Ina van Berckelaer-Onnes

Can the Children's Communication Checklist differentiate between children with autism, children with ADHD, and normal controls?

BACKGROUND The Childrens Communication Checklist (CCC; Bishop, 1998) is a questionnaire that was developed to measure pragmatic language use and may be completed by parents and teachers. Two studies are reported, which were designed to investigate: (1) whether children with Attention Deficit Hyperactivity Disorder (ADHD) encounter pragmatic language problems in comparison with normal controls (NC), (2) whether children with ADHD and children with High Functioning Autism (HFA) can be differentiated using the CCC, (3) the usefulness of the CCC for parents and teachers in a clinical and in a research setting, and (4) the role of age in pragmatic language use in ADHD and HFA. METHOD In the first study (clinical sample) 50 children with ADHD, 50 children with HFA, and 50 NC were compared to each other using the CCC. In the second study (research sample) CCC data was gathered on 23 children with ADHD (without co-morbid disorders), 42 children with HFA, and 35 NC. RESULTS Compared to NC, children with HFA showed pragmatic deficits on all CCC scales. Children with ADHD demonstrated deficits compared to NC as well. Moreover, the ADHD and HFA groups differed from each other on most of the scales. Discriminant analyses showed that CCC scales were relevant for case identification in these samples. Furthermore, profiles of impairment seen in children with HFA and ADHD did not vary with age. CONCLUSION Pragmatic difficulties do occur in both HFA and ADHD. The present studies indicate that the CCC is a useful instrument to obtain information concerning pragmatic language use in both a clinical and a research setting. Although the information of parents is more tightly linked to the diagnosis, combining the information of both parent and teacher slightly improves case identification.

Theory of Mind in Adults with HFA and Asperger Syndrome

Theory of mind was assessed in 32 adults with HFA, 29 adults with Asperger syndrome and 32 neurotypical adults. The HFA and Asperger syndrome groups were impaired in performance of the Strange stories test and the Faux-pas test and reported more theory of mind problems than the neurotypical adults. The three groups did not differ in performance of the Eyes test. Furthermore, correlations between the Eyes test and the three other theory of mind tests were low or absent. Therefore one can question the ability of the Eyes test to measure theory of mind. Of all theory of mind tests used, the self-report questionnaire had the largest discriminating power in differentiating the two disorder groups from the neurotypical group.

Brief Report: The Use of WAIS-III in Adults with HFA and Asperger Syndrome

The WAIS III was administered to 16 adults with high functioning autism (HFA) and 27 adults with Asperger syndrome. Differences between Verbal Intelligence (VIQ) and Performance Intelligence (PIQ) were not found. Processing Speed problems in people with HFA appeared. At the subtest level, the Asperger syndrome group performed weak on Digit Span. Comprehension and Block Design were relative strengths. In the HFA group, performance on Digit-Symbol Coding and Symbol Search was relatively poor. Strengths were found on Information and Matrix Reasoning. The results suggest that the VIQ-PIQ difference cannot distinguish between HFA and Asperger syndrome. WAIS III Factor Scale and Subtest patterning provides a more valid indicator.

Making Sense in a Fragmentary World Communication in People with Autism and Learning Disability

The communicative capabilities of people with autism are impaired and limited in significant ways. The problems are characterized by a lack of intentionality and symbol formation, which indicates that the deviant development of communication in autism is associated with a specific cognitive style. The central coherence theory can offer insight into the specific communication problems of people with autism, since a weaker drive for central coherence leads to problems in sense-making and, consequently, in communication. In the case of the comorbidity of autism and learning disability, the communication problems are aggravated. The crucial point is the determination of the level of sense-making, taking this comorbidity into account. Assessment and intervention have to be tuned to individual needs, in order to increase the communicative competence of people with autism and learning disability.

Patterns of intellectual, adaptive and behavioral functioning in individuals with mild mental retardation

Many researchers have studied the population of individuals with mild mental retardation (MIMR) as if it is a clear entity. Few researchers have investigated potential subtypes within the MIMR population. The purpose of the present study was to investigate which subtypes can be identified on the basis of intellectual, adaptive and behavioral functioning. Seventy-three individuals with MIMR were assessed on measures of intellectual, adaptive and behavioral functioning. An agglomerative hierarchical cluster-analytic technique was used to define potential subgroups with characteristic behavioral patterns. Four subtypes were identified. The behavioral patterns are described and implications for assessment are discussed.

Diagnosing Autism Spectrum Disorder: who will get a DSM‐5 diagnosis?

Background Introduction of proposed criteria for DSM-5 Autism Spectrum Disorder (ASD) has raised concerns that some individuals currently meeting diagnostic criteria for Pervasive Developmental Disorder (PDD; DSM-IV-TR/ICD-10) will not qualify for a diagnosis under the proposed changes. To date, reports of sensitivity and specificity of the new criteria have been inconsistent across studies. No study has yet considered how changes at the ‘sub domain’ level might affect overall sensitivity and specificity, and few have included individuals of different ages and ability levels. Methods A set of DSM-5 ASD algorithms were developed using items from the Diagnostic Interview for Social and Communication Disorders (DISCO). The number of items required for each DSM-5 subdomain was defined either according to criteria specified by DSM-5 (Initial Algorithm), a statistical approach (Youden J Algorithm), or to minimise the number of false positives while maximising sensitivity (Modified Algorithm). The algorithms were designed, tested and compared in two independent samples (Sample 1, N = 82; Sample 2, N = 115), while sensitivity was assessed across age and ability levels in an additional dataset of individuals with an ICD-10 PDD diagnosis (Sample 3, N = 190). Results Sensitivity was highest in the Initial Algorithm, which had the poorest specificity. Although Youden J had excellent specificity, sensitivity was significantly lower than in the Modified Algorithm, which had both good sensitivity and specificity. Relaxing the domain A rules improved sensitivity of the Youden J Algorithm, but it remained less sensitive than the Modified Algorithm. Moreover, this was the only algorithm with variable sensitivity across age. All versions of the algorithm performed well across ability level. Conclusions This study demonstrates that good levels of both sensitivity and specificity can be achieved for a diagnostic algorithm adhering to the DSM-5 criteria that is suitable across age and ability level.

Vineland Screener 0–12 years research version (NL). Constructing a screening instrument to assess adaptive behaviour

In Western countries the need to assess the adaptive behaviour of a wide range of individuals within the framework of research and policy‐making has increased in recent years. To meet this need a screener version of the Vineland Adaptive Behaviour Scales (VABS) was developed in the Netherlands. This screener is a questionnaire to be filled out by primary care‐givers. Using a limited number of items the instrument covers the four domains of adaptive behaviour portrayed in the original Expanded Version of the VABS.

Intentional communication in nonverbal and verbal low-functioning children with autism.

UNLABELLED In this study we characterized profiles of communicative functions and forms of children with autism and intellectual disability (n=26), as compared to typically developing children (n=26) with a comparable nonverbal mental age (2-5 years). Videotapes of the Communication and Symbolic Behavior Scales - Developmental Profile were analyzed using a standardized observation scheme in which three main functions were distinguished: behavior regulation, social interaction, and joint attention. Different forms of communication were also investigated: gestures, vocalizations/verbalizations, and eye gaze. Results indicated that in typically developing children the proportion of communication for the purpose of joint attention was much higher than for behavior regulation, whereas in children with autism the opposite pattern was seen. Low-functioning nonverbal children with autism mainly communicated for behavior regulation and not or only rarely for declarative purposes. Generally, this subgroup used the least complex forms to communicate. Low-functioning verbal children with autism differed from typically developing children only in the rate, not in the proportion of communication for specific functions. Combinations of three different communicative forms were used by verbal children with autism less frequently than by typically developing children. LEARNING OUTCOMES After reading this paper, readers should be able to: (1) describe early development of communicative functions, (2) explain differences in communication profiles with respect to form and function between verbal and nonverbal low-functioning children with autism and typically developing children matched on nonverbal mental age and (3) discuss clinical implications of the findings for communication interventions in verbal and nonverbal low-functioning children with autism.

Brief Report: Six Months Continuation Treatment in Naltrexone-Responsive Children with Autism: An Open-Label Case-Control Design

There is controversy about the status of naltrexone, an orally active opioid antagonist, in the treatment of autism. It has been posited that excessive activity of opioid systems in the brain is basic to autism and that opioid antagonists would be of therapeutic value (Panksepp, 1979). Double-blind placebo-controlled studies with naltrexone in children (Campbell et al., 1993; Kolmen, Feldman, Handen & Janosky, 1995, 1997; WillemsenSwinkels, Buitelaar, & Van Engeland, 1996; WillemsenSwinkels, Buitelaar, Weijnen, & Van Engeland, 1995) and adults (Willemsen-Swinkels, Buitelaar, Nijhof, & Van Engeland, 1995) with developmental disorders failed to find significant effects on social and communicative behavior. A remarkably consistent finding across all studies on children with autism was that treatment with naltrexone resulted in a modest reduction of hyperactivity. Since many subjects with autism present with concomitant symptoms of motor restlessness, it was recommended to offer these subjects a trial with naltrexone, and particularly those who failed to respond to treatment with neuroleptic agents (Campbell & Harris, 1996). We report here on a 6-month continuation treatment with naltrexone of six children who had shown to be responsive to naltrexone in a 4-week trial. The aim is to examine effectiveness and safety of naltrexone over a long period.

Autistic disorder symptoms in Rett syndrome

According to the major classification systems it is not possible to diagnose a comorbid autistic disorder in persons with Rett syndrome. However, this is a controversial issue, and given the level of functioning of persons with Rett syndrome, the autistic disorder is expected to be present in a comparable proportion as in people with the same level of functioning. To investigate, parents of 52 females with classical and atypical Rett syndrome (2.4—49.3 years) completed the Developmental Behavior Checklist (DBC), the Diagnostic Interview for Social and Communication Disorders (DISCO) and the Dutch Vineland Screener 0—6 (VS 0—6). All participants had a severe to profound intellectual disability (ID) according to the VS 0—6. Behavior indicated an autistic disorder in 42 (DBC) to 58 percent (DISCO) of the Rett cases. Autistic behavior had decreased in 19 percent such that they no longer met the criteria for autistic disorder. Some participants were suspected of having a comorbid autistic disorder, though not more often than can be expected at their level of functioning. Clinicians should be aware of the possibility of a comorbid autistic disorder as much as they should be in other people with this level of functioning.