Sandra Fisman

Parenting stress, child behavior problems, and dysphoria in parents of children with autism, Down syndrome, behavior disorders, and normal development.

Abstract We assessed differences in parental reports of parenting stress, child behavior problems, and dysphoria in 150 families who had children with autism (n = 30), behavior disorders (n = 30), Down syndrome (n = 30), or normal development (n = 60). We measured stress with the Parenting Stress Index, child behavior problems with the Eyberg Child Behavior Inventory, and dysphoria with the Beck Depression Inventory. We controlled data for sociodemographic differences across groups, and results indicated the following: (1) Parents of children with autism and behavior disorders experienced statistically and clinically higher levels of parenting stress than parents in the other two groups. (2) Parents of children with behavior disorders reported that their children presented behavioral difficulties that were statistically and clinically more intense and numerous than those of all other children. (3) Mothers of children with autism and behavior disorders experienced statistically and clinically higher levels...

Effects of Risperidone on Conduct and Disruptive Behavior Disorders in Children With Subaverage IQs

OBJECTIVE To determine whether risperidone is effective in reducing symptoms of disruptive behaviors (such as aggression, impulsivity, defiance of authority figures, and property destruction) associated with conduct disorder, oppositional defiant disorder, and disruptive behavior disorder-not otherwise specified in children with subaverage IQs. METHOD The trial consisted of a 1-week, single-blind, placebo run-in period and was followed by a 6-week, double-blind, placebo-controlled period. One hundred ten children (aged 5-12 years inclusive) with an IQ of 36-84 with a disruptive behavior disorder and a score of at least 24 on the Conduct Problem subscale of the Nisonger Child Behavior Rating Form (NCBRF) were enrolled. Eighty percent of subjects had comorbid attention-deficit/hyperactivity disorder (ADHD). Risperidone doses ranged from 0.02 to 0.06 mg/kg per day. Subjects were rated on the NCBRF, Aberrant Behavior Checklist, Behavior Problems Inventory, Clinical Global Impressions (CGI), modified California Verbal Learning Test (CVLT), and a continuous performance task (CPT). RESULTS The intention-to-treat analysis of risperidone-treated subjects showed a significant (p < .001) reduction in mean scores (from 33.4 at baseline to 17.6 at end point; 47.3% reduction) versus placebo-treated subjects (mean baseline of 32.6 to 25.8 at end point; 20.9% reduction) on the Conduct Problem subscale of the NCBRF. Between-group differences in favor of risperidone were seen as early as week 1 and were significant at all post-baseline visits. Other subscales showed significant improvement with risperidone compared with placebo. CGI scale ratings of improvement showed highly significant gains for risperidone over placebo. A subanalysis demonstrated that the effect of risperidone was unaffected by diagnosis, presence/absence of ADHD, psychostimulant use, IQ status, and somnolence. Risperidone produced no changes on the cognitive variables (CPT/modified CVLT). The most common side effects included somnolence, headache, appetite increase, and dyspepsia. Side effects related to extrapyramidal symptoms were reported in 7 (13.2%) and 3 (5.3%) of the subjects in the risperidone and placebo groups, respectively (p = .245). CONCLUSIONS Risperidone appears to be an adequately tolerated and effective treatment in children with subaverage IQs and severe disruptive behaviors such as aggression and destructive behavior.

Asperger's Syndrome and Autism: Differences in Behavior, Cognition, and Adaptive Functioning

OBJECTIVE To determine whether subtypes of children with pervasive developmental disorder (PDD) differed on variables that were relatively independent of distinguishing criteria. METHOD Higher-functioning children with PDD, 4 through 6 years of age, were differentiated into those with autism (n = 47) and those with Aspergers syndrome (n = 21) on the basis of delayed and deviant language development. The groups were then compared on a wide range of measures including PDD symptoms, adaptive behaviors in communication, socialization, and activities of daily living, and an assessment of verbal and nonverbal cognitive skills. RESULTS Significant differences between the groups existed on many PDD symptoms, adaptive behaviors, and cognitive measures of language competence, but not on aspects of nonverbal communication, nonverbal cognition, or motor development. CONCLUSION Subtypes of children with PDD can be identified that differ on variables relatively independent of defining characteristics. These findings should provide a firm foundation into research to determine whether children with autism and Aspergers syndrome also differ on outcome, etiology, and response to treatment.

A Longitudinal Study of Siblings of Children with Chronic Disabilities

Objective: To examine the unaffected siblings of 2 different groups with chronic disabilities, pervasive developmental disorder (PDD) and Down syndrome (DS), over 3 years, comparing their adjustment with each other and with the siblings of a nondisabled group. Method: This study examines 137 siblings of children with PDD, children with DS, and developmentally normal children (control group) initially and 127 siblings at follow-up 3 years later. Their adjustment is measured by the Survey Diagnostic Instrument (SDI), completed by caregivers and teachers. Predictor variables include sibling self-perception, social support, and relationship with sibling, as indicated by siblings; caregiver psychosocial factors such as parental stress, caregiver depression, and marital relationship; family systems characteristics as viewed by both caregiver and sibling; and difficulty that disabled child causes as perceived by the primary caregiver. Results: Significantly more adjustment problems are found in the siblings of PDD children at both times when compared with siblings of DS and control children. Caregivers of PDD children report the highest levels of distress and depression, and this persists over time. Parent distress was found, at both times, to be related to sibling adjustment problems, regardless of study group. Conclusion: These results have implications for preventive intervention for the unaffected siblings of PDD children.

Risk and protective factors affecting the adjustment of siblings of children with chronic disabilities

OBJECTIVE To examine the adjustment of nondisabled siblings of handicapped children. METHOD In a 3-year longitudinal study, 46 siblings of children with pervasive developmental disorder (PDD), 45 siblings of children with Down syndrome, and 46 siblings of developmentally normal children (serving as controls) were examined at time 1 using the sibling, primary caretaker, and teacher as informants. Both direct and indirect variables related to sibling adjustment were considered. RESULTS Significantly more difficulties were found in the siblings of children with PDD compared with the other two groups. Different correlates of adjustment were present in the siblings of the disabled compared with nondisabled children, and mediating factors differed in parent and teacher reports of internalizing difficulties in siblings of children with PDD. Marital satisfaction, lack of parental depression, a cohesive family, and a warm, nonconflictual sibling relationship were protective for normal control and Down syndrome siblings but not for PDD siblings. CONCLUSION Findings underline the risks for the siblings of children with PDD and suggest the importance of a transactional mechanism rather than identification of single risk or protective factors in predicting sibling adjustment. Subsequent data analysis in this longitudinal study will assist in defining these mechanisms and allow for improved intervention strategies.

Parent and teacher agreement in the assessment of pervasive developmental disorders

Although it is well known that informants often disagree about the degree of psychopathology in children, this issue has not been systematically evaluated in children with autism. The objective of this paper is to estimate the extent of agreement between parents and teachers on the assessment of autistic symptoms and adaptive behavior skills. We assessed 83 children, 4–6 years of age, with a diagnosis of pervasive developmental disorder (PDD), using the Autism Behavior Checklist (ABC) and the Vineland Adaptive Behavior Scales (VABS). Parents and teachers rated each child on each measure. While there was good agreement between informants on the VABS, teachers tended to rate the PDD children higher that parents. In contrast, there was virtually no agreement on the ABC. High levels of stress experienced by parents appeared to be associated with parents reporting more autistic behaviors and less adaptive skills than teachers. As with other child psychiatric disorders, caution must be exercised in combining information from several informants.

Lack of cognitive impairment in first-degree relatives of children with pervasive developmental disorders

OBJECTIVE The objective of this study was to test the hypothesis that mild cognitive impairments aggregate in the unaffected first-degree relatives of probands with autism or pervasive developmental disorders (PDD). METHOD The unaffected siblings and parents of 52 PDD probands and 33 Down syndrome and low birth weight controls were administered a battery of psychometric tests. The tests included measures previously found to be depressed in siblings of autistic children as well as cognitive deficits seen in PDD subjects of normal IQ. In addition, the Vineland Adaptive Behavior Scales were administered to siblings to measure the social-communication impairments found in PDD. RESULTS Neither the siblings nor parents of the PDD probands demonstrated lower cognitive or adaptive behavior scores compared with controls. Developmental histories did not reveal greater rates of social, cognitive, or language delays, nor was there evidence to suggest that relatives of subgroups of PDD probands were different from each other. CONCLUSION These findings indicate that, apart from relatives with PDD, cognitive and social impairments do not aggregate in the families of PDD probands.

Effect of Sibling Perception of Differential Parental Treatment in Sibling Dyads With One Disabled Child

OBJECTIVE To examine sibling perception of parental differential treatment in families of children with pervasive developmental disorder (PDD), Down syndrome (DS), and nondisabled controls. METHOD Sibling self-concept and social support were studied in the context of sibling perceptions of parental differential treatment and caretaker plus teacher evaluations of sibling behavioral adjustment. Measures were completed at time 1 and time 2. The effect of parental stress and the difficulty of the disabled child, as well as the sibling relationship, were considered. RESULTS For siblings of PDD children, internalizing and externalizing behavior problems identified by caretakers were evident at time 1 and more accentuated at time 2, at which time teachers also identified these difficulties. DS siblings were reported by caretakers and teachers to have only internalizing problems and only at time 2. These difficulties related to the perception for PDD siblings that they were preferred over their disabled sibling and for the DS sibling that their disabled sibling was preferred. Feelings of low competence predicted internalizing difficulties. Social support, especially over time, had a positive effect for all siblings, including the controls. CONCLUSION The elucidation of specific mechanisms contributing to adjustment problems in the siblings of disabled children will allow for the development of specific preventive interventions.

Case Study: Anorexia Nervosa and Autistic Disorder in an Adolescent Girl

The development of anorexia nervosa in a high-functioning, early adolescent, autistic female is described. This case raises the issue of co-occurrence of childhood-onset disorders sharing the phenomena of obsessions and compulsions. The role of dysregulation of the serotonergic neurotransmitter system as a common underlying mechanism in these disorders is suggested. Psychoactive agents affecting the serotonin system and in particular the atypical neuroleptic risperidone may be of value in these disorders. There is added benefit to the combined use of biological and behavioral therapies.

Salivary cortisol in children: correlations with serum values and effect of psychotropic drug administration.

This study compares the paired serum and salivary Cortisol levels of 60 children and adolescents, obtained while performing a routine Dexamethasone Suppression Test. The results reveal significant correlations between serum and salivary cortisol levels in both drug-free (r = 0.90, p <.001) and medicated patients (r = 0.81, p < .0001). Multiple regression analysis suggests that, while the slopes of the two regression curves are parallel (0.15 < p < 0.20), the intercepts are significantly different (p < 0.05). This study supports the use of salivary measures of cortisol for children and adolescents. The authors suggest care in the use these measures while the patient is taking psychotropic medication.