Validation and determining an optimal cut-off score of the Infant Behavior Checklist for autism spectrum disorder.

Aim: Given the escalating prevalence of autism spectrum disorder (ASD), the persistent paucity of child psychiatrists in Japan, and the need to prepare for unforeseen situations, such as the COVID-19 pandemic, it is essential to establish a reliable screening tool. This study aims to validate the Infant Behavior Checklist (IBC) developed by Japanese experts and determine its appropriate cut-off score. Methods: A total of 354 clinic-referred children, along with their caregivers, participated in this research. Clinical records, including diagnoses established through the sub-structured diagnostic interviews, and the IBC assessments, were subjected to rigorous statistical analysis. Results: Among the 24 items, six failed to reach significance to differentiate ASD from non-ASD cases. The Cronbach's alpha coefficient for the IBC was calculated at 0.77. The IBC total score for ASD cases was significantly higher than that of non-ASD cases. With the chosen cut-off score, the IBC demonstrated an area under the ROC curve of 0.803, along with sensitivity, specificity, positive predictive value, and negative predictive value of 8.03, 0.79, 0.69, 0.34, and 0.94, respectively. Conclusion: The IBC exhibits satisfactory internal consistency and content and discriminant validity. The high sensitivity and other associated indices for the optimal cut-off score of the IBC affirm its validity as a screening instrument for ASD. Nevertheless, further investigations are warranted to ascertain the clinical utility of the IBC.

The factor structure and construct validity of the parent-reported Inventory of Callous-Unemotional Traits among school-aged children and adolescents.

In this study, we assessed the factor structure and construct validity of the parent-reported Inventory of Callous-Unemotional Traits (ICU) among school-aged children and adolescents, aged 6 to 15 years, in a community setting in Japan (n = 10,936). We investigated 15 models that have been reported in previous studies and used confirmatory factor analyses to determine a model that might actually be the best-fit among these. We then examined the correlations between the score of ICU and the Strengths and Difficulties Questionnaire (SDQ) in the best fit model and the three-factor bifactor (3FBF) model with the original ICU through cross-sectional and longitudinal analysis to determine the concurrent and predictive validity of the ICU. The results showed that the best-fit model was the two-factor bifactor (2FBF) model with a revised version of the ICU with 12 items, excluding all but one item of unemotional factors. The cross-sectional and longitudinal analysis showed that higher general callous-unemotional factor scores, callousness and uncaring specific factor scores were significantly associated with a higher level of conduct problems and a lower level of prosocial behaviors in the SDQ. These tendencies were shown both in the 2FBF model with the revised version of the ICU and the 3FBF model with the original ICU. We conclude that the 2FBF model was useful for school-aged community samples, as it predicts increases in conduct problems and decreases in prosocial behavior with fewer items than the 3FBF model.

Depression risks in mothers of children with developmental disabilities: a cross-cultural comparison of Brazil, Colombia, Malaysia and Thailand.

BACKGROUND: Compared with US or European countries, there are fewer mental health services for mothers of children with developmental disabilities in Latin American and/or Southeast Asian countries. AIMS: To explore the risk of depression in mothers of children with developmental disabilities in countries with a lack of mental health professionals, we conducted cross-cultural comparisons for four countries: Brazil, Colombia, Malaysia and Thailand. METHODS: Using the CES-D, we compared the participants' depressive symptoms, by which we also estimated the probability of morbid depression. RESULTS: In every country, participants tended to show depressive symptoms. In the CES-D total scores and the numbers of mothers who were observed to have a high level of depressive symptoms, there were significant differences among countries (F = 4.36, p = .006; χ2 = 10.3, p = .015). CONCLUSIONS: Considering cultural models, we could apply evidence-based intervention to depressive mothers of children, and conduct intervention and treatment for those mothers and evaluate ways of providing better mental health services to these individuals.

Longitudinal developmental courses in Japanese children with autism spectrum disorder.

We followed up 67 children with autistic disorder (AD) and 31 children with pervasive developmental disorder not otherwise specified (PDDNOS) for more than 10 years by reviewing medical records at a clinic for children with developmental disabilities. The participants' data were collected between their first visit to the clinic and the visit at which they applied for basic disability benefits. The standardized IQ scores and autistic symptoms were examined as measures of the children's personal functioning. For environmental factors, we examined the participants' educational placements and work and residential status. Using structural equation modeling, we examined the longitudinal developmental courses of AD and PDDNOS. Participants diagnosed with AD consistently showed lower IQ and more severe autistic symptoms than those diagnosed with PDDNOS. Relationships between personal functioning and environmental factors differed between the two groups. AD and PDDNOS are heterogeneous, so they must be treated differently to improve children's prognoses.

Utility of the Kyoto Scale of Psychological Development in cognitive assessment of children with pervasive developmental disorders.

Based on the clinical records of 74 children with pervasive developmental disorders (PDD; mean age, 45.2 months; 62 boys), the utility of the Kyoto Scale of Psychological Development in cognitive assessment of young and/or mentally retarded PDD children was investigated. Because the overall developmental quotient (DQ) had the highest correlation with the IQ (Pearson's r, 0.88) and the Cognitive-Adaptive DQ showed a non-significant difference in mean (65.8) from the IQ (66.4), they both seem useful as an equivalent to an IQ. The test would enable clinicians to carry out continual developmental assessments and to develop appropriate remedial programs for those children from infancy.

Cognitive and symptom profiles in Asperger's syndrome and high-functioning autism.

Asperger syndrome (AS) and autistic disorder are two subtypes of pervasive developmental disorders (PDD), but there has been considerable debate over whether AS and autistic disorder without mental retardation (IQ > or = 70), called high-functioning autism (HFA), are distinct conditions or not. The aim of the present paper was to clarify this issue through a comparison of cognitive function and autistic symptom profiles. Based on the DSM-IV and ICD-10 definitions of language acquisition, 36 age- and IQ-balanced subjects with AS (mean age, 12.8 years; mean full-scale IQ, 98.3) were compared with 37 subjects with HFA (mean age, 12.6 years; mean full-scale IQ, 94.6) on the Japanese version of the Wechsler Intelligence Scales and the Childhood Autism Rating Scale-Tokyo Version (CARS-TV). Compared with the HFA subjects, the AS subjects scored significantly higher on Verbal IQ, Vocabulary, and Comprehension, but scored significantly lower on Coding. Although the total CARS-TV score did not differ significantly between the two groups, AS subjects scored significantly lower (i.e. less abnormal) on Verbal communication and Non-verbal communication than did the HFA subjects. A history of normal language acquisition in early childhood could predict his/her better verbal ability in mid-childhood or later. Autistic cognitive characteristics shared by both AS and HFA subjects appear to support the validity of the current diagnostic classification of PDD.

Cognitive and symptom profiles in high-functioning pervasive developmental disorder not otherwise specified and attention-deficit/hyperactivity disorder.

Age- and IQ-balanced 27 children with high-functioning (IQ>or=70) pervasive developmental disorder not otherwise specified (HPDDNOS) and 27 children with attention-deficit/hyperactivity disorder (ADHD) were compared on the Japanese version of Wechsler Intelligence Scale for Children Third Edition (WISC-III) and the Childhood Autism Rating Scale-Tokyo Version (CARS-TV). Compared with the ADHD children, the HPDDNOS children scored significantly lower on verbal comprehension, vocabulary, and comprehension, but significantly higher on block design. After controlling for the total CARS-TV score, the HPDDNOS children were significantly more abnormal on "relationships with people," "nonverbal communication," and "general impressions," but less abnormal on "near receptor responsiveness" and "activity level." These differences in cognitive and autistic symptom profiles may help professionals to distinguish clinically between both conditions.

Autism-Spectrum Quotient-Japanese version and its short forms for screening normally intelligent persons with pervasive developmental disorders.

A Japanese version of the Autism Spectrum Quotient (AQ), AQ-J was administered to 25 normally intelligent high-functioning pervasive developmental disorder (HPDD) patients (mean age, 24.2 years; 24 male, one female) and 215 controls (mean age, 30.4 years; 86 male, 129 female) randomly selected from the general population. The AQ-J had satisfactory internal consistency reliability (Cronbach's alpha > 0.70 in the two groups), test-retest reliability, and discriminant validity [i.e. the AQ-J score was significantly higher in the HPDD (mean, 29.6) than controls (mean, 22.2)]. At a cut-off of 26, the AQ-J had satisfactory sensitivity, specificity, and negative predictive value, but it had low positive predictive value (0.24) possibly due to the facts that the 25 mild HPDD patients scored lower and the controls scored higher on the AQ-J than British counterparts on the AQ. The AQ-J-21 (consisting of 21 items significantly associated with HPDD diagnosis) and the AQ-J-10 (consisting of 10 of the 21 items with an effect size > 0.17) had higher, although not satisfactory, positive predictive values of 0.35 and 0.46 at cut-offs of 12 and 7, respectively, than the AQ-J. The AQ-J and two short forms are useful not to predict but to rule out mild HPDD, the most difficult part of HPDD to be distinguished from non-PDD conditions, in persons scoring under the cut-offs and to consider professionals' examination of HPDD in persons scoring over them, because their negative predictive values were satisfactory.

Comparison of childhood disintegrative disorder and disintegrative psychosis not diagnosed as childhood disintegrative disorder.

To clarify the difference of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) childhood disintegrative disorder (CDD) from International Classification of Diseases (9th revision; ICD-9) disintegrative psychosis (DP), 10 CDD children (mean age, 7.7 years) and 18 DP children (mean, 6.5 years) not diagnosed as CDD divided into DSM-IV autistic disorder (DP-AD; n = 11) and pervasive developmental disorders not otherwise specified (DP-PDDNOS; n = 7) were compared on 31 variables not directly related to the normalcy before regression. The CDD, DP-AD, and DP-PDDNOS groups did not differ significantly in 28 variables. The DP-PDDNOS group met significantly a smaller number of items in criterion A of DSM-IV autistic disorder criteria than the CDD and DP-AD groups, both of which did not differ significantly in this respect. The CDD group tended to be more abnormal in auditory responsiveness and verbal communication than the DP-PDDNOS group. While CDD is distinct from DP-PDDNOS, its validity apart from AD with regression remains to be studied.

Validity of childhood disintegrative disorder apart from autistic disorder with speech loss.

In order to test clinical validity of DSM-IV childhood disintegrative disorder (CDD), 10 CDD children (mean age = 8.2 years, SD = 3.8; 7 male and 3 female) and 30 age- and gender-matched children with DSM-IV autistic disorder (AD) with speech loss (SL) (ADSL) were compared on 24 variables not directly related to CDD criteria. Compared with the ADSL children, the CDD children showed fearfulness significantly more frequently during the period of SL; displayed epilepsy significantly more frequently and stereotypy significantly more prominently at first visit on average about 6 years after SL; and had significantly less uneven intellectual profile at first visit to support the validity of CDD to a certain extent. No significant difference in the retardation level at first visit between the two groups suggested no worse short-term outcome in CDD than ADSL, although a long-term prospective study to compare them from infancy is needed.

External validity of childhood disintegrative disorder in comparison with autistic disorder.

To examine the external validity of DSM-IV childhood disintegrative disorder (CDD), 10 children (M = 8.2 yrs) with CDD and 152 gender- and age-matched children with autistic disorder (AD) were compared on 24 variables. The CDD children had a significantly higher rate of epilepsy, significantly less uneven intellectual functioning, and a tendency of greater abnormality in auditory responsiveness than AD children, to validate CDD externally. Their short-term outcome, as shown in the degree of retardation, was not worse than the AD children, which is in disagreement with previous studies reporting worse outcomes in CDD than autism. These results need to be verified by a long-term prospective study that compares CDD and AD patients from infancy.

Comparison of high-functioning atypical autism and childhood autism by Childhood Autism Rating Scale-Tokyo version.

To assess autistic symptom differences between high-functioning atypical autism (atypical symptomatology) (HAA; IQ >/= 70) and childhood autism (HCA), 53 HAA children (mean: 6.0 +/- 0.5 years) were compared with 21 HCA children (mean: 8.2 +/- 1.1 years) on the Childhood Autism Rating Scale-Tokyo version (CARS-TV). Because IQ on the Japanese version of the Stanford-Binet and CARS-TV total scores differed significantly between HAA and HCA, analysis of covariance was conducted with IQ and CARS-TV total scores controlled for. In two items of CARS-TV (relationship with people and general impressions) the HAA children were significantly less abnormal than the HCA children. Affect tended to be significantly milder in HAA than HCA. Anxiety reaction was significantly more abnormal in HAA than HCA. These findings may be useful to distinguish between HAA and HCA.

Validity of DQ as an estimate of IQ in children with autistic disorder.

The purpose of the present paper was to test the validity of developmental quotients (DQ) on the Mental Development Scale for Infants and Young Children (MDSIYC) as an estimate of intelligence quotient (IQ). Correlations were carried out of its DQ with an IQ on the Japanese version of the Stanford-Binet in 94 children with Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) autistic disorder. With IQ, DQ in the five MDSIYC areas (motor, play, socialization, self-help, and speech) and full-scale DQ (mean of five-area DQ) had significant correlations (Pearson r) of 0.46, 0.56, 0.53, 0.46, 0.85, and 0.68, respectively, suggesting that speech DQ is the most valid estimate of IQ.

Childhood autism rating scale--Tokyo version for screening pervasive developmental disorders.

To assess the utility of the Childhood Autism Rating Scale - Tokyo Version (CARS-TV), its total score was compared among 430 children with DSM-IV per subgroup (i.e. autistic disorder (AD), childhood disintegrative disorder (CDD), Asperger's disorder, and pervasive developmental disorders (PDD) not otherwise specified (PDDNOS)). Values of Cronbach's alpha were 0.91 for the PDD group and 0.89 for the non-PDD mental retardation (MR) group, and 0.93 for both groups combined. The total score was significantly higher in PDD (mean = 30.1, SD = 4.5) than in non-PDD MR (mean = 22.9, SD = 3.3), t(503) = 13.7, P< 0.0001. The cut-off to distinguish PDD from non-PDD MR was 25.5/26, with sensitivity, specificity, positive predictive value and negative predictive value of 0.86, 0.83, 0.97 and 0.50, respectively. The total score differed significantly among the four groups, with CDD and AD being significantly higher than both PDDNOS and Asperger's disorder, PDDNOS being significantly higher than Asperger's disorder and no significant difference between CDD and AD. The cut-off to distinguish AD from PDDNOS was 30/30.5, with sensitivity, specificity, positive predictive value and negative predictive value of 0.71, 0.75, 0.77 and 0.69, respectively. CARS-TV seems to be a useful instrument for differentiating between PDD and non-PDD MR and between AD and PDDNOS, although further replication is needed.