Michael Davidovitch

Developmental Regression in Autism: Maternal Perception.

Developmental regression among children with autism is a common phenomenon of unknown origin. The purpose of this study was to identify the differences between children with autism who reportedly regressed with those who did not regress. A representative group of 39 mothers were interviewed (40 children—1 pair of twin girls) about familial, pregnancy, perinatal, as well as medical history and developmental milestones. The study focused on mothers perceptions of developmental regression. Nineteen children (47.5 %) regressed in verbal and non-verbal communication and social but not in motor abilities. Mean age of regression was 24 months, with 11 children who regressed before and 8 after this age. No significant differences were reported by mothers of children who did or did not regress. More mothers of children who regressed, than those of children who did not, expressed guilt feelings regarding the development of autism, and almost all of them had an “explanation” for the possible mechanisms that might have influenced their childrens developmental course. In conclusion, developmental regression in our population appears to be a typical event in the natural course of autism. There is little difference between those children who regressed and those who did not regress in maternal perceptions and reports of development, family, and medical history.

Prevalence and incidence of autism spectrum disorder in an Israeli population

The prevalence of autism spectrum disorders has been steadily rising. In most parts of the world, rates as high as 1xa0% are reported, including in the United States. In Israel, previously reported prevalence rates have been in the 0.2xa0% range, and were based on parental reporting of diagnosis. In this study, records from one of the largest Israeli Health Maintenance organizations were used to calculate both incidence and prevalence of autism spectrum disorder (ASD) in Israel. Israeli prevalence of ASD was calculated at 0.48xa0% for 1–12xa0years olds and 0.65xa0% for 8xa0year old children in 2010, higher than previous Israeli reports, but still lower than prevalence estimates for the US. Incidence calculations ranged from 0.65 to 0.84 per 1,000 children for children 1–12xa0year olds. Reasons for these differences are suggested and discussed.

The Relationship Between Joint Hypermobility and Neurodevelopmental Attributes in Elementary School Children

Joint hypermobility is associated with motor developmental delay in infancy. To assess this finding in school-aged children, 320 first- and second-grade elementary school children and 110 children attending a special education program were assessed. Joint hypermobility was found in 40 (12.4%) and seven (6.4%) of the children attending the regular and special education classes, respectively. No difference in the neurologic status or verbal and eye-hand coordination task performance was found between the children of the study group and their age- and sex-matched controls. It appears that joint hypermobility and neurodevelopmental dysfunctions are not causally related and have a different maturational course. (J Child Neurol 1994;9:417-419).

Differences in Autism Spectrum Disorders Incidence by Sub-Populations in Israel 1992-2009: A Total Population Study.

We analyzed data from the Israeli National Insurance Institute (NII). Autism Spectrum Disorder (ASD) incidence was calculated for all children born in Israel 1992–2009, and by population groups. Overall, 9,109 ASD cases among 2,431,649 children were identified. ASD cumulative incidence by age 8 years increased 10-fold during 2000–2011, from 0.49xa0% to 0.49xa0%, while other child disabilities in NII increased only 1.65-fold. There was a consistent increase in ASD incidence with advancing birth cohorts born 1992–2004, stabilizing among those born 2005–2009. ASD rates among Israeli Arabs were substantially lower, and increased about 10xa0years later than the general population. The findings suggest a role for ASD awareness, accessing of the government benefit, or the way the concept of ASD is perceived.

Late diagnosis of autism spectrum disorder after initial negative assessment by a multidisciplinary team.

Objective: Describe a cohort of children who received a diagnosis of autism spectrum disorder (ASD) after age 6 and after having undergone a comprehensive multidisciplinary assessment before the age of 6, through which they were not diagnosed with ASD. Methods: Extensive chart review of patients electronic medical records comprised a representative population-based registry of patients seen during 2004 to 2011. The study focused only on the cohort of children who were diagnosed with ASD after the age of 6 but were not diagnosed with ASD at an earlier age. The charts were reviewed for the number of developmental assessments completed and the clinicians diagnostic impressions. The charts were also examined for documentation of ASD-suggestive features pulled directly from the text of the evaluators reports. Results: A total of 221 patients (189 males) were diagnosed with ASD after age 6 although their initial comprehensive developmental evaluations before the age of 6 were negative for ASD. The study cohort underwent a total of 1028 developmental evaluations before the age of 6, with initial diagnostic impressions that included language deficits (70%), motor difficulties (67%), attention problems (46%), and cognitive difficulties (42%). Less than half of the cohort had ASD-suggesting features documented in their initial assessment. Conclusions: Subsequent late diagnosis of ASD after an initial ASD-negative comprehensive assessment is a common clinical experience. Reasons for this scenario may include evolving diagnosis as well as missed and overdiagnosed cases of ASD.

Israeli children with autism spectrum disorder are not macrocephalic.

The prevalence of macrocephaly in autism spectrum disorder is reported to be much higher than in the general population, 12% to 37%. Progressive macrocephaly is even considered a warning sign for the development of autism. We evaluated the prevalence of an abnormal head circumference in children with autism in Israel and compared it with the head circumferences of children with developmental language disorder and children with normal development. We did not find a higher prevalence of macrocephaly among Israeli children with autism spectrum disorder (4.4%). Although children with autism spectrum disorder had a significantly higher rate of a head circumference above the 75th percentile compared with children with developmental language disorder, it was not significantly different compared with normal controls. We conclude that there is no increased prevalence of macrocephaly in Israeli children with autism; this can be attributed to a different genetic background.

Learning Disabilities With and Without Attention-Deficit Hyperactivity Disorder: Parents' and Teachers' Perspectives

Our objective was to delineate the educational and behavioral differences between learning disabled children with and without attention-deficit hyperactivity disorder (ADHD). A restrospective (TROHOC) multimeasure comparative design was employed. Parents and teachers questionnaires (ANSER system) pertaining to attention-activity, associated behaviors, and scholastic achievements were compared. Parents questionnaires failed to distinguish between the two groups. Teachers questionnaires were significantly more sensitive. Significant correlations between educational achievements and attention-activity and associated behaviors scores among children with learning disabilities were evident, no such correlations were found in the group with learning disability with ADHD. The factor analysis identified different educational and behavioral aggregates with language related difficulties and externalizing behaviors more typically aggregated in the learning disabled group with ADHD and recall deficit and internalizing/neurotic behaviors in the group with learning disability only. ADHD appears to be an associated comorbidity and not necessarily a specific learning deficit. However, children with learning disability with ADHD possibly have a different underlying neurocognitive pattern than their peers with learning disabilities only. (J Child Neurol 1998;13:270-276).

Does Physical Therapy Improve Outcome in Infants with Joint Hypermobility and Benign Hypotonia

This study examined the effect of the frequency of physical therapy on the outcome of infants referred for delayed motor development due to joint hypermobility and benign hypotonia. The study groups comprised 29 infants (8-12 months) who were randomly placed into a monthly and weekly treatment groups. No difference was found between the 2 study group scores on the different tests at all assessment points. However, assessment of walking at the age of 15 months revealed a clear advantage of the infants who were treated weekly. Our study demonstrated a minor benefit of weekly treatment protocol only in the achievement of independent walking in children with joint hypermobility and benign hypotonia. It did not prove an advantage of weekly physical therapy. It seems that monthly physical therapy combined with a home treatment protocol implemented by the primary caregivers is sufficient to achieve motor catch-up.

Behavioural Problems among Visually Impaired between 6 Months and 5 Years.

The prevalence and types of behavioural problems among legally blind children were assessed by employing a cohort study design in a well defined geographic area. One hundred and eighty two children between the ages of 6 months and 5 years were consecutively assessed over a period of 13 years. A standardized ophthalmological, neurodevelopmental and physical examination, a parental interview and video recording were employed. Diagnostic classification was based on the DSM-III-R criteria (American Psychiatric Association, 1987). Behavioural problems were documented in 49%. In 61% of these, three disorders were identified: (1) overanxious (n = 14), (2) oppositional with or without attention deficit hyperactivity (n = 15), and avoidant with or without stereotypy (n = 26). The first category is associated with partial sightedness and the third with neurodevelopmental deficits. The prevalence of behavioural problems among blind children is high and therefore a careful psychological monitoring and assistance should be offered to them and their parents.

Visuomotor tracking related to attention-deficit hyperactivity disorder (ADHD)

Deficient visuomotor tracking in children with attention-deficit hyperactivity disorder (ADHD) has been described, but the specific influence of attention on this deficit has not yet been elucidated. The present study compares visuomotor tracking under different conditions of attentional loading in children with ADHD with that of age-matched controls. A computerized visuomotor attentional tracking test that incorporated several levels of distraction was administered to 131 typical children. The same test, as well as a standard Matching Familiar Figures Test and the Proteus Maze test, was administered to 32 children with ADHD and 21 control children. Significant differences between children with ADHD and controls in visuomotor attentional tracking indices that relate to pacing and the accuracy of the tracking movements were observed under all levels of distraction. In parallel, a significant performance decrement was observed in all subjects once distraction was introduced. Discriminant analysis, based on the visuomotor attentional tracking test findings, resulted in correct classification of 92.3% of the typical children and 46% of the children with ADHD. Significant correlations between Matching Familiar Figures Test latency, as well as errors and visuomotor attentional tracking indices, were noted among children with ADHD when the visuomotor attentional tracking did not involve distraction. Under distraction, these correlations extended to the control group as well. In conclusion, visuomotor tracking appears to reflect the availability of attentional resources in general and is significantly affected by the presence of ADHD in particular. These results have potential implications related to the evaluation of children with ADHD on and off drugs. (J Child Neurol 2006;21:502—507; DOI 10.2310/7010.2006.00135