René Pry

Outcome of young children with autism Does the amount of intervention influence developmental trajectories

The study aims were to identify developmental trajectories of young children with autism and investigate their prognostic factors. The participants were 208 children, assessed first at the age of 5 years, followed longitudinally, and reassessed 3 years later. The children’s clinical characteristics and the interventions received were recorded. The results indicated two distinct outcome groups with more stability than change. When changes did occur, they pertained to symptom severity (which decreased) and speech level and adaptive behavior (which improved). A logistic regression analysis pointed out two main risk factors (symptom severity and speech level) and two main protection factors (communication skills and person-related cognition). Surprisingly, the amount of intervention (in terms of number of hours) was not related to outcome.

Joint Attention and Set-Shifting in Young Children with Autism:

Executive function deficits in autism have been consistently found in many studies, using a wide range of measures, but usually involving older children and adults and those of higher IQ. The interpretation of executive function deficits is difficult because the concept itself is poorly defined (inhibition of prepotent responses, set-shifting, action planning etc.). Analyses have focused mainly on the atten-tion participants pay to physical entities (object handling and problem solving) rather than social ones. The present study investigated whether attehfting these two types of attention are linked in autistic development. Fifteen children with autism (mean mental age = 24 months) were compared to 21 normally developing children (mean mental age = 25 months). A strong correlation was found between joint attention and set-shifting in the typically developing children but not those with autism. The results are discussed from a psychopathological perspective on development.

Attentional flexibility and perseveration: developmental aspects in young children.

Whereas a growing interest in the development of attentional flexibility (AF) and in perseverative behavior, being one marker of this component, exists in neuropsychological studies and in the domain of developmental psychopathology (e.g., PKU, infantile schizophrenia, autism and Parkinsons disease) (Pennington & Ozonoff, 1996; Stahl & Pry, 2002), only a few studies have concerned themselves with this subject in normal children. It is thus of interest to add more empirical data to the existing literature in this domain. Therefore, the aim of our study was to explore the development of AF and of perseverative errors in young preschool children with normal development, aged 1.5 to 6 years. Using set-shifting tasks of increasing difficulty level, three age groups were compared with respect to their AF skills.Results show a developmental factor underlying AF, with different levels of this form becoming more and more complex with age, ranging from a rudimentary visual form to a complex representational form of flexibility. Overall, few perseverative errors occurred and they decreased with age. Results are discussed from a developmental and neuropsychological perspective. This work was supported by a grant from the Fondation France Télécom. The study was made possible through the cooperation of the Service Médico-Psychologique pour Enfants et Adolescents, Peyre Plantade CHU Montpellier, France. We are grateful to Cécile Rattaz and Philip Worthington, who devoted a lot of their time and effort to this research.

Pain expression in children with an intellectual disability

Background: Children with an intellectual disability (ID) are sometimes unable to verbalize and describe their painful experience; therefore family members and health carers can assess the intensity of the pain only from the behaviour exhibited by the children.

Impact of autism in adolescents on parental quality of life

PurposeTo study the impact of autism spectrum disorders (ASDs) on parental quality of life (QoL) at adolescence using the parental–developmental disorders-quality of life scale (Par–DD-QoL).MethodsOne hundred and fifty-two mothers of adolescents with ASD completed Par–DD-QoL. This scale assesses the following dimensions: emotional, daily disturbance and global QoL. This cross-sectional study uses a subset of data collected at the final time of a follow-up study (EpiTED cohort).ResultsA polytomic regression identified an increase in aberrant behavior scores as the major independent risk factor for parental QoL. The identified protective factors were the increase in daily living, communication and object cognition scores and a higher number of siblings.ConclusionsThose results suggest that there is a negative effect of externalizing behaviors and a protective effect of adaptive skills, communication and object cognition on parental QoL. Study limitations and implications are discussed.

Autisme et Douleur – Analyse Bibliographique

The purpose of the present article was to assess the available literature concerning pain and autism. First, authors summarized the published articles on pain reactivity in people with autism. Second, the hypotheses envisaged to explain the presence of expressive particularities in people with autism spectrum disorders were reviewed; these included endogenous opioid excess theory, sensorial abnormalities and sociocommunicative deficit. Finally, the present review dealt with the tools available to assess and manage pain in people with autism. In conclusion, the authors revealed the need for more research to obtain more consensual data and provided some recommendations in this domain that were under exploited by the scientific community. From a clinical point of view, more knowledge about pain in people with autism should enable the development of specific assessment tools and, consequently, better pain management in daily care.

The relationship between expressive language level and psychological development in children with autism 5 years of age

The age of detection of autism varies and may be linked to differences in the severity of disturbance and any associated retardation. Symptom intensity, overall language level, age of recognition of first disturbances and level of psychological development were examined in 222 children with pervasive developmental disorder with a mean age of 5 years. Results showed a positive correlation between language level and psychological development as well as between language level and intensity of symptoms. The central position of language in psychological development is discussed.

Vocal and Verbal Expression of Postoperative Pain in Preschoolers

The purpose of this study was to examine the development and construction of vocal and verbal expression of postoperative pain in young children with limited linguistic abilities. The main objective was to highlight specific pain vocalizations, which may lead to easy and quick detection and assessment of postoperative pain relative to the age of the suffering child. Forty-seven children aged 1 to 6 years were observed during two periods of surgical hospitalization: a preoperative and a postoperative period. The results showed that there was a significant relation between their age and the types of vocalization they expressed during the postoperative period. Regarding the development in relation to certain contexts, a minor modification seems to be concerned not with the type but with the frequency of the items of vocalizations. The study confirms earlier observations and clinical experience that an efficient and reliable assessment of pain in infants and young children necessitates taking several factors into account, such as the developmental age of the children, and especially a consideration of the whole spectrum of pain markers present in the childs behavior and captured by the assessment tools.

Introduction : L'enfant autiste est aussi un enfant

L’autisme est estime comme le plus severe des troubles psychopathologiques du developpement de l’enfant. L’ensemble du developpement est affecte des la petite enfance, et la construction de reperes en fonction de l’experience en est profondement troublee. Il ne s’ensuit pas pour autant que son etude soit toujours menee dans une perspective developpementale. Constat bien banal, mais encore trop peu nourri de donnees de recherche. Pour preuve, les frequentes declarations comme “ l’enfant autiste a un deficit en ceci ” ou “ ne peut pas faire cela ”, sans plus d’information sur l’âge chronologique, l’âge de developpement, le sexe, l’environnement familial, etc., comme si l’autisme etait une entite fixee. Plus qu’une position, c’est un etat d’esprit, d’autant plus contestable que l’heterogeneite du syndrome est averee, et que beaucoup preferent desormais parler d’autismes au pluriel, ou de sous-groupes d’autisme, ou de spectre autistique ( “ autistic spectrum ” ), reconnaissant ainsi que des developpements differents peuvent etre attendus a partir de troubles de niveaux et d’etendue differents. En organisant un numero thematique cible sur le developpement dans les cas d’autisme, Enfance a l’ambition de mettre l’accent sur la necessite – dans la recherche et les pratiques –, de voir l’enfant au diagnostic d’autisme avant tout comme un enfant en developpement.