Completeness of case ascertainment for surveillance of autism spectrum disorders using the autism developmental disabilities monitoring network methodology.

BACKGROUND: The Autism and Developmental Disabilities Monitoring Network (ADDM), sponsored by the Centers for Disease Control and Prevention, is the largest-scale project ever undertaken to identify the prevalence of Autism Spectrum Disorders (ASD) in the United States. OBJECTIVE: The objective of the present study was to examine the accuracy of the ADDM methodology in terms of completeness of case ascertainment; that is, to assess the success of the ADDM Network in identifying and accurately classifying all existing cases of ASD among 8-year-old children in the target study areas. METHODS: To accomplish this objective, the ADDM methodology was applied to a selected region of South Carolina for 8-year olds in 2000 (birth year 1992) and again seven years later for the same region and birth year. RESULTS: For this region and birth year, completeness of case ascertainment was high, with prevalence estimates of 7.6 per 1000 at both ages 8- and 15-years. For children common to both surveillance years, concordance in case status was also high (82%). CONCLUSIONS: Given that prevalence did not change within this region and birth year, continued research is needed to better understand the changes in prevalence estimates being found by the ADDM network across surveillance groups.

High prescription drug use and associated costs among Medicaid-eligible children with autism spectrum disorders identified by a population-based surveillance network.

PURPOSE: We assessed medication use and associated costs among 8- and 15-year-old children with autism spectrum disorders (ASD) identified by the South Carolina Autism and Developmental Disabilities Monitoring (SCADDM) Network. METHODS: All Medicaid-eligible SCADDM-identified children with ASD from surveillance years 2006 and 2007 were included (n = 263). Children were classified as ASD cases when documented behaviors consistent with the DSM-IV-TR criteria for autistic disorder, Asperger disorder, or pervasive developmental disorder-not otherwise specified were present in health and education evaluation records. Medication and cost data were obtained by linking population-based and Medicaid data. RESULTS: All 263 SCADDM-identified children had Medicaid data available; 56% (n = 147) had a prescription of any type, 40% (n = 105) used psychotropic medication, and 20% (n = 52) used multiple psychotropic classes during the study period. Common combinations were (1) attention deficit hyperactivity disorder medications and an antihypertensive, antidepressant or antipsychotic; and (2) antidepressants and an antipsychotic. Multiple psychotropic classes were more common among older children. Both the overall distribution of the number of prescription claims and medication costs varied significantly by age. CONCLUSIONS: Results confirm that medication use in ASD, alone or in combination, is common, costly, and may increase with age.

The prevalence of youth with autism spectrum disorders in the criminal justice system.

Past surveys have reported high rates of youth with disabilities in the juvenile justice system, however, little research has examined the frequency with which youth with Autism spectrum disorders (ASD) are in contact with law enforcement. Using records linkage with the Department of Juvenile Justice and the South Carolina Law Enforcement Division and the South Carolina Autism and Developmental Disabilities Monitoring Program (SC ADDM), this study compares the frequency, type, and outcome of criminal charges for youth with ASD and non-ASD youth. Youth with ASD had higher rates of crimes against persons and lower rates of crimes against property. Youth with ASD were more likely to be diverted into pre-trial interventions and less likely to be prosecuted than comparison youth. When compared to the overall SC ADDM sample, charged youth were less likely to have comorbid intellectual disability.

Autism spectrum disorders in preschool-aged children: prevalence and comparison to a school-aged population.

PURPOSE: The purpose of this study was to determine the prevalence and case characteristics of children with autism spectrum disorders (ASDs) among 4-year-olds and to compare findings to previous prevalence estimates for 8-year-olds in the same geographic area. METHODS: South Carolina (SC) has been a participant in the Centers for Disease Control and Prevention's active, population-based, multiple-site ASD surveillance network for 8-year-olds since 2000. The 8-year-old methodology, designed to identify children both with and without prior diagnosis, was applied in SC with modification to include information sources for younger children. RESULTS: The ASD prevalence among 4-year-olds in 2006 was 8.0 per 1000 (95% confidence interval [CI], 6.1-9.9), or 1 in 125. In comparison, ASD prevalence among 8-year-olds in the same geographic area was 7.6 (95% CI, 5.7-9.5) in 2000 and 7.0 (95% CI 5.1-8.9) in 2002. Developmental concerns were documented at earlier ages across time, and while most cases received services, only 20% to 29% received services specific to ASD. CONCLUSIONS: Findings should provide useful information for the planning of health/education policies and early intervention strategies for ASD.

Prevalence and characteristics of children with autism-spectrum disorders.

PURPOSE: The purpose of this study was to determine the prevalence of autism spectrum disorders (ASD) and associated characteristics among 8-year-old children. METHODS: This is an ongoing active, population-based surveillance program conducted in South Carolina as part of the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network. Cases from the state's first two study years (2000 and 2002) have been combined for analysis, resulting in surveillance of 47,726 children who are 8 years of age. RESULTS: A total of 295 children met criteria for ASD, yielding a prevalence of 6.2 per 1000. The racial distribution of cases was similar to that of 8-year-old children in the study area, with boys more commonly affected than girls (3.1:1). Seventy-nine percent of cases were served in special education, 36% of these under Autism classification. Analyses by gender showed differences in diagnostic criteria and intellectual functioning. Girls more often were cognitively impaired (IQ

Correlation of the cranial base angle and its components with other dental/skeletal variables and treatment time.

Many authors have studied the correlation of cranial base flexure and the degree of mandibular prognathism and classification of malocclusion. This indicates that the cranial base flexure may or may not have an effect on the degree of mandibular prognathism and classification of malocclusion. This study evaluates the correlation of the pretreatment cranial base angle and its component parts to other dental and skeletal cephalometric variables as well as treatment time. The sample consisted of 99 Angle Class II and Class I malocclusions treated in the mixed dentition with cervical headgear and incisor bite plane. Thirty of the patients required full appliance treatment. Treatment duration averaged 4.3 years (SD, 1.5 years). Only the starting cephalograms were used to acquire linear, proportional, and angular cranial base dimensions using Ba-S-N (total cranial base), Ba-S/FH (posterior cranial base), and SN/FH (anterior cranial base). Pearson product moment correlation coefficients were computed and used to assess the association of the following skeletal and dental variables: N-Pg/FH, MP/FH, Y-axis/FH, U1/L1, L1/MP, A-NPg mm, A-Perp, B-Perp, and treatment time with the cranial base measurements. Significance was determined only when the confidence level was P < .05. Although there was no significant correlation of BaSN or SN/FH with NPg, the angular BaS/FH, linear BaS mm, and proportional length of BaS %BaN were all statistically negatively correlated to the facial angle. This indicates that the posterior cranial base leg is the controlling factor in relating the cranial base to mandibular prognathism.

Statistical evaluation of possible factors affecting the sagittal position of the first permanent molar in the maxilla.

A cephalometric analysis was designed to evaluate several factors that may affect the sagittal position of the maxillary first permanent molar. A total of 184 Class II and Class I malocclusion patients were randomly selected before orthodontic treatment. The mandibular and palatal planes were related to Frankfort Horizontal and used to create the interjaw or B angle. Age and cephalometric landmarks (Ba, N, point A, pterygomaxillary fissure, and maxillary molars) were projected at right angles to the Frankfort Horizontal for effective length. Actual maxillary length and actual molar location were determined by projecting landmarks at right angles to the palatal plane. Correlation coefficients and P values were used to evaluate the data with a minimal significance value of .05 to determine a 95% confidence level. A statistically significant linear and proportional positive correlation (P < .0001) existed between molar location, age, and maxillary size. There was a strong negative correlation (P < .0001), both linearly and as a proportion of the actual length of the maxilla, between the actual position of the maxillary molar and the interjaw and mandibular plane angles. A significant correlation also existed between the molar position and palatal plane angles. The results show that increased interjaw, mandibular, and palatal plane angles are accompanied by a more posterior position of the maxillary first molar in the maxilla, whereas the molar occupied a continuing more forward position in the maxilla with increasing age, cranial base length, and maxillary size.

Pulmonary complications after esophagectomy.

BACKGROUND: Pulmonary complications are common in patients who have undergone esophagectomy. There are no good predictive variables for these complications. In addition, the role that preoperative treatment with chemotherapy and radiation may play in postoperative complications remains unclear. METHODS: We performed a retrospective review of all patients who underwent esophagectomy by a single surgeon at our institution over a 6-year period. Data were analyzed for a correlation between patient risk factors and pulmonary complications, including mortality, prolonged mechanical ventilation, and hospital length of stay. RESULTS: Complete data were available on 61 patients. Nearly all patients had some pulmonary abnormality (eg, pleural effusion), although most of these were clinically insignificant. Pneumonia was the most common clinically important complication, and 19.7% of patients required prolonged ventilatory support. Significant risk factors identified included impaired pulmonary function, especially for patients with forced expiratory volume in 1 second (FEV1) less than 65% of predicted, preoperative chemoradiotherapy, and age. CONCLUSIONS: Impaired lung function is a significant risk factor for pulmonary complications after esophagectomy. Patients with FEV1 less than 65% of predicted appear to be at greatest risk. There also seems to be an associated risk of preoperative chemoradiotherapy for pulmonary complications after esophagectomy.