Michael Rutter

Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders

Describes the Autism Diagnostic Interview-Revised (ADI-R), a revision of the Autism Diagnostic Interview, a semistructured, investigator-based interview for caregivers of children and adults for whom autism or pervasive developmental disorders is a possible diagnosis. The revised interview has been reorganized, shortened, modified to be appropriate for children with mental ages from about 18 months into adulthood and linked to ICD-10 and DSM-IV criteria. Psychometric data are presented for a sample of preschool children.

The Autism Diagnostic Observation Schedule-Generic: A Standard Measure of Social and Communication Deficits Associated with the Spectrum of Autism

The Autism Diagnostic Observation Schedule—Generic (ADOS-G) is a semistructured, standardized assessment of social interaction, communication, play, and imaginative use of materials for individuals suspected of having autism spectrum disorders. The observational schedule consists of four 30-minute modules, each designed to be administered to different individuals according to their level of expressive language. Psychometric data are presented for 223 children and adults with Autistic Disorder (autism), Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) or nonspectrum diagnoses. Within each module, diagnostic groups were equivalent on expressive language level. Results indicate substantial interrater and test—retest reliability for individual items, excellent interrater reliability within domains and excellent internal consistency. Comparisons of means indicated consistent differentiation of autism and PDDNOS from nonspectrum individuals, with some, but less consistent, differentiation of autism from PDDNOS. A priori operationalization of DSM-IV/ICD-10 criteria, factor analyses, and ROC curves were used to generate diagnostic algorithms with thresholds set for autism and broader autism spectrum/PDD. Algorithm sensitivities and specificities for autism and PDDNOS relative to nonspectrum disorders were excellent, with moderate differentiation of autism from PDDNOS.

Psychosocial resilience and protective mechanisms

The concept of mechanisms that protect people against the psychological risks associated with adversity is discussed in relation to four main processes: reduction of risk impact, reduction of negative chain reactions, establishment and maintenance of self-esteem and self-efficacy, and opening up of opportunities. The mechanisms operating at key turning points in peoples lives must be given special attention.

Autism as a strongly genetic disorder : evidence from a British twin study

Two previous epidemiological studies of autistic twins suggested that autism was predominantly genetically determined, although the findings with regard to a broader phenotype of cognitive, and possibly social, abnormalities were contradictory. Obstetric and perinatal hazards were also invoked as environmentally determined aetiological factors. The first British twin sample has been re-examined and a second total population sample of autistic twins recruited. In the combined sample 60% of monozygotic (MZ) pairs were concordant for autism versus no dizygotic (DZ) pairs; 92% of MZ pairs were concordant for a broader spectrum of related cognitive or social abnormalities versus 10% of DZ pairs. The findings indicate that autism is under a high degree of genetic control and suggest the involvement of multiple genetic loci. Obstetric hazards usually appear to be consequences of genetically influenced abnormal development, rather than independent aetiological factors. Few new cases had possible medical aetiologies, refuting claims that recognized disorders are common aetiological influences.

Autism Diagnostic Observation Schedule: A standardized observation of communicative and social behavior.

The Autism Diagnostic Observation Schedule (ADOS), a standardized protocol for observation of social and communicative behavior associated with autism, is described. The instrument consists of a series of structured and semistructured presses for interaction, accompanied by coding, of specific target behaviors associated with particular tasks and by general ratings of the quality of behaviors. Interrater reliability for five raters exceeded weighted kappas of .55 for each item and each pair of raters for matched samples of 15 to 40 autistic and nonautistic, mildly mentally handicapped children (M IQ=59) between the ages of 6 and 18 years. Test-retest reliability was adequate. Further analyses compared these groups to two additional samples of autistic and nonautistic subjects with normal intelligence (M IQ=95), matched for sex and chronological age. Analyses yielded clear diagnostic differences in general ratings of social behavior, specific aspects of communication, and restricted or stereotypic behaviors and interests. Clinical guidelines for the diagnosis of autism in the draft version of ICD-10 were operationalized in terms of abnormalities on specific ADOS items. An algorithm based on these items was shown to have high reliability and discriminant validity.

Implications of resilience concepts for scientific understanding.

Abstract:  Resilience is an interactive concept that refers to a relative resistance to environmental risk experiences, or the overcoming of stress or adversity. As such, it differs from both social competence positive mental health. Resilience differs from traditional concepts of risk and protection in its focus on individual variations in response to comparable experiences. Accordingly, the research focus needs to be on those individual differences and the causal processes that they reflect, rather than on resilience as a general quality. Because resilience in relation to childhood adversities may stem from positive adult experiences, a life‐span trajectory approach is needed. Also, because of the crucial importance of gene–environment interactions in relation to resilience, a wide range of research strategies spanning psychosocial and biological methods is needed. Five main implications stem from the research to date: (1) resistance to hazards may derive from controlled exposure to risk (rather than its avoidance); (2) resistance may derive from traits or circumstances that are without major effects in the absence of the relevant environmental hazards; (3) resistance may derive from physiological or psychological coping processes rather than external risk or protective factors; (4) delayed recovery may derive from “turning point” experiences in adult life; and (5) resilience may be constrained by biological programming or damaging effects of stress/adversity on neural structures.

Developmental psychopathology: concepts and challenges.

The defining features of developmental psychopathology concepts include attention to the understanding of causal processes, appreciation of the role of developmental mechanisms, and consideration of continuities and discontinuities between normality and psychopathology. Accomplishments with respect to these issues are reviewed in relation to attachment disorders, antisocial behavior, autism, depressive disorder, schizophrenia, and intellectual development. Major research challenges remain in relation to measurement issues, comorbidity, gender differences, cognitive processing, nature-nurture interplay, heterotypic continuity, continuities between normal variations and disorders, developmental programming, and therapeutic mechanisms in effective treatments.

Resilience concepts and findings: implications for family therapy

Resilience is a term used to describe relative resistance to psychosocial risk experiences. There is abundant evidence that there is enormous variation in childrens responses to such experiences but research to determine the processes underlying the variations needs to take account of several crucial methodological issues. The findings emphasize that multiple risk and protective factors are involved; that children vary in their vulnerability to psychosocial stress and adversity as a result of both genetic and environmental influences; that family-wide experiences tend to impinge on individual children in quite different ways; that the reduction of negative, and increase of positive, chain reactions influences the extent to which the effects of adversity persist over time; that new experiences which open up opportunities can provide beneficial ‘turning- point’ effects; that although positive experiences in themselves do not exert much of a protective effect, they can be helpful if they serve to neutralize some risk factors; and that the cognitive and affective processing of experiences is likely to influence whether or not resilience develops. The implications of these findings for family therapy are considered in terms of the need for therapists to look carefully at the ways in which different risk factors interact; to assess and take account of individual differences in susceptibility; to consider the extent to which risk factors impinge on the individual and, in that connection, to note the importance of patterns of social interaction outside as well as inside the family; to appreciate the role of both the peer group and individual characteristics in the development of negative and positive chain reactions; and to pay attention to the ways in which individuals process their experiences.

Developmental Catch‐up, and Deficit, Following Adoption after Severe Global Early Privation

The extent of developmental deficit and catch-up following adoption after severe global early privation was examined at 4 years in a sample of 111 Romanian children who came to the U.K. before the age of 2 years, and compared with respect to their functioning at the same age to a sample of 52 U.K. adopted children placed before the age of 6 months. The measures at 4 years included height, head circumference, and general cognitive level (assessed on both the McCarthy and Denver Scales). The children from Romania were severely developmentally impaired at the time of U.K. entry, with about half below the third percentile on height, on weight, on head circumference, and on developmental quotient. Many were also in a poor physical state with recurrent intestinal and respiratory infections. The catch-up in both physical growth and cognitive level appeared nearly complete at 4 years for those children who came to the U.K. before the age of 6 months, despite the fact that their background prior to U.K. entry was similar to the children who came to the U.K. when older. The developmental catch-up was also impressive, but not complete, in those placed after 6 months of age. The mean McCarthy General Cognitive Index was 92 compared with 109 for the within-U.K. adoptees. The strongest predictor of level of cognitive functioning at 4 years was the childrens age at entry to the U.K. It was concluded that the remaining cognitive deficit was likely to be a consequence of gross early privation, with psychological privation probably more important than nutritional privation. A further follow-up at age 6 years will determine whether there is continuing recovery after 4 years.

Isle of Wight Studies, 1964–1974

The Isle of Wight Studies began in 1964–65 with a series of epidemiological studies of educational, psychiatric and physical disorders in 9- to 11-year-old children. These early studies were financed by the Department of Education and Science and the Foundation for Child Development (then the Association for the Aid of Crippled Children). The findings were fully reported in two books (Rutter, Tizard & Whitmore, 1970; Rutter, Graham & Yule, 1970) and only brief details are included here.