Bernard Golse

Attentional skills during the first 6 months of age in autism spectrum disorder.

OBJECTIVEnTo study the quality of early attention in autism spectrum disorder (ASD) through home movies.nnnMETHODnFifteen home movies from the first 6 months of life of children who later received a diagnosis of ASD were compared with home movies of 15 normal children. The diagnosis was performed after the third year of life of children by two senior child and adolescent psychiatrists using a checklist of symptoms according to the. The films of the two groups were mixed and rated by blind observers through a Grid for the Assessment of Attentional Skills in Infants, composed of 13 items grouped into three developmental areas.nnnRESULTSnUsing multivariate analysis of variance, the authors found significant differences between the two groups for the items in the social attention and the social behavior areas; on the contrary, there were no differences in nonsocial attention.nnnCONCLUSIONSnThe authors pose some hypotheses about a specific early-appearing impairment of attention in ASD in which children shift their spontaneous attention mainly toward nonsocial stimuli rather than toward social stimuli. The importance of this finding for early diagnosis and treatment is underlined.

Developmental Coordination Disorder, An Umbrella Term for Motor Impairments in Children: Nature and Co-Morbid Disorders

Background: Developmental Coordination Disorder (DCD) defines a heterogeneous class of children exhibiting marked impairment in motor coordination as a general group of deficits in fine and gross motricity (subtype mixed group) common to all research studies, and with a variety of other motor disorders that have been little investigated. No consensus about symptoms and etiology has been established. Methods: Data from 58 children aged 6 to 13 years with DCD were collected on DSM-IV criteria, similar to DSM-5 criteria. They had no other medical condition and inclusion criteria were strict (born full-term, no medication, no occupational/physical therapy). Multivariate statistical methods were used to evidence relevant interactions between discriminant features in a general DCD subtype group and to highlight specific co-morbidities. The study examined age-calibrated standardized scores from completed assessments of psychological, neuropsychological, and neuropsychomotor functions, and more specifically the presence of minor neurological dysfunctions (MND) including neurological soft signs (NSS), without evidence of focal neurological brain involvement. These were not considered in most previous studies. Results: Findings show the salient DCD markers for the mixed subtype (imitation of gestures, digital perception, digital praxia, manual dexterity, upper, and lower limb coordination), vs. surprising co-morbidities, with 33% of MND with mild spasticity from phasic stretch reflex (PSR), not associated with the above impairments but rather with sitting tone (p = 0.004) and dysdiadochokinesia (p = 0.011). PSR was not specific to a DCD subtype but was related to increased impairment of coordination between upper and lower limbs and manual dexterity. Our results highlight the major contribution of an extensive neuro-developmental assessment (mental and physical). Discussion: The present study provides important new evidence in favor of a complete physical neuropsychomotor assessment, including neuromuscular tone examination, using appropriate standardized neurodevelopmental tools (common tasks across ages with age-related normative data) in order to distinguish motor impairments gathered under the umbrella term of developmental coordination disorders (subcortical vs. cortical). Mild spasticity in the gastrocnemius muscles, such as phasic stretch reflex (PSR), suggests disturbances of the motor pathway, increasing impairment of gross and fine motricity. These findings contribute to understanding the nature of motor disorders in DCD by taking account of possible co-morbidities (corticospinal tract disturbances) to improve diagnosis and adapt treatment programmes in clinical practice.

Evaluation of neuromuscular tone phenotypes in children with autism spectrum disorder: An exploratory study

OBJECTIVEnMotor disorders are known in autism spectrum disorder (ASD), but muscle tone assessments are rarely performed. Muscle tone underpins movement. We investigated muscle tone in 34xa0ASD children using a standardized neuro-developmental battery, which uses the French norms for muscular tone in children.nnnMETHODSnDangling and extensibility were used to examine passive muscle tone in the upper and lower limbs and the body axis. A comparison between muscles of the right and left sides enabled the determination of tonic laterality.nnnRESULTSnWe found a disharmonious tonic typology, with a tonic component for the muscles of the trunk and the proximal muscles of the lower limbs and a laxity component for the ankles and the proximal and distal muscles of the upper limbs (wrists and shoulders). No establishment of tonic laterality was found in the upper limbs in 61% of ASD children (P<0.001).nnnCONCLUSIONnThe disturbed tonic organization influenced by subcortical structures, such as the cerebellum, may partially explain the motor disorders, and indefinite tonic laterality may also be linked to low hemispheric brain dominance described in autism. This preliminary examination is necessary before any gross motor assessments to understand the nature of movement disorders, explore typologies and highlight possible soft neuro-motor signs.

Developmental dysgraphia is often associated with minor neurological dysfunction in children with developmental coordination disorder (DCD)

OBJECTIVESnChildren with developmental coordination disorder (DCD) are particularly affected by handwriting disorders, which remain poorly understood and are not clearly defined. The aim of our study is to provide a better understanding of handwriting disorders, and specifically of dysgraphia in children with DCD.nnnMETHODSnSixty-five children with DCD (5-15 years), enrolled according to DSM-5, were assessed with handwriting testing and standardized assessments of neuropsychological, neurovisual, MRI and neuropsychomotor functions, with special attention paid to muscular tone examination.nnnRESULTSnWhile handwriting disorders were strongly represented in our sample of children with DCD (89%), dysgraphia appeared uncommon (17%) and was closely related to several specific dysfunctions of laterality establishment; mild pyramidal tract dysfunction with distal phasic stretch reflex (PSR) in lower limbs; digital praxis slowness (both P<0.05).nnnDISCUSSIONnIn our sample, dysgraphia was closely related to minor neurological dysfunction (MND) suggesting a disturbance of motor control at the level of the corticospinal motor pathway. This highlights the uncommon character of dysgraphia in children with DCD for which diagnosis should be made through a particular attention to evaluation of MND with muscular tone examination. This consideration, both in the research setting and in clinical practice, appears necessary to avoid inaccurate clinical diagnosis and to optimize appropriate therapeutic management.

Nature of motor impairments in autism spectrum disorder: A comparison with developmental coordination disorder

ABSTRACT Introduction: Several authors have suggested the existence of motor disorders associated with developmental coordination disorder (DCD) in individuals with autism spectrum disorder (ASD). However, there are few comparative studies of psychomotor profiles that include assessments of neurological soft signs in children with ASD or DCD. We used a neuropsychomotor assessment for children with ASD from a standardized neurodevelopmental examination to understand the nature of the difficulties these children encounter. To uncover the differences and similarities in psychomotor profiles, we compared the profiles of children with ASD with those of children with DCD and focused on two recently described DCD subgroups: visuospatial–constructional (VSC) and mixed (MX). Methods: We compared 18 children with ASD and 58 children with DCD (33 with VSC-DCD and 25 with MX-DCD) who were assessed with a battery of French-language tests (the NP-MOT) to evaluate the neuropsychomotor functions associated with visual perception and visual–spatial–motor structuring. Results: Although there were similarities between the profiles of children with ASD and those with DCD (VSC-DCD or MX-DCD), these similarities were not associated with the predictive diagnostic markers that characterized subtypes of DCD. Instead, many variables (visuospatial–motor structuration, synkinetic movements, dynamic balance, manual dexterity, coordination, praxis, bodily spatial integration, and digital perception) differed among the three groups; the best performance was observed in the children with ASD. Conclusion: The neuropsychomotor profiles of children with ASD and those with VSC-DCD or MX-DCD differed, and these differences are discussed. Our results highlight that impairments of ASD are specific about lateralization disturbances and support the hypothesis of proprioceptive impairment due to visual fixation problems influenced by muscular tone in relation to the subcortical and cortical structures and possible interhemispheric disorder. Thus, some neuropsychomotor functions that underpin both gestures and a set of motor skills are affected.

P-348 - Importance of multidimensional assessment to refine subtypes of developmental coordination disorder

Objectives The DSM-IV-TR criteria for Developmental Coordination Disorder (DCD) involve a marked impairment in the development of motor coordination although visuo-spatial, digital and visuo-motor perception, neuromuscular tone, qualitative and quantitative measures of gross and fine motor coordination related impairments might be used to isolate three main subtypes of DCD/dyspraxia: ideo-motor, visuo-spatial and constructional, and a mix group sharing common impairments with additional comorbidities. This study focus on isolating specific markers of coordination disorder and their interactions in mix vs. pure form of dyspraxia. Methods Tree-based bagged classifiers were used to highlight relevant markers among 49 pass/fail tests that best discriminate two clinical subgroups based on a sample (Nxa0=xa063) of 5–15 years old children having IQ in the expected range (40% mix dyspraxia). Model calibration was done on a training sample through nested repeated 5-fold cross-validation while predictive performance were assessed on a held-out validation sample, using a split ratio of 0.7/0.3. Results We found that digital praxia, imitation of gestures, manual dexterity, digital perception, lego blocks, and visual motor integration were among the top most important impairments when predicting subtypes. Specific interactions among those predictors and other impairments (motor pathway, visual evoked potential, language) were shown to provide additional insights into DCD subtyping. Conclusions Taylored follow-up of patients presenting with DCD should consider the specificity of visuo-spatial, neuromotor and neuropsychological impairments whose co-occurrence allow to define different subtypes of DCD.