Amanda Brignell

Autism spectrum disorder: Presentation and prevalence in a nationally representative Australian sample.

Objective: The aim of this study was to identify the prevalence of parent-reported autism spectrum disorder diagnosis in Australia, and examine the developmental profile of children with autism spectrum disorder compared to their peers. Design/Setting: Secondary analyses were undertaken on data from the Longitudinal Study of Australian Children. Participants: Children were recruited at kindergarten (K cohort) and birth (B cohort), and subsequently completed two-yearly ‘waves’ of assessments. Main Outcomes: Autism spectrum disorder diagnostic status was ascertained at Wave 4 along with age of diagnosis by parent report. Standardised tools were used to assess children’s quality of life, behaviour, receptive vocabulary and non-verbal intelligence. Results: Prevalence of autism spectrum disorder was 2.5% (95% confidence interval = [2.0, 3.0]) in the B cohort compared to 1.5% (95% confidence interval = [1.2, 2.0]) in the K cohort. In both cohorts, children with autism spectrum disorder had poorer mean quality of life, emotional-behavioural functioning and receptive vocabulary compared with non-autism spectrum disorder peers, and a higher proportion of children with autism spectrum disorder had problems in these areas. However, between 6% and 9% of children with moderate to severe autism spectrum disorder and 12–20% with mild autism spectrum disorder were not reported to have problems with social interaction. Conclusion: The prevalence of a parent-reported diagnosis of autism spectrum disorder before age 7 in Australia was higher in the B cohort. Data from future Longitudinal Study of Australian Children waves will clarify whether autism spectrum disorder has been diagnosed earlier in the B cohort or if there is a continued increase in prevalence. Future waves will also provide crucial information about the types and severity of problems experienced during the primary and secondary school years which will assist service planning.

Autism spectrum disorder: updated prevalence and comparison of two birth cohorts in a nationally representative Australian sample

Objectives This study aimed to (1) provide an update on the prevalence of parent-reported autism spectrum disorder (ASD) diagnosis and new information about teacher-reported ASD in two nationally representative Australian cohorts at ages 10–11 years, (2) examine differences in cohort demographic and clinical profiles and (3) compare the prevalence of teacher-reported ASD and any changes in categorisation over time across the cohorts. Design Secondary analyses were undertaken using data from the Longitudinal Study of Australian Children (LSAC). Participants Children were recruited at kindergarten age (K cohort; birth year 1999/2000) and birth (B cohort; birth year 2003/2004), with follow-up of every 2  years for six waves. Primary outcome measures Parent-reported and teacher-reported ASD diagnosis was ascertained at three time points (waves 4–6). Results At age 10–11 years, the adjusted prevalence of parent-reported ASD diagnosis was 3.9% (95% CI 3.2 to 4.5) and 2.4% (95% CI 1.6 to 2.9) in the B and K cohorts, respectively. Teacher-reported prevalence of ASD was 1.7% (95% CI 1.2 to 2.1) in the B cohort and 0.9% (95% CI 0.56 to 1.14) in the K cohort. Parents reported fewer conduct and peer problems and teachers more pro-social behaviour in B relative to K cohort ASD children. Children reported only by parents in the later-born B cohort had milder behaviour problems than parent-agreed and teacher-agreed cases. Although individual switching to ASD from other categories from 8–9 to 10–11 years was low (K cohort n=5, B cohort n=6), teachers reported more children with ASD in the B than K cohort at 10–11 years and fewer children with emotional/ behavioural problems. Conclusions The higher prevalence of parent-reported and teacher-reported ASD diagnosis in the later-born cohort may be partially explained by identifying children with milder behavioural problems as ASD and a change in the use of diagnostic categories in schools.

Diagnosing autism: Australian paediatric research network surveys

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with reported prevalence of more than 1/100. In Australia, paediatricians are often involved in diagnosing ASD and providing long‐term management. However, it is not known how paediatricians diagnose ASD. This study aimed to investigate whether the way Australian paediatricians diagnose ASD is in line with current recommendations.

Regression in autism spectrum disorders

Since the Journal of Paediatrics and Child Health was first published, there has been substantial change in the field of autism spectrum disorders (ASDs) with an exponential increase in the amount of funded and published research. In this paper, we focus on regression in children with ASD, a phenomenon that remains poorly understood. We discuss the implications of what we know about regression in ASD for the way we think about ASD more broadly and for paediatric practice.

Parent-reported patterns of loss and gain in communication in 1- to 2-year-old children are not unique to autism spectrum disorder

We compared loss and gain in communication from 1 to 2 years in children later diagnosed with autism spectrum disorder (n = 41), language impairment (n = 110) and in children with typical language development at 7 years (n = 831). Participants were selected from a prospective population cohort study of child language (the Early Language in Victoria Study). Parent-completed communication tools were used. As a group, children with autism spectrum disorder demonstrated slower median skill gain, with an increasing gap between trajectories compared to children with typical development and language impairment. A proportion from all groups lost skills in at least one domain (autism spectrum disorder (41%), language impairment (30%), typical development (26%)), with more children with autism spectrum disorder losing skills in more than one domain (autism spectrum disorder (47%), language impairment (15%, p = 0.0003), typical development (16%, p < 0.001)). Loss was most common for all groups in the domain of ‘emotion and eye gaze’ but with a higher proportion for children with autism spectrum disorder (27%; language impairment (12%, p = 0.03), typical development (14%, p = 0.03)). A higher proportion of children with autism spectrum disorder also lost skills in gesture (p = 0.01), sounds (p = 0.009) and understanding (p = 0.004) compared to children with typical development but not with language impairment. These findings add to our understanding of early communication development and highlight that loss is not unique to autism spectrum disorder.

Trends in the Overlap of Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder: Prevalence, Clinical Management, Language and Genetics

Purpose of ReviewTo review recent literature on the overlap of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), now both conditions can be dually diagnosed in the Diagnostic and Statistical Manual of Mental disorders 5th edition.Recent FindingsThere is a high comorbidity with rates of comorbid ASD and ADHD ranging from 40 to 83%. Multidisciplinary assessment and management of the combined presentation is thus required. Language difficulties are a common comorbidity in both ASD and ADHD with around 60% of children with ASD and 40% of those with ADHD having language problems. Twin studies show up to 72% of the co-variance of ADHD, and ASD symptoms can be explained by shared additive genetic factors providing a genetic basis for the observed clinical overlap.SummaryThere are still many gaps in our knowledge with limited research exploring well-defined groups of children with ASD only, ADHD only and ASD with ADHD. Clinicians should thoroughly assess ADHD symptomatology in children with ASD and vice versa to understand the challenges for these children and inform treatment planning.

How relevant is the framework being used with autism spectrum disorders today

Abstract Camarata (2014) provides a comprehensive summary of the current state of the research on early identification and intervention for children with autism spectrum disorders (ASD). Extending on the foundations provided by Camarata, this commentary discusses the value of a diagnosis of ASD and questions whether there is sufficient evidence on which to base continuing calls for early identification and ASD-specific intervention. Gaps are highlighted in the evidence base, suggestions made about how to fill those gaps, and an alternative framework is proposed for achieving best outcomes for children with early developmental problems of the type seen in ASD and their families.

Overall prognosis of preschool autism spectrum disorder diagnoses

This is a protocol for a Cochrane Review (Prognosis). The objectives are as follows: The primary objective of this review is to synthesise the available evidence on the proportion of individuals who have a diagnosis of autism spectrum disorder at baseline and at follow-up one or more years later. The secondary objectives of this review are to: investigate whether there are differences in the proportions of individuals with autism spectrum disorder who maintain a diagnosis at follow-up dependent on use of the different classification systems (i.e. DSM or ICD criteria) and their revisions; and investigate the proportion of individuals with autism spectrum disorder who maintain diagnosis at follow-up in important subgroups of individuals, including those of different ages and those with different language levels (verbal/non-verbal; standard score ≤ 70 or > 70), IQs (≤ 70 or > 70), adaptive behaviour (standard score ≤ 70 or > 70), and different diagnostic subgroups (Aspergers syndrome/disorder, autistic disorder, childhood autism, PDD-NOS, atypical autism, PDD and autism spectrum disorder). We will investigate potential sources of heterogeneity that may impact outcomes such as differences in study participation, study design, length of follow-up, participant attrition and participant outcome measurement factors. We will use internationally recognised standards for systematic reviews to guide the review.

Communication intervention for autism spectrum disorders in minimally verbal children

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the e@ectiveness of communication interventions in children with ASD who are minimally verbal. Communication intervention for autism spectrum disorders in minimally verbal children (Protocol) Copyright

A systematic review and meta-analysis of the prognosis of language outcomes for individuals with autism spectrum disorder

Background Language difficulties are common in autism spectrum disorder, yet little is known about the prognosis of language in children with autism spectrum disorder. The aim of this study was to systematically review studies reporting language outcomes in individuals with autism spectrum disorder. Method A comprehensive search strategy with a well-established sensitive prognosis filter for Medline, adapted for five other databases, was used. Included studies observed individuals diagnosed with autism spectrum disorder for ≥12 months and had ≥30 participants. Risk of bias was assessed. Results Fifty-four studies (N = 5064) met inclusion criteria. Language outcomes were standardised assessments (n = 35), notation of presence/absence of verbal language (n = 11) or both (n = 8). Age at baseline ranged from 17 months to 26 years, duration of follow-up from 1 to 38 years. Most publications (92%) were rated medium to high risk of bias. In all but one study individuals had below-average scores at baseline and follow-up. However, in most (n = 24/25; 96%) studies reporting standard scores, individuals (aged ≤ 11 years at follow-up) progressed at a comparable rate to age-expected norms or demonstrated some ‘catch up’ over time. Meta-analyses found mean standard scores increased over time in three language domains (composite receptive language, composite expressive language and adaptive language). Nineteen to thirty percent of children aged five years and under gained verbal language. For children aged over five years 5–32% gained verbal language over the course of study. Age, baseline language scores, IQ and length of follow-up did not moderate between study differences in composite language or adaptive language growth or the acquisition of verbal language. Conclusion Despite variability in study methods, findings were consistent, with the majority of studies reporting children under 11 years on average progressed at a comparable rate to age-expected norms or with some ‘catchup’ over time. Implications This review provides synthesised information for families and clinicians on language development over time and on language outcomes for individuals with autism spectrum disorder. Such information can be useful for prognostic counselling and may assist planning around future resources and support needs. This review also makes recommendations regarding methodology for future studies so that prognosis can become more fine-tuned at an individual level.