Sandra Maestro

Attentional skills during the first 6 months of age in autism spectrum disorder.

OBJECTIVE To study the quality of early attention in autism spectrum disorder (ASD) through home movies. METHOD Fifteen home movies from the first 6 months of life of children who later received a diagnosis of ASD were compared with home movies of 15 normal children. The diagnosis was performed after the third year of life of children by two senior child and adolescent psychiatrists using a checklist of symptoms according to the. The films of the two groups were mixed and rated by blind observers through a Grid for the Assessment of Attentional Skills in Infants, composed of 13 items grouped into three developmental areas. RESULTS Using multivariate analysis of variance, the authors found significant differences between the two groups for the items in the social attention and the social behavior areas; on the contrary, there were no differences in nonsocial attention. CONCLUSIONS The authors pose some hypotheses about a specific early-appearing impairment of attention in ASD in which children shift their spontaneous attention mainly toward nonsocial stimuli rather than toward social stimuli. The importance of this finding for early diagnosis and treatment is underlined.

Early Behavioral Development in Autistic Children: The First 2 Years of Life through Home Movies

Objective: The main aim of the research is to study the early behavioral development in autistic children through home movies. Methods: fifteen home movies, regarding the first 2 years of life of autistic children are compared with the home movies of 15 normal children. The films of the two groups were mixed and rated by blind ratings with the Grid for the Assessment of Normal Behavior in Infants and Toddlers. The grid is composed of 17 items grouped into three developmental areas: social competence, intersubjectivity and symbolic activity. For every area, we have identified specific children’s behaviors. Results: Significant differences between the two groups are found both in the range of age 0–6 for intersubjectivity, and in the ranges of age 6–12 and 18–24 for symbolic activity. Conclusions: The authors pose some hypotheses about an early-appearing impairment of intersubjectivity, the ability to represent other’s state of mind, in subjects with autistic disorder.

Course of Autism Signs in the First Year of Life

Autism spectrum disorders (ASD) are thought to be present right from birth, even if a minority of children displays a normal course during infancy followed by a regression during the second year of life. However, established criteria are not yet available to differentiate these different courses of ASD, and data coming from different sources have not yet been organized into a clear definition. The aim of this study was to elucidate the time of onset, as well as type, frequency and stability of symptoms during the first year of life in ASD. The behavioral summarized evaluation scale, applied to 40 home movies of children later diagnosed as having ASD, showed that most of the subjects (87.5%) display symptoms within the first year of life, when only a small group (12.5%) is completely symptom free. A group of more rated symptoms was found, constituting a typical pattern characterized by being withdrawn, and displaying poor social initiative, hypoactivity, and lack of emotional modulation. The importance of these findings is discussed in relation to early diagnosis and treatment.

Study of the onset of autism through home movies.

The authors describe the natural history and the beginning of pervasive developmental disorders (PDD) by the observation of home movies. The sample is composed of 26 children aged 18 months to 5 or 6 years at the first consultation. The methodology used in the observation of home movies includes: (1) application of the ERC-A-III scale for recognizing the precocious symptoms of autism; (2) analysis of the coming out and coming off of social, emotional and cognitive competences. The authors, starting from the analysis of these data, describe three kinds of onset and courses of PDD: progressive, regressive and fluctuating. The authors present some conclusive considerations on the different age of PDD onset in home movies, in anamnestic reconstruction and in recall for diagnosis.

An exploration of symmetry in early autism spectrum disorders: Analysis of lying

BACKGROUND Early identification of children with autism spectrum disorders (ASD) is recognized as a critical aspect of their medical management and treatment. Movement disorders are considered one of the first signs which probably precede social or linguistic abnormalities. OBJECTIVES to verify, through observational methods, the possibility of distinguishing infants with ASD from infants with typical development or with mental retardation by movement. METHODS The Eshkol-Wachman movement analysis system, which analyses static symmetry (SS) and dynamic symmetry (DS) during lying, was applied to retrospective home videos regarding the first 5 months of life of children with ASD (n=18), typical development (n=18), or developmental delay (n=12). RESULTS Significant differences between ASD and the two control groups were found for both SS (p<.001) and DS (p<.01). Within ASD two groups of infants could be differentiated on the basis of the higher (HLS) or the lower (LLS) levels of symmetry. Early onset ASD are more likely to belong to the LLS group. CONCLUSION We suggest that motor functioning may define specific subgroups of early ASD which are related to different pathways to the syndrome. LLS could be used as an early indicator of potential autism since the first months of life.

A view to regressive autism through home movies. Is early development really normal

Objective:  To describe early development of children with regressive autism.

Child Behavior Check List 1½-5 as a tool to identify toddlers with autism spectrum disorders: a case-control study.

Tools to identify toddlers with autism in clinical settings have been recently developed. This study evaluated the sensitivity and specificity of the Child Behavior Check List 1½-5 (CBCL 1½-5) in the detection of toddlers subsequently diagnosed with an Autism Spectrum Disorder (ASD), ages 18-36 months. The CBCL of 47 children with ASD were compared to the CBCL of 47 toddlers with Other Psychiatric Disorders (OPD) as well as the CBCL of 47 toddlers with Typical Development (TD) in a case control study. One-way analysis of variance (ANOVA) and logistic regression with odds ratio (OR) analyses were performed. In order to establish the optimal threshold able to discriminate children with ASD from children with OPD and TD, Receiver Operating Characteristic (ROC) analyses were performed. One-way ANOVA revealed significant differences between the three groups. Logistic regression analysis showed that the Withdrawn and the Pervasive Developmental Problems (PDP) subscales can recognize toddlers subsequently identified as ASD from both children with TD (p<0.001) and OPD (p<0.001). ROC analyses showed very high sensitivity and specificity for the PDP (0.98 and 0.91) and Withdrawn (0.92 and 0.97) subscales when ASD was compared to TD. Sensitivity and specificity of Withdrawn (0.90 and 0.83) and PDP (0.85 and 0.83) remained high when comparing ASD versus OPD. In conclusion, the CBCL 1½-5 seemed to be able to identify toddlers subsequently diagnosed with ASD from children with TD and OPD. Its high sensitivity and specificity, coupled with its efficiency in terms of time and cost, suggest this broadband tool should be tested in a pilot screening survey of toddlers in the general population.

Denial of Symptoms and Psychopathology in Adolescent Anorexia Nervosa

Objective: To evaluate the psychopathological status and denial of symptoms in a sample of 38 consecutively admitted adolescents with anorexia nervosa (AN). Method: The Schedule for Affective Disorders and Schizophrenia for School-Aged Children was used to determine the categorical diagnosis of eating disorder. The anorexic adolescents completed the EAT-40 (Eating Attitude Test) and, on the basis of its score, the sample was dichotomized in a false-negative group (FNG) scoring under 30 and a positive group (PG) scoring over 30. We compared these two subgroups in terms of clinical variables (age of onset and admission, duration of illness prior to admission, diagnosis, BMI) and psychopathology assessed by the CBCL (Child Behaviour Checklist) and the YSR (Youth Self-Report). In order to evaluate the possible role of diagnosis and BMI on the EAT score we also dichotomized the sample with respect to the diagnosis (full vs. partial AN) and to the mean female BMI (≤15 vs. >15). Results: A significant difference was found in terms of duration of illness prior to admission, which was briefer in the FNG. Higher CBCL and YSR values were found in the PG with significant differences in terms of YSR internalizing symptoms. A large amount of significantly positive Pearson’s correlations were found between the CBCL and YSR values in the FNG. No significant Pearson’s correlations were found between EAT, BMI and diagnosis. Conclusions: The lower CBCL and YSR values in the FNG seem to point out a tendency of this group to deny anxiety and depression as well as an eating pathology; the longer duration of illness prior to admission in the PG seems to support the hypothesis that the PG may be considered to be not so much more disturbed as more aware of its eating attitudes and psychopathology. The nature of denial in anorexic adolescents is discussed.

Computerized home video detection for motherese may help to study impaired interaction between infants who become autistic and their parents

Autism is a well‐defined clinical syndrome after the second year of life, but information on autism in the first two years of life is still lacking. The study of home videos has described children with autism during the first year of life as not displaying the rigid pattern typical of later symptoms. Therefore, developmental/environmental factors are claimed in addition to genetic/biological ones to explain the onset of autism during maturation. Here we describe (1) a developmental hypothesis focusing on the possible implication of motherese impoverishment during the course of parent–infant interactions as a possible co‐factor; (2) the methodological approach we used to develop a computerized algorithm to detect motherese in home videos; (3) the best configuration performance of the detector in extracting motherese from home video sequences (accuracy = 82% on speaker‐independent versus 87.5% on speaker‐dependent) that we should use to test this hypothesis. Copyright

Neuropsychological functioning in children and adolescents with restrictive-type anorexia nervosa: An in-depth investigation with NEPSY-II

Several studies have investigated the neuropsychological functioning of patients with anorexia nervosa restrictive type (AN-r), but results are conflicting. Here we compared the neuropsychological profile of 23 female children and adolescents with AN-r and of 46 typical controls (aged 9–16 years) using the second edition of the NEPSY (a Developmental Neuropsychology Assessment) neuropsychological battery. AN-r patients presented subtle cognitive flexibility impairments in audiomotor responses (p = .033). Conversely, superior performance in verbal fluency (p = .024) and memory (p = .034) was observed only in AN-r patients with an associated unipolar mood disorder. This profile of marginally impaired and enhanced performance was independent from illness duration and starvation degree, suggesting that it may preexist and represent a vulnerability factor for the disease onset.