Bryna Siegel

Home-based behavioral treatment of young children with autism

This study evaluated the impact of intensive behavioral treatment on the development of young autistic children. The treatment reported in this study was home based and was implemented by parents of autistic children with the assistance of community-based clinicians. Although treatment was unable to be observed directly, parents reported that therapy was based on methods developed by Lovaas et al. (1981). Treatment differed from that described in previous reports of intensive behavior therapy for this population in that it was implemented outside an academic setting and for a shorter period. In addition, children received fewer hours per week of therapy than in previous reports. Children in the experimental treatment group were pairwise matched to children in a control group (who received conventional school-based and brief one-on-one interventions) on the basis of pretreatment chronological and mental age, diagnosis (autism vs. PDD), and length of treatment. The groups did not differ on pretreatment IQ. Children receiving the experimental treatment had significantly higher posttreatment IQ scores. Smaller, but still statistically significant effects on symptom severity were also found, though experimental subjects still met diagnostic criteria for autism or PDD.

How Children with Autism are Diagnosed: Difficulties in Identification of Children with Multiple Developmental Delays

We obtained chart reviews and parent surveys for 75 autistic children to understand better how they, and other children with uneven or unusual behavioral development, are identified and diagnosed. Our goal was to determine when parents became concerned about developmental delay, what concerns they expressed, to whom they expressed them, when evaluations were made, what kinds of evaluations were carried out, and which diagnostic models were most effective. We found that, most often, parents expressed their initial concerns to pediatricians, noting both language and social delays by the time their child was 1 1/2 years old; they began diagnostic evaluations when their child was around 2 1/2 years old, and received diagnoses of autism at around 4 1/2 years. These results are discussed in terms of the role of the childs primary care physician in improving early identification, and placement into early intervention programs. The relationship between problems in the diagnosis of autism and other developmental disabilities is considered. J Dev Behav Pediatr 9:199–204, 1988. Index terms: autism, developmental screening, developmental disabilities.

Empirically derived subclassification of the autistic syndrome

A method is presented for empirical subclassification of autistic and autisticlike children, based on observations of current behavior. The advantage of the method is that it identifies profiles of cooccurring behaviors and accordingly assigns children to subtypes. The subtypes are more clinically homogeneous than the overall sample of autistic children. Preliminary findings are presented, including an effort to validate the subclasses by suggesting possible relationships between subtype membership and perinatal markers, developmental milestones, and independent measures of concurrent behavior.

Cortical auditory system maturational abnormalities in children with autism disorder: an MEG investigation

UNLABELLED Latency of electric (e.g., P1 and N1) and magnetic (e.g., M100) auditory evoked components depends on age in typically developing children, with longer latencies for younger (4-6 years) and shorter, adult-like latencies for older (14-16 years) children. Age-related changes in evoked components provide indirect measures of auditory system maturation and reflect changes that occur during development. We use magnetoencephalography (MEG) to investigate maturational changes in cortical auditory systems in left (LH) and right (RH) hemispheres in children with autism disorder (AD) and CONTROLS. We recorded auditory evoked responses over left and right temporal lobes in 17 Control and 15 AD children in the age range 8-16 years and measured M100 latency as a function of age, subject group and hemisphere. Linear regression analyses of age and M100 latency provided an estimate of the rate of latency change (ms/year) by hemisphere and subject group. CONTROLS M100 latency for the group ranged from 100.8 to 166.1 ms and varied linearly in both hemispheres, decreasing at a rate of -4 ms/year (LH) and -4.5 ms/year (RH). AD: M100 latency ranged from 116.2 to 186.2 ms. Slopes of regression lines did not differ from zero in either LH or RH. M100 latency showed a tendency to vary with age in LH, decreasing at a rate of -4.6 ms/year. M100 latency in RH increased slightly (at a rate of 0.8 ms/year) with age. Results provide evidence for a differential auditory system development in AD children which may reflect abnormalities in cortical maturational processes in AD.

The DSM-III-R Field Trial of Pervasive Developmental Disorders

This article describes the method and results of a national field trial of the proposed criteria for the DSM-III-R diagnosis of autistic disorder at 11 sites which have experience in diagnosing pervasive developmental disorders. Using the diagnosis of autistic disorder made by expert clinicians as a standard, the diagnostic criteria that were finally included in DSM-III-R demonstrated high sensitivity and specificity across different age groups and in children with and without language.

The Use of Signal Detection Theory to Assess DSM-III-R Criteria for Autistic Disorder

Sixty cases from the DSM-III-R field trials for autistic disorder (AD) were studied to derive an optimally sensitive and specific combination of scoring criteria based on the 16 DSM-III-R criteria for AD. Signal detection theory, a statistical method new to psychiatric research, was applied. Two of the sixteen criteria tested with this methodology yielded a sensitivity of 0.82, a specificity of 0.89, and a total predictive value of 0.91 relative to clinical diagnosis. Excluded criteria were redundant; unrelated to diagnosis; or highly correlated with degree of mental retardation, mental age, and/or chronological age.

Pervasive Developmental Disorders: From DSM-III to DSM-III-R.

The present paper provides a brief history of the development of the DSM-II-R (American Psychiatric Association [APA], 1987) section on Pervasive Developmental Disorders. It describes the process by which the contents of the text and criteria for Autistic Disorder and Pervasive Developmental Disorder Not Otherwise Specified were decided and gives the reasons for the changes from DSM-III (APA, 1980) categories and criteria. The paper concludes with a short discussion of critical diagnostic issues.

USING SIGNAL DETECTION METHODOLOGY TO REVISE DSM-III-R : RE-ANALYSIS OF THE DSM-III-R NATIONAL FIELD TRIALS FOR AUTISTIC DISORDER

Signal detection theory which takes into account the relative prevalence, sensitivity, and specificity of each of a set of criterion symptoms is used to determine an algorithm optimally predictive of a clinical diagnoses of autistic disorder using the data from the DSM-III-R national field trials. Findings support inclusion of one diagnostic criterion (marked lack of awareness of others) as mandatory, and four more (impaired imitation, abnormal social play, abnormal nonverbal communication, and abnormal speech) as alternate, associated criteria. Advantages of signal detection over other statistical methods for empirically deriving diagnostic standards are given, and implications for DSM-IV are discussed.

Pervasive Developmental Disorder in Monozygotic Twins

Monozygotic twin brothers were diagnosed as having pervasive developmental disorder, not otherwise specified (DSM-III-R). They show different levels of cognitive and behavioral impairment, consistent with a greater number of suboptimal pre-, peri-, and postnatal factors present in one of the twins. This case study lends support to the hypothesis that genetic factors are of importance in the expression of a pervasive developmental disorder, but that degree of developmental delay, its severity, and certain clinical features may be determined by nongenetic suboptimal pre-, peri-, and postnatal events.

Acceptance or Despair? Maternal Adjustment to Having a Child Diagnosed with Autism

Psychological adjustment to having one’s child diagnosed with an autism spectrum disorder has important implications for a parent’s mental health. In a longitudinal study, we examined the association between maternal adjustment to the diagnosis and measures of distress and well-being in 90 mothers of children with autism (baseline and 18 months). We used a novel 30-item scale “Adjustment to the Diagnosis of Autism.” Factor analysis identified three dimensions of adjustment: acceptance, self-blame, and despair. Acceptance appeared to be a protective response, as it was associated with lower depressive symptoms, cross-sectionally and over time. Conversely, caregivers with increasing levels of self-blame and despair about the diagnosis over 18 months had worsening of mental health and satisfaction with life during this period.