Factor analysis of the autism spectrum screening questionnaire in a population-based child sample.

PURPOSE: The aim of this study was to investigate several possible factor structures of the Autism Spectrum Screening Questionnaire (ASSQ). MATERIALS AND METHODS: We used the 27-item screening tool for school-aged children in a general population of 8-year-old children (n = 3,538) and compared the occurring solutions to previously published factor models. RESULTS: A one-factor solution and a four-factor solution were identified in Exploratory Factor Analysis (EFA) and confirmed with Confirmatory Factor Analysis (CFA), while two-, three-, five- and six-factor solutions were rejected. In CFA, our four-factor solution showed the best goodness-of-fit indexes when compared with factor models previously presented by Posserud et al. and Ehlers et al. CONCLUSIONS: The results indicate a strong underlying connection between all ASSQ items which is elicited by the one-factor solution. Although as a screening tool, ASSQ is functioning with the unifactorial solution, the four factors can help to identify certain clusters of autism spectrum traits.

[Autism spectrum disorders in children and adolescents]. / Autismikirjon häiriöt lapsilla ja nuorilla.

Childhood autism, Asperger's syndrome and atypical autism together make up autism spectrum disorders (ASDs) with a prevalence of 0.6-0.7%. These disorders are defined by qualitative impairments in social interaction, qualitative abnormalities in communication, and by restricted, stereotyped, repetitive patterns of behaviour, interests and activities. Many children or adolescents with ASDs have sensory abnormalities, neurological disorders and additional disabilities of vision, hearing or ambulation. Psychiatric co-morbidity is common. Diagnostics and rehabilitation are implemented in multi-professional collaboration. Early recognition makes up the basis for early intervention that improves the prognosis. Screening of these disorders in well-baby clinics is being developed.

Validation of the Finnish Autism Spectrum Screening Questionnaire (ASSQ) for clinical settings and total population screening.

We assessed the validity and determined cut-off scores for the Finnish Autism Spectrum Screening Questionnaire (ASSQ). A population sample of 8-year-old children (n = 4,408) was rated via the ASSQ by parents and/or teachers, and a subgroup of 104 children was examined via structured interview, semi-structured observation, IQ measurement, school observation, and medical records. Autism spectrum disorders (ASDs) were diagnosed following DSM-IV-TR criteria. A search for hospital-registered ASDs was performed. For Finnish higher-functioning primary school-aged, 7- to 12-year-olds, the optimal cut-off score was 30 in clinical settings and 28 in total population screening using summed ASSQ scores of parents' and teachers' ratings. Determining appropriate cut-off scores in ASD screening in different languages and in different cultures is of utmost importance.

Autism spectrum disorders according to DSM-IV-TR and comparison with DSM-5 draft criteria: an epidemiological study.

OBJECTIVE: The latest definitions of autism spectrum disorders (ASDs) were specified in DSM-IV-TR in 2000. DSM-5 criteria are planned for 2013. Here, we estimated the prevalence of ASDs and autism according to DSM-IV-TR, clarified confusion concerning diagnostic criteria, and evaluated DSM-5 draft criteria for ASD posted by the American Psychiatry Association (APA) in February 2010. METHOD: This was an epidemiological study of 5,484 eight-year-old children in Finland, 4,422 (81%) of them rated via the Autism Spectrum Screening Questionnaire by parents and/or teachers, and 110 examined by using a structured interview, semi-structured observation, IQ measurement, school-day observation, and patient records. Diagnoses were assigned according to DSM-IV-TR criteria and DSM-5 draft criteria in children with a full-scale IQ (FSIQ) ≥50. Patient records were evaluated in children with an FSIQ <50 to discover diagnoses of ASDs. RESULTS: The prevalence of ASDs was 8.4 in 1,000 and that of autism 4.1 in 1,000 according to DSM-IV-TR. Of the subjects with ASDs and autism, 65% and 61% were high-functioning (FSIQ ≥70), respectively. The prevalence of pervasive developmental disorder not otherwise specified was not estimated because of inconsistency in DSM-IV-TR criteria. DSM-5 draft criteria were shown to be less sensitive in regard to identification of subjects with ASDs, particularly those with Asperger's syndrome and some high-functioning subjects with autism. CONCLUSIONS: DSM-IV-TR helps with the definition of ASDs only up to a point. We suggest modifications to five details of DSM-5 draft criteria posted by the APA in February 2010. Completing revision of DSM criteria for ASDs is a challenging task.

Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: a community- and clinic-based study.

The present study identifies the prevalence and types of comorbid psychiatric disorders associated with Asperger syndrome (AS)/high-functioning autism (HFA) in a combined community- and clinic-based sample of fifty 9- to 16-year-old subjects using the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version. The level of functioning was estimated using the Children's Global Assessment Scale. The results support common (prevalence 74%) and often multiple comorbid psychiatric disorders in AS/HFA; behavioral disorders were shown in 44%, anxiety disorders in 42% and tic disorders in 26%. Oppositional defiant disorder, major depressive disorder and anxiety disorders as comorbid conditions indicated significantly lower levels of functioning. To target interventions, routine evaluation of psychiatric comorbidity in subjects with AS/HFA is emphasized.

When does the Autism Spectrum Screening Questionnaire (ASSQ) predict autism spectrum disorders in primary school-aged children?

The aims of this study were, firstly, to study the association between parents' and teachers' ratings for the Finnish version of the Autism Spectrum Screening Questionnaire (ASSQ), secondly, to find out whether the original cut-off scores of the ASSQ identify primary school-aged children with Asperger syndrome (AS) or autism by using the Finnish ASSQ, and thirdly, to evaluate the validity of the ASSQ. Parents and/or teachers of higher-functioning (full-scale intelligence quotient > or = 50) 8-year-old total population school children (n = 4,408) and 7-12-year-old outpatients with AS/autism (n = 47) completed the Finnish version of the ASSQ. Agreement between informants was slight. In the whole total population, low positive correlation was found between parents' and teachers' ratings, while in the sample of high-scoring children the correlation turned out to be negative. A cut-off of 30 for parents' and teacher's summed score and 22 for teachers' single score is recommended. A valid cut-off for parents' single score could not been estimated. The clinicians are reminded that the ASSQ is a screening instrument, not a diagnosing instrument. The importance of using both parents' and teachers' ratings for screening in clinical settings is underlined.

An epidemiological and diagnostic study of Asperger syndrome according to four sets of diagnostic criteria.

OBJECTIVE: This study evaluated the diagnostic process and prevalence rates of Asperger syndrome (AS) according to the DSM-IV, ICD-10, and criteria developed by Gillberg and Gillberg and by Szatmari and colleagues and clarified confusion about AS. METHOD: An epidemiological study of 5,484 eight-year-old children in Finland, 4,422 (80.6%) of whom rated on the high-functioning Autism Spectrum Screening Questionnaire by parents and/or teacher, 125 of them screened and 110 examined by using structured interview, semistructured observation, IQ measurement, school day observation, and patient records. Diagnoses were performed by following the DSM-IV, ICD-10, and criteria developed by Gillberg and Gillberg and by Szatmari and colleagues in detail. RESULTS: The prevalence rates per 1,000 were 2.5 according to the DSM-IV, 2.9 to ICD-10, 2.7 to Gillberg and Gillberg's criteria, and 1.6 to the criteria of Szatmari et al. CONCLUSIONS: The results emphasize the need to reconsider the diagnostic criteria of AS. The importance of multi-informant sources came up, and the need of several informants was highlighted, especially when diagnosing the broader pervasive developmental disorders.

Intervention,treatmentand care in autistic disorder. Challenging case reports from northern Finland.

OBJECTIVES: Autism produces characteristic patterns of behaviour, and individuals with autistic disorder (AD) have a lot in common in terms of behaviour and mannerisms. Individuals with autism, however, also have their own overall personalities, which both underlie and interact with their autism. This article focuses on challenges of identifying AD and delivering appropriate services in face of long distances and limited resources. STUDY DESIGN: This study is a retrospective descriptive chart review and cases series. Hospital records and data on the treatment/habilitation status of 187 children and adolescents with autistic disorder aged 3-18 years were evaluated from Northern Finland. METHODS: Nine subjects, representing the age group of 9- to 17-year-olds, did not show any improvement on the Childhood Autism Rating Scale (CARS) and in the clinical examination during the follow-up period 1990--97. In this study, these children and adolescents with AD were evaluated more carefully. RESULTS: The treatment programs and therapies varied, depending on the availability of trained staff. There were various reasons for the absence of the most suitable treatment, or habilitation, at the individual level. The difficulties also varied over time and between individuals. In addition, after the follow-up period, four of the nine (55.6%) individuals showed more positive outcome when the level of autism had been taken into account in the planning of the intervention for, treatment and care of AD. CONCLUSION: The possible reasons for poor outcome included the level of mental disability, impairments of speech and communication, lack of knowledge of autism at the municipal level, long distance to services, severe epilepsy, additional medical diagnosis, parental acceptance of the child's autism and late start of the intervention for, or habilitation of autism.

Associated medical disorders and disabilities in children with autistic disorder: a population-based study.

A population-based survey was conducted among 152,732 Finnish children and adolescents aged under 16 years and living in northern Finland. Diagnoses and associated medical conditions were derived from the hospital and institutional records of this area. One hundred and eighty-seven children with DSM-IV autistic disorder were identified. Associated medical disorders or associated disorders of known or suspected genetic origin were found in 12.3 percent, including tuberous sclerosis, Down syndrome, fragile X syndrome, Klinefelter syndrome, XYY syndrome, chromosome 17 deletion, chromosome 46, XX, dup(8) (p) and mitochondriopathy. Other associated medical disorders identified were epilepsy, hydrocephalus, foetal alcohol syndrome and cerebral palsy. Hearing impairments were found in 8.6 percent and severe impairment of vision in 3.7 percent of the individuals with autistic disorder. Medical disorders seem to have a special impact on the genesis of autistic disorder and need to be thoroughly examined in each child with autistic disorder.

Deficient auditory processing in children with Asperger Syndrome, as indexed by event-related potentials.

Asperger Syndrome (AS) is characterized by normal language development but deficient understanding and use of the intonation and prosody of speech. While individuals with AS report difficulties in auditory perception, there are no studies addressing auditory processing at the sensory level. In this study, event-related potentials (ERP) were recorded for syllables and tones in children with AS and in their control counterparts. Children with AS displayed abnormalities in transient sound-feature encoding, as indexed by the obligatory ERPs, and in sound discrimination, as indexed by the mismatch negativity. These deficits were more severe for the tone stimuli than for the syllables. These results indicate that auditory sensory processing is deficient in children with AS, and that these deficits might be implicated in the perceptual problems encountered by children with AS.

Some aspects of treatment and habilitation of children and adolescents with autistic disorder in Northern-Finland.

Hospital records and data on the treatment/habilitation status of 187 children with autism aged 3-18 years were gathered from Northern Finland. The treatment programs and therapies varied, depending on the trained staff available. One-hundred and fifty-two (82.9%) children and adolescents with autism received more than one therapeutic intervention or specific training program. The most common therapies were physiotherapy as well as speech, occupational and music therapy. 43.9% of the children and adolescents with autism received specific training according to TEACCH (Treatment and Education of Autistic and related Communication-Handicapped Children), 10.2% according to Lovaas and 30.5% according to the Portage program. Antiepileptic medication had been prescribed to 23.9% and psychopharmacological interventions to 14.9% of the individuals with autistic disorder (AD). One hundred and seventy-eight subjects out of 187 showed some improvement on the Childhood Autism Rating Scale (CARS), even if no statistically significant difference was found between the outcome of the available habilitation methods.