleep and vigilance did not change in puberty in the expected fashion. The disturbances may well have an impact on the psychosocial situation of the patients.
Subject(s)
Circadian Rhythm/physiology , Craniopharyngioma/surgery , Pituitary Neoplasms/surgery , Postoperative Complications/physiopathology , Sleep Stages/physiology , Wakefulness/physiology , Adolescent , Adult , Child , Craniopharyngioma/physiopathology , Female , Humans , Male , Neurologic Examination , Pituitary Gland/physiopathology , Pituitary Neoplasms/physiopathology , Sleep, REM/physiologyABSTRACT
An analysis of 16 cases of optic glioma in childhood is presented. All tumours were astrocytomas of the juvenile pilocytic of type low malignancy. In 7 of 13 patients with involvement of the chiasm there was a significant progression of tumour during the follow-up period, including 4 cases with fatal outcome. Patients under 5 years of age had a more unfavourable course than older children, but at the same time they had received lower doses of radiotherapy. The 5 patients treated with an absorbed dose of 39 Gy or more are alive without signs of progression 7-20 years after treatment. It is concluded from this material and from a survey of literature that many cases of optic glioma in childhood do not have a benign course. Guidelines for treatment are proposed.
