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After attention was drawn in the late 1960s to the poor reproducibility of psychiatric diagnosis between clinicians, methods and procedures used to diagnose psychiatric disorders were greatly improved. Sources of variance contributing to the poor reliability of psychiatric diagnosis were identified that included: information variance (how clinicians go about enquiring about symptoms), interpretation variance (how clinicians weigh the observed symptomatology towards diagnostic formulations), and criterion variance (how clinicians arrange symptom constellations to generate specific diagnoses). To improve the reliability of diagnosis, progresses were made in two major directions. First, diagnostic instruments were developed to standardize the way symptoms are elicited, evaluated, and scored. These diagnostic interviews were either highly structured for use in large‐scale studies (e.g. the DIS), by lay interviewers without a clinical background, and with a style of questioning that emphasized adherence to the exact wording of probes, reliance on closed questions with simple response formats (Yes/No) and recording respondents' answers without interviewer's judgment contribution. By contrast, semi‐structured interviews (e.g. the SADS) were designed to be used by clinically trained interviewers and adopted a more flexible, conversational style, using open‐ended questions, utilizing all behavioral descriptions generated in the interview, and developing scoring conventions that called upon the clinical judgment of the interviewer. Second, diagnostic criteria and algorithms were introduced in nosographies in 1980 for the DSM and soon after in ICD. Algorithm‐derived diagnoses could subsequently be tested for their validity using follow‐up, family history, treatment response studies, or other external criteria. [ABSTRACT FROM AUTHOR]

The SPARK cohort was established to facilitate recruitment in studies of large numbers of participants with autism spectrum disorder (ASD). Online registration requires participants to have received a lifetime professional diagnosis by health or school providers although diagnoses are not independently verified. This study was set to examine the validity of self- and caregiver-reported autism diagnoses. Electronic medical records (EMR) of 254 SPARK participants (77.6% male, age 10.7 years) were abstracted. Using two different methods, confirmation of ASD diagnosis in EMRs was obtained in 98.8% of cases. Core clinical features recorded in EMRs were typical of autism samples and showed very good agreement with SPARK cohort data, providing further evidence of the validity of clinical information in the SPARK database. [ABSTRACT FROM AUTHOR]

Black children with autism are diagnosed at an older age. Whether or not late detection is paralleled by differing clinical presentation is not known. We evaluated symptom profiles of 245 Black and 488 sex- and age-matched White non-Hispanic participants (82.8% male; mean age: 4.2 years) referred for ASD diagnosis. Both groups showed similar overall levels of autistic symptoms. Black children had significantly but slightly lower scores on cognitive tests and on the Vineland communication domain than White children. Groups were comparable on internalizing and externalizing co-occurring problems. Given the largely similar clinical profiles, clinical differences in initial presentation may not be a primary reason for Black/White disparities in diagnostic and services use. Limitations of a cross-sectional referred sample are acknowledged. [ABSTRACT FROM AUTHOR]

Recent worldwide epidemiological surveys of autism conducted in 37 countries are reviewed; the median prevalence of autism is.97% in 26 high-income countries. Methodological advances and remaining challenges in designing and executing surveys are discussed, including the effects on prevalence of variable case definitions and nosography, of reliance on parental reports only, case ascertainment through mainstream school surveys, innovative approaches to screen school samples more efficiently, and consideration of age in interpreting surveys. Directions for the future of autism epidemiology are discussed, including the need to systematically examine cross-cultural variation in phenotypic expression and developing surveillance programs. [ABSTRACT FROM AUTHOR]

This study examined lifetime medical and psychiatric morbidity reported by caregivers of 2917 autistic adults participating in the US research cohort SPARK. Participants were 78.4% male, 47.3% had intellectual disability, and 32.1% had persistent language impairments. Childhood language disorders (59.7%), speech/articulation problems (32.8%), sleep (39.4%) and eating problems (29.4%), motor delays (22.8%) and history of seizure (15.5%) were the most frequently reported clinical features. Over two thirds (67.2%) had been diagnosed with at least one psychiatric disorder (anxiety disorders: 41.1%; ADHD: 38.7%). Compared to verbally fluent participants, those with language impairments had lower frequencies of almost all psychiatric disorders. Female sex and older age were associated with higher medical and psychiatric morbidity. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy may be more common among parents of children with autism spectrum disorder (ASD). We examined factors associated with ASD-specific vaccine hesitancy among caregivers of children with ASD who participated in the SPARK study (Simons Foundation Powering Autism Research for Knowledge). 225 participants completed an online survey containing the Parent Attitudes About Childhood Vaccines (PACV) questionnaire (measure of vaccine hesitancy) and the Illness Perception Questionnaire revised for parents of children with ASD (IPQ-R-ASD; measure of parents' views about ASD). 65 participants (28.8%) were vaccine hesitant (PACV score ≥ 50); children of vaccine-hesitant parents (VHPs) were less likely to be first born (n = 27, 41.5%), had greater ASD-symptom severity (mean Social Communication Questionnaire score = 23.9, SD = 6.9), and were more likely to have experienced developmental regression (n = 27, 50.9%) or plateau (n = 37, 69.8%). Compared to non-hesitant parents, VHPs significantly more often endorsed accident/injury, deterioration of the child's immune system, diet, environmental pollution, general stress, parents' negative views, parents' behaviors/decisions, parents' emotional state, and vaccines as causes for ASD. VHPs also had higher scores on the Personal Control, Treatment Control, Illness Coherence, and Emotional Representations subscales of the IPQ-R than did non-hesitant parents. In the final model, ASD-related vaccine hesitancy was significantly associated with higher scores on the Emotional Representations subscale (OR = 1.13, p = 0.10), agreement with deterioration of the child's immunity as a cause of ASD (OR = 12.47, p < 0.001), the child not having achieved fluent speech (OR = 2.67, p = 0.17), and the child experiencing a developmental plateau (OR = 3.89, p = 0.002). Findings suggest that a combination of child functioning and developmental history, as well as parents' negative views about and their sense of control over ASD, influence vaccine hesitancy among parents of children with ASD. [ABSTRACT FROM AUTHOR]

The theme of camouflage recently gained unexpected momentum in autism research. Symposia and panel discussions are devoted to ' camouflage' in autism conferences. Because of its association with intended deception, the term camouflage has poor fit with the autism world. However, psychopathologists have a long tradition of resorting to camouflage‐like terminology, from Freud's reaction formation, to pseudoschizophrenia, to Winnicott's false self, to masked depression, and even to the recent quasi‐autism, artfully telling us that what we see is actually not what we see but rather what we cannot see. Is 'Camouflaged Autism' the next in line nosographical pearl? [ABSTRACT FROM AUTHOR]

Fear of autism has led to a decline in childhood-immunization uptake and to a resurgence of preventable infectious diseases. Identifying characteristics of parents who believe in a causal role of vaccines for autism spectrum disorder (ASD) in their child may help targeting educational activities and improve adherence to the immunization schedule. To compare caregivers of children with ASD who agree or disagree that vaccines play an etiological role in autism for 1) socio-demographics characteristics and 2) developmental and clinical profiles of their children. Data from 16,525 participants with ASD under age 18 were obtained from SPARK, a national research cohort started in 2016. Caregivers completed questionnaires at registration that included questions on beliefs about the etiologic role of childhood immunizations and other factors in ASD. Data were available about family socio-demographic characteristics, first symptoms of autism, developmental regression, co-occurring psychiatric disorders, seizures, and current levels of functioning. Participants with ASD were 80.4% male with a mean age of 8.1 years (SD = 4.1). Overall, 16.5% of caregivers endorsed immunizations as perceived causes of autism. Compared to caregivers who disagreed with vaccines as a cause for ASD, those who believed in vaccine causation came disproportionately from ethnic minority, less educated, and less wealthy backgrounds. More often their children had experienced developmental regression involving language and other skills, were diagnosed earlier, had lost skills during the second year of life, and had worse language, adaptive, and cognitive outcomes. One in six caregivers who participate in a national research cohort believe that child immunizations could be a cause of autism in their child. Parent social background (non-White, less educated) and child developmental features (regression in second year, poorer language skills, and worse adaptive outcomes) index caregivers who are more likely to harbor these beliefs and could benefit from targeted educational activities. [ABSTRACT FROM AUTHOR]

An editorial is presented on possibility of genetic influences on autism. Topics include advances of the Human Genome Project and the development of large-scale sequencing and genome-wide association; and co-occurring with either intellectual disability, epilepsy, chromosomal abnormalities, or congenital malformations.

Validated screening and diagnostic tools for autism spectrum disorder for use in Arabic-speaking individuals are scarce. This study validated the Arabic version of the Social Communication Questionnaire. The total study sample included 206 children with autism spectrum disorder and 206 typically developing children (73.8% male; mean age: 8.5 (standard deviation = 2.6) years). The mean Social Communication Questionnaire total score was significantly higher in autism spectrum disorder children than in typically developing children (p < 0.0001). Scores on the three Social Communication Questionnaire subscales also differed significantly between the groups (p < 0.001). Of the 39 items, 37 were endorsed significantly more often in the autism spectrum disorder group. The total Social Communication Questionnaire score did not vary by age or gender. Internal consistency was excellent (alpha = 0.92). In the receiver operating characteristic analysis, the area under the curve for the total score showed excellent discrimination between autism spectrum disorder and typically developing children (area under the curve = 0.95; 95% confidence interval: 0.93–0.97). The areas under the curve for the scale subscores were 0.923 (95% confidence interval: 0.898–0.949) for the social interaction score, 0.872 (95% confidence interval: 0.838–0.905) for the communication score, and 0.856 (95% confidence interval: 0.819–0.893) for the repetitive behaviors score. The findings support the use of the Arabic Social Communication Questionnaire to successfully differentiate children with clinically diagnosed autism spectrum disorder using the established cutoff value for the English version. [ABSTRACT FROM AUTHOR]

The first autism surveys were simple head counts of children already diagnosed with a severe autism phenotype and residing in small, circumscribed geographical areas. Prevalence was low, ranging from 0.4 to 2/1,000 in the 1960's and 1970's. Today, the methodology of surveys has become more complex; studies include large populations, multiple sites, stratified samples and rely on intricate sets of screening activities followed by some form of diagnostic confirmation procedures. Yet, and as surprising as it may be, there is no standardization of autism survey methodology. Each survey has unique design features that reflect the local educational and health services infrastructure and current social policies for children with disabilities, they include or not parents, teachers and subjects with Autism Spectrum Disorder (ASD), and rely on variable screening and diagnostic instruments and methods. As such, prevalence differences between studies are hazardous to evaluate and whether observed discrepancies are due to method factors or true differences in population parameters, cannot be determined. [ABSTRACT FROM AUTHOR]

In this editorial, the author reflects on changes that occurred in the quality of research on developmental psychopathology over the last 35 years. This is illustrated in the increased quality of nine longitudinal studies that are included in the current issue of JCPP. Using approaches that capitalize on the passage of time, ranging from 28 days to 40 years across investigations, these studies employed multiple levels of analysis, used sophisticated statistical methods to control for confounding factors, included measurement at both the biological, cognitive, and behavioral levels, and collectively provided results that allow improved assessment of causality. [ABSTRACT FROM AUTHOR]

Evaluation of environmental risk factors in the development of autism spectrum disorder (ASD) is needed for a more complete understanding of disease etiology and best approaches for prevention, diagnosis, and treatment. A pilot experiment in 54 children (n = 25 ASD, n = 29 controls; aged 12.4 ± 3.9 years) screened for 87 urinary mycotoxins via liquid chromatography-tandem mass spectrometry to assess current exposure. Zearalenone, zearalenone-4-glucoside, 3-acetyldeoxynivalenol, and altenuene were detected in 9/54 (20%) samples, most near the limit of detection. No mycotoxin/group of mycotoxins was associated with ASD-diagnosed children. To identify potential correlates of mycotoxin presence in urine, we further compared the nine subjects where a urinary mycotoxin was confirmed to the remaining 45 participants and found no difference based on the presence or absence of mycotoxin for age (t-test; p = 0.322), gender (Fisher’s exact test; p = 0.456), exposure or not to selective serotonin reuptake inhibitors (Fisher’s exact test; p = 0.367), or to other medications (Fisher’s exact test; p = 1.00). While no positive association was found, more sophisticated sample preparation techniques and instrumentation, coupled with selectivity for a smaller group of mycotoxins, could improve sensitivity and detection. Further, broadening sampling to in utero (mothers) and newborn-toddler years would cover additional exposure windows. [ABSTRACT FROM AUTHOR]

There are no epidemiological data on autism for Mexico. This study was conducted to generate a first estimate of ASD prevalence in Mexico. We surveyed children age eight in Leon (Guanajuato). The sample was stratified in two strata: (1) children having special education and medical records (SEMR; N = 432) and (2) children attending regular schools (GSS; N = 11,684). GSS children were screened with the SRS and those with the highest scores were invited to a diagnostic evaluation. The final sample comprised 36 children (80.6 % male) who had confirmed ASD. A third had intellectual disability, 25 % were non-verbal, 69 % had co-occurring behavioral problems. The prevalence overall was 0.87 % (95 % CI 0.62, 1.1 %). This survey provides an estimate for ASD prevalence in Mexico that is consistent with recent studies. [ABSTRACT FROM AUTHOR]

Aims. Trajectories of alcohol abuse from adolescence onwards are not well known. We examined the relationship between repeated alcohol intoxication in adolescence and later alcohol abuse, testing whether this association varies depending on individuals’ socioeconomic context.Methods. Study participants (n= 674, age 22–35 years in 2009) belong to the French TEMPO cohort study; their parents also participate in an epidemiological study—the GAZEL cohort. Repeated alcohol intoxication was assessed by questionnaire in adolescence (1999) (defined by ≥3 episodes of alcohol intoxication in the preceding 12 months). In young adulthood (2009), alcohol abuse was assessed by the WHO AUDIT questionnaire. Socioeconomic characteristic studied was childhood family income. Data were analyzed using logistic regression models controlling for age, sex, childhood temperament, parental history of alcohol use, and the quality of family relations.Results. Among adolescents who reported repeated alcohol intoxication, 30.8% reported alcohol abuse in young adulthood (adjusted OR=4.27, 95%CI 2.21–8.27). This association appeared stronger in participants who grew up in families with low income (adjusted OR=11.86, 95%CI 3.35–41.94 vs. 2.49, 95%CI 1.09–5.68 for youths from families with intermediate or high income).Conclusions. In most adolescents (69.2%), alcohol abuse is a time-limited behavior. Nonetheless, in participants from low income families, the likelihood of persistent alcohol abuse beyond adolescence may be increased. Although some limitations are noted, a preliminary conclusion is that alcohol abuse trajectories over time need to be monitored, particularly in certain subgroups. [ABSTRACT FROM PUBLISHER]

Abstract: Little is known about patterns of cognitive impairment in depression comorbid with conduct disorder. The study included clinically depressed children with (N = 23) or without conduct disorder (N = 29), and controls without psychiatric disorder (N = 37). Cognitive biases typical of depression and patterns of social information processing were assessed. Both depressed groups had substantially higher rates of negative cognitive distortions, attributional biases and ruminative responses than non-depressed children. Children in the comorbid group made more hostile attributions and suggested more aggressive responses for dealing with threatening social situations, whilst children with depression only were more likely to be unassertive. Depression has a number of similar depressotypic cognitive biases whether or not complicated by conduct disorder, and may be potentially susceptible to similar interventions. The results also highlight the importance of recognising social information processing deficits when they occur and targeting those too, especially in comorbid presentations. [Copyright &y& Elsevier]

Objective: Changes in autism diagnostic criteria found in DSM-5 may affect autism spectrum disorder (ASD) prevalence, research findings, diagnostic processes, and eligibility for clinical and other services. Using our published, total-population Korean prevalence data, we compute DSM-5 ASD and social communication disorder (SCD) prevalence and compare them with DSM-IV pervasive developmental disorder (PDD) prevalence estimates. We also describe individuals previously diagnosed with DSM-IV PDD when diagnoses change with DSM-5 criteria. Method: The target population was al! children from 7 to 12 years of age in a South Korean community (N = 55,266), those in regular and special education schools, and a disability registry. We used the Autism Spectrum Screening Questionnaire for systematic, multi-informant screening. Parents of screen-positive children were offered comprehensive assessments using standardized diagnostic procedures, including the Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. Best-estimate clinical diagnoses were made using DSM-IV PDD and DSM-5 ASD and SCD criteria. Results: DSM-5 ASD estimated prevalence was 2.20% (95% confidence interval = 1.77-3.64). Combined DSM-5 ASD and SCD prevalence was virtually the same as DSM-IV PDD prevalence (2.64%). Most children with autistic disorder (99%), Asperger disorder (92%), and PDD-NOS (63%) met DSM-5 ASD criteria, whereas 1%, 8%, and 32%, respectively, met SCD criteria. All remaining children (2%) had other psychopathology, principally attention-deficit/hyperactivity disorder and anxiety disorder. Conclusion: Our findings suggest that most individuals with a prior DSM-IV PDD meet DSM-5 diagnostic criteria for ASD and SCD. PDD, ASD or SCD; extant diagnostic criteria identify a large, clinically meaningful group of individuals and families who require evidence-based services. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to examine the relationship between lifetime socioeconomic position and alcohol use in young adults. Methods: The participants (n = 1103, age 22-35 years in 2009) were the French TEMPO cohort, offspring of employees (all French nationals) of the French national gas and electricity company (GAZEL) who were in a previous cohort study. Alcohol use was assessed by the WHO AUDIT questionnaire (none, low or intermediate alcohol use, alcohol abuse). Childhood socioeconomic position was measured using parental income documented in the GAZEL study in 1989 (low: =2592€/month vs. intermediate/high: >2592€/month). Adult socioeconomic position was measured by participants' educational level (=high school degree vs. >high school degree). Combining family income and educational attainment, we ascertained participants' social trajectory (stable high, upward, downward and stable low). Data were analyzed using multinomial regression analyses controlled for demographic, social, psychological and family characteristics. Results: Compared with participants with a stable high social trajectory, those with an upward, downward or low social trajectory were more likely to abstain from alcohol (compared with a stable high social trajectory, sex and age-adjusted ORs: OR = 2.22, 95% CI 1.35-3.65 for an upward social trajectory; OR = 3.20, 95% CI 1.78-5.73 for a downward social trajectory; OR = 3.27, 95% CI 1.75-6.12 for a stable low social trajectory). Additionally, participants with a downward social trajectory were disproportionately likely to abuse alcohol (sex- and age-adjusted OR: 1.48, 95% CI 0.89-2.48). In multivariate analyses, social trajectory remained associated with alcohol use. Conclusion: Lifelong socioeconomic position may shape patterns of alcohol use early in life. [ABSTRACT FROM AUTHOR]

EDITOR - We wish to respond to Morris et al.'s letter regarding our study and methodology.1,2 In our study, Social Responsiveness Scale (SRS) mean differences between neurofibromatosis type 1 (NF1) and controls became negligible when they were adjusted on confounding variables measuring attention-deficit/hyperactivity (ADHD) and internalizing symptoms, and communication skills. Here, the issue is whether a raised SRS score means true elevation of autistic symptomatology or whether an SRS score can rise due to non-autistic phenomena that interfere with the measurement process and contaminate SRS scores. 3 Grzadzinski R, Dick C, Lord C, Bishop S. Parent-reported and clinician-observed autism spectrum disorder (ASD) symptoms in children with attention deficit/hyperactivity disorder (ADHD): implications for practice under DSM-5. [Extracted from the article]

The impact of bilingual exposure on language learning has not been systematically studied in children with Autism Spectrum Disorders. This study compared the social abilities and language levels of children (mean age = 56 months) with ASDs from bilingual (n = 45) and monolingual (n = 30) environments. Bilingually-exposed children were subgrouped based on simultaneous bilingual exposure from infancy (SIM, n = 24) versus sequential post-infancy bilingual exposure (SEQ, n = 21). Despite significantly different amounts of bilingual exposure across all groups ( p = <0.001) and significantly stronger social interaction scores in the SIM group compared to the SEQ group on the Vineland Adaptive Behavior Scales-II Interpersonal subdomain ( p = 0.025), there were no significant group differences in language level. Bilingually-exposed children with ASDs did not experience additional delays in language development. [ABSTRACT FROM AUTHOR]

Observational (non-experimental) studies of the association between infant feeding and subsequent child or adult behaviour are prone to residual confounding by subtle differences in psychological attributes and interactional styles of mothers who breast feed vs. those who formula-feed. We followed up 13,889 6.5-year-old Belarusian children who participated in a large cluster-randomised trial of a breast-feeding promotion intervention. Behaviour was evaluated using the Strengths and Difficulties Questionnaire (SDQ), completed independently by the children's parents and teachers. We compared the results of experimental (intention-to-treat, ITT) and observational analyses (based on feeding actually received), both adjusted for clustering. Observational analyses were additionally adjusted for geographical region, urban vs. rural residence, child's sex, age at follow-up, birthweight, and maternal and paternal education. No differences between the randomised experimental vs. control groups were observed in ITT analyses. In contrast, small but statistically significant associations with weaning prior to 3 months were observed for parent and teacher SDQ scores on total difficulties, conduct problems and hyperactivity, even after multivariable adjustment. The absence of associations based on ITT analyses, in contrast with the significant associations based on observed breast-feeding duration, strongly suggests that the latter are biased by residual confounding. [ABSTRACT FROM AUTHOR]

Although many previous studies have reported an association between preterm birth or small size at birth and later behaviour, multiple methodological limitations threaten the validity of causal inferences from reported associations. The authors have examined the association between gestational age and gestational age-specific size at birth (weight, length and head circumference) and behaviour in a large sample of children born healthy at term. The data were from the 6.5-year follow-up of 13,889 Belarusian children who participated in the Promotion of Breastfeeding Intervention Trial, a cluster-randomised trial of a breast-feeding promotion intervention. Child behaviour was measured using the parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ). Differences in SDQ scores by gestational age and by birthweight, birth length and birth head circumference standardised for gestational age and sex (z-scores) were analysed after controlling for potentially confounding maternal and family factors. There was no association between gestational age and child behaviour after adjusting for potential confounding factors. Lower birthweight-for-gestational age was associated with higher scores in problem behaviours including total difficulties, conduct problems, hyperactivity, emotional symptoms and peer problems. Similar but smaller differences were observed with birth length and birth head circumference, but those differences were attenuated with adjustment for birthweight. The patterns of association were consistent in both parent and teacher assessments. Among school-age children born at term within normal range of birthweight, fetal growth, but not gestational age, was associated with behavioural problem scores. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the prevalence of suicidal ideation and behaviours in a large, representative sample of French youth and to evaluate age and sex correlates.Method: We surveyed a large (n = 1106) cohort of French adolescents and young adults, aged 15 to 26 years and diversified throughout France, using a mailed-in self-report questionnaire.Results: Lifetime prevalence rates for suicidal ideation, plans, and attempts were 47.2%, 14.8%, and 5.7%, respectively. Rates for female youth were higher than for male youth across the entire spectrum of suicide-related outcomes. Rates generally increased between the ages of 15 and 20 years and decreased after age 21.Conclusions: The findings suggest that suicidal thoughts and behaviours are widespread phenomena among adolescents and constitute a major public health issue. [ABSTRACT FROM AUTHOR]

OBJECTIVES. Despite epidemiologic evidence to the contrary, claims of an association between measles-mumps-rubella vaccination and the development of autism have persisted. Such claims are based primarily on the identification of measles virus nucleic acids in tissues and body fluids by polymerase chain reaction. We sought to determine whether measles virus nucleic acids persist in children with autism spectrum disorder compared with control children. PATIENTS AND METHODS. Peripheral blood mononuclear cells were isolated from 54 children with autism spectrum disorder and 34 developmentally normal children, and up to 4 real-time Polymerase chain reaction assays and 2 nested polymerase chain reaction assays were performed. These assays targeted the nucleoprotein, fusion, and hemagglutinin genes of measles virus using previously published primer pairs with detection by SYBR green I. Our own real-time assay targeted the fusion gene using novel printers and an internal fluorescent |)robe. Positive reactions were evaluated rigorously, and amplicons were sequenced. Finally, anti-measles antibody titers were measured by enzyme immunoassay. RESULTS. The real-time assays based on previously published primers gave rise to a large number of positive reactions in both autism spectrum disorder and control samples. Almost all of the positive reactions in these assays were eliminated by evaluation of melting curves and amplicon band size. The amplicons for the remaining positive reactions were cloned and sequenced. No sample from either autism spectrum disorder or control groups was found to contain nucleic acids from any measles virus gene. In the nested polymerase chain reaction and inhouse assays, none of the samples yielded positive results. Furthermore, there was no difference in anti-measles antibody titers between the autism and control groups. INTERPRETATION. There is no evidence of measles virus persistence in the peripheral blood mononuclear cells of children with autism spectrum disorder. [ABSTRACT FROM AUTHOR]

Research into depression in paediatric cancer is in its early stages, but nevertheless has presented interesting challenges regarding the recognition and measurement of depression in a medically ill population. In this article we discuss the complex interaction between physical and psychological variables, and the diagnostic difficulties arising from this. We review the epidemiological findings regarding prevalence, evaluating the apparently low prevalence rate in the light of methodological weaknesses. Hypotheses put forward to explain the findings are discussed. We conclude by highlighting areas for future research. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This article reviews epidemiological studies of autism and related disorders. Study designs and sample characteristics are summarized. Currently, conservative prevalence estimates are: 13/10000 for autistic disorder, 21/10000 for pervasive developmental disorders not otherwise specified, 2.6/10000 for Asperger disorder, and 2/100000 for childhood disintegrative disorder. Newer surveys suggest that the best estimate for the prevalence of all autistic spectrum disorders is close to 0.6%. A detailed analysis of time trends in rates of pervasive developmental disorders in then provided. It is concluded that most of the increase is accounted for by changes in diagnostic concepts and criteria, and by improved identification. Whether or not there is, in addition to these factors, a true increase in the incidence of the disorder cannot be examined from available data. [ABSTRACT FROM AUTHOR]

The objective of this review is to summarize the data about metabolic side effects of atypical antipsychotics in children. Original research articles about side effects of atypical antipsychotics used in children were reviewed. The data was obtained mainly through Medline searches, identifying articles focusing on the use of atypical antipsychotics in children. Forty studies that addressed the issue of metabolic side effects were selected. The use of atypical antipsychotics in children has been consistently associated with weight gain and moderate prolactin elevation, while only a few case reports address the issue of glucose dysregulation and dyslipidaemia. The risk of weight gain and hyperprolactinaemia might be higher in younger children. Other risk factors have also been associated with antipsychotic-induced metabolic disturbances. These changes seem to be reversible, at least in some cases. Metabolic side effects of atypical antipsychotics could read to serious complications in children who are prescribed these medications. Serious considerations should be given before initiating treatment and consistent clinical monitoring is essential More research is needed, especially regarding glucose dysregulation and dyslipidaemia. [ABSTRACT FROM AUTHOR]

Objective: The rate of reported pervasive developmental disorders has increased, and the authors found a rate of 62.6 per 10,000 in a previous study of preschoolers in Stafford, U.K. They conducted another survey in 2002 to estimate the prevalence in children in a later birth cohort and to compare it to previous findings from the same area. Method: Screening for developmental problems included 10,903 children ages 4.0 to 6.0 years who were living in a Mid- lands town on the survey date. Children with symptoms suggestive of pervasive developmental disorders were intensively assessed by a multidisciplinary team using standardized diagnostic interviews, psychometric tests, and medical workups. Results: Sixty-four children (85.9% boys) were diagnosed with pervasive developmental disorders. The prevalence was 58.7 per 10,000, with a 95% confidence interval (Cl) of 45.2-74.9, for all pervasive develop- mental disorders, 22.0 per 10,000(95% C1 14.1-32.7) for autistic disorder, and 36.7 per 10,000 (95% Cl=26.2-49.9) for other variants. These rates were not significantly different from the previous rates. The mean age at diagnosis was 37.8 months, and 53.1% of the children were originally referred by health visitors. Of the 64 children with pervasive developmental disorders, 29.8% had mental retardation, but this rate varied by disorder subtype. Few children had associated medical conditions. Conclusions: The rate of pervasive developmental disorders is higher than re- ported 15 years ago. The rate in this study is comparable to that in previous birth cohorts from the same area and surveyed with the same methods, suggesting a stable incidence. [ABSTRACT FROM AUTHOR]

Abstract: Background:: The objective of the study was to examine in both genders the link between childhood hyperactivity-inattention symptoms (HI-s) and smoking in adolescence, controlling for psychopathology, temperament and environmental risk factors. Methods:: Subjects (421 males, 495 females), aged 7 to 18, were recruited in the GAZEL cohort representative of the general population and surveyed in 1991 and 1999. Parent and adolescent self-report measures were used to assess child psychopathology and smoking patterns. Logistic regression was used to assess the effects of childhood hyperactivity-inattention symptoms and other predictors on adolescent smoking. Results:: In females, hyperactivity-inattention symptoms contributed independently to subsequent daily smoking (OR=1.98, p =0.04). In males, hyperactivity-inattention symptoms alone did not increase the risk for smoking. Conduct disorder symptoms was an important predictor in males (OR=2.95, p &#60;0.01) and females (OR=1.75, p =0.09). The risk of adolescent smoking was significantly increased in boys with high activity level (OR=1.70, p =0.03) and decreased in shy girls (OR=0.60, p =0.02). Parental smoking increased the liability to smoking in their offspring (males: OR=1.96, p &#60;0.01; females: OR=1.63, p =0.02). Conclusions:: If replicated, these findings suggest a role for smoking prevention in girls with hyperactivity-inattention symptoms and in boys with high activity level. [Copyright &y& Elsevier]

Background: We report on the validity of the computerized diagnoses of autism in a large case-control study investigating the possible association between autism and the measles, mumps and rubella vaccine in the UK using the General Practitioner Research Database (GPRD). We examined anonymized copies of all relevant available clinical reports, including general practitioners' (GP) notes, consultant, speech therapy and educational psychologists reports, on 318 subjects born between 1973 and 1997 with a diagnosis of autism or a related disorder recorded in their electronic general practice record. Methods: Data were abstracted to a case validation form allowing for the identification of developmental symptoms relevant to the diagnosis of pervasive developmental disorders (PDDs). Information on other background clinical and familial features was also abstracted. A subset of 50 notes was coded independently by 2 raters to derive reliability estimates for key clinical characteristics. Results: For 294 subjects (92.5%) the diagnosis of PDD was confirmed after review of the records. Of these, 180 subjects (61.2%) fulfilled criteria for autistic disorder. The mean age at first recording of a PDD diagnosis in the GPRD database was 6.3 years (SD = 4.6). Consistent with previous estimates, the proportion of subjects experiencing regression in the course of their development was 19%. Inter-rater reliability for the presence of a PDD diagnosis was good (kappa = .73), and agreement on clinical features such as regression, age of parental recognition of first symptoms, language delay and presence of epilepsy was also good (kappas ranging from .56 to 1.0). Conclusions: This study provides evidence that the positive predictive value of a diagnosis of autism recorded in the GPRD is high. [ABSTRACT FROM AUTHOR]

The aim of this study was to carry out a preliminary examination of a research instrument developed specifically to collect cost information for individuals with autistic spectrum disorder. There is very little cost information on children or adults with autism or autism-related disorder, and no study appears to have carried out a specific cost collection in this area. Although some global cost estimates can be made, little is known about the cost implications of parental burden. By using different techniques to collect indirect costs, the study outlines a functional methodology. Results from this small pilot study point to considerable economic burden for parents and give some indication of the associated costs of autistic spectrum disorder. [ABSTRACT FROM AUTHOR]

This paper was commissioned by the committee on the Effectiveness of Early Education in Autism of the National Research Council (NRC). It provides a review of epidemiological studies of pervasive developmental disorders (PDD) which updates a previously published article (The epidemiology of autism: a review. Psychological Medicine 1999; 29: 769–786). The design, sample characteristics of 32 surveys published between 1966 and 2001 are described. Recent surveys suggest that the rate for all forms of PDDs are around 30/10,000 but more recent surveys suggest that the estimate might be as high as 60/10,000. The rate for Asperger disorder is not well established, and a conservative figure is 2.5/10,000. Childhood disintegrative disorder is extremely rare with a pooled estimate across studies of 0.2/10,000. A detailed discussion of the possible interpretations of trends over time in prevalence rates is provided. There is evidence that changes in case definition and improved awareness explain much of the upward trend of rates in recent decades. However, available epidemiological surveys do not provide an adequate test of the hypothesis of a changing incidence of PDDs. [ABSTRACT FROM AUTHOR]

The prevalence of childhood disintegrative disorder (CDD) is unknown. In this study, 32 epidemiological surveys of autism and pervasive developmental disorders published in English language journals since 1966 were reviewed. Four surveys yielded estimates for CDD ranging from 1.1 to 6.4 per 100,000 subjects. A pooled estimate across these four surveys is 1.7 per 100,000 (95 percent Confidence Interval: 0.6-3.8 per 100,000). The conclusion is that CDD is very rare and its prevalence is 60 times less than that for autistic disorder, assuming a prevalence of 10 per 10,000 for autism. Ifa rate of 30 per 10,000 is taken for all PDDs, only one child out of 175 children with a PDD diagnosis would, on average, meet criteria for CDD. [ABSTRACT FROM AUTHOR]

Objective: The prevalence of pervasive developmental disorders (PDD) is not well established and needs monitoring. The prevalence of PDD in the 1999 nationwide British survey of child and adolescent mental health was investigated. Method: A randomized, stratified sample of children (N= 12,529) aged 5 to 15 years was generated from the Child Benefit Register. Trained interviewers interviewed parents and youths aged 11 or older with a standardized diagnostic interview (Development and Well-Being Assessment), and questionnaire data (Strengths and Difficulties Questionnaire) were obtained from teachers and parents, who also completed self-report measures of psychological distress. Final diagnostic determination was achieved by a team of experienced clinicians using all data sources. Results: A total of 10,438 (83%) interviews were conducted. There were 2 girls with Rett syndrome (weighted prevalence: 3.8/10,000 girls) and 27 children with other PDD (weighted prevalence: 26.1/10,000). Compared with children with a psychiatric disorder other than PDD, social but not behavioral problems were more frequent in the PDD group. Parents of children with PDD had higher rates of psychological distress than those from the two comparison groups. Conclusions: Consistent with other recent surveys, PDD rates are higher than those reported 30 years ago. The burden associated with PDD is very high. [ABSTRACT FROM AUTHOR]

Presents a study to estimate the prevalence of pervasive developmental disorders (PDDs), or autism-spectrum disorders, in a geographically-defined population of preschool children. Context; Objective; Design, setting, and participants; Main outcome measure; Results; Conclusion that the rates of PDD are higher than previously reported.

Data from a series of 126 autistic children ages 2–16 years and referred to an Autism Diagnosis Unit in South-West France were examined. Macrocephaly (head circumference > 97th centile) was observed in 16.7% of the sample, a significantly higher proportion than that expected. Macrocephaly was more frequent among older subjects but was otherwise not associated with gender, developmental level, the presence of epilepsy or of medical disorders, or severity of autistic symptomatology. Microcephaly (head circumference < 3rd centile) was also significantly raised and found in 15.1% of the sample. Microcephaly was significantly associated with the presence of medical disorders. Results support those from recent studies suggesting a raised rate of macrocephaly in autism which, pooling published data, can be estimated to be 20%. It is argued that the raised incidence of microcephaly among low-functioning autistic subjects with medical disorders might have contributed to delay the recognition of an increased head circumference among a minority of subjects with idiopathic autism. [ABSTRACT FROM AUTHOR]

The relationships of adoptive status to presenting psychopathology and to demographic and psychosocial variables were examined in a large sample of children and adolescents who attended psychiatric outpatient services over a 14-year period. Adopted boys and girls were both at increased risk of disruptive behavior, including conduct disorders and ADHD. Age at time of adoption was not related to psychopathology. [ABSTRACT FROM AUTHOR]

Argues the point that the prevalence of autism is increasing and suggests the need to study epidemiological surveys to examine rates of prevalence of autism. Method used in the study; Occurrence of increased rates in conducted surveys like the study made by Wing in 1993; Fluctuations in published rates of prevalence of autism not to be construed as evidence of an increased incident of autism.

Estimates the prevalence of autism, with focus on the strength of its association with specific medical disorders. Information on the survey conducted on autism during 1992-1993; Comparison of results from the survey to the results of 1985-1990; Methodology used in the study; Details on the tests carried out to determine a secular increase in autism incidence; Objective of autism surveys.

Interpersonal psychotherapy for adolescents (IPT-A) is a short-term treatment for adolescents with major depression. Unlike most supportive, expressive forms of psychotherapy that are often used to treat depressed adolescents and are not standardised, IPT-A has a treatment manual available (Mufson et al., 1993) and specific training is required for the therapist. Unfortunately, there is no training centre yet in the U.K., although several groups, including ours, are developing expertise in IPT-A. This paper discusses the role of IPT-A, outlines the structure of sessions, and offers an analysis of the differences between this and other therapies. [ABSTRACT FROM AUTHOR]

The Vineland Adaptive Behavior scale (survey form) was used in a sample of 151 normal children under age 18. Standardized mean scores of French children were comparable to those of the American normative sample. From the age of 6 onwards, French children scored consistently lower in the Daily Living Skills domain though the magnitude of this difference remained moderate While the overall findings support the cross-cultural stability of the psychometric properties of this instrument, attention is drawn to potential problems in the use of the Vineland scales, with special reference to autistic samples [ABSTRACT FROM AUTHOR]

This paper introduces the basic principles of Receiver Operating Characteristics (ROC) analysis, a technique to evaluate and compare the discriminant power of questionnaires employed in psychiatric research. ROC curves may assist in the selection of an optimal cut-off point, which has been shown to depend upon the prevalence rate, the consequences of correct and incorrect classifications, and the distributions of scale scores among normal individuals and cases. Then, ROC analysis is applied to the Child Behavior Checklist on a sample of 564 6-11-year old French children. The performances of the social competence scales of this instrument are poorer than those of the behavior problem scales. The findings suggest also that the cut-offs should be varied within this same age group and be higher for screening in community surveys. Further applications of ROC analysis are discussed. [ABSTRACT FROM AUTHOR]

To assess whether or not claims of an increase in the incidence of bulimic disorders are empirically justified. Epidemiological studies conducted since 1980 do not show an upward trend in rates. Reports of increased rates among recent birth cohorts were unreliable and did not control for confounding comorbid disorders. Changes in diagnostic and referral practices are likely to account for higher numbers of patients seen in specialized treatment centers. Although based on a limited number of studies, the empirical evidence does not support secular changes in the incidence of bulimic disorders. In keeping with this conservative conclusion, it is noted that high rates of dieting and body dissatisfaction were already reported 30 years ago among adolescent girls. [ABSTRACT FROM AUTHOR]

Cites a study which examined gender differences and the correlates of suicidal behavior in adolescents. Details on the subjects used in the study; Identification of several factors which predict suicidal behavior; Measures used in the study; Results of the study.

1Abstract The evidence for an increased incidence of rates of psychosocial disorders including depression, suicide, delinquency, eating disorders, and drug and alcohol abuse is summarized. Findings from prospective studies, family genetic studies, community surveys, repeated cross-sectional surveys, and data from mortality and police statistics suggest that the increase over time of several of these disorders is supported by epidemiological evidence, particularly for suicide, delinquency, addictive behaviors, and depression. Several studies also indicate that an earlier age of onset for these disorders is seen in the most recent birth cohorts, with most of these disorders having their onset in adolescent years. The implications of these findings for child psychiatric treatment and services are discussed [ABSTRACT FROM AUTHOR]

Editorial. Discusses developments concerning studies in autism. Characteristics of the condition; History of the identification of autism; Causes of autism; Risk factors of the condition.

Editorial. Focuses on autism spectrum disorders (ASD). Discussion of a survey in Atlanta, Georgia that is reported by Yeargin-Allsopp et al in this journal; Issues of whether the prevalence of ASD has increased over time, possible interpretations of this increase in prevalence, the hypothesis of an increasing trend in the incidence of ASD, and the social context that seems to exert a stronger influence on the debate that there is an epidemic of autism, than the scientific arguments; Opinion that researchers need to use multiple ascertainment sources in epidemiological studies of ASD and not rely on single service provider databases.

Presents a critical examination of statistics on autism in California. Population of autistic children in California; Efforts to control for changes in diagnostic concepts and definitions; Reasons for the misuse of the statistical data.

Mobile health (mHealth) screening tools for autism are gaining in prevalence, and have benefits such as video content and direct resources linkage. However, it is unclear whether such tools will ameliorate autism inequities or will help only those already advantaged in autism care. To investigate this issue, we conducted semi-structured qualitative interviews with 18 primary care and Early Intervention/Early Childhood Special Education providers in six US states. Providers were given hypothetical scenarios in which a family presents to care with results from one of 9 mHealth autism screening tools. Providers discussed their clinical approach and assessed the tool's fit with their patient/client population. Each transcript was audio-recorded, transcribed, and coded; a phenomenological approach was used to develop key themes. 4 themes and 18 subthemes emerged. These included Clinical and business factors (e.g. scope of practice concerns and clinical efficiency), Validity and trustworthiness (e.g. familiarity, data privacy/security), Family interaction quality (e.g. supporting family advocacy, provision of information, affecting family anxiety, and emotional support), and Accessibility (e.g. English proficiency/language issues, cultural inclusivity, and literacy/educational level). Providers suggested modifications to enhance equity, such as portraying diverse families, reducing the reading level of text, and making tools shorter to better fit clinical context. Families may find information about autism online, and health care and education providers may use online tools to screen for autism. However, we do not know if online autism screening tools are easily used by families and providers. We interviewed primary care and educational providers, asking them to review results from online tools that screen for autism. Providers had concerns about how usable and accessible these tools are for diverse families and suggested changes to make tools easier to use. [ABSTRACT FROM AUTHOR]