Rhea Paul

Social deficits in autism: an operational approach using the Vineland Adaptive Behavior Scales.

Abstract Although social factors are commonly viewed as an important defining characteristics of the autistic syndrome, earlier research studies have not systematically evaluated social dysfunction in autistic individuals. In this study, the Vineland Adaptive Behavior Scales were used to assess adaptive behavior in a group of autistic and a group of nonautistic, developmentally disabled, individuals. As compared to nonautistic subjects, the autistic group exhibited significantly greater deficits in adaptive social behaviors. The result suggests the utility of a well-standardized, normative assessment instrument for documenting autistic social dysfunction.

A prospective study of toddlers with ASD: short‐term diagnostic and cognitive outcomes

BACKGROUND Despite recent increases in the number of toddlers referred for a differential diagnosis of autism spectrum disorders (ASD), knowledge of short-term stability of the early diagnosis as well as cognitive outcomes in this cohort is still limited. METHOD Cognitive, social, and communication skills of 89 clinic-referred toddlers were assessed at the average age of 21.5 (SD = 4.9) months, and reassessed at 46.9 (SD = 7.7) months. Groups with stable and unstable diagnostic presentation were identified and compared on their profile of cognitive and social-communicative skills obtained at the time of initial diagnosis. RESULTS Stability of the ASD diagnosis was 100%; diagnosis of autism was stable in 74% of cases as compared to 83% and 81% in PDD-NOS and Non-ASD groups, respectively. Worsening of social disability symptoms resulting in autism diagnosis was noted in 17% of toddlers initially diagnosed with PDD-NOS and in 19% of toddlers with initial diagnosis of non-ASD disorder. However, marked improvement was noted in approximately 1/4 of children initially presenting with autism, warranting diagnostic reassignment to PDD-NOS at follow-up. An analysis of developmental skills profiles suggests particular relevance of the assessment of verbal and nonverbal communication skills to diagnostic differentiation between subtypes within ASD in the second year of life. CONCLUSIONS Stability of ASD diagnosis in toddlers is high, though marked changes in severity of symptoms is to be expected in a minority of cases. Simultaneous consideration of cognitive, social, and communication skills profiles enhances accuracy of diagnostic classification and prediction of outcome.

An Evaluation of DSM-III Criteria for Infantile Autism

DSM-III represents the most recent effort to provide diagnostic criteria for infantile autism. In this study the adequacy of DSM-III diagnostic criteria was assessed in a group of 50 individuals, all of whom had been diagnosed as autistic before age 5 and had been followed at our Center. A structured developmental history was completed by parents, and items relating to the childs early development and behavior before age 6 were abstracted and used to operationalize DSM-III criteria. Problems arose in the specificity and applicability of these criteria. While DSM-III represents an advance in the diagnosis of infantile autism, these problems limit its applicability to autistic children; operationally defined criteria for this disorder are needed. The question of possible continuities between infantile autism and other pervasive developmental disorders must be addressed.

Out of the mouths of babes: vocal production in infant siblings of children with ASD

BACKGROUND Younger siblings of children with autism spectrum disorders (ASD) are at higher risk for acquiring these disorders than the general population. Language development is usually delayed in children with ASD. The present study examines the development of pre-speech vocal behavior in infants at risk for ASD due to the presence of an older sibling with the disorder. METHODS Infants at high risk (HR) for ASD and those at low risk, without a diagnosed sibling (LR), were seen at 6, 9, and 12 months as part of a larger prospective study of risk for ASD in infant siblings. Standard clinical assessments were administered, and vocalization samples were collected during play with mother and a standard set of toys. Infant vocal behavior was recorded and analyzed for consonant inventory, presence of canonical syllables, and of non-speech vocalizations, in a cross-sectional design. Children were seen again at 24 months for provisional diagnosis. RESULTS Differences were seen between risk groups for certain vocal behaviors. Differences in vocal production in the first year of life were associated with outcomes in terms of autistic symptomotology in the second year. CONCLUSIONS Early vocal behavior is a sensitive indicator of heightened risk for autistic symptoms in infants with a family history of ASD.

Issues in the classification of pervasive and other developmental disorders: toward DSM-IV

Recent research has demonstrated the utility and limitations of the DSM-III diagnostic scheme for the pervasive developmental disorders. Changes in the axial placement of disorders and further elaboration of the multiaxial system would permit increased specificity of individual differences within diagnostic categories. Current research suggests that the specificity of diagnostic criteria could be improved substantially and that such criteria could be made truly operational. The elaboration of such a diagnostic scheme would benefit both research and clinical service.

Outcomes of severe disorders of language acquisition

Data on speech, language, performance IQ, school placement, and behavior are presented on 18 subjects diagnosed in childhood as “aphasic” and followed through adolescence. Results reveal that slow but steady growth in language is made, with expressive skills showing somewhat more rapid progress than comprehension. Performance IQ is highly correlated with language skills in later childhood and, along with receptive skill, is a good predictor of school placement. The diagnostic and prognostic implications of this information are discussed.

Adaptive behavior in autism and Pervasive Developmental Disorder-Not Otherwise Specified: microanalysis of scores on the Vineland Adaptive Behavior Scales.

The purpose of this study is to provide a microanalysis of differences in adaptive functioning seen between well-matched groups of school-aged children with autism and those diagnosed as having Pervasive Developmental Disorder-Not Otherwise Specified, all of whom functioned in the mild to moderate range of intellectual impairment. Findings indicate that the major area of difference between children with autism and those with Pervasive Developmental Disorder-Not Otherwise Specified, was expressive communication; specifically, the use of elaborations in syntax and morphology and in pragmatic use of language to convey and to seek information in discourse. Linear discriminant function analysis revealed that scores on just three of these expressive communication item sets correctly identified subjects in the two diagnostic categories with 80% overall accuracy. Implications of these findings for both diagnosis and intervention with children with Autism Spectrum Disorders will be discussed.

A Longitudinal Study of Patients with Severe Developmental Disorders of Language Learning

Longitudinal data on 28 children diagnosed during the past decade as aphasic are reported. These subjects have been involved in a series of studies on the biological, psychological, social, and linguistic correlates of neuropsychiatric disorders of childhood. Results reveal that half this group of children with severe language deficits evidence some features similar to autism. Progress in language and behavioral areas is generally modest at best, although a few subjects make great gains. Children with and without autistic characteristics who have some strengths in the comprehension of language tend to make gains in social engagement, even if social skills were very poor to begin with. The implications of these; findings for research into the natural history of developmental language disorders are discussed.

Language Outcomes of Toddlers With Autism Spectrum Disorders: A Two Year Follow-Up

Thirty‐seven children 15–25 months of age received clinical diagnoses of autism spectrum disorder (ASD) and were re‐evaluated two years later. All subjects were judged to have retained a diagnosis of ASD at the follow‐up evaluation. Communication scores for the group as a whole during the first visit were significantly lower than nonverbal IQ. However, by the second visit, verbal and nonverbal scores were no longer significantly different. The group was divided into two subgroups, based on expressive language (EL) outcome at the second visit. The two groups were similar in the second year of life in terms of expressive communication skills and autistic symptoms, except for a trend toward more stereotypic and repetitive behavior in the worse outcome group. By the second visit, however, the groups differed significantly on all standard measures of expression and reception, as well as on autistic symptomotology and nonverbal IQ. When assessed during their second year, children who ended up in the better outcome group showed higher average nonverbal cognitive level, receptive language (RL) scores, number of sounds and words produced, use of symbolic play schemes, and response to joint attention bids. Regression analysis revealed that the variables for which significant differences between the two outcome groups in their second year of life were found provided significant prediction of EL outcome at age four. Stepwise regression identified RL and presence of stereotypic and repetitive at the first visit as significantly associated with EL outcome. Implications of these findings for early identification and intervention are discussed.

Promoting social communication in high functioning individuals with autistic spectrum disorders

This article reviews a range of social communication interventions that have been developed for students with autism at the preschool, school age, and adolescent level. Adult-mediated and peer-mediated methods that use highly structured, child-centered, and hybrid methods are examined. Programs that provide information on generalization and maintenance are identified. A set of recommendations for programs that would seem to be most appropriate for students with Asperger syndrome is presented.