Sophie H. N. Willemsen-Swinkels

The effects of prenatal stress on temperament and problem behavior of 27-month-old toddlers

AimTo examine, in a prospective study, the influence of prenatal stress on infant temperament and problem behavior.MethodSelf-report data on stress and anxiety, and levels of cortisol in saliva were collected from nulli-parous women during pregnancy. Temperament of the child was measured at 27 months by parent report on the Infant Characteristics Questionnaire. Behavior of the child was assessed by direct observation during the administration of the Bayley Scales of Development 2–30, and by parent report on the Child Behavior Checklist 2–3.ResultsComplete data were available for 103 healthy toddlers. Logistic regression analyses were performed and results were adjusted for possible prenatal, perinatal and postnatal confounders. Perceived stress during pregnancy was a predictor of lower levels of restless/disruptive temperament (OR=0.77), more total behavioral problems (OR=1.17), and more externalizing behavioral problems (OR=1.12) in 2-year-olds. Fear of bearing a handicapped child was a predictor of higher levels of restless/disruptive temperament (OR=1.39) and more attention regulation problems in toddlers (OR=1.46).ConclusionsIncreased levels of maternal prenatal stress appear to be associated with temperamental and behavioral problems in toddlers.

Open-label study of olanzapine in children with pervasive developmental disorder.

The effects of olanzapine on the symptomatology of children with pervasive developmental disorder with emphasis on problems of communication and the safety of the drug were investigated in a 3-month open-label, open-dosage study. Participating in the study were 25 children age 6 to 16 years with a diagnosis of either autistic disorder or pervasive developmental disorder not otherwise specified. Psychometric measures included the Clinical Global Impression of Severity/Improvement, the Aberrant Behavior Checklist, and the TARGET (a checklist of five target symptoms). Communication skills were assessed during behavioral analysis of a playroom session. Safety measures included clinical chemistry variables, electrocardiography, the SimpsonAngus Neurological Rating Scale, the Barnes Akathisia Scale, and vital signs. Twenty-three children completed the study and showed significant improvement on three subscales of the Aberrant Behavior Checklist (Irritability, Hyperactivity, and Excessive Speech) and the TARGET. The final mean dose was 10.7 mg/day. Several aspects of communication were also improved after olanzapine treatment. However, only three children were considered responders in terms of the Clinical Global Impression of Severity/Improvement scores. The most important adverse events were weight gain, increased appetite, and loss of strength. Three children showed extrapyramidal symptoms that disappeared after the dose was lowered. Thus, while olanzapine was a relatively safe medication in children, its clinical relevance in children with pervasive developmental disorder may be limited.

Medication treatment in subjects with autistic spectrum disorders

Autism is a pervasive developmental disorder that is aetiologically and clinically heterogeneous. Twin and family genetic studies provide evidence for strong genetic components. An international consortium using an affected sib pair strategy has found a promising linkage to a region on chromosome 7. In 10–15% of the cases autism is due to associated medical conditions that affect normal brain functioning. Post-mortem studies on small case series report cellular abnormalities in the limbic system and cerebellum. Between 10 and 20% of subjects with autism have macrocephalia, which is in accordance with MRI findings of an increased total brain tissue volume and enlargement most prominent in the occipital and parietal lobes. The most robust and well-replicated neurobiological abnormality in autism is an elevation of whole blood serotonin found in over 30% of the patients. Pharmacological interventions with serotonin reuptake blockers or with atypical neuroleptics that block both dopamine (D2) and serotonin (5-HT2) receptors seem to offer clinical benefit and merit further study.

Subtyping Stereotypic Behavior in Children: The Association between Stereotypic Behavior, Mood, and Heart Rate.

The Stereotypic behavior of children (N = 26) while in a playroom session with their parent was studied. The sample included children with a pervasive developmental disorder, an attention-deficit/hyperactivity disorder, a developmental expressive language disorder, or a developmental receptive language disorder and normally developing children. Stereotypic behaviors associated with distress, elation, and composure were compared on mean duration and form of the stereotypies and heart rate changes around the onset of the stereotypies. Results showed that stereotypies associated with different moods differed in all variables studied. Results confirm that a valid classification scheme for Stereotypic behaviors is needed as they indicate different functions of individual stereotypies.

Timing of Social Gaze Behavior in Children with a Pervasive Developmental Disorder

The aim of the study was to compare social initiatives and gaze behavior in low-functioning children with a pervasive developmental disorder (PDD), high-functioning children with a PDD, children with a language disorder, and normally developing children. Behavior of the children was observed while they watched television and performed a playful task with a parent. Compared to the high-functioning children, the low-functioning children with a PDD showed fewer social initiatives. The high-functioning children with a PDD did not differ from the non-PDD control children in the number of social initiatives and gazes. However, in children with PDD, timing of social gaze proved to be different in that they had lower levels of visual checking before but not after a declarative pointing gesture. Furthermore, they had lower levels of returning gaze.

Brief Report: Six Months Continuation Treatment in Naltrexone-Responsive Children with Autism: An Open-Label Case-Control Design

There is controversy about the status of naltrexone, an orally active opioid antagonist, in the treatment of autism. It has been posited that excessive activity of opioid systems in the brain is basic to autism and that opioid antagonists would be of therapeutic value (Panksepp, 1979). Double-blind placebo-controlled studies with naltrexone in children (Campbell et al., 1993; Kolmen, Feldman, Handen & Janosky, 1995, 1997; WillemsenSwinkels, Buitelaar, & Van Engeland, 1996; WillemsenSwinkels, Buitelaar, Weijnen, & Van Engeland, 1995) and adults (Willemsen-Swinkels, Buitelaar, Nijhof, & Van Engeland, 1995) with developmental disorders failed to find significant effects on social and communicative behavior. A remarkably consistent finding across all studies on children with autism was that treatment with naltrexone resulted in a modest reduction of hyperactivity. Since many subjects with autism present with concomitant symptoms of motor restlessness, it was recommended to offer these subjects a trial with naltrexone, and particularly those who failed to respond to treatment with neuroleptic agents (Campbell & Harris, 1996). We report here on a 6-month continuation treatment with naltrexone of six children who had shown to be responsive to naltrexone in a 4-week trial. The aim is to examine effectiveness and safety of naltrexone over a long period.

Prevention and Early Detection of Developmental Disorders

This chapter focuses on developmental disorders. The term “developmental” implies that individuals with these conditions suffer from disturbances in the normal sequence of developmental milestones in terms of skills and competencies, with possible important implications throughout the life span. The developmental problems of young children are attracting increasing interest because it is now possible to achieve an early diagnosis. This, in turn, makes it possible to provide timely medical care, educational planning, and family support and instruction, which will reduce the stress and anguish experienced by the families of these children.